In the words of Dr Rodrigo Vilches, Joao from Brazil is one of our ‘star patients’! He has a T9 level spinal cord injury and came for epidural stimulation treatment and had his epidural stimulator placed in 2021. He came back in 2022 for remapping, more stem cell injection and physical therapy. Towards the end of his follow-up treatment, he took part in a Question and Answers webinar with two of our Mexico based doctors, Dr. Rodrigo Vilches and Dr. Paulina Marin.
Please can you introduce yourself Joao
I am 24 years old. In 2018, I fell 10 meters and broke the T9 vertebra in my spine. It was a very ugly injury and doctors told me the first time I talked to them that I would never walk again because my spinal cord is completely injured. Before this, I was always an independent person who loved sports, so in the beginning it was really hard to accept this challenge and deal with it, but with time it gets better.
And how was your condition before you came to us initially?
As I told you guys, I had a complete injury so I couldn't move anything below my chest. I always did therapy but I needed braces to stand up. I didn't have any voluntary muscle contractions. Since the epidural stimulation, I have voluntary contractions and I can walk. I'm starting to walk and stand by myself, so I would say I jumped from a complete injury to an incomplete injury.
After your initial 35 days with us last year, what could you do?
So I really saw gains right after the surgery. We started mapping in the hospital after surgery, and I was able to move my legs and have more trunk control. The first idea was to get strength in the muscles, so this last year, I've been working on my quads and my glutes, so I will be able to stand for a long time and walk without the help of someone.
Did you have any complications or anything after the surgery?
The only thing that changed a little bit was my spasms but I would say that it's a good thing because it meant that I could stand up without any programming because of the spasms and my legs got really strong. So I think it's normal for the spasms to be stronger.
When you went home you continued with your physiotherapy - did you continue to improve with that?
Yeah! I would say that physiotherapy, it's essential, because the more you use the stimulator, the more connections you make and your body gets used to it. It always improves and I can see that the restimulation adapts to the body and to the stimulus you send so it's important to use it constantly.
We're very glad to have you here again - how has it been this time?
It's been two weeks and I'm very happy to be here. My goal is to walk with a walker alone, so we’ve focused on that. Mostly my programs are for getting stronger muscles and walking independently but I have a great mapping program for bicycles that I'm really happy with. My legs have improved a lot because I didn't have any contraction in my muscles and they were really loose. Now we can see the muscles are tight and I got a lot of vascularity too. So I think that's really good. I'm improving every day here and I think this time next year will be so important - I will be starting to walk by myself with a walker. The stem cells were really good. It didn't hurt and today is a day off, just to recover. I really liked the routine here and the team is perfect, they’re great.
Can you stand up by yourself? And you talked about walking with a walker?
With the epidural stimulation, I'm able to stand by myself. I have been making some progress on walking with a walker. Before, I needed a lot of help from the physiotherapists to lock my knees so I could kick. Now, I'm already locking my knees by myself and I'm starting to have more kicks, or hip flexions.
Excellent! Can you tell me about the bladder and bowel control after this treatment?
Sure. So, I’ve got, I would say, a strong bladder. First time I came here, I had a program for peeing, but I didn't get well adapted to it so we are not using it as much. But I know a lot of people who use it. My bladder is much better since the last time.
Can you tell us a little bit about sensitivity? Has it improved?
Yeah! I got some sensitivity a few centimeters below my injury and one of the biggest things was that I started feeling some numb feeling in my hips and I started feeling vibrations. So let's say that it's going down this way! But the improvements are lower than the motor functions. I do think stem cells are important for the long term. You're stimulating your spinal cord, you gain new neural paths, and you can restore the spinal cord. So I think it's a really good combo.
Do you feel that the surgery and coming to the treatment was a good decision?
For sure. Like I said, I had a complete injury but now I feel like I don't have a complete injury. The remapping is always an opportunity to get better and get new programs. So I strongly recommend that everybody that has the opportunity, should do the surgery.
We just opened this new facility in Mexico - you're in the gym there now. So what do you think about the new facility?
It's really nice! Now, everything is in the same place, so that's best for training and for resting. Everything is adapted so I’m here by myself and I can do everything alone without help. The routine it's hard because you have a lot of physiotherapy but it pays off.
How long did it take from the first time you got out of the clinic to the remapping and why did you do it?
It took one year. I had a lot of physiotherapy and I was getting better each time. But after 1 year, I felt that the programs had changed a little bit. I already had the strength necessary to do all the programs I wanted. So it depends a lot on your goals and how much you do physical therapy when you get home after your initial treatment.
I think it's also really important for you to remember what Joao said - he worked a lot and did a lot of physical therapy. It is not magic. You need to do the treatment and after that continue working on the programs.
I think it's also really important for you to remember what Joao said - he worked a lot and did a lot of physical therapy. It is not magic. You need to do the treatment and after that continue working on the programs.
Here's another question Joao, were you able to regain your sexual function?
I didn't lose my sexual functions, but it got much better after the stimulation - my sensitivity too.
And what about neuropathic pain?
I didn't have much neuropathic pain, but because the sensitivity increased further down my body, now I can feel more of my back. So I feel a bit of pain where my injury is that I didn’t before. But I would say that's a good thing because the sensitivity is moving down my body. I know that the first ever use for epidural stimulation was in neuropathic pain treatment, so it is useful for that.
How often do you do physical therapy at home?
When I go home I'm going to practice and do a lot of physiotherapy. My goal this year is to stand up at every possible chance I get, and start walking with the walker by myself. So I'm gonna go back home, and jump right into the rehab. I do therapy three times a week in a clinic. I also do more at home - things I can do by myself. But I go to the clinic three times a week, because it's long, it's almost three hours, so I need time to recover too.
It is important to say that Joao is in really good shape and that helps a lot. I think you are doing some sports, is that right?
Yeah! I am more focused at the gym right now than on sports, and I will say it's really important for resistance, especially for standing in the beginning, you use a lot of your arms and shoulders. If you can come here trained, your physiotherapy will be better, you will have a better experience.
The above is not a verbatim transcript of Joao’s’ interview and the exact wording and order of words have been edited to be read more easily. You can watch the full interview on our YouTube Channel.
