Oct.1, 2018 -- The phones have been ringing off the hook at the Christopher & Dana Reeve Foundation since the news broke that an electronic device put into the spinal cord of several paraplegic patients allowed them to take steps.
“People are wanting to know how they can sign up,” says Susan Howley, executive vice president of research for the nonprofit started by Christopher Reeve, the late film star paralyzed in a horseback riding accident. “So many of them are desperate. The wisdom was simply these people were hardwired at injury and no matter what we did it wouldn’t improve on ability to function. This is saying all is not lost.”
Howley and several other researchers stressed that the findings – announced last week by researchers at the Mayo Clinic, UCLA and the University of Louisville -- while promising, are preliminary.
“It needs to be kept in perspective,” she says, “These were a limited number of case studies, not large clinical trials. But it’s safe to say the findings are very promising.”
Technology Plus Intense Therapy
In the studies, separate teams of researchers produced similar results by surgically implanting an electrical stimulator in paraplegic patients below the injury. This sent a signal to the damaged spinal cord, awakening dormant nerves to receive the signal to move.
The procedures were done along with intense physical rehab. Three out of five paraplegic patients involved in the studies were able to step with a walker after years of being unable to move from the point of their injury down.
The results disprove the accepted wisdom that a spinal injury means a lifetime of paralysis. “We used to think that all of the neurons below the lesion level had died,” Howley says, but the case studies show “some of them may be asleep.”
The studies that made news add additional evidence that people with clinically complete paralysis can take steps with the help of technology, says Monica Perez, PhD, a professor in the Department of Neurological Surgery with the Miami Project to Cure Paralysis at the University of Miami.
Studies in 2015 and 2016 showed that by using brain-machine signals -- sent to an electrical stimulator worn externally, or exoskeleton -- it was possible to cause muscle activity that allowed some patients to take steps after a lot of training.
The new studies add to evidence that epidural stimulation, via an implant on the covering of the spinal cord, is a therapy that could change the lives of paralyzed people who were once told that they had no hope of recovery.
From a scientific point of view, Perez says, the studies also increase awareness about the need for scientists to work harder to understand how to better involve remaining nerve connections, even when an injury happened years ago.
Stephen Estes, PhD, a post-doctorate fellow and clinical research scientist at Shepherd Center, a nonprofit rehabilitation hospital in Atlanta, expressed cautious optimism about the new findings.
“It’s a very small sample size,” he says. “The next step is to do this in larger patient populations.”
He noted that it took over a year of intensive physical therapy for those who succeeded in stepping.
“From a rehab standpoint, and unfortunately from an insurance standpoint, having individuals get that in a normal setting is quite a hurdle; it’s a lot of time and a lot of resources.”
“It’s an important step, for sure,” he says. “But there’s always a risk of inflating it too quickly.”
Improved Quality of Life
According to the National Spinal Cord Injury Statistical Center at the University of Alabama in Birmingham, there are about 17,700 new spinal cord injuries every year, mostly caused by vehicle crashes, followed closely by falls.
The average age of injury has increased from 29 in the 1970s to 43 today, something Howley attributes to aging baby boomers.
Howley says that while the announcement focused on the ability of paraplegic people to walk, the more important findings have to do with the way any movement affects a paralyzed person’s quality of life.
“When we stand and bear weight we have better blood circulation, our skin is healthier and there are fewer chances for pressure sores, skin breakdowns and bladder infections,” she says.
Giving paralyzed people control over these functions improves their health and gives them more independence.
“Their injury is not destiny,” she says.
The importance of the research findings would not be lost on Christopher Reeve, who died in 2004 at the age of 52 from an infection caused by a bedsore. He had been a quadriplegic for the last 9 years of his life -- and always said he hoped to walk again.
“He would say: ‘I told you so,’ ” Howley says. “He really understood the capacity for science to deliver on its promises.”