Answering Your Spinal Cord Injury Questions with Dr. Shelly Hsieh

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katie Peters, and this is the Brain and Life Podcast.

Dr. Correa:
So this week here on the Brain and Live podcast, we're going to switch it up a little bit. Katie's not joining me today. Instead, I get to welcome Dr. Shelley Hsieh. She's a spinal cord specialist who works at a neurorehabilitation specialty, so stay tuned. Soon, we're going to be going into our discussion and going through listener questions. We're going to be covering some about what is spinal cord injury, the types of injuries, and the various terms that you might hear relating to spinal cord injuries. How the injuries are classified, how they're tracked, how the functional progress is tracked, and strategies to help with the activities that matter most to you when you or a family member are living with a spinal cord injury.
And then beyond just the movement strength and sensation aspects, we get to talk some about how to deal with and some of the possibilities of the emotional toll that can occur after a spinal cord injury. And stay tuned through the end where Dr. Hsieh mentions and specifically highlights the key aspects about advocacy in making sure your voice and story are heard, so that more individuals who are living with spinal cord injury can benefit from the knowledge and the community and all the many tools that are out there.
Welcome back to the Brain and Life Podcast. Now, today I'm excited for a little bit of a different spin on our question and answer episodes, and I'm happy to welcome Dr. Shelly Hsieh. She is a physical medicine and rehab specialist or PM&R doctor who specializes particularly in spinal cord injury. Many of our readers and listeners know that in the Brain and Life Magazine, we've had a variety of content talking about the experiences and challenges and questions that those who live with spinal cord injuries can incur, and we thought it would be great to get through some of your own listener questions, together alongside with a spinal cord injury specialist.
Dr. Hsieh works at the Burke Rehabilitation Hospital in White Plains, New York, just outside New York City. Shelly. thank you so much for joining us and our listeners here today, and please, let's use Shelly and Daniel because we're here along in the room and in our ears with our listeners. Can you tell us a little bit more about what a neurorehabilitation center does?

Dr. Hsieh:
Thank you so much again, Daniel, for inviting me to speak on the Brain and Life Podcast. Again, it's so wonderful to be back and answering audience questions. I serve as the outpatient spinal cord injury director at Burke Rehabilitation Hospital in White Plains, New York. It's a 150 bed acute adult inpatient rehabilitation hospital where we have units dedicated to spinal cord injury, brain injury, stroke, amputee, ortho, medical rehabilitation and cardiopulmonary rehabilitation. It is accredited by the CARF and Joint Commission, and ranked the top rehab hospital by the US News and World Report.
We also have an outpatient physician practice and 15 outpatient therapy sites, so we are a member of the larger Montefiore Healthcare System here in New York, and I serve on national committees for advocacy and public policy as well.

Dr. Correa:
Wonderful. I'm so glad. Also, we'll get a chance to hear some about the ways we can advocate for those living with spinal cord injury. Now, as I mentioned before, we have, I took a look, we've gotten some great listener questions and magazine reader questions that have been submitted over time, and so we thought let's sit down here with you, Shelley, and we'll go through some of those. So let's start off with Rachel. She wrote in, what exactly happens to the spinal cord during an injury and how does that affect the recovery?

Dr. Hsieh:
That's a great question. I think sometimes as physicians or healthcare providers, we use the term spinal cord and we assume that the person might know exactly what it means, so I'm glad that I get to describe it. If you can imagine the brain as the processing unit or control center, it then sends signals down to the rest of the body. And the spinal cord is the wire which consists of a bundles of nerves and tracks that then send these signals down to the arms and the legs for sensation, so the ability to feel, strength, the ability to move, but also the rest of your organs like your heart, your lungs, your bladder, bowel, sexual organs, it sends pain signals. So when a spinal cord injury occurs, those signals from the brain to the rest of the body are being affected.
When we talk about spinal cord injuries, there's traumatic spinal cord injuries, so most commonly from a car accident, falls, gunshot wounds unfortunately, sports accidents. And then there's non-traumatic spinal cord injury, so that could be from arthritis, spinal stenosis, viruses, conditions such as transverse myelitis or multiple sclerosis, which you may have heard of, so there are different etiologies or causes or mechanisms of action that cause the spinal cord injury.
When a trauma occurs, it really damages the bundle of spinal cord nerves and cells and that's the primary mechanism, and then after the next few days and hours, you have secondary mechanisms of injury which is due to lower oxygen levels in the area and increased inflammation. And so if a spinal surgery or decompression is indicated, having that surgery within the first 24 hours has really been shown to lead to superior outcomes.

