Q: What factors need to be considered with an acute spinal cord injury (SCI)?

A: For acute spinal cord trauma, stabilization is the first priority. After an injury, according to Jack de la Torre MD PhD, there are biochemical, metabolic and physiological issues that arise such as reduced blood flow to the spinal column, the formation of free radicals, sodium channel activation, inflammation and energy substrate depletion.

To address these issues de la Torre suggests the use of fructose 1,6-diphosphate combined with dimethyl sulfoxide (DMSO) as when combined, the two stabilize the SCI and provide a high-energy substrate to the damaged tissue. Dr. de la Torre is a professor of neurosurgery and physiology at the University of New Mexico Medical School in Albuquerque who has been one of the main advocates for the use of DMSO, a controversial drug that has many healing properties.

Anders Holtz with the Department of Neurosurgery, University Hospital in Uppsala, Sweden emphasizes the need to consider secondary injuries that can result from surgery. He believes that the aim of surgery is to minimize neurological deterioration, stabilize and align the spinal cord, reduce pain and prevent secondary complications.

Immediately after a trauma to the spine, Holtz stresses the importance of monitoring the respiration system in order to time drug treatment so that the chosen medication is given at the most optimal time. In addition to the respiratory system playing an important role in medication administration, it also accounts for a high percentage of illnesses in SCI patients.

According to the Journal of Neuroscience Nursing in an article by Kathleen T. Lucke, “lung diseases and breathing complications cause significant illness in patients following spinal cord injuries. The mortality rate from pulmonary complications, such as pneumonia, lung collapse, respiratory failure, and infections, can be 40-80% in the first year after injury.”

As you can see, there are a variety of important factors that need to be addressed and closely monitored immediately and soon after a SCI. Awareness of the areas of special concern will help you to better understand what your doctor is focused on and why - not to mention that this knowledge will help you to determine if your doctor is competently approaching the treatment of the injury.

The majority of people who sustain SCIs will not have the medical knowledge to determine the best course of treatment, but even some awareness of the problems that can arise can add to you overall security that you are getting the best treatment available.

For further reading:
Essentials of Physical Medicine and Rehabilitation, Review and Self-assessment, Julie K. Silver & Walter R. Frontera, pp. 346, 2003. Price £28.99. ISBN: 1-56053-563-6. Hanley & Belfus, Philadelphia

Pulmonary management following acute SCI. (spinal cord injury) Journal of Neuroscience Nursing; Apr 1, 1998; Lucke, Kathleen T.

Many find themselves caught up in a Monday afternoon daydream where they get to wake late and spend their afternoons with nothing better to do than watch their favorite TV program…and then the phone rings or the boss looks their way and they snap back into the reality of work.

What if this wasn’t your daydream? What if you were stuck at home, not because of some windfall of luck, but because employer after employer refused to hire you? For many disabled people, this is an all-too-real scenario.

The Americans with Disabilities Act (ADA) of 1990 found that society has had a tendency to isolate and discriminate against those with disabilities by refusing them work, housing, education, health care and other vital services. Add to this physical barriers such as inaccessible workstations and unmodified entryways and the need for the ADA becomes apparent.

To prevent these discriminatory acts from continuing to happen, the ADA has set up certain provisions that protect qualified people against discrimination related to hiring, job advancement, discharge, compensation, training and other such employment rights and opportunities. This includes providing “reasonable” (meaning that the size of the company and its financial resources are taken into consideration) modifications to the workplace such as ramps, workstations and the location of necessary work tools.

Companies who fail to meet the ADA standards can be required to pay a fine, go to court or both. This process begins with a person who has experienced discrimination filing a claim to any United States Equal Employment Opportunity Commission (EEOC) office within 180 days of the incident. If a reasonable settlement isn’t reached, then it is possible to file a lawsuit with the Federal court after receiving a “right-to-sue” letter from the EEOC.

While the ADA enforcement has helped to prevent and curtail workplace discrimination, there are still countless cases of disabled persons being turned down for work who believe it is due to their particular disability.

