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Does spontaneous recovery really happen?

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    #16
    Originally posted by Wise Young View Post
    Most people recover some function from spinal cord injury. If you have "incomplete" spinal cord injury, i.e. ASIA B or C during the first days after injury, you have about a 40% and 90% chance of recovering unassisted locomotion within a year. If you have ASIA A, you have a high probability of getting sensory recovery for at least 2 dermatomes below the injury site within a year and many people have even more sensory recovery. For example, Christopher Reeve recovered sensation down to his knees and it took several years. Most people recover at least one and perhaps two segmental levels of motor function below the injury site. At the present, over 60% of people who are hospitalized for spinal cord injury in the United States have "incomplete" spinal cord injuries. Furthermore, since 1991, methylprednisolone has been used and our trials show that people who get the drug recover on average about 20% more motor and sensory function than those who don't get the drug. This usually translates into 2-3 segments more recovery. In other words, a large majority of people, probably 70-80%, recover significant function from spinal cord injury. Very few people recover nothing.

    The more severe the injury, the longer it takes for recovery to occur. Of course, less recovery occurs. One question that I frequently get is whether intensive locomotor training will yield walking recovery in people with chronic spinal cord injury. Many groups have studied this question and I think that there is general agreement in the literature that recovery of unassisted locomotion in people who are chronic ASIA A is rare, even if they engage in intensive locomotor training. On the other hand, a majority of people who were ASIA C shortly after injury but did not engage in locomotor training and did not walk after injury should improve their walking from locomotor training. In the mid-1990's, Wernig [1] showed that 76% of such people recovered "independent" locomotion from treadmill training.

    An unanswered and controversial question is how much and what kind of locomotor training is necessary and sufficient to improve walking. There has been much interest in weight-supported automatic walking, using machines like a Locomat but little evidence suggest that these devices are better than overground walking. Because weight-support harnesses cannot be applied for longer than an hour because it may cause pressure sores, most such training are limited in time.

    Recovery of voluntary manual strength and dexterity is usually limited after ASIA A injuries. Partial recovery of biceps (C5) and wrist extensors (C6) can occur after ASIA A injuries at C4. Predictors of such recovery include recovery of pinprick sensation in the fingers. If you look at the sensory dermatomes for the hand, you will find that C6 represents the thumb, C7 the middle finger, and C8 the pinky. Recovery of pinprick sensation in these fingers often heralds motor recovery of the wrist extensors (C6), triceps (C7), and finger flexors (C8).

    Wise.

    1. Wernig A, Muller S, Nanassy A and Cagol E (1995). Laufband therapy based on 'rules of spinal locomotion' is effective in spinal cord injured persons. Eur J Neurosci 7: 823-9. Department of Physiology, University of Bonn, Germany. Rehabilitation of locomotion in spinal cord (s.c.) injured patients is unsatisfactory. Here we report the effects of a novel 'Laufband (LB; treadmill) therapy' based on 'rules of spinal locomotion' derived from lower vertebrates. Eighty-nine incompletely paralysed (44 chronic and 45 acute) para- and tetraplegics underwent this therapy, then were compared with 64 patients (24 chronic and 40 acute) treated conventionally. The programme consisted of daily upright walking on a motor driven LB initially with body weight support (BWS) provided by a harness and assisted limb movements by the therapists when necessary. Forty-four chronic patients with different degrees of paralysis undertook the programme for 3-20 weeks (median = 10.5), 0.5-18 years after s.c. damage. At the onset of LB therapy 33/44 patients were wheelchair-bound (no standing and/or walking without help by others) whereas at the end of therapy 25 patients (76%) had learned to walk independently, 7 patients with help [corrected]. Only 1 subject did not improve. It was striking that voluntary muscle activity in the resting position was still low in several patients who had gained walking capability. Eleven patients who could already walk before LB therapy improved in speed and endurance. Of the 44 patients, six were capable of staircase walking before LB therapy compared with 34 afterwards. In order to validate the apparent superiority of LB therapy two types of comparisons were performed. In a 'temporal' control 12 spastic paretic patients, still wheelchair-bound after the period of postacute conventional therapy, performed LB immediately thereafter. After completion of LB therapy nine of these patients had learned to walk without help from others.(ABSTRACT TRUNCATED AT 250 WORDS).

    Thanks for such a detailed response!

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      #17
      Originally posted by ineedmyelin View Post
      freedom from religion feels great
      Not wishing to change the subject, but I definitely concur.
      Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

      T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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        #18
        NL or I may have recounted this story before...if so, pardon the repetition. Not long after I was injured, my mother recounted to NL a piece she had read in the Reader's Digest. The story was about a man (I don't recall, para/quadriplegic) in Hawaii who lived with his wife in their home. One night, the home caught on fire and the man arose from his chair and ran into the house to rescue his wife. Now, there are many of you who think that I am a bit of a flame thrower, but NL is as blunt as it is to be blunt. She looked steely eyed at my mother and asked her, do you think if I set our house on fire, GJ will rise out of his chair and rescue me....ah...yah!!!

        Spontaneous healing...I need a big time explanation of the original injury.'

        All the best,
        GJ

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          #19
          Spontaneous = Possibilities are there but to what degree of Recovery ?
          hmmmmmm
          So far in my case nothing phenominal has happened as long as I can think back but I am not optimistic as I do hold strong on Hope .
          I live on Hope

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            #20
            Originally posted by 2TiRods View Post
            Frank Reynolds went in for spinal surgery and came out paralyzed. He was not in an accident so there was probably no "major" trauma to his spinal cord. This may be why he recovered walking.
            In all fairness, I was not in an accident, and the skeleton of the spine was not disrupted. I never had anything worse in my life than very occasional sciatica, which was not debilitating. After resuming yoga, I was never bothered again. The killer was an interruption to the SC blood supply. So what is the relevance of "major trauma"?
            2010 SCINet Clinical Trial Support Squad Member
            Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature.

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              #21
              On this thread, while in the spinal unit in Salisbury, I met someone in passing in the corridor who said he was previously there, and relied on a wheel chair. He said he was one of the lucky ones; as we were both on our way somewhere else I was not able to get much follow up on this conversation.
              As SCI nurse says, it all depends on exactly what the nature of the injury is - and of course how "complete" that damage.
              Last edited by chris arnold; 23 Jun 2012, 5:45 AM. Reason: Addendum
              2010 SCINet Clinical Trial Support Squad Member
              Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature.

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                #22
                Chris yepppers I hear Ya
                Good Morning

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                  #23
                  Hello, I was reading posts about treadmill training, i have Tm 3 years now and was in a wheelchair parelized belly button down almost 2 years had therapy and got up with a walker walked short distances left therapy worked with a trainer in the gym at the rehab. we started treadmill training around 8months, me holding the sides him behind me started going slow 15 minutes 3times a week . now i walk still with a walker i walk very far still cant walk around walmart or fleamarkets. i even go up steps . huge improvements. iwear afo iam aL1 S1 with no ankel movements. Marge

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