Dr. Correa:
Now, Rachel did also add some more context of her own situation, so I wanted to follow up with some of that because I think it helps clarify also some other questions that people might have. She wrote that, "After my injury, I kept hearing terms like incomplete and complete SCI or spinal cord injury, but I didn't really understand what that meant for my future. Could you explain what's actually happening in the spinal cord and how that impacts recovery related to this incomplete and complete term? I feel so lost," she added.

Dr. Hsieh:
That's a great question. I'm so glad she brings that up because I will often ask patients, do you know if you had a complete or incomplete injury when I'm meeting them in the outpatient setting. So I'll describe the exam which we use to classify spinal cord injury. It's called the ISNCSCI Exam, but more commonly, it's known as the ASIA exam here in America, which stands for American Spinal Injury Association, and it's a very standardized exam. It's done in the hospital or in the clinic room, and it's really testing the entirety of the spinal cord in terms of sensation and strength. So it tests 28 key sensory points on each side of the body using a Q-tip to test light touch, because that's the posterior column tract of the spinal cord. And then it also uses a pin to test the person's ability to distinguish sharp versus dull sensation, and that's assessing the spinal thalamic tract of the spinal cord.
And then we're testing 10 key muscles on each side of the body, such as the ability to bend the elbow, lift up the wrist, extend the elbow or lift up the hip, straighten the leg, move the ankle up and down, and that's assessing the corticospinal tract for the strength fibers. And then at the conclusion of this exam is the rectal exam, and that's arguably one of the most important parts of the exam because that will tell us if it's a complete or an incomplete spinal cord injury. The bottom of the spinal cord sends signals to the bottom, quite literally, so the rectal exam gives us some important information. We would assess light touch and pin prick with the Q-tip and safety pin in that rectal area. We would also assess deep anal pressure by seeing if the person could feel a gloved finger in the rectal area, and voluntary anal contraction, if they're able to squeeze that sphincter. Just like their sensation and strength in the arm or the leg, there is of that rectal aspect as well.
So now that I've described the exam, I'm going to step back a little bit and describe what information we get from the exam. We obtain a neurologic level of injury, which is the level at which the spinal cord is affected and where it's really affecting the sensation and strength that we're seeing on exam, meaning if let's say you had a C6 fracture, that doesn't necessarily mean that's your level injury. It could be C5 because it's affected the nerves a little bit higher.
Then when we talk about severities of injury, we classify as ASIA Impairment Scale, so AIS A, B, C, D, or E. A is a complete injury, and then E is as if you were back to normal, as if you were before the spinal cord injury, so you've completely healed. When we talk about complete injury, that's meaning motor complete and sensory complete, meaning motor is strength and sensory is the sensation. So we are not seeing strength or sensation in those rectal or sacral segments that I've described, and unfortunately, that results in a more severe injury because all those signals are not getting through to the bottom of the spinal cord, and that would play a factor in the prognosis or how we anticipate one to recover. It's quite a complex exam and the interpretation is complex, so I hope that helps clarify it a little bit, but please ask further questions.

Dr. Correa:
I think that can help provide some guidance. It also helps give some context and explanation of why it requires someone who really specializes and has seen so many different people who have had various types of injuries, and what the recovery tends to look like. Why so much attention is spent to the different types of rehab an individual might need.
Now, is there a reasonably approachable resource for community members, patients and families that explain some about the different types and levels of injury that we can reference and share with our readers and listeners?

