[jawheeler]

Hi,

I'm doing research for a novel, and I have some specific questions. Any help/hearsay would be much appreciated. I'm not seeking medical advice of any kind, I just want to hopefully convey a realistic best case experience of a paraplegic.

What would be a reasonable minimum hospitalization for an SCI patient?

More specifics:
I gather that time in hospital has decreased dramatically over the last ten years (at least in the USA).
Assume a 2007 injury in California, USA (the statistics I've seen show mean time in acute care of 11 days, and 26 days of rehabilitation).

Assume (incomplete) paraplegia, wheelchair confinement, no complications.

I suspect that acute care could be less than a week? I suspect that rehabilitation could even be outpatient? Is in-home rehabilitation a possibility? How much professional care per day would be required?

I've read that some patients have relatively little pain. What is the minimum amount of pain like for a paraplegic?

I've heard that paraplegics can experience phantom sensations. Does this only occur with total loss of sensation, or could this occur with partial loss of sensation?

If a person was in an accident causing spinal damage, how soon (best case) would they be fully aware and able to carry on a conversation?

Thanks a bunch. Any information, including links to other online resources would be much appreciated.

[nomis]

I can't help with California rehab today, but a few points....

Assume (incomplete) paraplegia, wheelchair confinement, no complications.
Incomplete and 'no complications' are an unlikely mix as incomplete usually means a complex uncertainty.

I've read that some patients have relatively little pain. What is the minimum amount of pain like for a paraplegic?
Some, eg from a virus, may have no pain. If it's from trauma it's gotta hurt somewhere.

I've heard that paraplegics can experience phantom sensations. Does this only occur with total loss of sensation, or could this occur with partial loss of sensation?
Both. Big variations. Not necessarily same phantoms felt by amputees, but it might be.

If a person was in an accident causing spinal damage, how soon (best case) would they be fully aware and able to carry on a conversation?
Did they get hit on the head? What happened to them? Some'll talk immediately some may never talk again. If you cleanly cut the spinal cord it shouldn't affect speech but the shock might.

I'd suggest you draw up a specific profile then match that to what you can learn to create a convincing character.

[jawheeler]

nomis, on Jul 19 2007, 11:27 PM, said:

I'd suggest you draw up a specific profile then match that to what you can learn to create a convincing character.

Thanks Nomis.

Ok, how about this: In Santa Cruz, California (USA) a 23-year-old male suffers a T12 spinal compaction due to shoulder impacting an unforgiving surface (a stationary bus) at a weird angle, at about 30 mph while wearing a helmet. Patient is taken to a hospital via ambulence and transfered within 12 hours to an acute care facility in a nearby city (San Jose). Patient suffers from extensive bruising on shoulder, minor lung collapse, loss of 75% of sensation in legs, loss of 95% of motion in legs, loss of bladder control, complains of prickly, burning sensations in his legs when stimulated, and the sensation that his legs are bending back behind him, or cycling, although he can see them stationary in his bed/chair. Patient can sit without assistance. Patient has a cell phone conversation 60 hours after the injury while in the acute care clinic, hazy from pain medication, and describes the phantom sensations. After showing good progress and stability, patient is discharged to a rehabilitation center (or possibly his own home with daily visits from a rehabilitation specialist?) 7 days after the injury, in a wheel chair. He's taking oral pain medication, but is completely cogent at this point, eating normal food, and mostly self sufficient, only needing help while transfering to the toilet and bath tub. 20 days after his injury, he has no significant improvement in symptoms, but is self sufficient accept while transfering to the bath. He returns home (if not before) and professional care is reduced or eliminated, but he employs an unskilled assistant to help with cooking and cleaning.
Is there anything about this that is implausible? Is there anything about it that is impossible?

Thanks again.

This post has been edited by jawheeler: 20 July 2007 - 01:34 AM

[BillS]

My experience was way out of date for you but I was awake and talking immediately after the injury. I had a compression fracture at T8 due to sliding head first into a tree stump while snow skiing. I felt a large shock through my body but I've never felt any pain. I talked to the ski patrol and told them about not feeling anything from the bottom of my ribcage on down. I stayed conscious and talked to the ambulance crew. I made sure the guys I was with had my car keys before I was taken away in the ambulance. On the trip to the hospital I asked the paramedics if it was OK if I went to sleep, they gave me permission and that was the time I finally passed out, probably from shock or just the overwhelming emotions from being paralyzed. I did wake up in the hospital but was able to carry on conversations right away.

