Dominique
- Spinal Cord Injury (SCI),
- C6, C7, Incomplete
Stem Cells, Epidural Stimulation
- Name:Dominique
- Age at Time of Treatment:55+
- Sex:Female
- Nationality:Belgian
- Treatment Location:Thailand
- Diagnosis on Admission:Spinal Cord Injury (SCI)
- Injury Level:C6, C7, Incomplete
- Time Since Injury:1 - 2 years
- ASIA Before Treatment:C
- ASIA After Treatment:C
- Treatment Received:Stem Cells, Epidural Stimulation
- Date of Admission:23/10/2024
- Date of Discharge:26/11/2024
Patient Overview
Patient Condition on Admission
Dominique is currently missing her fine motor skills in her hands and fingers, and she also suffers from paralysis, which prevents her from moving her legs. As a result, she is not able to stand of walk and is wheelchair bound. She also suffers from autonomic postural hypotension and neurogenic bowel and bladder dysfunction. Dominique had daily physiotherapy and ergotherapy sessions lasting around 3 hours per day. She is also on a regimen of medications.
Treatment Received
Dominique proceeded with the implantation of the Epidural Stimulator at the lumbar spinal cord. Following the operation, there was an observation period of 2 days before she started the rehabilitation and device mappings where we were able to see strong muscle contraction. As part of the regenerative medicine treatment, she received Amniotic Fluid Stem Cells in the form of 1 intravenous and 2 lumbar puncture injections, totaling 100 million stem cells.
| Treatment received | Implantation site | Number of devices | Duration of stay |
|---|---|---|---|
| Epidural Stimulation | Lumbar spinal cord | 1 | 35 days |
Stem Cells Treatment Summary
| Stem cells treatment | Number of stem cells | Deliver method |
|---|---|---|
| Amniotic Fluid Stem Cells (AFSCs) | 30 million cells | Intravenous injection (IV injection) |
| Amniotic Fluid Stem Cells (AFSCs) | 35 million cells | Lumbar puncture injection (LP injection) |
| Amniotic Fluid Stem Cells (AFSCs) | 35 million cells | Lumbar puncture injection (LP injection) |
| Total number of stem cells | 100 million cells |
Device Mapping and Therapy
| Post-surgical care | Total sessions | Sessions per week | Time (Hr.) per session |
|---|---|---|---|
| Mapping | 90 | 20 | 1 |
| Physical therapy | 24 | 5 | 1 |
| Total sessions of rehabilitation | 114 |
Muscle Power Improvement Post-Surgery
Lower Body
| Muscle improvement | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Hip flexors | 2 | 4 |
| Hip extensors | 2 | 4 |
| Hip abductors | 2 | 3 |
| Hip adductors | 2 | 3 |
| Knee extensors | 2 | 3 |
| Knee flexors | 2 | 3 |
| Ankle dorsiflexors | 1 | 3 |
| Ankle plantarflexors | 2 | 3 |
| Long toe extensors | 2 | 2 |
Muscle power improvement was assessed according to the Manual Muscle Testing (MMT) protocol on the patient’s discharge date, with the stimulator on. 0 indicates total paralysis, 1 indicates visible contraction, 2 indicates active movement, full range of motion (ROM) with gravity eliminated, 3 indicates active movement, full ROM against gravity, 4 indicates active movement, full ROM against gravity and moderate resistance in a muscle-specific position, and 5 (normal) indicates active movement, full ROM against gravity, and moderate resistance in a muscle-specific position expected from an unimpaired person.