Dr. Hsieh:
Oh, absolutely. The United Spinal and the Christopher and Dana Reeve Foundation have a lot of educational material, and they will break this down in understandable terms to help our listeners and readers understand what the neurologic level of injury means and what the classification means.

Dr. Correa:
Great, and we'll get the links and codes and information so that we can include that in the show notes for everyone. And you can go back to that, because I know and understand completely, many things with some of these neurologic conditions and classifications can turn into a little bit of a word soup, but to make it make sense for the context that you have, either for you, your family member or someone you know.
Now, I wanted to go on to then a question from Luis. He asked us, "Why do some people regain movement and others don't? I was injured in a biking accident two years ago. I've seen people with similar injuries make huge strides. I have plateaued. I'd love to ask someone who knows what factors really determine how much function someone gets back."

Dr. Hsieh:
That's actually a great lead-in to what we make of the ASIA exam. So it's very helpful in helping us determine a prognosis or the recovery potential of a person, and what we do know is it's actually the most important piece of information for prognosis. So it's more important than knowing how the injury occurred, it's more important than knowing the imaging findings like our CAT scan or MRI, or even the neurophysiological signals.
So with the complete injury, we do see about 30% of the patients progress incomplete, and I actually want to step back a little bit and say that that ASIA exam within the first 72 hours to one week after injury is what is used in a lot of the literature and then the research that one would read. So in a complete injury, I usually share with my patients that in that one year post-injury timeframe is when they will achieve their new baseline, and an incomplete injury, because it has not been as severe of an injury and their nerves are continuing to really work to improve and grow and heal, and about two years post-injury is when one might see their new baseline. So this is to really emphasize, it's a marathon, it's not a sprint. And so daily effort, rehabilitation exercise, all of that is so important in working towards neuro-recovery.
And the first six to nine months I would say is the quickest rate of recovery, but even past that, you are going to continue to have recovery, but the rate might be a little bit slower, but you will continue to see recovery at that time point. I hope that helps to explain a little bit as to why one person with the same type of accident might have a different outcome than another person.

Dr. Correa:
Yeah, and I think maybe a question to follow up Luis's specific situation. He described that he has found his progress to have plateaued. If an individual in their recovery phase even several years out from a spinal cord injury feels like they're at a plateau, are there different approaches or things that they can add or requests to consider in their rehabilitation moving forward that might give them a different opportunity to have some further gain or adaptation?

Dr. Hsieh:
I think what's great about spinal cord injuries is that there are so many tools, technology that's out there that can really help enhance and add to someone's function to give them more independence. So every year, there's new technology being developed, and that can really help change the way one is living their life, even if let's say the strength or the sensation has felt like it has plateaued.
And also in the prior episode, we talked about the spinal cord stimulation, ARC-EX, and that's really exciting. Although right now, the FDA approval is for people living with chronic tetraplegia to helping upper extremity sensation, strength and function, they're also seeking FDA approval for people with paraplegia and helping leg movement, walking, bowel-bladder function, and they're seeing improvement in outcomes for people even 34 years post-injury, so that's really exciting. Because it's serving as like a hearing aid for the spinal cord, so it's really amplifying those signals that are going through the spinal cord even many years out.

Dr. Correa:
Very interesting. Okay. Now, before we go on to another question, I know we have mentioned it in past episodes, but for those who may have just heard some terms that were newer to them, quadriplegia, tetraplegia, paraplegia, and then sometimes instead of plegia, we use the term paresis. Can you help just explain what the difference is between these terms?

Dr. Hsieh:
Yeah, absolutely. Thanks for clarifying. So tetraplegia would be an injury causing weakness of the arms and the legs, so tetra like the forelimbs. Quadriplegia is another way of saying tetraplegia. When we say paraplegia, we're talking about weakness of the legs. And then quadri or tetraparesis or paraparesis, and one could say that tetraplegia would be complete paralysis more so, and let's say tetraparesis or quadriparesis is weakness without complete paralysis. But that being said, I would say that now, tetraplegia can be used as an umbrella term, so it's weakness of the arms and the legs without being full paralysis.

