In September, results were published showing how three of five paralysed spinal cord injury patients that underwent revolutionary new treatment involving electrode stimulus were able to walk again with minimal assistance. The breakthrough, achieved by doctors in Kentucky, U.S.A, involves electrical stimulation of the area of the spinal cord that has lost contact with the brain, combined with an intense course of physio therapy.
While not a miracle cure, and ineffective in cases where the spinal cord has been completely severed, the development does offer new hope for the millions of paraplegics around the world who have lost their ability to walk following a serious spinal injury.
The findings, published in the New England Journal of Medicine, involved two separate teams of scientists. Co-author Dr Claudia Angeli of the Kentucky Spinal Cord Injury Research Centre, which is hosted by the University of Louisville, is hopeful that the new technology, termed epidural stimulation, will mean millions of patients who have been told they will not walk again may defy those expectations.
The treatment involves an implant of a device made up of 16 electrodes being inserted into the lower back below the injury between a bone in the spine and the spinal cord. While patients, with the help of a supporting harness, are exercised on a treadmill by physiotherapists moving legs and feet in a walking motion, the electrodes send pulses stimulating the remaining nerves. This, it appears, allows them to hear the ‘faint’ signals still reaching them through the brain.
The nerve system in the spinal cord actually controls most of functions related to movement of the legs and feet and requires minimal input from the brain. Stimulating these nerves via electrodes during assisted walking activity allows them to interpret the faintest of command whispers from the brain and act on them, controlling the legs, feet and trunk stability. Unfortunately, patients still have issues with balance as this comes from the brain. But with some support such as walking sticks or assistance from another person, 2 of the four Kentucky patients, who had not been able to walk for at least 2.5 years, were able to following months of sessions. The fifth patient the treatment has worked for was part of a separate research project carried out by a combined team from Minnesota’s Mayo clinic and UCLA.
The electrode implant is not even the latest technology in the world but simply an adaptation of a device originally made to help with pain relief. The next step for researchers will be to transition the treatment from a continuous pulse to the electrodes to one that is only activated when the brain sends the signal that the person wishes to move their legs.
In a separate branch of research around spinal cord injuries, biotech rather than tech is the preferred approach. The Nicholls Spinal Injury Foundation is supporting research into a technique that combines the transplant of nerve cells from a patient’s nose with nerve fibres. It is showing promise and it is hoped will offer a ‘natural’ and permanent alternative for spinal cord injury patients.