The Fall

Mr. Seiler had agreed to assist a local farmer, herding and feeding his sheep along the farmer’s mountain farm. As he dispersed feed one morning to the sheep along the shear mountainside, one of the wilder spirited animals ran at him and leapt upon him, immediately knocking him over and sending him down the sloping surface. He fell rapidly, plummeting about ten meters before coming to a stop.

As I was tumbling down the mountainside, I thought to myself, ‘My God, when am I going to stop!’ I was so conscious during the whole fall, as I came to a halt, I was freezing, shaking — I couldn’t move my arms and legs; I was so very afraid. Like the cliché, I really did see my life pass before me. Now I continue to relive this over and over!

Mr. Seiler

Mr. Seiler’s fall was interrupted before more damage was done. However, he could not move either his arms or legs and lay helpless and in shock for some minutes before his fellow farm workers realized what had occurred and ran to his rescue.

First aid at the scene

As his colleagues arrived above him and looked down to assess the situation, they made a critical decision: not to move him and immediately call rescue service. This was the starting point of rehabilitation. While one of the other farmers carefully descended the slope to be with Mr. Seiler and comfort him, an emergency crew from a spinal cord center had been dispatched and was on their way via helicopter, the ideal transport method for SCI injuries. They arrived within a quarter of an hour.

The rescue team made a rapid assessment of the situation. From a brief discussion with the other farmers, they suspected a hyperflexion trauma. After descending the mountainside, the team stabilized the cerebral column with a stiff neck brace and the spinal column on a vacuum mattress. Mr. Seiler was carefully extracted and evacuated by helicopter to a near by SCI center. During the process, his consciousness and cardiopulmonary state were carefully monitored and pharmacological interventions were undertaken to treat Mr. Seiler’s shock.

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Optimal acute care

Mr. Seiler was admitted to the intensive care unit of the paraplegic center and quickly received acute care and a thorough assessment by the health care team. He was found to be oriented (with a Glasgow coma scale of 15) and in stable condition.

As I arrived at the emergency room, I thought, ‘This is the end of my life.’ I told the doctors that I just wanted to die, I wanted them to kill me - my body wasn’t working anymore…

Mr. Seiler, recalling the accident

As for his neurological status, he presented with clinical signs and symptoms of an ASIA C sub-C4 tetraplegia and there was a suspicion of centromedullary syndrome. Following his assessment, he was medically treated with analgesics for pain, prophylactic treatment for ulcers and thrombosis as well as for bowel rehabilitation and intensive respiration therapy for his breathing functions.

While spinal stabilization surgery was initially considered, a decision was made based upon the injury to first treat the injury conservatively with a neck brace for three months.

One of the doctors told me that they don’t kill anyone ... and are only there to help me. Somehow, I believed him and it calmed me down. They were all so kind and that really pulled me through. I thought they were all doing their best work.

Mr. Seiler, recalling the accident

I told the doctors that I just wanted to die, I wanted them to kill me - my body wasn't working anymore.

Once Mr. Seiler’s condition was stabilized, he was admitted to the Intensive Care Unit (ICU). To his and his health care team’s relief, his recovery proceeded immediately and without complications.Mr. Seiler wanted to avoid surgery if at all possible. Fortunately, his health care team made the decision to treat the impaired structures conservatively.

Seven days following his accident, Mr. Seiler was discharged to the early rehabilitation unit for early post-acute rehabilitation.

Marked increases in neurological recovery were already evident within a few days, particularly in his upper extremities where Mr. Seiler’s existing innervation recovered a degree of both power and fine hand function. His forearms showed neuropathological symptoms of paresthesia (not unpleasant abnormal sensation, whether spontaneous or evoked) and dysaesthesia (unpleasant abnormal sensation, whether spontaneous or evoked), and increasing neuropathic pain. Within the ICU, medical treatment continued.

These latter symptoms were being medically treated and would need monitoring through the course of rehabilitation. Catheterization was regularly performed to care for the bladder and respiratory therapy was completed successfully.

Seven days following his accident, Mr. Seiler was discharged to the early rehabilitation unit for early post-acute rehabilitation. At the time he was conscious and approachable with normal reactions. All of his vital signs were within normal limits and his neurological functions were improving. Here, a Rehab Cycle was begun to help Mr. Seiler along his way to an optimal recovery.

A few days after the accident, I said I wanted to walk. The health team didn’t believe that I could, but I insisted on trying at the very least. My physician agreed and with the nurses’ help I managed a bit. This was such a boost I can’t begin to describe it! An incredible psychological lift!

Mr. Seiler, recalling the accident

 Mr. Seilers ASIA Impairment Scale

Table 1: Overview: Mr. Seilers ASIA Impairment Scale (AIS) - The following data comprise Mr. Seiler’s AIS score as measured by the medical team at his admission to the spinal cord center. This score comprehensively evaluates sensitivity and motor function. In Mr. Seiler’s case, impairment occurs below the level of C4 and, given the preservation of different degrees of both sensory and motor functions, is classified as an incomplete injury.