Dr. Correa:
Okay, great. Yeah, I think that is helpful. And then another thing we've talked about and you were describing, the spinal cord's role in sending the signal and what happens with an injury in a way disconnecting or cutting off that signal. Now, many of our listeners may have been aware and heard various different episodes about other injuries that injure the brain like stroke and hemorrhages and otherwise that we've talked about. How are the injuries in the brain that those of us. And many of our listeners may be more familiar with hearing stories about, different from when the injury is at the spinal cord level?

Dr. Hsieh:
So the question is how are brain injuries different than spinal cord injuries? There are some similarities. They're both a result in let's say increased reflexes, similar conditions like nerve pain, spasticity. With the spinal cord injury, the good thing is that the brain is not affected. So you have your cognition, and education is such a key part in spinal cord injury rehabilitation, so having the ability to remember the tasks, the activities or the rehabilitation that you learn, and then also carrying it at home and teaching your caregivers as well. But that being said, there is a population with dual diagnosis where if someone has an injury severe enough to cause a spinal cord injury, it may have resulted in their brain injury as well because that impact was just so strong.

Dr. Correa:
Now, I wanted to get to then a question from Talia, and I'm sorry Talia if I'm not saying it right, but my Latino background just has defaulted to saying Talia. So she wrote, "How do neurologists track progress..." Or we'll broaden it here to neurologists and PM and R doctors, physical medicine and rehab doctors, "... track progress in spinal cord injury patients?" She added, "I've been in rehab for months and sometimes it's hard to tell if I'm improving. What do neurologists and the other doctors look for when they assess recovery? Are there specific milestones or tests that matter most?" Now, you've mentioned already the ASIA screening exam and the levels and how that's followed, but is there more that you're looking through along with the multidisciplinary team in the rehab setting to track and follow progress, both in the hospital and then afterwards?

Dr. Hsieh:
Yeah, I would say the ASIA exam performed at inpatient admission and discharge during that rehabilitation course is very important to say how the progress has been, but besides those numbers, it's really the functional progress the patient is making. A person at that same level of injury with that same classification can do very differently depending on number of factors, like body habitus or let's say their ability to control their trunk, their sitting balance, proprioception, their awareness in space, spasticity and how the secondary medical conditions are treated and controlled so it's not interfering with their function.
So every day, the rehabilitation team is assessing how the patient's doing in their activities of daily living like dressing, grooming, hygiene, toileting and physical therapy, and bed mobility, sitting balance, the ability to stand or walk. So all the functional progress is really what we're looking for, and then we want to be able to anticipate how, let's say, Talia might do in the next few weeks or months or years, and plan for that in terms of is she going to go home and what equipment might she need? If she has improvement in her function, then it might dictate what type of, let's say, shower chair or wheelchair or bed or transfer board or tools that she may need.

Dr. Correa:
Yeah, and I like that, the concept of structuring assessments and progress around types of function and the things that matter in each of our days. We often describe that under the acronym of activities of daily living or independent activities of daily living, but for most people, forget the acronym, it's just basically the day-to-day things that matter to them. And yes, we can directly test the muscle in your bicep, but I think what might matter sometimes most to people is finding out the things that they want to be doing more independently or more easily, and then using those tasks or the things that we know are important for their balance or getting around the home. So it sounds like you look at those things of getting in and out of bed, in and out of a chair, and structured those along with all the other many activities people either want to be getting back to or doing more independently.

Dr. Hsieh:
Yeah, that's a great point. Yes, we really want to know what's important to the patient, and work on it even as early as that inpatient rehabilitation setting. So one patient comes to mind. He's a thirty-year-old man, unfortunately had a sports accident, and his child just had turned one and he really wanted to bake a cake for his son. So he had tetraplegia, so it's weakness of his arms and his legs, but in inpatient rehabilitation, he worked with our therapists and our recreational therapy team as well to help bake a cake for his son, and then he also then learned the skills of cooking because what's important to him. And then he was very active in sports before, so even in the inpatient rehabilitation time, he went out and he participated in hand cycling and he got to meet people living with chronic spinal cord injury to hear how they've overcome these challenges early on and what life looks like afterwards.

