Question
QUESTION: My close friends daughter met with accident on 28th April 2007, broken her c3 c4 vertebre, she is out of ventilator since a week. She is not having any  feelings or sensation below her shoulder,will she be able to get the sensation, use her hands and legs. She is just 16 yrs.

ANSWER: Hi Anita-
I am very sorry to hear of your friend's daughter. She has had a very serious injury, as you know- I will try to give you some information.  Please remember though that I can only tell you what generally happens with injuries of this sort-

Due to the lack of feeling, I am assuming that she has an actual cord injury, yes?  (You can break a vertebra and still recover normal function if you don't cause trauma to the spinal cord itself)  C3-4 means the 3rd and 4th vertebrae down from where your spinal cord enters the skull.  Each vertebrae has a space where the nerves come out to the arms, legs, etc.  To have such a high injury as she has, I am surprised (and pleased) that she is able to breathe on her own.  Many who are injured at c3 require a ventilator for the rest of their lives.  This is a problem as it seems to lead to more infections and generally worse health.  

So, while it is good that she is able to breathe on her own, the rest of her prognosis - physically at least- is not great.  There are nerves in your arms and legs (the 'peripheral nervous system') that can heal themselves if they become injured.  The brain and spinal cord are not like this-- there is some evidence that damaged neurons here will try to regrow in a different path, sort of like trying to drive your car around a roadblock, but I have never heard of someone with a spinal cord injury recovering to a "like she was before" state.  Doctors will say things like "we never say never", but to the best of my knowledge it has not happened.
During the first year after injury there may be some change in her functioning- this tends to be the time where the neurons will do whatever compensating that they can.  This Change, though, is most often on a small scale- their triceps become more controllable, or they can feel things an inch or 2 lower than immediately after injury.  In all probability, your friend's daughter will not have sensation or movement in her hands or trunk or legs.  I am sorry to have to say it.

There is some good news, though, although it may take her a while to realize it.  Everything that makes her the person she is is still intact in her brain and mind.   it is not much consolation at first- she is beginning a very difficult adjustment, as if she died and suddenly born again into a whole new world.  There are many things she can learn to do, but without use of her hands she may be dependent on others for help.  This will be hard to accept, probably- at 16 you want to be like your friends, not 'different'.  And you certainly don't want to depend on others for help dressing or eating or all the many things we take for granted until they are gone.  I hope that she can be resilient enough to get through it- I thought I was tough, it took me four years of really really bad times before i began to go in the right direction.  I say this in case it takes her a while, too- don't give up.
Please write in again if you have further questions- or if she or her mother do as well.  At certain stages in this process it is very helpful to talk to people who have been there.  Again, I am sorry I do not have better news- being a spinal cord injury expert is not like being an Expert in tv repair or gardening. I remember very well how hard it is and I feel very sad knowing that others, especially the young ones, are having to do it too.  But young people are amazingly adaptive, and I am very hopeful that this girl will also adjust to her new situation.  I wish all of you good luck,and please let me know if I can help further.

Leslie

PS- I will tell you something my mother told me (she is always right! I never thought so when I was a teenager...), maybe it will someday be helpful in your case too:
To be 'Independent' does not mean that you can do everything by yourself, it means that you know when you need help and how to get it.

---------- FOLLOW-UP ----------

QUESTION: Hi
My friends daughter Lakshmi from India, is out of ventilator but they have put a tube in the neck to breathe.
Why her voice does not come out ? Will she be able to  talk ? It is very very difficult to talk to my friend also, who is totally shaken.Lakshi can not talk, no sensation below her shoulders. Thanks a lot for your reply.

Answer
Hi- the tube in her neck is a 'tracheostomy' and it is better for her than having a tube in her throat (which can scar vocal chords).  That tube in her neck is basically where she is breathing right now-- they can attach the ventilator there if she needs it, etc.  When you talk, the reason there is sound is that the air passes over your vocal chords, yes?  But with the tube, the air goes out there and never gets to the chords.  So, no sound.
I had this for 3 months, and if they take out the neck tube it heals quickly and she will be able to talk again.  It seems weird, but the neck tube is alot more comfortable than the kind that goes down your throat, plus it gets in the way less often.
I am sure your friend is very upset- I cannot imagine how my mother handled it.  Spinal cord injuries are difficult for all the people who care about the injured person, too.  She, like her daughter, will have to adapt.  
Again, good luck to you and thank you for your question
Leslie