Authors: Janice Eng, Dominik Zbogar | Published: 7 July 2025
Lending a hand to build SCI expertise in the Ukraine
We spoke to Dr. Andrei Krassioukov, Physiatrist in the Spinal Cord Program at Vancouver Coastal Health’s GF Strong Rehabilitation Centre.
Dr. Andrei Krassioukov, a rehabilitation physician with GF Strong Rehab Centre, clinician-researcher at the International Collaboration on Repair Discoveries (ICORD), as well as an expert contributor for the SCIRE Project, has been volunteering his time in Ukraine over the last two years.
Assembled by the World Health Organization, health care professionals in medicine, physical therapy, occupational therapy, nursing, and psychology have visited war zones on multiple occasions to establish a specialized national spinal cord injury centre in the Rivne region of Ukraine. Amidst the ongoing war, the number of patients with spinal cord injuries and other catastrophic injuries continues to increase. Spinal cord injury is a particularly specialized area of medicine so supplies, person power, and medical expertise are sorely needed.
Can you describe your role as a healthcare provider and World Health Organization representative in the Ukraine?
“It was mostly training, training, training clinicians. I had daily meetings with medical staff. We attended every morning clinical round on the acute wards and spinal cord wards.” Dr. K (how most people refer to him) taught clinicians how to conduct spinal cord injury assessments, using the International Standards for Neurological Classification (ISNCSCI). He provided training on autonomic dysreflexia, as well as bowel and bladder management. He led sessions on the management of spasticity after spinal cord injury, including how to use botulinum toxin injections and monitoring outcomes with muscle electromyography.
Ukraine street mural, as photographed by Dr. K. on April 12, 2024
What are some of the greatest challenges you have seen?
“Resources were scarce with only a few vials of botulinum toxin available per month. They were fortunate to get some international donations of botulinum toxin which helped to stretch their supplies. Most of these young people had multiple traumas, and their injuries are more complex than what we would see in a typical car accident. As the war has caused so much destruction, some people we discharge no longer have a place to go home to. Many people in Ukraine are already affected by depression, anxiety, and post-traumatic stress from the long war effort. This centre has brought in new resources for psychological support for coping with the devastating effects of these injuries and personal circumstances.”
What stood out for you the most during your time in the Ukraine?
“The work was stressful with continual alerts, bombings nearby, and evacuations to shelters, but not compared to the stress that Ukrainians have had to endure. What stood out for me was the humanity and resilience of the Ukrainian people who managed to find some happiness in moments of their life during the ongoing war. I saw this resiliency in the soldiers recovering from their injuries, and from the everyday people that I have met.”
The Spinal Cord Centre now has 100 beds and will serve as a model for similar facilities in other regions of Ukraine. We thank Dr. Krassioukov and all health care professionals who have been courageous enough to lend a hand during traumatic times.
The LOS for SCI rehabilitation varies significantly between countries due to differences in healthcare systems, insurance models, resource availability, economic factors, cultural and social factors, and adaptation of evidence-based rehabilitation practices. These factors are discussed in detail in the next sections.
Australia (2010 – 2011)
The evidence for how LOS affects individual functional improvement at discharge is mixed. Some studies report a longer LOS is associated with increased functional improvement while others report the opposite.
Primary care providers (PCPs) take care of the day-to-day health of people at all stages of life. They are often the first contact when someone has a non-emergency health concern. This person is often a family doctor, but the role can also be filled by a nurse practitioner, physician assistant. They play a central role in the care team for people with spinal cord injury (SCI) and you will maintain a relationship with your PCP for many years. The responsibilities of a PCP include:
Go to the emergency room or call your regional emergency number if…
If your PCP is interested in more in-depth information, 
Employment
Social support refers to one’s relationships with other people, and the interactions, support, and care provided by this network of people, including family members, friends, and peer community. There is consistent evidence that more social support is linked to higher QoL in people with SCI.
I was skiing when I broke my neck. I had just turned 19, living in Vancouver. I went on a run that was steep and ended up going quite fast and then crashing. Somewhere in the whole thing I felt my neck break. I experienced it as feeling my body was expanding, the size of the universe. I experienced it as a sound like multiple sirens going off, very loud noises going very broadly. Then, I experienced my body going into a fetal position but when I opened my eyes my arms were up here. I said to myself, “You broke your neck – don’t move.” Eventually, people went down and got a piece of plywood to carry me off the mountain. They took me down, sort of bouncing, which is probably where more damage came.