Dr. Correa:
Yeah, I think that can really be a source of more practical hope for many people, when it's not just the exercises and what looks to them like a gym, but starting to incorporate them into activities and things that they both either enjoy or want to get back to doing. And so it might still be working similar muscles, coordination and balance in the hand and arm to be able to whisk, but it starts to mean more than just picking up a weight or doing things with the therapist if we start to relate it to those activities.

Dr. Hsieh:
Absolutely.

Dr. Correa:
Now, we talked about just a little bit before, a little bit about how spinal cord injuries are different from the brain, and one of the big things you pointed out is that we don't generally have cognitive and emotional pathways that go through the spinal cord. But Justin now, and his question I think really leads into another important aspect, and he asked, how do you deal with the emotional side of spinal cord injury? He added, "My spinal cord was injured recently in an accident and I'm in a wheelchair now. Physically, I'm doing okay, but mentally, it has been a rollercoaster. I don't hear people talk enough about the emotional toll. How am I supposed to cope with the grief and the uncertainty?" Thank you so much Justin from Massachusetts for sharing this with us. I think this is really important. I'm looking forward to Shelley's thoughts.

Dr. Hsieh:
Thank you Justin, yes, for sharing that question, because to be truthful, it is hard and it is really tough. It's a life-changing injury, and at first, it happens, you're in the hospital, you're working on being medically stabilized, then you're in rehabilitation and you have the therapy schedule, you're working with nursing, social work. And I think one of the hardest parts is actually when the person living with spinal cord injury goes home, because now they're not surrounded by healthcare professionals and now they have some time to think, what's next?
What does this mean for me and my life? And all sorts of thoughts can come to mind, and I want to reassure you that that is completely normal to feel down or anxious during that time, and please do seek help if you need it. But I do want to let you know that there is so much more to life and that's why I love the field of spinal cord injury, because there's so much we can do to help someone return to living life to the fullest and find meaning and do what they love. And truthfully, my patients are some of the strongest people that I have ever met.
It's not only possible to survive but really thrive after spinal cord injury. Of course, it takes time to change one's thoughts, feelings, behavior, and it takes time to rebuild your community and find a new identity, but it will happen with time. And at Burke, we have our great neuropsychology team who is well-versed in helping people with spinal cord injury, so they're seeing them early on. We have a family meeting, so it's the physician, nursing therapy, social worker, the patient and family members, and we talk about how they've been progressing, how we expect them to progress, and speak about prognosis so that they are in this supportive environment. But I would recommend that every person speak with a psychotherapist, because having good coping mechanisms is really key, and that's also where peer mentor support groups are so important.
So on the inpatient rehab admission, we will have our patients speak with a peer mentor, to speak to the person and explain how they've overcome these tough challenges in their life or this early part of injury and how they're living life now. Because if you can see that so many people can do this, then you know that you can too.
And know that you are not alone. Your team is with you every step of the way. I always tell my patients, I'm always there with them. Always reach out, always ask for help. Lean into your support network. And I think there was one question about it's a very long journey, so sometimes getting lost and feeling like you're not progressing, but recognizing also and celebrating the little achievements. Let's say your ultimate goal is to be able to stand or to walk, but to be able to sit by yourself for even two minutes longer, that is a stepping stone into your larger goal. Or let's say you've progressed from a power wheelchair that you were driving with the use of your head or a sip and puff with the use of your breath, but now, you're able to progress to a joystick because now you have that hand control. That is amazing progress and that is going to lead to something bigger. There's so much afterwards, and it's knowing that that future is there for you.

