Courtesy of the Christopher and Dana Reeve Foundation

Cotton Kills!

1. Invest in good quality outer wear. Stick to name brands like The North Face, Patagonia, Hot Chillys, and Obermeyer.

2. Dress in layers. Wear loose, lightweight, warm clothing in several layers. Trapped air between the layers acts as an insulator and layers can be removed to avoid perspiration and subsequent chill. (Remember, layers can always be taken off.)

3. Avoid cotton, when it gets wet, it stays wet. Search and rescue teams stress that cotton once wet stays wet, allowing hypothermia to set in quickly. Instead, try clothing made from moisture-wicking fabric like Under Armour, polypropylene or any man-made fibers. Better yet, wool will still keep the body temperature up, even when wet.

Keeping your hands warm

4. Mittens for hands if opening fingers is challenging.

5. Carry two pairs of gloves with you at all times in the likelihood that one pair gets wet. Make sure the gloves are lined for the best protection.

6. Wet, cold hands cause a chill to set in quicker. If hands become cold put them under arms in arm pit or crotch area to warm rapidly. These areas are the warmest parts of the body.

Stay frostbite free

7. Head, feet, and hands lose heat the quickest. Always wear a hat or cap on your head since half of your body heat could be lost through an uncovered head.

8. If participating in outdoor sports, wear a full head mask, helmet, and neck warmer.

9. It’s very 1980s, yes, but both men and women can keep calves warm with leggings.

10. Use something like Grabber warmers that can be put in pockets and gloves to keep hands warm. These are not good for feet because you can’t regulate the heat.

11. Boot warmers can be very helpful keeping feet warm and dry. Remember to check skin when first using boot warmers. Hotronic is a good product.

Skin protection especially when it’s cold

12. Wear sunscreen! Even in the winter, sunburn is possible. When the sun reflects off the snow, severe sunburn can occur, especially under your nose and the bottom of your ears.

13. Apply Vaseline to the areas of your face that are not going to be covered. It acts as a moisture insulator and helps prevent your face from getting dry or chapped in the cold air.

14. Consistently check for any exposed skin. Shirts and jackets have a tendency to roll up on the back of wheelchairs.

Snow tires for your wheelchair?

15. You should invest in snow tires for both your wheelchair and car. Tires made from a soft rubber work best for gripping snow and ice.

16. For your wheelchair, mountain bike tires can be used as they have more traction.

17. For your car, snow tires are important because they have tread patterns that are designed to grab onto snow and ice. They also help to prevent from getting stuck.

18. Never use cruise control while driving in the winter. The time it takes to remove the cruise control is enough to send a vehicle spinning out of control.

Dealing with dehydration

19. Hydration is critical in winter weather. When the body gets dehydrated cold sets in more easily. Skin becomes dried out from heating and cold temps more so then in summer.

20. You can become dehydrated much more quickly in dry climates and high altitudes. Keep your body oxygenated by drinking lots of water.

What should be in your survival kit?

21. When traveling in winter weather, have a survival kit in your vehicle or backpack. The kit should include water, matches, food, shovel, flashlight, blankets, sleeping bag, and flares. Storms roll in quickly and getting stranded in a snow storm can be cold and dangerous. (Of course, make sure your cell phone is charged and you have a full tank of gas.)

22. Batteries lose 60% of their charge when the temperature reaches 0 degrees. Keep batteries warm with covers.

Make your own boot

23. Candace Cable, Executive Director of Turning Point Tahoe, which creates outdoor recreation and environmental education for people with disabilities in the Trucker/Tahoe are, creates her own specialized snow boot for winter weather.

She used a boiled wool slipper from Norway. “I had it made from a child’s slipper I saw in a store,” explains Candace. “I contacted the person that made it and asked them to make some for me.” Boiled wool slipperd can also be found online.

“There’s a hard white plastic piece I put on the bottom. Then there is a tall cover made of a waterproof material that I again had made to cover the slipper.”

To assemble all the pieces together, Candace says, “First the tall outer cover, then the plastic, and then the slipper, and of course my foot goes in the slipper. The idea is if it doesn’t exist create it!”

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Courtesy of TheAlternativePress.com

by Cara Townsend
Sunday, January 16 2011

MILLBURN, NJ – Ali Stroker, who may be the first actress in a wheelchair to have a leading role in a professional musical, will play the role of Olive in the Tony-award winning show, The 25th Annual Putnam County Spelling Bee, at Paper Mill Playhouse from January 19th through February 13th.

A graduate of Paper Mill Playhouse’s Summer Musical Theatre Conservatory, Stroker says that she is “thrilled” to return to the Garden State after  spending time on the West coast. In addition to pursuing professional goals in the Los Angeles area, Stroker says she learned how to surf. Yes, surf.

Though paralyzed from the chest down at the age of two, Stroker never let her disability stop her from performing. “I have tried since I was very young to make this work—to perform in a wheelchair—and I look for any chance I get to make that happen,” she said.

Stroker’s life experiences allow her to connect to her character, Olive, in her role at Paper Mill. “Olive is a 12-year-old girl who is having trouble in her life and uses words and language as her escape. She is full of imagination and love to get lost in stories and books. She is different.”

