1. What is the difference between complete and incomplete spinal cord injuries?
Complete injuries result in a total loss of sensation and function below the injury level. Incomplete injuries result in a partial loss. Complete does not necessarily mean the cord has been severed. In fact, the criterion for determining neurological ‘completeness’ is determined by ‘sacral sparing’ in the ASIA neurological assessment. This test requires examining the presence of voluntary contraction of the external anal sphincter upon digital stimulation. Both complete and incomplete categories can occur in paraplegia and quadriplegia.
Jacobs, P. L., & Nash, M. S. (2004). Exercise recommendations for individuals with spinal cord injury. Sports Medicine, 34(11), 727–751.
2. What is the difference between paraplegia vs quadriplegia?
Paraplegia is the loss of sensation and motor control in the legs and in part/all of the trunk resulting from an injury to the lower spinal cord (below the neck). Quadriplegia (also known as Tetraplegia) is paralysis of the legs, trunk, and arms (from the neck down) resulting from injury to the upper spinal cord (neck) (Jacobs & Nash, 2004; Roberts, Leonard, & Cepela, 2017).
Roberts, T. T., Leonard, G. R., & Cepela, D. J. (2017). Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clinical Orthopaedics and Related Research, 475(5), 1499–1504. https://doi.org/10.1007/s11999-016-5133-4
Jacobs, P. L., & Nash, M. S. (2004). Exercise recommendations for individuals with spinal cord injury. Sports Medicine, 34(11), 727–751.
https://doi.org/10.2165/00007256-200434110-00003
3. Is cannabis treatment advisable?
Cannabis/marijuana contains different types of compounds called cannabinoids. These cannabinoids activate specific receptors found throughout the body, particularly in the central nervous system and brain. Recreational marijuana has high levels of the THC compound which give the mind-altering effects, i.e. it makes you ‘high’. Medical cannabis is low in THC and higher in other compounds like cannabidiol (CBD) and cannabinol (CBN). These compounds are not mind-altering and have potential beneficial effects for various conditions, including pain and spasticity.
A 2017 evidence-based review by the National Academies of Sciences, Engineering, and Medicine Committee on the Health Effects of Marijuana summarised the evidence for benefits and risks associated with cannabis use. This report found substantial evidence that cannabis is effective for treatment of spasticity and for adult chronic pain. Moderate evidence was found for its effectiveness with specific sleep disorders.
The main concern with use of cannabis is the lack of regulation. Oils are typically purchased with unknown cannabinoid ratios with no guarantee with regard to their effectiveness
Cardenas, D. D., & Jensen, M. P. (2006). Treatments for chronic pain in persons with spinal cord injury: A survey study. Journal of Spinal Cord Medicine, 29(2), 109–117.
https://doi.org/10.1080/10790268.2006.11753864.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. Washington (DC): National Academies Press (US); 2017.
Warms, C. A., Turner, J. A., Ph, D., Marshall, H. M., & Cardenas, D. D. (2002). Treatments for Chronic Pain Associated With Spinal Cord Injuries : Many Are Tried , Few Are Helpful.
154 – 163.
4. What is vibration therapy?
Vibration therapy (VT) is the transfer of vibration to your body that causes the muscles to contract and relax. The direction and intensity of the vibrations determine its effectiveness. There are two types of VT, namely whole-body vibration (WBV) and localised vibration. The health benefits of VT include increasing bone density, increasing muscle mass, improving circulation, reducing joint pain, alleviating stress, and it may temporarily provide spasm relief specifically in relation to neurological injuries. Alternatively, the risks of VT include the use of blood thinners, patients who have heart disease, and females during pregnancy.
Cochrane DJ, North P, Zealand N. Vibration Exercise : The Potential Benefits. 2011;75 –99.
Yen CL, McHenry CL, Petrie MA, Dudley-Javoroski S, Shields RK. Vibration training after chronic spinal cord injury: Evidence for persistent segmental plasticity. Neurosci Lett
[Internet]. 2017;647:129–32. Available from: http://dx.doi.org/10.1016/j.neulet.2017.03.019
5. Are stem cell treatments advisable?
Stem cells are special human cells that have the ability to develop into many different cell types, from muscle cells to brain cells. In some cases, they also have the ability to repair damaged tissues.
The publicity around stem cell therapy has given many people who have sustained a devastating injury such as spinal cord injury (SCI) the hope of achieving partial or full recovery from their injuries. Several phase I and II clinical trials are being conducted owing to positive results obtained in animal models. While safety during the trials has been demonstrated, clinical efficacy in the outcome of ethically approved trials is still lacking. Many persons affected by SCI are, however, desperate for a cure and are lured into undergoing stem cell therapy by marketing campaigns and information readily available on the internet.
These people travel far and wide to undergo stem cell therapy, which has led to the term 'stem cell tourism'. Such tourism often involves large medical fees in an unregulated environment. Although promising, stem cells have not shown enough evidence in humans to yet become a valid medical treatment. Participation in medical studies undertaken by respectable universities is encouraged to accelerate the development of these treatments.
Skeen, M., Eksteen, C.A. and Pepper, M.S., 2019. Stem cell tourism and spinal cord injury in South Africa. South African Medical Journal, 109(8, Supplement 1), pp.S18-S24.
