What should you do?

 QUESTIONS : “

I have been spinal cord neck columns from C5 to C7.

I have not ever been undergone any surgery. 

What must I do now?

Hello My Friends,

What should you do?

I copied your question from the ChinaSCINet Update thread. What you describe is cervical spinal cord injury. Let me try to answer your question as best as I can. I am also answering the question from the beginning.

As you already know, injury to the cervical spine causes sensory loss and paralysis involving the arms and the legs. In addition, many people have spasticity and neuropathic pain. The extent of your recovery depends on both the level and severity of the spinal cord injury. Let me discuss these separately.

Most people have 7 cervical vertebra. Above and below each of these vertebra, spinal roots come out to innervate muscles and dermatomes. A dermatome is simply the area of skin that one spinal root innervates.

  • C3 innervates the dermatome of your neck and controls your diaphragm.
  • C4 innervates the shoulder and your deltoids, the part of the arm that allows you to flap your arms like wings.
  • C5 innervates the top part of your arm and the biceps.
  • C6 innervates the thumb side of your arm and your wrist extensors.
  • C7 innervates the middle part of your forearm to your index, middle, and ring fingers. It controls your triceps.
  • C8 innervates the lateral (pinky) side of your arm and hand. It controls your wrist flexors.
  • T1 innervates the inside of your forearm and controls your finger extensors. Note that there are only 7 cervical vertebrate segments but 8 cervical roots because one set of roots comes out between the skull and C1 and the 8th cervical roots exit the spinal cord between C7 and T1.

Dermatome map:

It sounds as if you had an initial injury at C5. This is the most common site for cervical spinal cord injury. It causes loss of voluntary movement and sensation below C4. In other words, initially, you probably could not move either of your arms and your sensation stopped at the line just above T2 in the picture above.

Most people recover one or two segments below their injury site over several months. In your case, this means that you should be getting your biceps (C5), wrist extensors (C6), and possibly triceps (C7). Each of these are very important. If you get your biceps back, that usually includes the brachioradialis muscle, which allows you to move your hand from side to side. With C5, you should be able to control a joystick of a wheelchair and computer. With C6, you should be able to extend your wrist and be able to operate a keyboard with a splint. With C7, you should be able to lock your elbow and do transfers. With C8 and T1, of course, you would be able to flex and extend your fingers.

Most people remain paralyzed below the cervical segments if they have a spinal cord injury that is judged to be “complete”. The term “complete” spinal cord injury (or defined as category A on the American Spinal Injury Association classification) means that you have some level below which you have no motor function or sensation. The lowest level of the spinal cord is S4-S5 (sacral 4 and 5) which innervates the anus and anal sphincter. If you have no sensation around your anus or ability to contract your anal sphincter voluntarily, you are classified as an ASIA A.

Despite the term “complete” about 5-15% of people with ASIA A spinal cord injury recover can recover anal contraction and sensation. Many will get back sensation in many parts of their body (ASIA B) and some may get back some motor function (ASIA C). A few may even get back walking (ASIA C and D). Several studies have shown that people who recover pinprick sensation in the arms, particularly around the elbow (T1), will recover motor function in the hands. This is because pinprick (pain) sensation is carried in the lateral columns and preservation of such sensations usually mean that the corticospinal tracts located in the lateral column may be intact as well.

Recovery usually occur slowly. Over a period of 3-6 months, most people will get 1-2 segmental levels of function back, often one side more than the other. If a patient can feel me pinching their index finger, that usually suggests that they have already or will soon get back their wrist extensors. If they can feel me pinching the tip of their middle finger, it suggests that they will get back C7 and triceps. If they can feel my pinching their pinky, that suggests that they may get back their wrist flexors and hand muscles.

From 6 months to 2 years, most people continue to recover some motor and sensory, often getting patches of sensation and even some movements in the legs. For example, Christopher Reeve recovered his ability to life 5 pound weights with his legs in a swimming pool and gravitation was removed. Sometime after two years, he began to feel sensation in his anal region. He eventually recovered almost sensation down to his knees. This often happens in people with high cervical spinal cord injuries. He recovered to become an ASIA C, i.e. a person who can feel the anus and can contract their anal sphincter or move the legs (even slightly) voluntarily.

What should you do?