At times Stroker says she grew up feeling out of place. “The greatest gift for me was finding my passion. I did not have to worry as much about fitting in. And I could be more than just ‘a girl in a wheelchair’—I could be a performer and develop my talent,” she said.

At age 6, Stroker performed “Annie” with family and friends in her backyard in Ridgewood, New Jersey. “ I watched the movie over and over to learn it. And that’s where the passion with performing started,” she said.

Stroker took voice lessons and performed in musicals at school and in town. At age 11 she was cast in a professional kids singing group in New York City called the Kids for Kids Project. The group performed musical reviews and raised money and awareness for Duchenne Muscular Dystrophy. She says that working with other professional kids made her realize she wanted to pursue performance as a career.

In the fall of 2005, Stroker moved to New York City to attend the Tisch School of the Arts at NYU. She has had roles on Sesame Street and in myriad of theatre performances, including Into the Woods, Pippin, Peter Pan, The Boys from Syracuseand Les Misérables.

An eternal optimist, Stroker believes that finding ways to perform in a wheelchair has allowed her to be an original performer. “I don’t look at obstacles as limitations,” she said. “Rather I see them as opportunities and possibilities.”

Furthermore, she sees The Arts as a great outlet for people with illness or disabilities. “The Arts allows expression and encourages you to do things your own way. It is life-changing,” she says.

Stroker has long-been a champion for the Christopher Reeve Foundation and says that she loves helping people. “I have been given so much. I am so blessed to have many people supporting me and I just want to give back. Performance is one way I can do that—for two hours I can take people on a journey. It’s a wonderful experience,” she says.

The 25th Annual Putnam County Spelling promises a fun, quirky experience for theater-goers. “We are thrilled to welcome a superb cast to Paper Mill Playhouse,” said Producing Artistic Director Mark S. Hoebee. “This clever, heartwarming musical demonstrates that it can be cool to be smart. This production is sure to entertain people of all ages with hilarious antics and a magnificent score.”

Tickets for The 25th Annual Putnam County Spelling may be purchased by calling 973-376-4343, or by visiting the Paper Mill Box Office on Brookside Drive in Millburn, or online at Paper Mill Playhouse’s website: www.papermill.org.

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Argo Medical Technologies Ltd. Develops, manufactures and markets walk restoration devices for people with lower limb disabilities. The company’s ReWalk™ line of products offers an ambulation and rehabilitation alternative to wheelchair users, enabling people with severe walking impairments to stand, walk and even climb stairs.

Founded in 2001 and situated in Northern Israel, Argo operated, until end of 2007, under the auspices of TechnionSeed (formerly the Technion Incubator).

Argo is operated by a team of experts in the fields of rehab devices, control and computer sciences  with decades of combined experience in R&D, engineering and manufacturing of multidisciplinary systems. Argo’s worldwide marketing, sales and business development activities are supported by  specialists with extensive experience in these areas. The company is assisted by an Advisory Board of renowned international experts in the fields of medicine, biomedical engineering, robotics and marketing.

ReWalk™ is a new realization of the powered exoskeleton concept and provides user-initiated mobility; it consists of a light wearable brace support suit, which integrates actuation motors at the joints, an array of motion sensors, a computer system based on sophisticated control and safety algorithms and tailored rechargeable batteries. It  enables people with lower limb disabilities such as Spinal Cord Injury (SCI) and Spina Bifida to carry out routine ambulatory functions. ReWalk™ restores a person’s mobility functions, thus improving both quality of life and physical health. It promises to dramatically reduce the need for physical therapy and re-hospitalization that occur due to immobility-related complications in individuals with severe walking impairments.

ReWalk™ is a man-machine device where the user is actively involved and has control of all mobility functions, through unique control processes. Walking is controlled through subtle changes in center of gravity, stability and safety are secured by use of crutches.
Participation in mobility control comes naturally and intuitively, and brings tangible health and emotional benefits. ReWalk™ is not just a vertical wheelchair – ReWalk™ restores the element of control over mobility so lacking for wheelchair users.
As any wheelchair user can attest, life in a wheelchair carries a hefty healthcare price tag. Serious problems with the urinary, respiratory, cardiovascular and digestive systems are common, as well as osteoporosis, pressure sores and other afflictions.
By maintaining users upright on a daily basis, and exercising even paralyzed limbs in the course of movement, ReWalk™ alleviates many of the health-related problems associated with long-term wheelchair use. In addition to relieving suffering, this has a real impact on healthcare costs – cutting, and enabling both insurers and individuals to redirect funds to other avenues.
Adoption of ReWalk™ by wheelchair users results in significant cost saving at both institutions and private homes. ReWalk™ makes standing devices, stair lifts, bed lifts, and other mobility assistance apparatus redundant. Similarly, ReWalk™ users don’t require expensive powered wheelchairs – or the oversize vehicles and devices required to handle them. With ReWalk™, users require only minimal additional mobility assistance – dramatically increasing independence together with cost saving on a yearly basis.