Dr. Correa:
Yeah, I really appreciate that, and I liked that you really highlighted the idea of starting by working on and looking for hope and purpose in the things that you can approach and do now, and I think that might help sometimes when there is a sense of loss to either both past activities and grief for that, and/or even towards the goals that someone would have. And it's great to hear that the skills that you build working with something that you have access to now can potentially also be part of your progress towards some of those goals in the future.
What I would say I also liked, you pointed out talking to therapists, which may also be both for physical and occupational therapists, but the emotional support team, whether that's a psychologist or neuropsychologist or in psychiatric help that you may have on the outpatient or the inpatient side. But Justin, I would really hope that you and others look for an opportunity to talk specifically about what are those things that you are grieving? What are the things that you feel that sense of uncertainty around? Because sometimes, out of that may come something that you can set as a goal to work on, and something that can be an actual part of your goals in the therapy process, and that way, also help you have a sense of potential progress and purpose as that moves forward.

Dr. Hsieh:
And I think finding that meaning and that purpose is such a key driving motivational factor, absolutely.

Dr. Correa:
Now there's a lot of things out there. We've got a few other questions but I wanted to just sort of summarize one of them, was you mentioned before, there's new technologies coming out. There's a lot of things people might see advertised online for all kinds of adaptive tools for both sports, for getting around, for mobility, for typing and texting. How do people navigate finding out things that might actually make a difference for them, and not very quickly burning through all the money and credit cards they have with Apple Pay and online ordering? That's entirely too easy nowadays.

Dr. Hsieh:
Yeah, absolutely. There's so much out there. I think that two great resources are the United Spinal and the Christopher and Dana Reeve Foundation. So they both have parts of their website where you can look through and see what equipment is out there. I think one of the best things is the environmental control unit, so using head tracking or eye tracking systems to then be able to, let's say, control the temperature, controlling the computer, opening, closing the doors, the blinds, to give you control of your environment so you're not reliant on someone next to you having to do that for you. We have the Nest that helps control temperature.
And then the Abilities Expo is a great conference. It happens seven times a year in New Jersey. It happens in May every year, and I love going to those events because they have a lot of vendors, technologies, products, like disability organizations there, they have some wheelchair rugby that goes on over there, to see every year what innovation's being developed, and then you can actually see the product and you can trial the product oftentimes. So the next one is actually in Dallas in August, but it occurs all over the country so you could look for a site closer to you. United Spinal also has a newsletter called New Mobility, N-E-W, and they will often publish on exciting resources out there.
I would say some of the technology that I think is really great to have for home use is the electrical stimulation bike or functional electrical stimulation device. You might see this in an outpatient therapy center, and it's something that you can purchase too for home use. Sometimes insurance will cover it and sometimes it does not, but sometimes these spinal cord injury organizations also have some grant funding to help you pay for part of these devices.
But what it does is it's pads that are placed on let's say the muscles of the arm, the leg or the trunk, and these electrical signals cause the muscle contraction, so it helps in strengthening the muscle, circulation, bulk, spasticity, cardiovascular tolerance. There's a lot of benefits to having your own device at home. And so I have a patient who cannot move his legs, but he bites on this device 30 miles a day, and it has a lot of benefits for him.
And one other thing. For anyone who is interested in having a voice in the technology that comes out, United Spinal does have a tech access initiative. So it's a community driven program and it pairs technology companies with people living with spinal cord injury to give input on certain products that are designed and what they want to see differently and what they want to see in the future, so that you could have a voice in this too.

Dr. Correa:
That seems like a great opportunity, both to see some of these different technologies at those expos around the country. Maybe they have an opportunity to share your own perspective and feedback and the technology that's needed.
Now, you mentioned the Christopher Reeve Foundation as a place where people can find a little bit more of a description across the different technologies that are out there, from an organization that has actually spent a little bit of time to make sure that these things are usable and not necessarily just scams being sold online. So we'll get some links and information that we can share in the show notes from Dr. Hsieh, and just make sure then to include those for you to take a look and so you can find some more of these events.
I wanted to also thank Sam, who submitted the question about adaptive tools, and I think we had gotten to talking about motivation during the recovery process, which was also shared with us by Jordan from Texas. And you just were talking about the idea of sharing your voice and advocacy in a way for spinal cord injury, and now we were talking about it, one, with technology companies, but there's so much more that's needed in research and really understanding many aspects about injuries and recovery and integration into our life and community.
I know that this is some work that you do, so I wanted to give you a chance to tell us ways that community members can be part of the advocacy work that's going on out there for spinal cord injury.

