Dr Koske Can Now Write, Comb His Hair And Push Himself In The Wheel Chair After Neuro-rehabilitation

After a successful stem cell treatment, which was performed on April 5, 2022, it was time for the doctors in India to embark on Dr Koske’s neuro-rehabilitation to help him achieve independence.

What is neuro-rehabilitation?

Neuro-rehabilitation comes from two words: Neuro, meaning nerves and rehabilitation, meaning a process of making it better or improving the function. It is the process of improving nerve and mobility function in a patient who has suffered injury involving the spine.

It is a complex medical process that is geared towards recovery from a nervous system injury. It includes different methods such as physiotherapy, occupational therapy, hyperbaric oxygen, nutritional assessment and supplementation, speech therapy, swallowing therapy among other therapies. It involves tailor-made rehabilitation techniques for individual patients. It is an ongoing process that is done after stem cell therapy. The rule of 6 states that the neuro rehabilitation process should be done 6 hours a day, 6 days a week for at least 6 months after stem cell treatment.

Dr Koske has completed his first phase of inpatient hospital treatment after his stem cell treatment and was discharged on April 16, 2022 after a two-week stay. He now moves to the second phase of treatment as an outpatient, which is neuro-rehabilitation. To enable him start on this new phase, Dr Koske was moved to an apartment near the hospital with wheel chair amenities for ease of logistics since he has to commute to the hospital on a daily basis. He will be assisted by Lydia, his nurse who has been faithfully tending to him. 

The two weeks of treatment during his stay in hospital have enabled him to start doing a few things on his own like move himself around with the wheel chair. This is a giant step towards making him more independent, which is the aim of the treatment.

Celebrating small milestones

As the days progress, Dr Koske is happy with the progress of his treatment. His days are spent between the hospital and the apartment where he takes time to relax and reflect on his progress. The process is not for the faint-hearted but Dr Koske is determined to keep going. The therapists begin on the process of re-training him how to work again by training him to stand again without their support. Such baby steps are important as his spinal injury treatment continues.

Each new day comes with re-learning a new skill. He undergoes physiotherapy session with his therapists for walking retraining. With time he gains some degree of trunk control, which is necessary for getting to this step. This helps establish connection between the  muscles of the trunk, the spinal cord, and the brain. These muscles have not been used since October 2020 when he suffered the spinal injury. As a result, they had become very weak with zero strength (muscle power). 

With this training (neuro-rehabilitation), the muscles slowly regain their strength as they, together with the spinal cord and the brain are fired up to work in tandem again. 

The stem cell treatment was the initial step in helping re-establish this connection (muscle, spinal cord and brain).

Re-acquiring old skills

On 22 April 2022, during an occupational therapy session, Dr. Koske wrote for the very first time since the spinal injury that he suffered in October 2020. The injury left him with inability to use his hands for fine movements such as writing. He also had no ability to perform simple tasks such as brushing his teeth or holding objects as he lost his grip.

As Dr Koske’s rehabilitation journey continues a step at a time, he is able to stand at what is called, ‘the parallel bars’ without his therapist’s support. Getting to this level of neuro-rehabilitation means that the trunk support and control has continued to improve. This is the earliest preparation for re-training him how to walk again.

Over the last few days, Dr. Koske has achieved significant trunk support and his therapist has now introduced shifting skills, which continue to improve the trunk support. Establishing proper trunk support is a very key component geared towards re-training him how to stand and walk again.

Dr Koske continues to achieve little milestones on his road to recovery and as the occupational therapy continues, he has now achieved some level of movement in his fingers on both hands, which was not there previously.  

Straightening out his fingers

As a result of not being able to use his fingers for a long period of time, they had been affected by a deformity, which was caused by shortening of the tendons (flexural contractures). This deformity has been limiting the movement of Dr Koske’s fingers. As such, there is need to straighten out the fingers, which involves putting a tiny plaster cast on each finger. These miniature plasters force the fingers to straighten out. The plasters are kept on for between 6 to 8 hours at a time, before they are removed. This is repeated on alternate days and this is the third time he is having the miniature plasters.

It is a delicate process and Dr Koske has to be keen and watch out for any unusual pain levels, tightness or change of colour on his fingers. In case any of these happens, he has to dip his fingers in water and remove the casts. The main objective of the process is to elongate the tendons and straighten out the fingers.

As the days go by, Dr Koske undergoes further training for trunk support and control with extended standing retraining. This is done with his hands free to allow this position and to allow normal functionality. He also undergoes hand retraining to improve function of the hands while in a standing position.

A continuous journey

Dr Koske’s neuro-rehabilitation continues every day as his journey towards being independent continues. He is now able to maximise on trunk control and ability to lift himself while in a seated position. This makes it easy for him to move from a wheel chair to a bed and vice versa, or from a wheel chair to a seat. His trunk control, support and coordination have improved.

During his therapy sessions, his therapists encourage him to do simple tasks like holding a ball and throwing it. In this process, hand to eye coordination is also demonstrated by ball control. Dr Koske is slowly learning to be independent with day-to-day basic activities. And as his finger movement improves, he can slowly feed himself and comb his hair, which he was not able to do before he underwent the stem cell transplant and neuro-rehabilitation. Dr Koske might not be there yet, but the neuro-rehabilitation is slowly making headway.

Dr Koske arrived back home on the morning of 29th June, 2022 and will continue with rehabilitation under the care of Viva Serenity doctors.

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