Functionality:

* All day usage
* Mobility – walking, sitting-to-standing, standing-to-sitting, ascending/descending stairs and slopes
* Training – replacing other training equipment at home and at rehabilitation center

Prerequisites:

* Ability to use hands and shoulders (walking with crutches)
* Healthy cardiovascular system and bone density

ReWalk™-I: ReWalk™ for institutional use

ReWalk™-I is a device that allows institutions to use it as a multi-user rehabilitation and training solution.
At institutions, ReWalk™-I can serve as a therapeutic and physical training device, used for intensive locomotion therapy. By replacing or supplementing expensive mechanized gait trainers, ReWalk™-I may enable institutions to redirect significant budget resources for other therapeutic activities.
The ReWalk™-I is supplied in two sizes to accommodate users height from about 1.60m to 1.90m. The smaller size accommodates users from about 1.60m to 1.75m and bigger size completes the range up to about 1.90m. The device supports body weight up to 100Kg.
ReWalk™-I is currently available for rehabilitation centers / hospitals in Europe and in the USA.

ReWalk™-P: ReWalk™ for personal use

ReWalk™-P has a sportive look and is intended for a daily use by qualified paraplegics, i.e. after medical examination and successful completion of a training program in a rehabilitation center.

As a personal device, the ReWalk™-P can be used indoors and outdoors in almost any urban scenario. The device is not intended for sports or aggressive use.

The ReWalk™-P will be available in the end of 2011.

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Courtesy of The Oakland Press

By CHRIS HAGAN

John Chatman, 56, stands with Dr. Timothy Sesi and PTA Lela Biebuyck, using the Wii as part of his rehabilitation after he suffered a stroke.

It’s being called “Wii-hab” and “Wii-habilitation” in the medical community, and several local hospitals have established a use for video games in rehabilitation treatments.

The Nintendo Wii is now a staple and one of the most popular pieces of equipment in the rehabilitation centers at Crittenton, Beaumont Hospitals and St. Joseph Mercy Oakland.

“It’s been a true revolution in rehab,” said Dr. Timothy Sesi, director of rehabilitation at St. Joe. “The minute we introduced (the patients) to it, the patient satisfaction had gone through the roof.”

What sets the Wii apart from every other gaming system — with the exception of Xbox’s new Kinect — is its ability to wirelessly detect movement in three dimensions through the use of a controller. Inside the controller are accelerometers and infrared detection that read speed and position. It’s this technology that made the Wii possible for rehab.

“We use the Wii to reorient the patients with their body,” Sesi said. “The features of the Wii Fit enable us to monitor the patients progress with balance.”

The Wii has been able to aid people who’ve had strokes or are recovering from major surgery as well as patients living with multiple sclerosis. Golf is just one of the many sports available on the Wii, and Sesi said it’s one of the best.

“It’s low impact. It forces the patient to monitor balance, arm flexion and then rotation when they hit the ball,” he said.

John Chatman is a patient at St. Joseph’s who had a stroke. The 56-year-old retired General Motors Corp. electrical engineer is no stranger to electronics and its capabilities, but he was surprised how much the Wii was able to do.

“I just didn’t think it was going to do much of anything, but I was impressed with the proficiency of the device,” Chatman said. “By using this, you have more hand-eye coordination.”

Beaumont, which incorporated the Wii to its program in 2007, introduced another video game a year later for its younger patients, Guitar Hero.

Karen Roffe, a recreational therapist at Beaumont Royal Oak, saw the benefits of the Wii and began looking into the hand-eye coordination of Guitar Hero. She believes in the device’s benefits, but knows it’s not the end-all.

“We use it as a reward system. It’s an incentive to finish the other required exercises first,” she said. “It’s not so much about points, it’s about mastering skills.”

Both facilities are now looking into the Xbox Kinect — which doesn’t use a remote, and instead reads body position — but the next step is developing driving skills in patients who are still capable of handling a vehicle. Mario and the rest of the characters in Mario Kart will be the teachers.

“Never in my wildest dreams would I think I’d be prescribing video games to patients,” Sesi said.

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Courtesy of WKYC-TV in Cleveland, OH.

January 12, 2011

CLEVELAND — Dick Clark is perhaps one of the most well known faces of stroke survival. Chances are you know someone and you probably think strokes only affect older people but they can happen at any age and about 200,00 happen to people under 65 each year.

It’s the leading cause of debilitating illness in this country but imagine being told as a teenager you’ll spend the rest of your life in a wheelchair.

Eighteen-year-old Ariadne Popma, of Michigan, was determined not to let that happen. A stroke paralyzed her left side two years ago, most likely caused by a blood disorder she has called beta thalassemia.

Electro-stimulation therapy to shock her muscles into working again didn’t work. She couldn’t feel her leg, let alone think about standing on it, until she came to Cleveland and met Dr. Jeffrey Bolek in the Cleveland Clinic’s Motor Control Program.

In three weeks, his therapy not only helped her stand, it helped her walk again. Unlike traditional therapies that electrically stimulate individual muscles, Dr. Bolek’s program forces Ariadne’s brain to tell her body what to do.

