Never thought I would look here

[ccincin]

But here we are. On 12/23 my sister and her boyfriend were in a major car accident. The vehicle went through a telephone pole at high speed. She, thankfully, was unhurt. He did suffer a crushed C3, broken left arm, left femur, and severed his spine at T6. They fused 6,7 and 8 (???, i think that's right). There were multiple more injuries I just don't think they are all relevant at the moment though. He was flown to Loma linda med center in Ca.
He was moved to rehab yesterday, he is an amazing person who has way more strength than anyone I know. A few yrs ago he had a heart transplant at the same hospital he was taken to that night. I have never met anyone that intrigued me more than him at that age. He is only 20.
The doctor said he is complete, again I don't know exactly what all the terminology means. His dr at the rehab would like to try a med that is not FDA approved but has to check with his cardiologist first. Crossing fingers that he is able to try it and it has a positive effect.
Anyone told they were complete and have a different outcome? He has regained feeling lower in his abdomen than before. Is that because he is beginning PT and sitting up now? It's only been 3 weeks
Regardless of what the outcome I am fully confident that he will make the most out of it.
Thanks for reading if you made it this far. Tons of ?'s to come I am sure.

[ccincin]

I do have to add that we are hoping for a miracle but as a visitor at the hospital said "Our miracle is that he is alive and my sister was not injured." So our miracle may have already been granted.

[betheny]

There's no law against hoping for more miracles...or if there is, we're all outlaws! I'll wait until you come up with a question before I start throwing info at you. Let me give you the beginner's mantra, though...WATCH HIS SKIN!

He needs to be rolled in bed every 2 hours, and frequent pressure shifts when sitting. We can't feel it, our circulation is poor, our skin breaks down unbelievably fast. That's a huge setback in rehab. Tell him, too, so he's not counting on a nurse to remember. He has to be proactive.

Why did he go to Loma Linda? It's crucial he go to the absolute best rehab possible. Proximity to loved ones is not nearly as important, right now. Below, a link to the Model SCI Centers:

http://www.spinalcord.uab.edu/show.a...1&return=21392

Keep us posted!

[Wise Young]

A heart transplant as a teenager is rare. It sounds as if he is a very lucky man, first not to have a higher spinal cord injury or head injury.

The term "complete" spinal cord injury is usually used to indicate a person who has some level below which he has complete loss of both sensation and motor control. Since the S4/5 (sacral 4 and 5) are the lowest level of the spinal cord, if he is missing anal sensation or voluntary anal sphincter contraction, he is "complete". If he has either anal sensation or voluntary anal sphincter contraction, he would be "incomplete". Generally, people who are complete would classified as ASIA (American Spinal Injury Association) A. Those that have preserved sensations without motor function would be ASIA B. Those that have preserved motor and sensory function below the level of injury but less than 50% of normal would be ASIA C. Those that have more than 50% of the motor score in key muscles below the neurological level would be ASIA D. ASIA E would be a person with normal pinprick, touch, and key muscle strength.

Sensation to pinprick and touch are tested separately, graded on a scale of 0-2 where 0 is unable to detect the touch or pinprick (pain), 1 is able to feel but the feeling is abnormal, 2 is normal. Each dermatome is tested separately as specified points. The total number of points is 114 for touch and 114 for pinprick.

Muscle strength is graded on a scale of 0-5 where 0 is no movement, 1 is flicker movement, 2 is definite movement, 3 is movement against gravity, 4 is movement against resistance, and 5 is normal. There are ten key muscles that are tested on each side of the body and the total motor score is 100. The level of injury is defined as the lowest contiguous segment of the spinal cord that has "intact" sensation and motor function. Note that since the most muscles are innervated by two levels, a level where the muscle is a 3 or greater would be considered considered "intact".

Generally, people who have ASIA A have less than 5% chance of recovery walking while those with ASIA B have about 30-40%, those with ASIA C have 90%, and those with ASIA D almost always walk. The exception is when the injury is to the lower spinal cord which is situated at L1 and the spinal roots that form the cauda equina below L1. Injuries to these parts of the spinal cord or roots damage motoneurons or their axons. When this happens, the leg muscles that are affected may be flaccid, i.e. paralyzed without reflexes, spasticity, or spasms. Spasticity is when the legs show heightened tone and reflexes. Spasms are spontaneous or non-voluntary movements.

