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New Frontiers in Spinal Cord Injury Research

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Using this principle, Peckham's team worked out a way to deliver electrical stimulation in a way that could be tolerated by the patient. They decided to start by implanting the stimulator in tissues near the point of injury, rather than using external stimulation. The main drawback with external or surface stimulation, says John Chae, MD, MS, is that few patients can tolerate sufficient energy to get adequate deep muscle stimulation. Chae is an assistant professor at Case Western Reserve University School of Medicine and the director of stroke rehabilitation at MetroHealth. Peckham says that too much surface stimulation not only can cause burns, but can also result in uncontrolled leg movements.

Thus far, two implantable stimulators developed by Peckham's team are approved by the FDA. Vocare -- a device facilitating bladder and bowel control that has been implanted in more than 1,600 paralyzed patients -- and Freehand, a stimulator that permits patients with a neck spinal injury who have some shoulder control to open and close a hand for grasping and holding objects, are manufactured by NeuroControl of Cleveland.

While these may seem like impressive accomplishments, they are just the beginning of what may be a 'golden age' of spinal research. David Yu, MD, an assistant professor of medicine at Case Western Reserve, is principle investigator of an NIH- and VA-funded study that will, for the first time, look at whether it is feasible to help people with high neck injuries who have virtually entire body paralysis. "This is an injury like Christopher Reeve's injury," Yu tells WebMD. "Thus far we have [operated on] five limbs of three subjects," Yu says. "We've demonstrated that we are able to generate a response in one of the three subjects," he says.

Although this work is very preliminary, Yu says that he sees it as a necessary task to prepare the next big step in spinal cord research: a link-up between those working in functional restoration, such as the Cleveland FES Center, and biologic researchers who are concentrating on nerve regeneration. Yu says that nerve regeneration has just "really taken off in the last 10 years, because it's only in the last 10 years that it has been apparent that something can be done."

The studies now underway in Cleveland, such as Yu's study, will become especially useful in an era "when we have incomplete spinal cord injuries," says Yu. If nerve regeneration is successful in the future, it is likely to lead to only partial restoration, which will mean incomplete spinal cord injuries. In that case FES becomes even more important, as stimulation can be used not only to strengthen muscles but also to help nerve pathways begin working again, Yu says.

The Cleveland team is hoping to put this theory to the test in a joint project with nerve regeneration researchers. The first steps toward that goal are preliminary talks slated to begin later this spring with researchers from Washington University in St. Louis.

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