6. What is epidural stimulation?
Epidural Electrical Stimulation (EES) is a medical device which makes use of an electrical current to directly stimulate the spinal nerves below the level of injury, therefore bypassing the traditional brain-to-spinal cord pathway. EES makes use of an electrode array which is placed in the epidural space of the spinal cord. By producing electrical currents, the electrode stimulates the nerve fibers which ultimately results in muscular contraction. EES helps to reactivate and stimulate the remaining, intact neural networks within the spinal cord. This can be used to stimulate muscle activity and movements required for standing and walking.
EES is not considered a “cure” to spinal cord injury, but rather a form of rehabilitative technology. It has shown promise and has been found to possibly elicit changes including recovery of weight-bearing, independent standing, improved postural control, generation of rhythmic stepping patterns, control of bladder and bowel function and improvements in blood pressure and temperature control. It is important to note that EES is not solely responsible for these changes and that it should be used in conjunction with exercise rehabilitation including standing and gait training.
Victor Reggie Edgerton & Susan Harkema (2011) Epidural stimulation of the spinal cord in spinal cord injury: current status and future challenges, Expert Review of Neurotherapeutics, 11:10, 1351-1353, DOI: 10.1586/ern.11.129
7. Would you advise the use of Baclofen?
Baclofen is a prescription drug used to treat muscle spasms in individuals with neurological conditions. It can be taken as tablets or intrathecally (a pump that’s implanted in the abdomen and delivers a small dose directly into the spine). Baclofen works by reducing nerve signals to muscles, helping to decrease muscle tone and spasticity.
Dosage is important because if the dose is too big, it would severely limit any voluntary muscle contractions and also affect your alertness. An optimal dose does however offer your rehabilitation team a window of opportunity to try and strengthen key muscles when it “relaxes” the muscles that are notoriously stiff. Good communication is needed between your rehabilitation team and doctor to find the correct dose.
Rekand, T., 2010. Clinical assessment and management of spasticity: a review. Acta neurologica scandinavica, 122, pp.62 - 66.
8. What are nerve transfers?
A nerve transfer is a surgical technique that may be used when a patient has a nerve injury resulting in complete loss of muscle function or sensation. Therefore, it is a procedure which is often fairly difficult and complex, where one end of a healthy nerve is transferred to the site of an injured nerve. In a nutshell, nerve transfers involve taking nerves with less important roles or branches, or which perform redundant functions to other nerves and “transferring” them to restore function in a more crucial nerve that has been severely damaged.
Domeshek, L.F., Novak, C.B., Patterson, J.M.M., Hasak, J.M., Yee, A., Kahn, L.C. and Mackinnon, S.E., 2019. Nerve Transfers—A Paradigm Shift in the Reconstructive Ladder. Plastic and Reconstructive Surgery Global Open, 7(6).
9. Is Botox treatment a requirement of therapy?
Botulinum Toxin, or Botox, is a common and temporary therapy used to treat spasticity relating to neurological conditions such as stroke, cerebral palsy and traumatic brain injuries. Spasticity is a condition where the muscles become stiff and contracted as a response to muscle stretch. It occurs due to a ‘miscommunication’ between the brain and the muscles where, due to the injury, the brain is unable to control muscular contraction and as a result the muscle becomes overactive.
Spasticity can be managed in several ways. These include stretching, electrical stimulation, vibration therapy, certain medications and Botox. Botox acts as a ‘nerve block’ that prevents the release of chemicals that cause muscular contraction, this results in muscular relaxation. It is a temporary treatment that lasts approximately 12-16 weeks. Botox is used to treat smaller areas as very large dosages can be toxic. Larger areas are often treated with baclofen. The effects of Botox should be used to create an opportunity to perform rehabilitation exercises that will help to re-establish neuromuscular (brain-muscle) connections that will lead to more long-term and long-lasting results.
Pavone, V., Testa, G., Restivo, D.A., Cannavò, L., Condorelli, G., Portinaro, N.M. and Sessa, G., 2016. Botulinum toxin treatment for limb spasticity in childhood cerebral palsy. Frontiers in pharmacology, 7, p.29.
10. Please explain the Therapy and Beyond Centre’s pricing structure
Biokinetics, physiotherapy, occupational, and speech therapy may be covered by medical aid on a comprehensive health plan as it is considered an allied health benefit.
The cost of sessions can vary depending on the type of treatment; a typical range would be from R380 to R650 per hour session. Special funding may be available for you if your condition falls under a Prescribed Minimum Benefits (PMB) – see list here: (https://www.semdsa.org.za/images/The_270_PMB_Conditions_(non-chronic).pdf). For those with lower tier plans including hospital plans, the cost of these sessions will come from your medical savings or will need to be paid privately.
As we are an accredited training centre for both the University of Cape Town and University of the Western Cape, we have both fully qualified biokineticists and intern biokineticists at the centre; our interns are in their final year of practical training and are directly supervised by a senior biokineticist. Sessions with an intern are at an approximate 50% discount. A qualified biokineticist will always perform your initial assessment and if affordability is a concern then you may start to work with an intern.
We are also registered with the Road Accident Fund (RAF). RAF provides compensation for individuals injured in motor vehicle accidents which can be used to cover your sessions with any of our staff. You will need to inform your case manager, as well as provide a link number and underwriting in order to claim from RAF.
For individuals from a financially disadvantaged background who are unable to afford rehabilitation, we offer a subsidised programme. We are fortunate enough to have the National Lotteries Commission and other businesses, such as Apex Hi, who have provided us with funding to cover a percentage of the session fee for those who cannot afford it. Based on your financial situation, you can receive anything from 20%-70% discount on your session fee.
11. What is the Weyergans Vacumed?
12. How would you prepare for your first rehab session?