“If you can give success in one or two muscles, a lot of the other things fall into place,” Dr. Bolek says.

He also adds his method works faster which may be economical to the patient paying for healthcare. However, the therapy may not work for everyone.
It works as Ariadne walks on the treadmill and watches a monitor in front of her. Two moving lines let her know if she’s hitting her target.

But what keeps her going is the fact that her walking is powering a DVD player that shows a movie. It plays as long as she walks correctly. “This one actually gives me feedback to use what I need so I can use my muscles accordingly to my brain,” Ariadne says.

The therapy isn’t for everyone but it also helped Ariadne regain control of her left arm. Enough that she can now shuffle cards.

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Courtesy of the Armenian Spectator

December 18, 2010

VIENNA, Austria – Pioneering results of researchers at the Vienna University of Technology shall improve mobility in spinal cord injured persons without surgical intervention.

Severe spinal cord injury is a devastating neurological condition and often results in confined and dependent lives of the persons concerned.  The ultimate goal must be prevention, immediate cure or regeneration.  However, until these solutions are found, scientists continue to seek methods to enhance quality of life of those so afflicted.  A team of young scientists in Austria, working in an interdisciplinary field of human neurosciences, medicine and engineering, is committed to spinal cord research and the development of novel therapeutic interventions and has achieved pioneering results.  Ursula Hofstoetter and Karen Minassian, who are with the Institute for Analysis and Scientific Computing at the Vienna University of Technology and the Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria, described a novel method to electrically stimulate the spinal cord with surface electrodes placed over the skin of the lower back and abdomen.

Spinal cord injury interrupts descending neural pathways originating from the brain.  The terminal spinal cord, that issues the nerves to the lower limb muscles, is then (partially) separated from brain control.  Depending on the severity of injury, one of many consequences is the impairment or loss of voluntary control of muscles below the injury, including the ability to walk.

For some time, the spinal cord was regarded as a bundle of nerves transmitting signals between brain and body.  But the spinal cord – like the brain – can process and generate neural signals.  Specialized neural circuits in the spinal cord can autonomously produce commands for controlling simple behavior, like the rhythmic contractions of muscles.  Such circuits, called pattern generators, are preserved in the lower spinal cord after injury and are the basis of the studies of Hofstoetter and Minassian.

The group has earlier demonstrated that electrical stimulation of the lower spinal cord with simple signals can produce rhythmic, cyclical movements in paralyzed lower limbs.  This was achieved using electrodes that had been implanted inside the spine, close to the spinal cord, for the therapeutic treatment of involuntary muscle contractions (spasms).

The novel method of so-called “transcutaneous spinal cord stimulation” utilizes commercially available, self-adhesive electrodes as used in physical therapy.  The simple and cost-effective method does not depend on surgery and could be widely applied in rehabilitation medicine.  First results in the attempt to improve mobility in spinal cord injured people with transcutaneous spinal cord stimulation are promising.  Spasms can be reduced and muscle activities can be increased in individuals with complete spinal cord injuries who have some remaining ability to walk.  People with severe injuries who do not respond to contemporary gait rehabilitation therapies could benefit from transcutaneous spinal cord stimulation when combined with the treatment concept of “motor learning” – this is the repetitive practice of stepping on a treadmill supported by therapists or a robot.

The next essential step is the transfer of the scientific results to clinical research and – ultimately – to clinical practice.  Whether this goal can be achieved in near future also depends on the financial support of following projects.

The Austrian group collaborates with international sciences and clinical partners in Europe, Asia and the U.S. Among them is the Shepherd Center in Atlanta, GA, one of the top rehabilitation centers in the United States, specialized in medical treatment, research and rehabilitation for people with spinal cord or brain injury.  Hofstoetter and Minassian are currently supported by a Translational Brainpower Project of the Austrian Science Fund (FWF) under the mentorship of Prof. Milan R Dimitrijevic, Baylor College of Medicine, Texas neurologist and human neuroscientist, and one of the founders of Restorative Neurology.

In their interdisciplinary work, Hofstoetter and Minassian are strongly supported by Prof. Frank Rattay, head of the Association for Biomedical Engineering at the Vienna University of Technology, Prof. Heinrich Binder, head of the Neurological Center at the Sozialmedizinisches Zentrum Baumgartner Hoehe, Otto-Wagner-Spital and Prof. Winfried Mayr, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna.  One of the first supporters of the team was the Red Bull-backed Wings for Life Foundation for Spinal Cord Research, Salzburg.

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From “Charting a New Course: The Guide to Independent Living After Spinal Cord Injury

Courtesy of The University of Michigan Model Spinal Cord Injury Care System

Chronic pain after SCI affects one in three people.  Based on a variety of studies, people with SCI report they have pain about 64-80% of the time.  Pain can have serious effects on people’s mood and quality of life in addition to limiting their activities.

The severity of pain seems to be associated with the completeness of the injury but not the level of injury. Forty seven percent of people with SCI in one study reported the onset of chronic pain within the first year after their injury.  Many people are dissatisfied with current treatment efforts and at least 19% in one study and 39% in another reported experiencing severe pain.

