Over the past few days, there has been a worldwide buzz about the latest advances in spinal cord injury research. Last Monday’s Washington Post headline is a good example — “Paralyzed people are beginning to walk with a new kind of therapy.”
A majority of the press focuses on Kelly Thomas, who sustained a spinal cord injury in 2014 ad is now walking on her own, using only a walker for balance.
When you mention the word “walk” in combination with “paralysis”, the press takes notice. And this is exciting news, albeit more of an update on a combination of two therapies that have been around for quite a while — “activity-based therapy,” which includes things like locomotor training (hanging above a treadmill while therapists move a person’s feet to simulate walking), combined with “epistim” (implanting an electrical stimulation device near the site of the injury).
Contrary to descriptions in the mainstream media, it is rare for a spinal cord to be severed, as a majority of SCI is caused by trauma that kills the spinal cord circuits. However, the new understanding is that many people with SCI, even complete injuries, still have some functioning nerve pathways — but information can’t get through the mangled injury site. One researcher, who has studied countless high-resolution MRIs of spinal cord injuries, estimates that 70 percent of people with SCI still have 30 percent of their spinal cord connections left intact.
The theory of how these therapies work is that if the spinal cord isn’t making muscles walk on a regular basis, it forgets how, but it has the ability to re-learn. Activity-based rehab retrains the spinal cord how to walk and this excites the nerves — think ‘turns up the volume.’ The more repetitive the activity, the higher the volume.
For subjects with electrical stimulation implants to be successful, they first have to go through many months of activity-based rehab, and then the implant seems to act as a hearing aid to pump up that volume. Research shows just adding a stimulator without a great deal of rehab doesn’t do the trick.
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