If you or anyone you know has questions regarding their own situation, here are some good resources:

EEOC field office locater: (800) 669-4000 (voice) & (800) 800-3302 (TTY)

ADA Accessibility Guidlines

This week’s technology report is on wheelchair seating products. For those who spend large periods of time in a wheelchair, finding the right seating enhancements that provide both comfort and support is of high importance.

There are a wide selection of seat cushions that take into account everything from moisture resistance to pressure relief. Some products include materials that are lightweight and contoured to fit your body, while others emphasize your degree of activity and how likely your lifestyle is to cause skin breakdown.

Other options to look for are whether or not the manufacturer provides a solid cushion such as those made with gels or foam or a liquid one that prevents bottoming out - a situation that can lead to skin sores. Most companies will take into account your size and shape, fitting you with the best seat for your situation.

Backrests are another important item to consider when shopping for optimal comfort and health. There are an assortment of wheelchair backs that are suited to a variety of lifestyles. For the active person, there are specifications such as flexible positioning systems, removable hardware and lightweight structure. For those with a more sedentary or indoor lifestyle, you can find backs that will align your posture, provide maximal support and easy release.

Backs come in as many different materials as seats do and can be found in either hard shelled form or with an upholstered structure. Some are created for a greater weight bearing ability and others specifically for those who want to travel quick and light.

Consider what sort of life you lead and under what conditions before buying a wheelchair and seating products. These run in a wide price range and it will pay off later to research first!

While we don’t endorse any specific manufacturer, Sunrise Medical may be a good place to start looking as they have over 30 years of experience providing assistive products to those with disabilities.

Rich Newsome with the Newsome Law Firm, along with Tom Harmon, Pete Newsome and Clancey Bounds will be participating in the Nov. 2nd 2008 Florida Ironman on behalf of the Christopher and Dana Reeve Foundation as “Team Reeve Ironman.” Team Reeve Ironman is raising money for the Reeve Foundation.

The Florida Ironman race will take place in Panama City, Fla. and is one of only seven official Ironman races held annually in the United States. Ironman Florida is also a qualifying event for the Ironman world championship in Kona, Hawaii. The Florida Ironman race includes a 2.4 mile swim, 110 mile bike race and a 26 mile run.

The athletes who are part of Team Reeve Florida hope to raise not just money, but also awareness about the Reeve Foundation and the vital work they are doing for the SCI community. The Reeve Foundation is focused on finding a cure for paralysis as well as giving spinal cord injury (SCI) survivors much needed direct aid.

Please help support this worthy cause.

For more information on how to support the Team Reeve Ironman, please visit their Web page.

This week’s resource is the Assistive Technology Industry Association’s (ATIA) list of upcoming events that focus on new developments and accessibility in the area of assistive technology.

Some of the upcoming events include the ATIA 2009 Orlando celebration that will showcase new and innovative technology for both adults and children, the ATIA Leadership Forum on Accessibility that is designed to “help large corporations, government agencies and educational institutions derive business value through accessibility,” and the ATIA 2009 Chicago technology celebration.

ATIA has been focused for the past ten years on providing education and a forum for communication between those with disabilities, who work with the disabled and who provide assistive technology. They are a non-profit membership organization of manufacturers of assistive devices and services.

If you are interested in any of these or future events, please visit their Website here.

Last Friday night Houston Texas receiver Harry Williams sustained a spinal cord injury (SCI) during a game against the Dallas Cowboys leaving him temporarily paralyzed. Monday he underwent surgery to fuse two vertebrae in his spinal column, a procedure that will hopefully allow him to lead a normal life, but won’t put him back in the game.

Williams was only 26, an age that would have given him years more on the field had this accident not happened. An estimated 14 percent of SCIs are a direct result of a sports related injury. Considering that there is about ten thousand new SCIs a year, this is a fairly significant number.

Last year Kevin Everett with the Buffalo Bills football team was paralyzed during a game. He has since recovered his ability to move his arms and legs, but he will never play football again. His recovery from paralysis, along with Williams’, is a rare occurrence as most who experience paralysis stay paralyzed.