For proof on how times have changed. I was in the acute care area for about 2 weeks. The total time between acute care and rehab was 100 days back in 1977.

Quote

I've read that some patients have relatively little pain. What is the minimum amount of pain like for a paraplegic?

I'd say the minimum amount of pain is zero. I have never felt pain from the compression fracture, from the paralysis or from anything. I just don't feel a thing below my ribcage.

[wheeliebear75]

Everyone is different 1st off. You can have two people of relatively same "stats", and still have two different outcomes. It is true that with the advancement of medicine people are not only having shorter hospital stays but are having more positive outcomes. My concern would be if somebody gets the notion that because the stay of one person with a similar injury to them is only 3months that they are being kept unnecessarily after 4.

I was injured in 1990. I was 14 and it was from an impact to my head that caused several dislocations and a compression fracture of L2. I spent 6weeks in Children's Hospital. I did my rehab as an outpatient after about a week or so as an inpatient. (my mother is an OT and I was only 14 so I did NOT fit in with the adult programs and group discussions. I had frequent migraines from sound and the hospital and rehab was always full of sounds. I had to take naps A LOT, and I was less frustrated with my mother doing my therapy than the regular staff.....so they had her do mostly everything, I did not have mood swings on her like I did staff. My brain injury made things more complicated than if it had just been a simple break. (I got the whole CNS package bad joke I know) I had to demonstrate that I was able to do certain things like a driving test only with the chair, walker, etc. [I am a incomplete with 75-80% feeling], I had medical clearance as far as that only because my mom had some additional training as nursing goes because my father had been very ill in the 80's before he died. These are very unusual circumstances) {ICU 8 days, regular ward for just over a month, and then rehab for 1 week, outpatient for an additional 6mo.} (like I said not many injured kids have a parent as a medical staff that can help get you home faster)

[nomis]

Quote

jawheeler
...Is there anything about this that is implausible? Is there anything about it that is impossible?

Seems plausible. BillsS and wheeliebear75 have the real life info.
I wonder if the seven days in hospital and 20 days to self sufficient aren't rushing it a bit. Certainly in my experience a compact fracture at T12 would involve longer bedrest to stabilise the fracture. Maybe someone with up-to-date info can help.

This post has been edited by nomis: 20 July 2007 - 08:03 AM

[Texaswheelz]

Your story does seems like it could be possible, but if I was to read a book with that story in it I would be highly skeptical. Granted my accident was almost 17 years ago, but I had tubes down my throat for a week due to my collapsed lung and then another 3 weeks of breathing treatments after that. I also understand that you probably just gave a quick rough outline to us to read over so there could be more to it, espeically with the treatments the guy goes through.

I had a surgery to stabalize my spine within 8 hours of the wreck(your guy didn't seem to have any procedures done to stabalize or help him recover in anyway), I then spent a week in ICU drugged up and letting the swelling go down. I can't imagine anyone up and about within a week of such trama to the spine, coherent and able to have a phone conversation, sure. It took 3 days after that first week of ICU for me to be able to sit up without passing out due to the change of blood pressure while being prone for so long. I was also outfitted with a plastic back/chest piece to stabalize my back further and had to wear it for 2 months, while only being able to remove the front piece while lieing flat on my back. Your guy is going to have to have something to stabalize his spine and give it time to recover, which also limits mobility and the ability to learn to move, transfer, hell even to sit up and lay down.

After the week in ICU and 2 weeks in a normal hospital room, I had limited rehab while in the hospital as I had lost almost all strenght in my arms(I was a football player and weightlifter)and even though I had full use of my upper body, doing curls with 2.5 lbs weights was a huge effort at first. I finally got moved to the rehab center where I spent a month and a half of working my ass off 5 hours a day to recover enough to be allowed to move back home with my parents. I was about 75% self sufficient. My therapist and Dr.'s told me that I was one of the few that get out less then 2 months of rehab and most with my type of injury spent 4-8 months there depending on their drive and frame of mind.

I don't know if you happened to watch the TV show(not movie) last fall called Friday Night lights or not, but there was a football player that gets a spinal injury in the first or second game. His rate of recover was such that within 1 to 1 1/2 months of his injury he was off on his own trying out for the US quad rugby team to go to the olympics. So either they did their research and the recovery rate now for spinal injury has increased a ton, or they really didn't know what they hell they were doing. Personally, I loved the show, but to see a person with a higher lvl injury than I have doing the things they had him doing in such a short time drove me nuts. My Dad even called me and was wondering how they could show such bs. Of course I understand for the sake of the show and the story being told they couldn't have him laid up in bed for months, but for a quad to recover that fast was very far fetched, but I wouldn't say impossible.