Chronic pain can result in psychological issues as well.  This does not mean that it is “all in your head,” just that your physical and very real pain is causing mental and emotional stress as well.  The pain can also be magnified by other personal factors, including depression or unemployment.

Understanding the source of the pain can enable you and a health provider to find effective ways to treat and deal with pain.  There may be some pain that can be reduced and managed, but not completely eliminated.

The Anatomy of Pain

Pain occurs, for instance, when the skin is irritated by all sorts of stimuli, such as a burn or a cut.  Receptors in the skin transmit a signal to nerve cells (called neurons), which move along the nerves away from the source of the stimulus.  The nerve cells transmit a message to the spinal cord and up to the brain, which translates the message.  If the brain interprets the stimulus as pain, then it can initiate a response, such as sending a signal via a motor nerve to cause movement, such as pulling away from a painful stimulus.

Pain after Spinal Cord Injury

After an SCI, some nerve pathways are disconnected.  There may be damage to sensory nerves in the spinal cord that results in abnormal processing of a stimulus.  This results in decreased or absent sensation, numbness, or tingling.  The pain may not be sensed in the area where it would usually be felt.  Or, pain occurs without a stimulus that would usually cause pain.  Sometimes, pain is generated from damaged nerves or nerve roots.  This type of pain is called neuropathic pain and can be further classified by the area where it feels painful.

Pain is due to activation of pain nerve fibers at some level of the neural axis.  Pain can be acute or chronic.  Acute pain has a specific cause, such as an injury or a disease.  Once the medical condition is treated and the area heals, the pain ends.  Immediately after and SCI there may be pain from the original injury with gunshot wounds tending to create more pain than other types of injuries.

Chronic pain is pain that occurs over long periods of time.  The cause of the pain may be unknown and the pain can come and go.  There are basically two types, nociceptive and neuropathic pain.  Nociceptive pain is sometimes thought of as “normal” pain, as it is due to actual tissue damage, like a bruise or cut.  The nerves are working normally, signaling that something is wrong in an area of the body.  With neuropathic pain there is not an identifiable problem in the area of the pain due to abnormal processing of sensory input from the original SCI.

Types of Neuropathic Pain

In general, neuropathic pain with SCI can be defined into five different types.  Classifying it can make understanding the cause easier, treatment more specific and, hopefully, more successful.

• Central Pain is discomfort felt below the level of injury.  This can include numbness, pins and needles, burning and other types of pain.  Central pain can be difficult to treat, and can range in severity from annoying to limiting everyday functions.
• Root Pain is caused by compression of the nerve roots and is experienced at the injury level.  Some people feel this as pain radiating around the body.  Root pain may have a pattern of waves and can change in intensity over time.
• Sympathetic Pain takes place in areas where you don’t have normal sensation.  This is pain associated with abnormalities in sympathetic activity seen as swelling, coolness, warmness, redness or blue discoloration, localized tenderness, and skin changes.
• Nerve Compression Pain is seen at or above the level of injury.  This includes nerve root compression from disc disease, nerve entrapment like carpal tunnel syndrome, and syrinx, which is a rare condition that affects about 2% of people with SCI.  A fluid-filled cavity, called a “syrinx” forms in the spinal cord, sometimes years after the initial injury.  The symptoms may include pain and loss of nerve function, although some people with a small syrinx may never know they have one.  An MRI or CT/myelogram will aid in diagnosing this condition.
• Referred Pain is pain that is sensed in an area away from the source of the problem.  One example occurs when an individual has spasticity due to a stimulus in an area of the body without sensation.  The pain is “referred” from one are to another.

Pain may also trigger other problems, including autonomic dysreflexia and spasticity.  These symptoms should be reviewed when visiting a health provider about pain.  These conditions are described elsewhere in this manual.

Upper Extremity Pain is often related to transfers, pressure relief and wheelchair mobility.  In one study, upper extremity pain interfered with the ability to transfer 65% of the time.  Research has found that most common upper extremity pain problems occur in the shoulders (75%), then the wrists (53%) and less often in the hands and elbows.

Shoulder pain is associated with time elapsed since spinal cord injury, shoulder range of motion limitations, lower overall health and lower function.  Strengthening the shoulders and increasing endurance training may help decrease the intensity and frequency of shoulder pain.

Treatment of Pain

Managing chronic pain can be an involved process.  It may require a combination of drugs, therapy and other treatments and may take some time to work out.  Some of them may involve alternative or psychological methods, such as bio-feedback.

Try to keep an open mind about treatment and be flexible and cooperative.  Do tell your doctor about pain and describe it as well as you can.  Keep track of when the pain occurs, how it feels (burning, stabbing, tingling, aching, etc.), its intensity, how long it lasts and anything and anything that either worsens or reduces the discomfort.  Keeping a diary or writing on a calendar may help chart pain.

Research has shown a person’s other concerns can worsen pain.  Stress, anxiety and inactivity can affect pain.  Emotional issues, which at first might not seem to play any role in feeling pain, may actually be important.  Having few outside activities and interests, being isolated and feeling hopelessness and negative can also reduce your ability to cope with pain.