In essence, what spinal cord injury does is to disconnect long spinal tracts that go from the brain and upper spinal cord to the lower spinal cord. Motor tracts descend while sensory tracts. Neurons (nerve cells) located in the brain, spinal cord, or in the dorsal root sensory ganglia on the spinal roots just outside the spinal cord send axons (nerve fibers) that go down and up the spinal cord. After injury, the parts of the axons that have been disconnected from the cell bodies will die.

The goal of regeneration is to get the axons to grow from the injury site to the neurons that that they use to connect to. In the case of injuries that damage motor or sensory neurons, neuronal replacement may be necessary and this is one of the reasons why there is so much interest in stem cells and particularly neural stem cell that can make neurons. However, cell transplants can also bridge the injury site.

Because axons grow very slow (<1 mm/day), regeneration takes a long time. Therefore, sustained growth factor support is necessary. The spinal cord also contain a number of molecules that are known to stop regeneration. These include myelin-based molecules called Nogo and extracellular matric molecular called chrondoitin-6-sulfate proteoglycan (CSPG). Treatments may be necessary to block Nogo (or its receptor on axons). An enzyme called chondrotinase is known to digest CSPG.

Some clinical trials are already underway to test various components of the combination therapies, with the intent of eventually putting at least three components together: cell transplants to bridge the injury site, sustained growth factor supprt, and blocking growth inhibitors in the spinal cord.

Wise.

Originally Posted by ccincin

But here we are. On 12/23 my sister and her boyfriend were in a major car accident. The vehicle went through a telephone pole at high speed. She, thankfully, was unhurt. He did suffer a crushed C3, broken left arm, left femur, and severed his spine at T6. They fused 6,7 and 8 (???, i think that's right). There were multiple more injuries I just don't think they are all relevant at the moment though. He was flown to Loma linda med center in Ca.
He was moved to rehab yesterday, he is an amazing person who has way more strength than anyone I know. A few yrs ago he had a heart transplant at the same hospital he was taken to that night. I have never met anyone that intrigued me more than him at that age. He is only 20.
The doctor said he is complete, again I don't know exactly what all the terminology means. His dr at the rehab would like to try a med that is not FDA approved but has to check with his cardiologist first. Crossing fingers that he is able to try it and it has a positive effect.
Anyone told they were complete and have a different outcome? He has regained feeling lower in his abdomen than before. Is that because he is beginning PT and sitting up now? It's only been 3 weeks
Regardless of what the outcome I am fully confident that he will make the most out of it.
Thanks for reading if you made it this far. Tons of ?'s to come I am sure.

[SCI-Nurse]

Welcome to our forums. Loma Linda has a decent SCI program, so it is good he was moved there, esp. with his history.

While he may currently appear to have a complete (ASIA A) injury, it is way too early to determine if he will or will not get any more return. The ASIA exam should be repeated periodically to see if he is getting anything back. While abdominal sensation is good, technically he would have to have sensation at his anus to be considered incomplete ASIA B.

You may want to read this article and share it with other family members and with your friend:

http://sci.rutgers.edu/index.php?pag...nalLevels.html

I also recommend both of these articles:

http://sci.rutgers.edu/index.php?pag...3@AcuteSCI.htm

http://sci.rutgers.edu/index.php?pag...adjustment.htm

(KLD)

[Lindox]

If Loma Linda's SCI program is anywhere near the quality of other functions in this hospital it is decent and above. It's really good that his cardiologist works out of there also.

[ccincin]

thanks everyone! I know more ?s will come as time goes. he is now at rehab and in great spirits...

[Stressman]

I have a question for Dr. Wise. I was interested in your explanation about regeneration and that some molecules can actually stop regeneration. My daughter in law was in an accident and has a T6 SCI (May 2007) Should we be pursueing treatments that will encourage regeneration? she is in the phoenix area and rehabs at Barrows Neurological Center/St. Joseph Hospital. I would appreciate any more information you could give me on this subject.
Thanks

[Stressman]

so sorry for the double entry

[SCI-Nurse]

I'll leave your question for Dr. Wise to answer...

CKF