So then, we went into sailing through 
We were able to put on the Public Salons for about four or five years, having received a million dollars from a foundation in California. We tried to raise additional money to bolster that, but eventually we ran out. We had to try to make it profitable on its own, but it wasn’t designed for fundraising, it was designed for giving me pleasure. Fundraising would be a real challenge. So, we had to totally revolutionize it a couple years ago. What I do now is bring in an international speaker, that’s the star, and then have local responders who give them questions, comments, critiques, etc. So that’s the new model and it seems to be working. I brought in a former chief planner of the World Bank, Alain Bertaud, and a recent Think-Tank Salon included experts on addiction and mental health. In a way, I’m still on those two issues of prices and addiction, now attacking them from outside, not from the inside as mayor.
Congenital NTSCIs are developmental defects, malformations, and abnormalities affecting the spinal cord which are present at birth. An infant can have one congenital condition, or multiple conditions at the same time. For example, Type 2 Chiari malformations almost always occurs in association with 
A genetic NTSCI comes from an abnormality in a person’s genes that affects the spinal cord. This abnormaility can be inherited from one’s parents or be a spontaneous mutation that occurred during development. The effects of this genetic abnormality can be present at birth or show up later in life. Most genetic NTSCIs lead to loss of movement and/or sensation from the degeneration of nerve cells.
Acquired conditions include the most common causes of NTSCI, such as degenerative spinal cord conditions, tumours, and vascular problems. This is a diverse category and the conditions become more common in older age.
Ainsley is 17 and plans on doing a Bachelor of Arts at the University of British Columbia after graduating high school this year!
Dan is 37 and a full-time student at Douglas College in Recreation Therapy! He enjoys cooking and has a dog.
Caleb is 35 and likes to spend his time outdoors and doing sports like scuba diving, whitewater kayaking and sitskiing!
This was very true for Dan. After his nerve transfer surgery, he lost some muscle strength in his left hand and arm. He was still strong enough to push his chair but not to stop. As a result, he went from strictly using a manual chair to using a power wheelchair for about 10 months. The rest of Dan’s recovery did not go so smoothly either. He explains, “in my left arm, when I moved my arm in a certain way, I would get a twang. It felt like I hit my funny bone but times 100. It was really bad and that lasted about two weeks. I also had some numbness in my left thumb all the way down to my palm. I still have numbness but it’s mostly the tip of my thumb so it’s better.” On top of everything, Dan was living at home and not at a rehabilitation centre when he had his surgeries. He came to realize post-surgery that he did not have all the necessary supports in place to accommodate the temporary losses in function. Reflecting on these struggles, he suspects that since people with 
Ainsley is now 2 years after the nerve transfers and has gained the ability to fully open both hands. On the left, her restored hand closing from nerve transfer is very strong and she can pick things up. The right-hand pinch gained from the tendon transfer is functional and continues to build strength. All these improvements in her fingers and hands mean that Ainsley can use her cell phone with finger gestures, scratch an itch, adjust her hair, and hold and use things like cutlery, a toothbrush, makeup, and bank cards. The triceps nerve transfer has recovered to the point where she can now extend both arms against gravity. These days, Ainsley is getting ready to hit the road in a custom hand control vehicle, something that would not have been possible if not for the triceps surgeries that improved her strength enough to turn a steering wheel. Hopeful for the future, Ainsley says that she is “still improving everyday”.
Dan is coming up on 3 years after the nerve transfers. Although his grip is not strong, it is strong enough that he can use and squeeze the brakes on the new e-bike attachment for his wheelchair, which he would not have been able to do without the nerve transfer. Being able to extend his fingers has made it much easier to open his hand to grasp things and move them around. He has more function in his hands then before, but he still has not recovered some of the strength he lost after the surgeries. Dan described how “Before the surgery I could lift a full backpack of groceries off of the back of my chair now I have difficulty if there’s any weight in my bag.” That said, he is still waiting to see how much he improves, explaining, “…it’s coming, it’s just not there yet. I think they say the plateau is four years for this surgery…”, referencing experts who say that improvements for nerve transfers typically reach their peak at around 4 years.
Even though Caleb is only 1 year and 3 months after the nerve transfer and still has a long way to go, he is already happy with the improvements. “Going from zero movement in my fingers to now, it’s kind of huge”. The first big impact the nerve transfers had in Caleb’s day-to-day life was probably around four months in, when he was able to open his hand to grab his toothbrush without any kind of assistance. He can now grab a toothbrush or pop can and hold on to it without a problem. His triceps progress has been harder to pin down. There is some movement in his left arm and a small amount in his right arm but he wonders if that would have come back naturally after SCI regardless of the nerve transfers. Whether or not the improvements came from the nerve transfers or from natural recovery, it has been a big help for Caleb’s mobility and being able to shift and transfer.
Age: 37
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