I’ve learned so much over the past six months – my injury has actually turned into a real opportunity for me.

This introductory quote encapsulates Simon’s personality. An optimistic and motivated 22-year-old, Simon was at the start of a promising career as an online graphic designer before his spinal cord injury. He had a large circle of friends with whom he enjoyed dancing on weekends and mountain-biking the terrain surrounding Zurich in the daytime. In 2007, he took a break from his design job to enjoy a few weeks of vacation with a group of close friends in Mallorca. It was there that he suffered an accident while swimming with friends, resulting in a fracture of his second cervical vertebra, a critical location of basic life functions.

After his evacuation, Simon was diagnosed with a Type II dens fracture. He was stabilized and treated conservatively until arrangements could be made for his safe transport back to a spinal cord injury center in his home country of Switzerland. Once there, he was admitted to the intensive care unit of the SCI center and initially diagnosed with complete sub-C2 tetraplegia. At the time, the injury was classified as ASIA A. In this case, the medical team opted to undertake surgery to stabilize the fracture. This was performed successfully, and Simon’s rehabilitation began.

...he suffered an accident while swimming with friends, resulting in a fracture of his second cervical vertebra, a critical location of basic life functions.

The first five months

I felt my recovery proceed almost on a daily basis. There were no huge steps, but rather small and continual improvements.

Simon

Simon was admitted to the early post-acute unit, and his first two weeks following the surgery found him completely dependent in all respects. He was on an artificial ventilator 24 hours a day and received only intravenous nutrition. He could move only his eyes and mouth and wore a stiff Philadelphia collar during the first six weeks to immobilize his neck and cervical region.

He was on an artificial ventilator 24 hours, a day and received only intravenous nutrition. He could move only his eyes and mouth.

After six weeks, his respiratory function had improved significantly and he required artificial ventilation only at night. Furthermore, his stiff collar was switched to a flexible collar that would be work for four more weeks. Overall, Simon’s improvements can be seen in his increasing SCIM scores, with each area demonstrating marked increases over the rehabilitation process.

CS10 0116

Over the five-month period, Simon’s physical functioning steadily improved, and he achieved a degree of independence in self-care. To support his recovery in walking, regular locomotor training (Box 3) was applied from the third month after his accident.

Table 1: Changes of the SCIM during the first five months of rehabilitation

Table 1: Changes of the SCIM during the first five months of rehabilitation

During the first five months, the capacity in Simon’s gait patterns improved but remained limited. His performance in walking made some gains, but challenges still persisted.

By the end of this initial period, he was able to stand with some support and even take a few steps forward. Based upon his progress, both Simon and his rehabilitation team looked forward to the next stage of rehabilitation, which would focus on improving his ability to walk.

Box 3 | Locomotor Training (Body Weight Supported Treadmill Training)

Locomotor training utilizes limb movements to produce locomotive sensory information that can promote the recovery of walking abilities in SCI patients. In humans, it is often combined with body weight support that decreases the weight placed on the legs, allowing for the retraining of various components of a patient's gait. Other less well-studied interventions include locomotor training combined with other feedback or supportive elements, including electrical stimulation-assisted walking, biofeedback and passive mechanical orthoses.

Given that the use of locomotor training had shown to be successful in animal models that resulted in "accelerated recovery and in maximizing the quality of the locomotor pattern", such training has been extended for use in humans. While meta-analyses are not yet conclusive, there is still some evidence that suggests this type of training could be a promising rehabilitative intervention