Learning to walk again!

Three patients with paraplegia participating in a clinical study in Switzerland regained muscle movement that they lost many years ago. Could their first steps towards uninhibited mobility result in a cure for spinal cord injuries?

Losing your ability to walk is one of the most difficult things to accept and overcome. It’s no surprise then that evidence of research into treatment for people with a spinal cord injury (SCI) dates back to ancient times. Today, scientists and medical professionals continue to be urged on by those with visions of regaining the independence they once took for granted.

Unfortunately, until now, SCI research and clinical trials have yielded limited success. Accordingly, the focus instead has been on rehabilitation and maintaining the limited mobility that remains after an SCI.

However, the tide is turning and preliminary results obtained from a number of ongoing clinical trials suggest that we may be getting closer to what can be considered true recovery. The most recent studies attempted to promote the regeneration of nerve cells or improve the function of nerves that remain after an SCI.

It must be said that while the results are encouraging, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development in the United States, there is still no cure for (chronic) SCI.

Restoring mobility

The progress being made by scientists should not be underestimated, however. This includes a clinical study in Switzerland in which a group of spinal cord research scientists, funded by the Wings for Life Foundation, have made a breakthrough. The study has reportedly resulted in the restoration of three study participants’ ability to control their muscles below the level of injury.

The study involved a new form of rehabilitation for incomplete SCI patients called stimulation movement overground (STIMO). It combines two different types of treatment: precise epidural electrical stimulation (EES) of the spinal cord and robot-assisted locomotion (walking) training.

EES is the application of an electrical current to the spinal cord. Stimulation is created through an electrode chip that is implanted over the dura (the protective coating of the spinal cord).

Robot-assisted locomotion, on the other hand, enables patients to move freely within a room during their rehabilitation process.

The system provides optimal body weight support, which can be adjusted to the respective patient’s abilities, while ensuring safety by preventing falls.

How it works

Stimulation is administered during rehabilitation training to facilitate movement and enhance reorganisation of nerve circuits. Although scientists do not yet fully understand the mechanism, the stimulation seems to “awaken” the dormant spinal tissue below the level of injury, relays the Wings for Life Foundation.

Professor Jocelyne Bloch, the head neurosurgeon involved in the study, explains: “We implant an array of electrodes over the spinal cord that allows us to target individual muscle groups in the legs. Selected configurations of electrodes activate specific regions of the spinal cord, mimicking the signals that the brain would deliver to produce walking.”

The challenge for the patients is to learn to coordinate their brain’s intention to walk with the targeted electrical stimulation. Fortunately, participants of the STIMO study did not take long to master this skill. “When all the patients could walk using body-weight support within one week I knew immediately that we were on the right path,” says Bloch.

Furthermore, improvement of voluntary muscle control in participants was reported to be significant after five months of training.

The use of targeted neurotechnology has enabled three participants to train their natural walking capabilities actively in the rehabilitation lab for long periods of time, rather than doing passive training, like exoskeleton-assisted stepping.

Revitalising hope

What’s truly exciting is the potential to reverse the damage done by an SCI. This is evidenced by the fact that all three patients involved in the study are able to move their once-paralysed muscles even when the stimulator is turned off.

Study participant Gert-Jan Oskam was told after a traffic accident in 2011 that he’d never be able to walk again. “Now I can walk short distances with the help of electrical stimulation and crutches,” he says. “I should be able to enjoy a barbeque standing on my own in the near future.”

Sebastian Tobler had an SCI so severe that doctors had no walking-rehabilitation programme to offer him. “Electrical stimulation has given me the opportunity to train. It gets my blood flowing and – more excitingly – gets me out in the forest. It’s good for the mind, and it’s good for the body too,” he says.

After seven years living with an incomplete SCI, David Mzee took his first shaky but voluntary steps. “It’s an amazing feeling,” he says. “Let’s see how far we can go with this technology.”

Following many years of limited success but sustained learning, current clinical trials are beginning to deliver results not thought possible only a decade or two ago. Today there is growing hope that the dedication of doctors and research partners will result in some major breakthroughs in the treatment of SCI in the not-too-distant future. And who knows? Maybe there will be no more spinal cord injuries.

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