There are 31 pairs of nerves that spread out from the spinal cord into the arms, chest, legs and abdomen. The nerves that are in charge of upper body movement are in the upper portion of the spine, while the ones that control the legs are in the lower area. Not only are these nerves responsible for limb movement, they also control basic functions such as breathing and heart beat.

The National Center for Catastrophic Sport Injury Research has reported that in 2006 there were 16 indirect deaths and only one fatality in football, and the death was caused by a SCI. In 2007 there were eight cervical cord injuries with incomplete recoveries. Six of these were at the high school level. The majority of the SCIs occurred in games with only two happening during practice.

Considering that in 2007 there were 1,800,000 football players, these statistics aren’t painting too bleak of a picture. While each injury or fatality is a reason for concern, innovative safety gear has greatly decreased the chance of experiencing an unrecoverable injury. We have neurosurgeons such as Richard C. Schneider to thank for the decrease in permanent spine and head injuries. He helped to develop the football helmets our players currently use which have directly influenced this decrease as documented in the National Football Head and Neck Injury Register.

As researchers come up with better and more intuitive protective gear, we will continue to see these traumatic injuries decrease. In the meantime, those who have had their lives irrevocably changed from a brain or spinal cord injury deserve our continued support.

We are always looking for new developments that can lead to spinal cord injury (SCI) recovery and press releases like this one are a great incentive to keep looking.

The PLoS Medicine site reports that researchers studying spinal cord injuries in mice found that chondroitin sulfate proteoglycan (CSPG) is needed for the repair of the neurons that will facilitate the regaining of movement, but after time, it actually hinders a full nervous system recovery. In studies on mice, the researchers allowed CSPG to act uninhibited for two days after the injury before interfering and by doing this, created a promising response in the animals.

Heavily secreted after an injury, CSPG helps to form glial scars after a SCI. These scars protect the damaged areas, but they also release chemicals that work to prevent further regeneration in the nervous system. Because of its link to preventing axonal development, researchers were focused on eliminating CSPG from the injured area.

This compounded data suggests that eliminating CSPG may not be the best answer, and scientists are opting instead to control it. CSPG has a place in the healing process as it regulates the local immune response which is vital for proper healing.

So far studies only extend to animals, not humans, but there are similar enough correlations between spinal cord repair processes that it’s believed this research can soon be applied to human subjects.

To read the original release, please click here.

Have you felt like you or someone else you know with a disability has been the victim of a hate crime? We will admit that this isn’t a subject that we knew much about before coming across a BBC article discussing the issue.

“Last year, Christine Lakinski - a woman in her 50s with learning and physical disabilities - had collapsed in the street near her home in Harlepool when she was set upon by a neighbour. She was covered in shaving foam, urinated upon and filmed on a mobile phone as she lay dying.”

This horrendous account started us thinking about the issue - if there is actually an issue with disabled hate crimes.

According to the same BBC article, there have been multiple deaths where the assailed was either physically or mentally disabled, or a combination of the two. The question asked seems to be - where does the title “hate crime” come into play?

If you are picking on someone who is different from you, is it a matter of “hate” or is it just a form of bullying? When someone is either physically or mentally hurt from the actions of another, does it matter what the label is? According to the law, there is a significant difference.

The Federal Bureau of Investigation defines a hate crime as “a traditional offense like murder, arson, or vandalism with an added element of bias. For the purposes of collecting statistics, Congress has defined a hate crime as a “criminal offense against a person or property motivated in whole or in part by an offender’s bias against a race, religion, disability, ethnic origin or sexual orientation.” Hate itself is not a crime—and the FBI is mindful of protecting freedom of speech and other civil liberties.”

