Dis­cov­er­ies

A ground­break­ing piece of tech­nol­ogy is help­ing vic­tims of se­vere spinal trauma re­gain the use of their legs

Focus-Science and Technology - - CONTENTS -

This month’s big­gest sci­ence news, in­clud­ing the world’s first paral­y­sis re­ver­sal.

Four pa­tients with se­vere spinal cord in­juries can walk again thanks to a new tech­nique that com­bines elec­tri­cally stim­u­lat­ing im­plants and phys­i­cal ther­apy, which has been de­vel­oped by re­searchers at the Univer­sity of Louisville.

Of the four pa­tients in the study, all were able to stand in­de­pen­dently and two were able to walk with the as­sis­tance of walk­ing aids such as walker frames or hor­i­zon­tal bal­ance poles de­spite be­ing in­jured more than two years ago.

“This re­search demon­strates that some brain-tospine con­nec­tiv­ity may be re­stored years af­ter a spinal cord in­jury as th­ese par­tic­i­pants liv­ing with com­plete mo­tor paral­y­sis were able to walk, stand, re­gain trunk mo­bil­ity and re­cover a num­ber of mo­tor func­tions with­out phys­i­cal as­sis­tance when us­ing the epidu­ral stim­u­la­tor and main­tain­ing fo­cus to take steps,” said Prof Su­san Harkema, as­so­ciate direc­tor of the Kentucky Spinal Cord In­jury Re­search Cen­ter. “We must ex­pand this re­search – hope­fully, with im­proved stim­u­la­tor tech­nol­ogy – to more par­tic­i­pants to re­alise the full po­ten­tial of the progress we’re see­ing in the lab, as the po­ten­tial this pro­vides for the 1.2 mil­lion peo­ple liv­ing with paral­y­sis from a spinal cord in­jury is tremen­dous.”

The treat­ment is based on the idea that, in spite of the dam­age to the spinal cord, some nerve con­nec­tions that cross the in­jury site re­main in­tact. Im­plants placed be­low the in­jury site send pulses of elec­tric­ity through the area ex­cit­ing the nerves in the spinal cord. It’s thought that this kick­starts the sys­tem: the ac­tiv­ity gives the spinal cord, which has been iso­lated from the brain by the in­jury, the sen­si­tiv­ity it needs to hear sig­nals from the brain again. This gives the legs a chance to re­con­nect with the brain and slowly re­learn the dis­tinct nerve ac­ti­va­tion pat­terns that re­sult in walk­ing via the lo­co­mo­tor train­ing. In a ses­sion, the par­tic­i­pants are placed into a har­ness while spe­cially trained staff move their legs to sim­u­late walk­ing on a tread­mill.

That’s the the­ory, in prac­tice how­ever, the pre­cise heal­ing process isn’t fully un­der­stood. “Now I think the real chal­lenge starts, and that’s un­der­stand­ing how this hap­pened, why it hap­pened and which pa­tients will re­spond,” says Kristin Zhao co-prin­ci­pal in­ves­ti­ga­tor the study.

Ini­tially, they were un­able to stand, walk or vol­un­tar­ily move their legs, even af­ter eight to nine

“THE TREAT­MENT IS BASED ON THE IDEA THAT, IN SPITE OF THE DAM­AGE TO THE SPINAL CORD, SOME NERVE CON­NEC­TIONS THAT CROSS THE IN­JURY SITE RE­MAIN IN­TACT. IM­PLANTS PLACED BE­LOW THE IN­JURY SITE SEND PULSES OF ELEC­TRIC­ITY THROUGH THE AREA EX­CIT­ING THE NERVES IN THE SPINAL CORD”

weeks of daily lo­co­mo­tor train­ing. How­ever, once the stim­u­la­tors were im­planted and switched on, all of the par­tic­i­pants were able to stand and two of them were able to walk us­ing mo­bil­ity aids.

“We are see­ing in­creas­ing in­ter­est in the use of tech­nolo­gies such as epidu­ral stim­u­la­tion in the treat­ment of spinal cord in­jury and restora­tion of lo­co­mo­tor, car­dio­vas­cu­lar and uro­dy­namic func­tions [blad­der con­trol],” said Maxwell Boakye, clin­i­cal direc­tor of the Kentucky Spinal Cord In­jury Re­search Cen­ter. “Epidu­ral stim­u­la­tion is likely to be­come a stan­dard treat­ment with sev­eral im­prove­ments in de­sign of the de­vice to tar­get more spe­cific neu­ro­log­i­cal cir­cuits.”

ABOVE: (From left) Dr Clau­dia An­geli, Jeff Mar­quis and Prof Su­san Harkema at the Kentucky Spinal Cord In­jury Re­search Cen­ter

ABOVE: An X-ray of the epidu­ral im­plant that pro­vides elec­tri­cal stim­u­la­tion to pa­tients with spinal cord in­juries

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