Wednesday, April 14, 2004

Erica Nader: Wheel-chair bound -- but determined

An air-bag injury took away her ability to walk. An operation in Portugal has put her on the long road to recovery.

BY PATRICIA ANSTETT - FREE PRESS MEDICAL WRITER

Erica Nader awakens each day wondering about the possibilities.

Will she be able to move her hand a little more?

Will today be one of the days she feels little impulses -- a pins-and-needles sensation that she thinks may signal new life in her spinal cord?

Or will it be a day she needs to take a day off from the arduous physical therapy that has consumed her life for more than two years?

Nader, 26, of Farmington Hills, is one of the first 20 Americans to undergo an experimental operation in Portugal to aid functional recovery after a spinal cord injury.

She was injured in a 2001 auto accident on the night of her parents' 25th wedding anniversary party. Her brother was driving as they headed through the family's dark, winding Farmington Hills subdivision and the car went off the road.

An air bag hit Nader and paralyzed her from the middle of her chest down, she says.

Her diagnosis: C6 injury, Asia-A, to distinguish the exact site of her injury and the severity of it. She had no finger movements and only limited ability to move her right arm.

"The grimmest diagnosis you can get is Asia A," Nader says.

A tough first year

Nader struggled the first year, as many people do after a spinal cord injury.

The rehabilitation program in which she participated didn't provide "the type of recovery I wanted." Beyond teaching daily skills, there was little hope or willingness to push further, she says.

"For most people with a spinal cord injury, you are told from the beginning what you can do to be functional. They help you get the products you need and help you get on with your life. You hear there's a 3- to 5-percent chance of walking again, but even so, you don't want to think too much about it or give yourself false hope and end up being crushed in the end. That, to me, never made sense."

Nader had gone from living an independent life in California as an activist with a peace group to living at home with her parents and being dependent on their help.

One day, she broke down crying. She remembers her dad, Fred, an executive with Southfield's Kenmar Corp., telling her: "You can make this be whatever you want it to be. You have to set goals for yourself and look in the mirror every day and see what you are doing."

Afterward, Nader got serious about undergoing extensive rehabilitation. She looked for options. Her search for resources led her to Dr. Carlos Lima of Lisbon, Portugal. She underwent the experimental procedure in March 2003.

Risks weren't a concern
In the surgery, doctors take the tissue from the lining of the olfactory bulb at the ridge of the nose and transplant segments of the tissue into the injury site.

Little is known about risks of the surgery because there are no good studies or even observational reports of how Portuguese patients have fared.

The risks didn't bother Nader.

The notion of living the rest of her life in a wheelchair dependent on others did, she says.

Almost immediately, upon awakening from surgery, Nader says she felt different. Her skin felt warmer, particularly her legs and toes. They weren't cold, as they had been since her injury.

Family members who touched her noticed the warmer skin, too.

Since then, she has regained hand and some upper body movement by teaming gains from surgery with an aggressive physical therapy program.

Initially, she went five days a week, three hours a day, to Project Walk in Carlsbad, Calif., outside San Diego.

By last summer, she had tapered the therapy to three days a week, three hours a day.

She also underwent acupuncture, hand therapy, and one hour of pool therapy three days a week. Her mother, Rita, moved with her to San Diego to help.

"We were putting 900 miles on a car a week driving all over the place," Nader says.

She will resume therapy soon at the Rehabilitation Institute of Michigan's new Spinal Cord Recovery Center in Detroit. She moved back to Farmington Hills earlier this month. .

The center will be home to the latest generation of equipment for the rehabilitation of spinal cord injuries. It will include devices like seated bicycles that send electrical signals into muscles making them move pedals.

Nader says she has seen her biggest gains in the past three to five months. Some of the most noticeable differences are in her spasticity -- feelings previously considered undesirable by some medical professionals but ones that may be broader signals of new growth within the spinal cord.

"Having that muscular spasticity allows me to strengthen my back and abdominal muscles," Nader says. "It's the beginning of a renewal process. What I feel going on is almost on a circuitry level. I feel something one day, and the next day it doesn't feel that way. Kind of like a buzzing."

She noticed improvements in proprioception, the inner sense of consciousness that alerts the body to when it's sitting erect, falling down or moving in some way. That sense helps people stand erect or ride a bike.

Nader wants to walk again. Her No. 1 goal these days is to build herself up enough to move upright from her wheelchair to a walker.

Nader says she is encouraged by changes on her MRI (magnetic imaging resonance) tests that show tissue growing in the site of her injury. "Blood is flowing through it," Nader says. "The MRI doesn't like a person with a spinal cord injury.

She awaits more gains. "This is exactly what I expected. A boost. Not running the Boston Marathon, but a very slow and arduous recovery . . . a kick start.

"I tell other injured people who ask me why I do what I do: 'I don't know how much recovery you can get. I don't know if Dr. Lima's procedure is going to make me walk again. But everything I do that helps -- great. That's the goal.' "