First, recover as much as you can. At the beginning, it will be very frustrating. As one person described it, she could not move her arms at the beginning any more than she could move her hair. However, as the days passed, she discovered that she could move her deltoids (lift the arm outside), contract her biceps (flex the elbow), extend her wrist (C6), extend the elbow (C7), flex the write (C8), and move the fingers (T1). Every segment makes a big difference.

Second, stand. At the beginning, you will feel faint every time you sit up. This is because your blood pressure will be low. However, with practice, you will be able to sit up and then stand up (with a tilt table). At home, you should use a standing frame or a device such as the Glider. You should do increase this gradually to the point where you are able to do weight-bearing on your feet for at least an hour a day.

Third, learn to control your posture. While you are sitting or standing, try to maintain your balance so that you can balance. Balancing is essential for walking and you should practice sitting without your arms to balance you. You will be surprised by how much you can do. Many people find that they can support their torso even though they cannot feel.

Fourth, join a locomotor training program. In the United States, this starts out on with stepping training on a treadmill, usually with a variety of weight support and braces for the knees and hips. In China, they go directly to standing in a rolling walker. Eventually, people who start on treadmills have to make the transition to overground walking. There is some disagreement concerning the intensity and duration of training. In China, one hospital uses what I call a 666 program, i.e. walking 6 hours a day, six days a week, for 6 months. The rationale for this is to try to get the brain to move the legs in a patterned activity for as many hours as possible. After injury, many axons sprout, including surviving and regenerated axons. Activity strengthened connections while unused connections undergo atrophy.

Fifth, getting into shape. Some people use functional electrical stimulation (FES) bikes. Others do intensive walking. I like to swim. Most people with cervical spinal cord injury can swim. Use floats and stand in the water. Try swimming to get your heart rate and breathing rate up. Your body needs to get into shape. Once you are in shape, you need to maintain it by exercising an hour a day.

So, once you have maximized your recovery and have gotten yourself in good shape, it is time to consider other means to improve your function. This of course crosses into the realms of experimental therapies because there are no proven therapies that restore function in chronic spinal cord injury. However, there are many therapies that regenerate the spinal cord in animals. There are some clinical trials starting and more will be happening in the coming year.

So, for example, we are doing a clinical trial of a combination therapy that we hope will regenerate the spinal cord: injecting umbilical cord blood mononuclear cells into the spinal cord and then treat the person with lithium, known to stimulate the cells to grow and to produce neurotrophins (growth factors that causes regeneration). We are doing a trial in Hong Kong to assess the safety of transplanting the cells into the spinal cord and planning a clinical trial in Austin, Texas to assess the feasibility of doing intensive locomotor training in the U.S.

In summary, here are five recommended steps:

1. Acute. Early treatment with high-dose methylprednisolone (started as soon as possible and no later than 8 hours), maintain perfusion of the spinal cord (make sure that blood pressure is normal), and stabilize the spinal cord injury site. If something is pressing on the spinal cord, surgery should be carried out as soon as possible to decompress the cord.

2. Subacute. If the person is on a ventilator, wean the person off as soon as possible. Prevent complications (i.e. decubitus, urinary tract infections). If necessary, reduce but do not completely prevent spasticity and spasms. Both spasticity and spasms will maintain muscles. Spend increasing time upright, eventually to an hour of weight-bearing a day.

3. During the first 6 months. Begin treadmill and then make the transition to overground walking. Spend as much time as possible to do this. Use swimming and FES to strengthen the muscles and get the body into shape. Learn how to use a computer, learn to drive, and work on minimizing drugs for spasticity, spasms, neuropathic pain, bladder spasticity.

4. Beyond 6 months. If you are going to school, make plans to continue. Don’t let spinal cord injury take more than a semester away. If you are not going to school, make plans to go to school. Many studies have shown the the quality of life of people after spinal cord injury correlate with educational achievement. No matter who or what you did before, you would be better off with more education. Take care of your body. Get yourself into shape. Stand at least an hour a day. Learn as much about spinal cord injury treatments as possible.

5. Clinical trials. Clinical trials are beginning. In the coming years, there will be more trials, offering a panorama of therapies. You can wait until the trials are done or participate. Make sure that you understand the therapies enough to be able to make good choices. Do not go overseas for unproven therapies. They are unlikely to work and will only waste your time and money, without helping others.

I hope that this is helpful.

Wise.

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