Functional Improvement Post-Surgery
Motor Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Standing with support | Unable | Able (with 30% body weight) |
| Stepping with support (for more than 10 meters) | Able (with robotic gait) | Able (with Lite Gait) |
| Standing balance | Not tested | Not tested |
| Sitting balance | Good | No change |
| Motor coordination (while stepping) | Independent (with moderate assistance) | Independent (with minimal assistance) |
| Sit to stand (in a walker) | Unable | No change |
| Ability to transfer | Unable | Maximum assistance |
| Ability to use abdominal muscles during bowel program | Able (contract abdominal muscle) | Able (better abdominal muscle contraction) |
| Stamina & Fatigue | Easily tired | Better endurance |
| Spasticity | Minimal | Minimal (less than before ES surgery) |
Sensory Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Neuropathic pain | Absent | No change |
| Temperature sensations | Normal | Normal |
| Proprioception | Normal | Normal |
| Bladder sensation | Absent | No change |
| Bowel sensation | Impaired | No change |
Autonomic Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Sweating ability | Absent | No change |
| Temperature regulation | Abnormal (always cold) | Normal |
| Blood pressure regulation | Abnormal (easily cold) | Normal |
Motor Funtions
89%
Sensory Funtions
0%
Autonomic Function
100%
Overall
71%
Improvements are monitored in 18 targeted areas: 9 Motor areas, 5 Sensory areas and 3 autonomic areas. However, the number of targeted areas may vary depending on patient’s condition prior to admission. If patient
does not experience symptoms in certain Motor/Sensory functions, or is not impaired in a specific targeted area prior to surgery, it is excluded from the report (Not Applicable). If there is progress in any given area — either mild, moderate, or significant — it is measured and reported as positive. No improvement, the existence of pain or spasms, or an inability to perform a measured function is reported as negative.
*According to the Functional Balance Grades, ‘Absent’ indicates that the patient is unable to perform a particular activity or function. ‘Poor’ indicates that the patient requires support and moderate to maximal assistance for a particular activity or function. ‘Fair’ indicates that the patient is able to perform a particular activity or function with minimal assistance. ‘Good’ indicates that the patient is able to perform a particular activity or function and can accept moderate challenge. ‘Normal’ indicates that the patient can perform a particular activity or function without any support.
Results Intrepretation
Motor Function
With further mapping, Daemen continued to improve to an extend where she regained the ability to stand, lock both knees and able to walk in a walker. Her balance, coordination, and control over the movements improved significantly.
Sensory Function
In terms of sensory functions, there were improved sensations in her lower limbs. Since Damen already had certain level of sensory function in her lower limbs, the recovery in sensory function was not as visible as in her muscle functions.
Autonomic Function
After the treatment she could stand for a whole 1 hour without having any issues.
Sitting
Her sitting balance improved significantly after the treatment. During the mapping process, she received mapping specifically targeting her abdominal and paraspinal muscles. Her static, as well as dynamic sitting balance improved.
Standing
Due to improved trunk control, Daemen’s standing balance also improved. She would hold herself much better when walking or standing.
Case Summary
Dominique sustained a traumatic spinal cord injury after a fall in 2023 resulting in complete loss of muscle function in her lower limbs. She received conventional physical therapy and occupational therapy and managed to improve her upper body functions, however her lower limb functions remained a major concern.
She received the Epidural spinal cord stimulation surgery for her lower limb functions and stem cell treatment. After the surgery for ES implantation, she had a normal recovery from the surgery and 2 days later she started mapping. During the mapping process, her muscle functions started to return which continued to improve gradually over the whole course of her stay. During the 2nd week, she also received stem cell treatment where she received 1 intravenous and 2 lumbar puncture injection of stem cells. All treatments went well without complications.
At the end of the treatment, Dominique showed remarkable recovery in her motor functions, the best among all the affected areas. As soon as the stimulator was turned on, there was an immediate muscle contraction. She also reported significant improvements in her sitting and standing balance and her autonomic functions. She regained the ability to stand, lock both knees and ultimately walk with support. Also, before the treatment, she suffered from postural hypotension where her blood pressure would drop just a few minutes into standing which significantly limited her ability to perform any meaningful level of body weight training. But, after receiving the treatment, she was able to stand for a whole 1 hour. This improved her ability to focus on her recovery in other areas without worrying about suffering from low blood pressure anymore.