Fixing the Unfixable

New Methods Show Promise for Rehabilitating Paralyzed Patients with Spinal Cord Injury

In the United States there are approximately 1,275,000 people currently living with paralysis caused by traumatic spinal cord injury (SCI). Annually that number increases by 12,000 people. SCIs are caused from mechanisms such as car accidents, sports, falls and violence. In a matter of seconds a human life can drastically change for the worse. People coping with paralysis may become dependent on a wheelchair due to a loss of sensation and function of their arms and legs. They may lose bladder, bowel and sexual function. In cases where the cervical region of the spinal cord is damaged people may lose function of the diaphragm, becoming reliant on a ventilator to help them breathe. Spinal cord injuries significantly alter quality of life. Researchers dedicate their careers to restoring neural function of physiological systems after an SCI.

Currently and in the future, techniques are being developed to improve quality of life and return spinal cord function to patients. Some of these techniques are robotics, functional electrical stimulation (FES), epidural spinal stimulation (ESS), drugs and umbilical blood cell transplantation.

Robotics

At the 2014 FIFA World Cup in Sao Paulo Brazil a paraplegic man kicked the commencing ball, initiating the world class soccer competition. The man was able to do this with the assistance of an Iron Man like robotic exoskeleton developed by a faculty member at Duke named Miguel Nicolelis. The suit was controlled with brain cues which translated into locomotion. Nicolelis was assisted by 150 scientists from around the world. 

Functional Electrode Stimulation

In FES, small pulses are delivered from an implanted device to essentially bypass the disrupted spinal cord and stimulated down-stream nerves to trigger muscle actions in the periphery. Patients triggering dormant hand muscles to hold a can of soda is a basic example of this concept. Researchers at Case Western Reserve University in Cleveland used this technique using an external controller. Patients were able to stand and take steps on their own. Researchers at Brown and the University of Pittsburgh have been developing a way to internally stimulate body actions. Subjects have been able to control robotic arms with their thoughts.  With more research, this method could be used to restore diaphragm and bladder function.

Epidural Spinal Stimulation

The University of UCLA and Pavlov Institute of Physiology in Russia implanted devices directly on the surface of the lumbar spinal cord. These devices were originally designed for pain management but when applied daily and coupled with training, damaged nerves were repaired. In the study 4 paraplegic subjects were capable of voluntarily moving their leg muscles. Rob Summers, a subject in the study claimed the treatment “completely changed” his life. He was able to move his legs, his sexual function returned and he had the capability to control his bladder and bowel without the assistance of the stimuli!

Drugs

Some first generation drugs have shown promise in SCI treatment. Methylprednisolone has shown a 20% increase in motor and sensory function if administered within 8 hours of injury. Monosialic Ganglioside has been show to speed up SCI recovery if administered within 48 hours of injury.

Cell Transplantation

The China Spinal Cord Injury Network carried out a study with 20 patients averaging 7 years since the SCI. Mononuclear cells, known to have exceptional repair and restoration characteristics, were drawn from umbilical blood. The cells were then transplanted above and below the injury site. After the implantation, subjects participated in intense walking training for 6 hours a day, 6 days a week for six months. At the end of the study 15-20 patients could walk at least 10 meters with minimal assistance. 12 of 20 were able to stand, sit and go to the bathroom unassisted. With imaging neural fibers could be seen spanning the injury site showing restoration of the spinal cord.

Some prospective studies have been done in mice introducing Schwann cells into the CNS but are still too early in human trials to draw any conclusions about their efficacy.

While many of these techniques have promising futures, they are expensive and exclusively available to research participants. With more research and understanding of the mechanism in which each treatment works, cost efficient techniques can be developed to help people with SCI live independently once again.

To see the full article, check out this link: http://www.aaas.org/news/new-methods-show-promise-rehabilitating-paralyzed-patients-spinal-cord-injury