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Ask The Expert Archive

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Spinal Cord Injury Rehabilitation Archive Questions

Below are Dr. Gorman’s answers to Spinal Cord Injury Rehabilitation questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 25.

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Q : 1

I received a gun shot wound in my back this year, with spinal cord injury. I'm unable to feel anything below the belly button. What kind of care would you suggest I try to get?

You need care from someone that is familiar with the multiple problems that is associated with spinal cord injury. This includes bladder, bowel, skin, pain, spasticity, equipment, and other issues. If you do not have a rehabilitation physician from your stay at a rehabilitation SCI center, you could call 410-448-6383 to set up an appointment with either me or Dr. Henry York or Dr. Melita Theyagaraj. We are all specialized in spinal cord injury medicine. I hope this information is helpful to you. Peter Gorman, MD

Q : 2

Do you know why symptoms of (surgical) sympathectomy are so similar to symptoms of SCI? Could you elaborate on this statement and what it means? "Sympathectomy involves dissection of the main sympathetic trunk in the upper thoracic region thus interrupting neural messages that ordinarily would travel to many different organs, glands and muscles. It involves division of adrenergic, cholinergic and sensory fibers which elaborate adrenergic substances during the process of regulating visceral function." Journal of Applied Sciences Research,6(6):659-664, 2010. I would much appreciate you giving this some thought. Thanks.

This is a complex question. An SCI, especially above T6, disrupts preganglionic sympathetic innervation that starts in the hypothalamus and travels down the intermediolateral gray areas of the spinal cord bilaterally . The pre-ganglionic sympathetic fibers then go out through small rami at each verterbral level to provide innervation to the sympathetic chains, which are the nerve cell bodies (ganglion) of the sympathetic nerves that in turn innervate the solid organs of the body. If your SCI is high enough, a major part of the body becomes sympathetically altered in that although there is not a cutting of the lower sympathetic nerves (i.e. sympathectomy), there is release of the sympathetic control by the brain. This allows for reflex sypathetic hyperactivity to occur with sensory stimulation below the level of the SCI, otherwise known as autonomic dysreflexia. This is often manifested by severe hypertension, sweating, headache and is relieved by removing the offending stimulus.

Q : 3

Is there someone I can contact in admissions? I'd like to have my husband transferred to Kernan.

The screening for patients to be considered for admission to Kernan who are currently at an acute care facility is through the post acute network. The phone number for their office is (410) 328-3191.

Q : 4

Is there a hydrotherapy "whirlpool" offered at Kernan Hospital?

We don't have a whirlpool program at Kernan. However, we do have a aquatic program in our large heated pool. That may or may not be helpful to you depending on the problem.

Q : 5

What are benefits of going to a rehabilitation center?

Usually when someone has an impairment due to medical or traumatic injury, then there is a loss of some type of function. For example, if one suffers a stroke, there might be leg weakness that leads to loss of the ability to walk. At a rehabilitation center, patients can receive therapy in a comprehensive way that can lead to restoration of some of the function lost and therefore a return to participation in daily life. A rehabilitation center can provide coordinated programs employing multiple professionals (physical therapists, occupational therapists and physicians, for example) that work together to reach these goals.

Q : 6

Do you accept patients with a tracheostomy in the neck?

Yes, we do accept patients with tracheostomies who are no longer on ventilators. Of course, there are other criteria for acceptance into our inpatient programs based on individual needs. Referrals for inpatient care are done through the post-acute care service at (410) 328-3191.

Q : 7

My father was in a car accident in September and fractured his neck at the c3/4/5 level and is now in rehabilitation. He's able to move his toes, has some movement in his legs and arms and can move his fingers slightly. Since he's 60 years old and making these kind of improvements, could this be a sign of him making a good recovery?

To have your father move his fingers and toes early after a cervical spinal cord injury is a good prognostic sign. While it is true that younger people in general tend to do better after injury than those that are older, this doesn't preclude a person who is 60 from making good progress.

Q : 8

Is the bowel program appropriate for patients with bowel problems due to muscle weakness from Becker muscular dystrophy?

Patients with Becker muscular dystrophy may or may not have bowel problems. Use of every other day Dulcolax suppositories is reasonable if constipation is a problem. The other components of a bowel program, namely a gentle laxative (senna) and a stool softener (Colace), can also be used if necessary to help move the stool down toward the rectum (senna) or soften the stool (Colace) to make moving the bowels easier.

Q : 9

I have been a T-12 for 3 years and 2 months. I have full control of my hips and can take steps in leg braces with the aid of a walker. I recently came across an article about a guy named Rob Summer who received an epidural stimulation from an implanted unit. Because of the procedure he is able to stand, move his lower limbs, and is able to walk a little (on his own no braces). Does Kernan offer this same procedure? Also, does Kernan offer locomotor training and/or functional electrical stimulation, beyond an electrical stimulate bike?