Medications

• Antiseizure medications: These drugs (including Gabapentin, Carbamazepine, Phenytoin) are used to treat neuropathic and central pain.  They also play a role in treating chronic pain.  Sometimes anti-seizure drugs are used along with anti-depressants.
• Anitdepressants: Two types of antidepressants, selective serotonin reuptake inhibiters (SSRIs) and tricyclics, are sometimes used to assist treating pain.  The reason behind using them is that these drugs can improve pain control, enable a pain medication to work more effectively, and help with sleep.
• Anti-inflammatory drugs: These medications, including aspirin, Motrin, Advil, Ibuprofen and others decrease pain that is caused by inflammation.
• Opiates: Traditional pain medications (such as morphine, codeine) and newer, synthetic narcotics (including oxycodone and levophanol) play a complex role in managing chronic pain.  These drugs have the potential for causing dependency and/or may no longer work after a time (an effect known as tolerance), so care must be taken with these medications, although they are very useful for some people.  Common side effects include cognitive effects (depression, irritability, and other symptoms) and slowing of the digestive tract causing constipation and other problems and depression of the respiratory system.  They typically have very limited use in the treatment of neuropathic pain.
• Marijuana: This drug has received widespread attention in the popular press.  Its role in pain management is not clear.

Physical Interventions

• Transcutaneous electrical nerve stimulation (TENS): This treatment involves a high frequency, low intensity nerve stimulation designed to block signals from the areas of nerve damage that are triggering a pain response.
• Dorsal column stimulator: This device is another type of high frequency, low intensity nerve stimulator placed surgically in the body to block neuropathic pain.  This approach can be effective for treating a specific nerve injury.
• Intrathecal morphine: A pump is surgically planted under the skin.  A catheter runs from the pump device to the spinal canal which delivers morphine to be delivered directly in an area to block pain, avoiding the need for taking morphine by mouth.  The advantage is that the drug’s side effects can be avoided.
• Physical therapy: This treatment is especially helpful in those people who have nociceptive pain, although it can be an effective treatment for neuropathic pain as well.

Other Treatments

There are other, alternative treatments for pain that people can investigate, especially if conventional therapy has not been effective.  Biofeedback, visualization, massage therapy, and acupuncture are other methods used to help treat and manage pain.

A recent study at the University of Michigan found that a natural, painkilling chemical was produced in the brains of volunteers who believed they were receiving a pain reliever while they were given a painful injection.  This suggests that the brain and nervous system’s complex role in perception may provide the key to managing chronic pain.

There are many different strategies to address chronic pain.  Try to educate yourself about different options and find methods that work so that pain does not rule your life.

~Anthony Chiodo, M.D.

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Troy, MI – The Michigan Spinal Cord Injury Association (MSCIA) has chosen to utilize donation money from their first major event to assist a woman in Detroit, who has not been able to leave her house in over a year except by ambulance to visit her doctor.

Marie was diagnosed with Lupus over thirteen years ago, but only recently has it disabled her to the point of not being able to leave her house without assistance.  Since November 2009, the disease has paralyzed her from the waist down.  In addition to her struggles with Lupus, Marie also suffers from Neuromyelitis optica, or Devic’s disease, a central nervous system disorder involving inflammation of the eye nerves and inflammation of the spinal cord. 

Marie is a mother of seven children, five of which currently live at home with her.  She contacted Janet Prince at the Rehabilitation Institute of Michigan, who in turn reached out to the MSCIA for help.  “I would very much enjoy to be able to go out and see the world,” Marie says of her need for a ramp at her front door.  “I’ve been a caregiver for most of my life, but now I am in need of help myself.”

The MSCIA held a very successful “Rolling with Promise” informational event and dinner at The San Marino Club in Troy, on July 15, and are eager to utilize the donations collected from the event to directly benefit spinal cord injured members of the community.  “We wanted all of the donation money received to go straight back to the community, and we are truly excited to have the opportunity to make such an impact on a person’s life.  We hope that we can do a lot more of this!” says MSCIA Board Member Stacey Murphy.

The focus of the MSCIA is to enhance and empower those with spinal cord injury and disease to achieve and maintain the highest levels of independence, health and personal fulfillment. The MSCIA is the Michigan chapter of the National Spinal Cord Injury Association, or the NSCIA.  The NSCIA, founded in 1948, is the nation’s oldest and largest civilian organization dedicated to improving the quality of life for hundreds of thousands of Americans living with the results of spinal cord injury and disease and their families. Collectively, there are over 24,000 voices representing the association.

After the project was approved unanimously by the MSCIA Board Members, Disability Made Easy of Troy (a barrier-free construction company) was given the task of building the ramp.  The Michigan Regional Council of Carpenters (MRCC) donated directly to the ramp-building project to cover all extra costs.  “This ramp is an opportunity to give a piece of equipment that will keep giving back to Marie every time she uses it,” says MSCIA Board Member Kathryn Warner.  “We love that we were able to help her out in such a big way.”

