Improving core strength is a big focus in treating spinal cord injuries, as it contributes to the regaining of many functions. In his second progress interview, Ryan Straschnitzki, who received epidural stimulation treatment for spinal cord injury, covers the benefits he has seen to his core, as well as other insights. With Hanna Charles, Director of Patient Representatives, he covers a number of topics, including the workings of the stimulator and how to qualify for the treatment.
Hello again everyone, this is Hanna from Verita Neuro, here for our next weekly update. Congratulations on your first steps Ryan, how does it feel?
Yes, exactly. We have lots of questions!
The first one asks what is your injury, was it complete or incomplete, and what ASIA scoring was it? How was it initially compared to now?
Ok, so another question - How are the gains so far? How long did the improvements take to appear?
What is required for the maintenance of the device, for example if something goes wrong or the battery needs charging? Is there somewhere local that can support this?
Yes, exactly. It's wirelessly charged. Usually, the battery life is estimated at nine years. This is quite some time and honestly, the patient who has worked the longest with us so far, it's been a little less than five years so we’ve never had a case where we need to replace the device. This is a Medtronic device, they’re one of the biggest companies manufacturing medical devices in the world. They are originally from the USA but they have offices and technical support teams in almost every country. When it comes to device mapping and fine-tuning, this is something we have to do here in Thailand, because it requires a specific skill set that our therapists have. It's still a treatment that is not widely available, so for any remapping or adjustment, we recommend patients to come back to us.
So the remote you're using, how do you use it? Do you use it to activate the movement?
If you were to name the areas that the treatment improved in your day-to-day life the most, what would it be?
So we have another question asking if you have any nerve pain or spasticity since you’ve received the epidural stimulation?
Yes, initially the spasticity can increase slightly. This is because the stimulation creates more activity in the spine. Long term we see that the stimulator can reduce the spasticity quite significantly in some patients.
How did you qualify - what reports were needed?
I can elaborate on this - the process is not complicated. We treat patients with different injury levels, starting with C-level injuries where we can also work on upper body functions. We can place two stimulators or one, for the upper body or the lower body, so any injuries usually from C4 to T10/T11 could qualify for epidural stimulation. The most important thing is to review the MRI images. We need the original images, to take a look at the injury and assess the chances. A small part of the spinal cord has to be connected, just to allow brain signals to be delivered to the electrode and the stimulator. But we do treat both complete and incomplete injuries - even if someone is diagnosed with a complete injury, there’s still a chance that there are connected fibers. We can evaluate each case and we do it free of cost, so whoever's interested in this can reach out and send us their MRI images to review.
So another question, when will the mapping be available in Canada?
I think we talked about this last week. I think Canada is or was a little behind in this sort of area and I think it'll take a while for them to actually get things going the way they have it set up here. The good thing is that there are already some physiotherapy centers that know how to work with epidural stimulation patients. They don’t do mapping, but they do know how to do physio exercises with the epidural stimulator. I’m attending Synaptic rehab. They provide resources to healthcare professionals and work hand in hand with individuals who have had Epidural Stimulation surgery.
Yes! Also, we work very closely with our patients after they return home. We prepare a treatment plan with videos of how to perform certain exercises, along with the training plan. It shows what to do each day, how many times per week, how many hours and how many repetitions for each exercise. We try to support the physiotherapy centers to work with our patients and we are in touch for at least one year so we're always available.