I am aware of the case report detailing Rob Summer's situation. He was classified as an ASIA B patient, in other words he has some sensation below the level of his injury but no motor movement. The epidural stimulator seemed to "release" his own spinal circuitry to allow him to move his legs voluntarily when the stimulator was on, but not able to do that when the stimulator was off. This is a very intriguing case report that provides some excitement about electrical "potentiation" of "sleeping" circuitry. We do not have that type of protocol (this was a research, not a treatment protocol) at Kernan, but we do have locomotor training through the use of the Lokomat, and we do have aquatic therapy. We are doing research on the effects of both of these treatments on fitness and walking in people with motor incomplete spinal injury (ASIA C or D).

Q : 10

Can you give me the basic causes of quadriplegia after cervical fusion surgery? Can a doctor ever really determine once limb weakness arose, whether or not it could it be fixed, if treated quickly? If so, how quickly?

There can be many reasons for weakness after cervical spine surgery. All of them relate to injury of the spinal cord at that level. The cord could be injured by direct trauma from the surgical instruments (usually unlikely if the surgery was from the front), the pushing of bone fragments against the spinal cord, or lack of blood flow to the cord during the operation. If recognized early, the chances for recovery are better. Minutes and hours are of the essence in these cases.

Q : 11

I was told by someone that in order for a patient to go to Kernan, he would have to be able to endure 3 hours of physical therapy from the start. Can you tell me if this is true?

For a patient to be eligible for "acute" rehabilitation, he would have to be classified as being able to participate in 3 hours of therapy a day. There are other classifications, especially if he qualifies for medicare, and he might qualify under those criteria. You can discuss this further with our post-acute services team at 410-328-3191.

Q : 12

My boyfriend was reccently discharged after breaking his neck and back. The surgeon put rods in his spine, but he is now a parapalegic with a complete injury. While he was in the hospital, he didn't have an incontinence problem, but now he is having quite a bit of leaking. He caths every 4 hours and has just started Ditropan. What causes this? Can it be stopped?

There are generally two possible causes of urinary incontinence in paraplegia - excessive bladder muscle activity (bladder spasms) or loss of the bladder sphincter (outlet) contraction. You can think of the bladder as a balloon with a knot - the bladder wall is the balloon wall and the sphincter is the knot. Either the bladder wall is contracting too much or the knot is not contracting enough. Depending on the level of spinal injury, sometimes there are changes in bladder activity over the first weeks after injury in that at the beginning, the bladder muscle is weak, and then later it becomes spastic, or starts to contract too much. The Ditropan can stop bladder muscle contractions. If it doesn't work, the problem may be the sphincter and the Ditropan won't help in that instance. There are other possible issues, such as urine infection, that need to be considered. You should follow up with your boyfriend's urologist for other possible treatment options.

Q : 13

What is the probability of someone with a c6 spinal injury walking again after rehab?

This is difficult to answer without some more information. Injuries are usually described not only by the level of injury but by the completeness of injury. Injuries can be complete- in other words there is no sensation or movement below the level of the injury, or incomplete, with preservation of some function (muscle movement, senstation). So that information is needed to provide some type of prognosis for walking. In addition, everyone is different, so a prognosis is not always 100 percent accurate for a given person.

Q : 14

My mother is 74 and just had surgery to break and fuse her T-12 vertebrae. She is not yet weight bearing. Is she possibly a good candidate for the Lokomat therapy?

It is difficult to know for sure whether Lokomat therapy in particular could help. It is a device that is geared to individuals with partial paralysis of the legs who might have a chance to regain walking or improve their walking capability. I don't know if your mom's injury is neurological or just orthopedic. Another approach that the therapists might consider is aquatic therapy. This is an alternative method of partial weight suspension, and tends to be gentler on other joints. Of course her surgical wounds would have had to heal prior to going into a pool environment. Ultimately the physical therapist working in conjunction with her spine surgeon should be able to determine if locomotor training of any sort (on land, in the pool, or in the Lokomat) would benefit your mother.

Q : 15

I had Guillain-Barre in 1995. I typically use a wheelchair but, I can also use crutches to get around. The only thing preventing me from becoming independently mobile is my atrophied hamstring muscles. I have started a weight and cardio routine to help strengthen my leg muscles, but my hamstrings are still incredibly weak. Do you have any suggestions for a home exercise that will help strengthen them?

With Guillain-Barre there is loss of the peripheral nerve function due to loss of the nerve covering (myelin), and in some cases (including yours) loss of the underlying nerves as well. Muscles therefore can atrophy over time. Have you tried bracing to stabilize the knee and to compensate for the hamstrings weakness? Maybe some type of dynamic spring bracing that would force a bending of the knees might be helpful. As far as exercise, the effect of this is dependent on the number of remaining nerve fibers still functioning, in terms of voluntary exercise as well as electrical stimulation. I can't say what is useful for you as I don't know the extent of your nerve loss. Nonetheless it is worth trying so long as you don't over exercise the quadriceps and therefore make the balance between the two groups even more asymmetric.

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