Construction for the ramp begins this Monday, November 8, and the MSCIA as well as all others involved are eager to see the project completed.  “The sooner we can have the ramp built, the sooner Marie can enjoy freedom to come and go from her home as she pleases,” says MSCIA Board Member Gregory Jamian.  “We hope, with these efforts, we can make her day-to-day living just a little bit easier for her and her family.”

For more information about the MSCIA and this upcoming project, or to interview Marie or an MSCIA member, please contact Cristina Shallal at 248.288.2270, or email info@mispinalcord.org.

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Published in “Charting a New Course:
The Guide to Independent Living after Spinal Cord Injury
By The University of Michigan Model Spinal Cord Injury Care System

A medical condition known as Autonomic Dysreflexia can occur in anyone with SCI at levels T6 and above, either complete or incomplete. This medical problem can happen at any time after SCI, even several years. Autonomic dysreflexia is a reaction of the body to a stimulus below the level of injury that results in a sudden increase in blood pressure. Symptoms may include a pounding headache, flushing of the skin, or a greatly slowed heartbeat.

Autonomic dysreflexia is a serious problem that can be life threatening. Promptly recognizing the condition and getting emergency medical attention is critical. Your family, friends and any caregivers should be able to recognize autonomic dysreflexia’s symptoms.

Autonomic dysreflexia is a very rapid increase in blood pressure that results as a response to a strong stimulation (such as a full bladder, pressure sore or other condition) below a person’s level of injury. The body’s normal inhibitory responses are blocked causing constriction of the blood vessels. This causes a rapid increase in blood pressure. The body may try to compensate resulting in a decrease in the heart rate and flushing above the level of the injury.

Sometimes, autonomic dysreflexia takes place following another serious medical condition such as a burn, fracture or pressure sore, or a minor event such as a medical exam, menstrual period or, even, overly tight clothing. In any case, the person must get medical care immediately.

Note: People with SCI often have a normally low systolic blood pressure (the higher number) of about 90-110. An increase of just 20-40 may be a sign of autonomic dysreflexia!

The sudden increase in blood pressure results in many other symptoms, which may include:

• Pounding headache,
• Slow heart rate relative to the normal rate,
• Sweating and flushing above the person’s injury level,
• Pale skin,
• Nasal Congestion,
• Anxiety, or
• Heartbeat irregularity (skipping heartbeats).

Occasionally, silent autonomic dysreflexia will occur where there are no symptoms besides elevated blood pressure.

Causes of Autonomic Dysreflexia

Bladder Distension

This is the most common cause of autonomic dysreflexia in people with SCI. This can be due to a kinked or clogged indwelling catheter or a full bladder in a patient who self catheterizes or reflex voids to empty their bladder. Other problems can include bladder or kidney stones, urinary tract infections or even a medical procedure such as insertion of a catheter or an endoscope examination of the bladder. For women, pregnancy, labor or menstruation can trigger autonomic dysreflexia.

Bowel

A distended bowel or bowel impaction can also bring on autonomic dysreflexia, as can digital stimulation or a rectal examination. Conditions such as appendicitis, a ruptured bowel and abdominal infections are other risk factors.

Skin

Skin problems such as ulcers, burns, trauma, tight clothing or equipment or ingrown toenails can cause autonomic dysreflexia.

Other Systems

Undiagnosed fractures, bone overgrowth, blood clots and medical or surcgical procedures put people with SCI at a higher risk for autonomic dysreflexia.

Treatment of Autonomic Dysreflexia

A medical provider will check a person’s blood pressure if autonomic dysreflexia is suspected or symptoms are present. A non-professional can also check blood pressure and take these steps:

If blood pressure is not elevated, refer to a physician as other causes of symptoms are possible. If blood pressure is elevated and the systolic blood pressure (the top number) is 15-20 above their usual level do the following:

• Call a doctor if the person appears very ill
• Sit person upright, if possible, to encourage pooling of blood in legs
• Loosen any clothing or restrictive devices (such as belts or ties)
• Recheck blood pressure
• People who catheterize should do so at once. An overly full bladder is the most common cause of autonomic dysreflexia. Place lidocaine jelly* in the urethra and wait 2-5 minutes, if possible. Then, recheck blood pressure.
• For people who use an indwelling catheter, check the tubing for kinks or blockages. Flush the tubing gently with several tablespoons of sterile water. Then use lidocaine jelly* solution. If there is blockage, change the catheter using lidocaine jelly, if available. Let the doctor know if there is difficulty passing a catheter.
• If the cause is not identified as urinary, a bowel problem may be suspected, such as possible fecal impaction (overly full bowel).
• Check for presence of stool and gently remove if it is in the rectum. It is possible that the person’s blood pressure will increase with this stimulation.
• Contact the doctor, then place a generous amount of lidocaine jelly* in the rectum and wait 2-5 minutes, then check the blood pressure.
• If the systolic blood pressure is over 150, treatment with drugs may be required.
• If no urinary or bladder source is identified and the autonomic dysreflexia persists, consult a doctor. The person should then be stripped down and inspected for other possible causes, such as tight clothing, a pressure ulcer, local trauma or musculoskeletal or skin problems.