Interestingly enough, “federal statutes prevent the FBI from investigating crimes of bias motivated solely by … disability” as this is primarily the domain of the local law enforcement. Because hate crimes are often a blurry area, they tend to get prosecuted as arson, murder or intimidation. For disability specifically, the majority of crimes usually fall under Title 42 - Criminal Interference with Right to Fair Housing. This statute focuses on preventing intimidation, interference or injury in regards to a person’s housing rights.

This makes sense when you consider the amount of disabled people who are unable to care for themselves physically and are dependent on either paid or non-paid companions to assert their rights. But what about those who are harassed outside of a housing situation?

The Criminal Justice Act of 2003 labels a hate crime as an “offense motived by hatred or prejudice towards a person because of their actual or perceived disability. It is also a criminal offense in which immediately before, after or during the offense the perpetrator demonstrates hostility towards a person because of their actual or perceived disability.”

So what does all this mean? People with a disability are protected from hate crimes or anything that can be construed as a hate crime by our legal system. The difficulty is not just in the justice system’s definition, but in what the person who encountered the situation considers the harassment, intimidation or abuse to be.

In our research we found multiple accounts of those who both supported the idea of a disabled hate crime and those who thought it was too strong or too general of a term. Where this becomes important is when the definition is imperative to categorizing acts against the disabled as hate crimes in order to better protect them from abuse.

In the UK, surveyors found that the 68 recorded cases of disability hate crimes prosecuted between April and September 2007 fell far short of the number those surveyed had directly experienced. When it’s a matter of protecting and denouncing this sort of crime, it becomes vitally important to have them not only clearly defined, but to have a precedent to follow that will help prevent future occurrences.

Call it “harassment” or call it a hate crime; any degree of abuse towards a disabled person should be confronted immediately for what it is. And hopefully, with a greater awareness of this issue, more people will be willing to protect those who are physically or mentally unable to protect themselves.

Remember that feeling of invincibility that you had as a teenager? For most of us, that feeling is almost unrecognizable now that life has caught up with us and we are aware of just how delicate life can be.

Dr. Najma Ahmed, the assistant director of trauma at St. Michael’s Hospital in Toronto, Canada, says that this feeling of invincibility is preventable. “Teenage drivers have the highest rate of injury and death from motor vehicle crashes of any demographic group in Canada,” says the Canadian Press, and most of these teens are oblivious to their danger.

Dr. Ahmed says “It’s my job, our job to save them.” With a new program at St. Michael’s, she is hoping to do just that. A study of 260 adolescents found that when teens met with their peers who had sustained paralysis or another such life altering injury, they were most likely to alter their attitude and behavior in regards to taking the risk of damage or death seriously.

Dr. Ahmed is promoting the ThinkFirst Injury Prevention Strategy for Youth (TIPSY) at St. Michael’s, a program that takes teens to see first hand what can happen to them. Some of the situations included visiting young victims of accidents in the ICU unit, a situation that worked to bring the intended point home.

Researchers are hoping that programs such as this will spread as parents begin to realize the importance of prevention. Traumatic brain injuries (TBI) or spinal cord injuries (SCI) are just some of the life changing results of a teen driving too fast and losing control of their car.

With early education, such as is given through TIPSY, the researchers at St. Michael’s hope to greatly minimize these traumatic situations as more youth leave behind the idea that “it can’t happen to me”.

Q: What are the most common results of a spinal cord injury?

A: Depending on the particular injury sustained, there are a wide variety of primary and secondary complications that can result from a spinal cord injury.

Damage to the nerve fibers that carry motor signals to the brain through severing or compression can lead to muscle paralysis and loss of sensations such as those experienced through touch or pressure. Other potential effects are loss of bladder control, muscle contractions, decreased breathing capacity, exaggerated reflexes, over or under sensitivity to temperature changes, lasting pain, impaired sexual functioning and issues with bowel control.

Some of the most common secondary effects are increased blood pressure, sweating, pressure sores and an increased susceptibility to respiratory ailments.

Typically any of these functions that are lost will be regained within six months, if they are to return at all. After that point your chances of recuperation decreases greatly. This is why it is so important to make sure you receive proper care immediately after sustaining a spinal cord injury.