Dr. Hsieh:
Thank you so much for the opportunity to speak about this, because advocacy is really a passion of mine and I feel like there's so much that we all as individuals can do for the field, as a person living with a spinal cord injury, as a caregiver, as a healthcare professional. Because there's a lot of legislation that's being passed and our legislators want to know what's important to you as their constituents, and the personal stories really go a really far away. They may read a bill, but these are numbers and words, but it's not how it's really affecting the person. So one way I would recommend listeners or readers to reach out is participating in the advocacy days. United Spinal and the Reed Foundation both have one every year, and for right now, they are also virtual, so it can make it so much more accessible to someone who can't, let's say, commute to DC.
When I've been involved, it's been healthcare professionals on the line, people living with spinal cord injury, caregivers or friends, and some of the causes we've championed are funding for the Paralysis Resource Center. That is a federally funded program and it creates a lot of educational resources for people, and that's going to be one of the links that I will share with everyone. And it funds community programs and we use it to create an adaptive sports track for people living with spinal cord injury. And for United Spinal, we've advocated for insurance coverage for the standing feature for the power wheelchair.
Again, we talked about standing is... Having the ability to stand is so important. One, medically, it helps the bowel, bladder, it helps skin, but emotionally, it also helps to be able to finally be standing, looking at someone eye level, and again, the access and reaching. But unfortunately, insurance did not feel that this is medically necessary, but we all know that it is, and so this is our opportunity to speak up, and advocacy is very empowering I would say.
Also, we advocate for accessible transportation on airplanes, and the spinal cord injury organization, ASKIP, were strongly supporting the continued telehealth services. If you think about how telehealth was one of the silver linings of the pandemic and how it's so much more available, but at any moment, they could say that insurance is not going to cover that anymore. But for patients, we know that transportation is one of the biggest barriers to going back into the community, and having to find transport, having to have someone with you in order to make it to a medical appointment is really a barrier to healthcare. So I would really encourage you to become involved in advocacy, and it can have such great effects for society as a whole.

Dr. Correa:
I think it's so important, the challenges that our community members living with spinal cord injuries and their family or they themselves encounter every day are each a key thing that they know and see, and all need some level of advocacy, whether it's with devices or getting insurance coverage. Even just accessing things in our communities or even parts of the hospital, all those are places that I think would be incredible places to have your voice heard. And that advocacy can start at the national level with these organizations, or probably I imagine through these organizations and many of the other foundations, they can help connect with advocacy efforts at state levels or community levels to really help push unique challenges that need to be addressed, whether it's in your city or town.
Thank you so much, Dr. Hsieh, for joining us here today, for sharing with our listeners, I know both in past episodes, but getting through with us some of these other listener and reader questions that we had related to spinal cord injury and rehab.

Dr. Hsieh:
Thank you so much, Dr. Correa, for inviting me. It's such a pleasure to be speaking on the Brain and Life Podcast, and thank you for all that your podcast does.

Dr. Correa:
Thank you again for joining us today on the Brain and Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life Magazine for free at braininlife.org.

Dr. Peters:
Also, for each episode, you can find out how to connect with our team and our guests, along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org, and leave us a message at 612-928-6206.

Dr. Correa:
You can also find that information in our show notes, and you can follow Katie and me and the Brain and Life Magazine on any of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City, and online @NeuroDrCorrea.

Dr. Peters:
And Dr. Katie Peters, joining you from Durham, North Carolina, and online, @KatiePetersMDPhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health, and everyone living with neurologic conditions.

Dr. Peters:
We hope together, we can take steps to better brain health, and each thrive with our own abilities every day.

Dr. Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find The Brain and Life Podcast. See you next week.

Answering Your Spinal Cord Injury Questions with Dr. Shelly Hsieh

Additional Resources

Other Brain & Life Episodes on this Topic

Follow us!

Episode Transcript