A new treatment has helped several paralyzed people walk.
The device has helped people like Kelly Thomas, who was paralyzed from the chest down, defy the odds.
Thomas, 24, is one of three paralyzed patients who can now walk again, thanks to a stimulation device implanted in her lower back coupled with intense physical therapy. News of the patients' progress — considered an important medical advancement — was published in separate studies in two scientific journals on Monday.
The surgically implanted device sends electrical impulses to Thomas' spine, mimicking the signals her brain used to send before the accident.
"I can walk into the library or into dinner with friends. It makes me feel normal again," Thomas said.
Transforming the spinal cord injury field Thomas is part of innovative research conducted at the Kentucky Spinal Cord Injury Research Center at the University of Louisville.
In a study published Monday in the New England Journal of Medicine, two of four patients with "motor complete spinal cord injury" — meaning no voluntary movement below their injury — were able to walk again after being implanted with a spinal cord stimulation device and then undergoing extensive physical therapy. They walk with the aid of walkers.
"This should change our thinking about people with paralysis," said Susan Harkema, one of the lead researchers on the project and a professor in the Department of Neurological Surgery at the University of Louisville. "It's phenomenal. This new knowledge is giving us the tools to develop new strategies and tools for recovery in people with chronic spinal injuries."
Claudia Angeli, the other lead researcher and a senior researcher at the Human Locomotion Research Center at Frazier Rehab Institute in Louisville, said it's a fascinating time to be involved in spinal cord research, bringing together decades of investigations culminating in modern-day breakthroughs.
"It just shows the capacity of the spinal cord and how much we're learning about using the epidural stimulation in combination with therapy," Angeli said.
Over the years, their research has involved 14 paralyzed people who have received what is called an epidural stimulator implanted over a portion of the lower spinal cord, enabling neurons below their injuries to receive signals similar to those the brain used to send before their accidents.
All 14 patients have experienced voluntarily movement with the implant, the researchers said. They also showed improvement in bowel and bladder function.
The latest study focused on four patients, including Thomas, who underwent therapy twice a day for five days a week for many months. A morning therapy session would involve working on stepping; an afternoon session would focus on standing. Thomas's therapy lasted 10 months after receiving the implant.
All four were able to stand independently, and two were able to walk over ground, the researchers said. One patient fractured his hip, setting his therapy back by several months, the researchers said.
The other patient who was able to walk had been paralyzed from his neck down with no ability to move his arms until he received the stimulator.
"With the stimulator off," Angeli said, "he can't even sit up."
Harkema and Angeli said they believe the positive results were the combination of the stimulation and improved physical therapy treatment.
Harkema underwent a federal investigation a couple years ago. Certain research activities were determined to be in violation of federal regulations, according to a letter from the Department of Health and Human Services in 2016. The letter states the University of Louisville took adequate corrective actions to address the noncompliance. Harkema says she stands by her work.
What's it like to see people who are paralyzed walk again?
"I draw inspiration from every person with a spinal cord injury who comes into this program," Harkema said. "They each have their own unique personalities and spirits. They are just pioneers."
Adding to the excitement of these advancements, another study published Monday in the journal Nature Medicine unveiled similar results. A man paralyzed since 2013 regained his ability to stand and walk with assistance due to spinal cord stimulation and physical therapy, according to research done in collaboration with the Mayo Clinic and the University of California, Los Angeles.
"What this is teaching us is that those networks of neurons below a spinal cord injury still can function after paralysis," Dr. Kendall Lee, the co-principal investigator and director of Mayo Clinic's Neural Engineering Laboratories, said in a press release.
There have been other cases in recent years in which paralyzed people have risen from their wheelchairs and walked. One study in 2015 and another in 2016 showed success in using rehabilitation combined with what is called "brain-computer interface," in which brain signals were sent to an electrical stimulator or exoskeleton resulting in the generation of muscle activity, allowing some patients to walk.
"They're different in terms of the way to activate the central nervous system, but the overall outcome is similar," said Monica Perez, a professor in the Department of Neurological Surgery with the Miami Project to Cure Paralysis at the University of Miami.
Monday's studies, Perez said, provide important additional evidence to the continued advances being made in the spinal cord injury field. She said it shows more proof that people with severe paralysis often have residual connections that "can be engaged in a functionally relevant manner — and that's amazing."
"What the studies demonstrate is that those connections in the central nervous system can still be recruited, even though you have an injury from years ago," said Perez, who was not connected to either study.
From a scientific point of view, she said, an important consequence of the studies is the awareness "that we need to work harder to understand how we can better involve those connections," she said. "These people with more severe paralysis are regaining this level of function — and that is beautiful. We also need more accurate assessments of our patients."
"It's not the first time an individual with severe clinically complete paralysis has walked with assistive technology without the help of a therapist," she said. "But it's tremendously important that in more cases the potential of these approaches can be demonstrated."
Harkema and Angeli, whose study was funded in part by the Christopher and Dana Reeve Foundation, said it's imperative for stakeholders to come together to fund more research to help as many of the 1.2 million people with paralysis as possible. More than 8,000 have expressed interest in being research participants in their program.
For Thomas, it's even more personal. She wants others with injuries as severe as hers to experience the transformation she's gone through.
"Nothing's going to be able to stop me in life, because I took something that was thought to be impossible, and I turned it into possible," she says.
Source : https://www.wesh.com/article/amazing-treatment-helps-paralyzed-people-walk-again/23459828