If autonomic dysreflexia is severe, management with prescription drugs may be necessary and your blood pressure will need to be carefully watched. If the autonomic dysreflexia is severe and resistant to treatment, you may need to be monitored. After an episode of autonomic dysreflexia, your blood pressure should be checked every 15 minutes for 2 hours. A doctor needs to document the episode of autonomic dysreflexia and its cause.

- William Scelza, M.D.

*Lidocaine jelly is both a lubricant and a mild anesthetic. If it is not available, another lubricant can be used, such as KY jelly.

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As published in “The University of Michigan Spinal Cord Injury Rehabilitation Guide for Health Professionals”
By The University of Michigan Health System

Spinal cord injury (SCI) is a relatively rare occurrence. Improved medical techniques and knowledge about the condition have resulted in better survival for those individuals with acute or chronic SCI. There are identifiable trends regarding the etiology of injuries and other injury characteristics, although statistics regarding SCI have been collected and analyzed only in the last 35 years. The vast majority of statistical data has been collected by Model SCI Systems.

Incidence and Prevalence
The statistics reported here regarding the incidence (new cases) and prevalence (existing cases) of SCI are based on data from several studies, not from the National SCI Database. In the U.S., an estimated 11,000 new spinal cord injuries occur each year, or about 40 cases for every one million in population. These numbers include people who experience a traumatic SCI, but not cases due to disease or those who die at the scene of an accident. New studies on the occurrence of SCI have not been conducted since the 1970s, so it is unknown if the incidence has changed. The number of people in the United States living with a spinal cord injury as of June 2006 is about 253,000. This prevalence estimate is between 225,000 and 296,000 individuals.

Etiology
The causes of SCI among Model System participants are dominated by motor vehicle crashes which cause nearly half of all injuries. The next most common causes, in order of occurrence are: falls, violence, diving, sports, medical/surgical complications, and others. During the 1990s, violence was an increasingly frequent contributor to SCI, peaking at 24.8% in the time period 1990-1999, and then declining 13.8% since 2000.

Diving as a cause of spinal cord injury has dramatically declined, from causing 9.5% of SCIs between 1973 and 1979 to only 3.9% between 2000 and 2003. This may be due to new safety practices (e.g., the removal of diving boards at pools and safer pool designs) as well as public education.

Demographic Trends
Based on information provided by Model SCI Systems to the National SCI Database, the average age of injury is now 33.0 years. Most people who acquire an SCI are younger adults, with those 16-30 years of age accounting for the greatest percentage of people with a new SCI. The age of onset has been increasing, in part due to an aging U.S. population. Another factor is that people over the age of 60 are experiencing an increased rate of SCI: 10.9% of injuries were in this age group since the year 2000, compared with 4.7% in 1980. A disproportionate number of those injured are male; the ratio of males to females in 4:1.

The percentage of people with SCI representing minority groups have risen. For injuries that occurred in the years 1973-1976, 76.9% were white, 14.1% African American, 6% Hispanic, and 3% from other groups. Since 2000, the percentages have shifted to 67.5% white, 19% African American, 10.4% Hispanic, and 3.1% other. The reasons for these shifts in race-linked rates are not clear. Such changes could be due to Model SCI System data collection and referral patterns, actual differences in race-specific incidence rates, or shifts in overall U.S. demographics.

Neurological Level and Extent of Lesion
People with tetraplegia have sustained an injury to the cervical segments of the spinal cord while those with paraplegia have sustained damage to the thoracic, lumbar and sacral regions of the spinal cord. Injuries are also classified by extent of lesion: complete or incomplete. Complete SCI is defined as an injury with no sensation or motor strength below the level of injury. With incomplete SCI there continues to be some sensation or motor strength below the level of injury. When discharged from acute rehabilitation, about 34.3% of SCI patients have a diagnosis of incomplete tetraplegia, 25.1% have complete paraplegia, 22.1% have complete tetraplegia, and 17.5% have incomplete paraplegia.

Occupational Status
More than half (63%) of people with SCI are employed when admitted to a Model System at the time of injury. Ten years after their injury, more people with paraplegia are employed versus those with tetraplegia (31.7% versus 26.4%). Employment is complicated by many factors, including loss of medical insurance and other benefits, discrimination against people with disabilities, inaccessible workplaces, secondary health conditions, and personal issues.

Life Expectancy
In years past, the leading cause of death for people with an SCI was renal failure. Respiratory infections and infections related to the skin also contributed to mortality. The development of antibiotics, modern materials such as plastic and latex, and better procedures for dealing with the everyday issues of living with SCI have resulted in much lower rates of death and complications. Since 1973, the most frequent causes of death related to SCI are pneumonia, pulmonary embolism, and septicemia. Pulmonary complications are more common in individuals with cervical injuries, particularly those on a ventilator. If those with higher lesions are excluded, cardiovascular disease is the most common cause of death for people with SCI. Life expectancy has significantly improved so that the life-span estimates for people with paraplegia approach U.S. population norms.

Most of the above information is from the National Spinal Cord Injury Association website, located at www.spinalcord.uab.edu. Further information concerning these topics can also be found in special issues of the journal Archives of Physical Medicine and Rehabilitation published in November 1999 and November 204.

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