There is a ton of info here on the site and from the forums, I'd like to hear from others also and if anyone was up and about at home within 20 days of their spinal trama.

On the other points, i have constant pain, in my back and sides and even the phantom pains in my legs. I can't say that they've ever feld as though they were in some weird position but they have felt if they were some place or position different they what they actually were. The Dr. always ask for me to rate the pain on a scale of 1-10, which I think my pain scale differs from a normal person after 16 years of constant pain. What I would have considered a 6 or 7 before my injury i would probably consider a 3-4 now and I'm almost always at that pain lvl. Marijuane is the only thing that has ever helped, other then something strong enough that makes me drool or knocks me out.

I'm wondering about that stat of 11 days of acute carea and 26 of rehab. Does it include any time inbetween? I would consider my week in ICU as Acute and my month and a half of rehab of course as rehab, but the 2 weeks I spent sitting around in the hospital room waiting for other things to heal and getting my strenght back i wouldn't consider as either of those. I did have about 80 or so stitchs in various parts of my head from glass and 50 staples to close where they dd the surgery on my back.

[brookelynn628]

I know you said complete, but I think I can give you some info on my boyfriend's injury - he's complete at the T11/12 level. He was injured in a motor vehicle accident in 1996. He told me that he felt searing pain in his back for a fraction of a second and then nothing. Both the T11 and T12 vertebrae shattered when the car flipped. He knew he was paralized right away, he couldn't feel anything below his navel, and he thought he was hanging from the car and was surprised to see that he was folded in half and his feet were next to his head. It took 3 hours to remove him from underneath the vehicle, during which time he went into shock and was nearly asphixiated by the weight of the vehicle. Staying alert saved his life - he talked with his uninjured (but trapped) passenger the entire time. He went to surgery right away in St. Louis to stabilize his spine. He began rehab almost as soon as possible after surgery. He probably would have started sooner, but was pretty doped up from painkillers. At his facility, patients were required to spend a week in the "apartment" to prove they could take care of themselves. However, at 28 days, he decided he was ready to leave. The doctors were impressed with his mobility and adjustment, and he negotiated and was able to leave the hospital after a 24 hour period in the apartment, 30 days after his injury.

After about 3 weeks at home, his pain began. It ran from his hip bone down to mid-thigh of his right leg. He described it as a hot stabbing feeling constantly. 18 months ago, he had surgery in Denver to remove the nerve from the root. He lost feeling in his lower abdomen but no longer feels pain. At this time, they also removed his spinal hardware. He does not experience phantom pain, but does has mentioned rare phantom feeling from time to time, usually only lasting a few moments. He also has had returns of feeling on his left side, down to about mid-thigh.

This post has been edited by brookelynn628: 20 July 2007 - 09:44 PM

[jawheeler]

Thanks again for the responses. They are all very useful, especially the details. Because I've never experienced anything like this, my ideas all came from unfocused web research. Having explicit descriptions like this is invaluable.

I just spent a while looking at pictures of spinal braces! I hadn't even thought of that...

A description of rehabilitation would be helpful. How much time per day? What does it include (weight lifting w/ arms etc.)?

[hockeydahc]

for starters...if you really want to get into the character more, try imagining yourself with the injury. your legs won't move to even slight positions. your arms have to pick them up and physically place them everywhere. your arms have to be able to support your entire bodyweight now. you have to pick yourself up over here and put your butt down over there for transfers.
add in situational chores. clipping toenails isn't always an easy chore. putting on pants when you have to lift yourself up with your hands, but also need hands to pull up your pants. how do you wash your ass when you are sitting on it? yuo learn it all in rehabilitation. I'd say that the easiest way would be to find a rehab clinic and watch a session, but that would be creepy and intrusive to the patients. my place had a video demonstration.



good luck

[Texaswheelz]

hockeydahc, on Jul 21 2007, 03:34 PM, said:

I'd say that the easiest way would be to find a rehab clinic and watch a session,
good luck

I agree, check with a rehab center or see if you can talk with some of the OT's and PT's there. I know that Tom Cruise spent a good amount of time at Baylor Rehab in Dallas before filming Born on the 4th of July. I was there about 6 months after him.