Paralyzed patients take the first steps after implantation, intense re-education

Three people whose legs have been paralyzed for years can get up and take action with an electric implant that zaps the injured spinal cord, as well as months of intense rehabilitation, researchers said Monday.

This step, reported by two teams of scientists working separately, is not a cure. Patients only walk with help – standing at a walker or with other help to keep their balance. Turn off the spinal stimulator and they can not move their legs voluntarily.

But during a physiotherapy session at the Mayo Clinic, 29-year-old Jered Chinnock made enough rounds to cover the length of a football field.

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"The side of the walk is not something where I leave my wheelchair behind me," said Chinnock, of Tomah, Wisconsin, at the Associated Press. But, "there is the optimistic side of, maybe I'll win, where I can leave the wheelchair behind, even if it's for walking up to the fridge".

The work is part of a quest to help people with spinal cord injuries return to their jobs, and experts say that even though it has only been attempted in a few people, it is not easy to find a job. is a promising approach that requires more studies.

"I'm really excited about this," said Dr. Cristina Sadowsky, a rehabilitation expert at Johns Hopkins University, who was not involved in the new research. He drew on "residual connections that are not used" after a spinal cord injury.

Still, "everyone who has a similar injury will not respond in the same way," warned Sadowsky, who heads the spinal cord treatment at the Baltimore Kennedy Krieger Institute.

Serious spinal cord injury leaves the brain's instructions "move" unable to reach the nerves that activate the muscles. Researchers have tried other technologies, such as wrapping patients in robotic exoskeletons or implanting muscle stimulators, to help move paralyzed limbs.

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According to the new approach, the three patients are taking action on their own – intentionally moving, according to reports released Monday by Nature Medicine and the New England Journal of Medicine.

How it works? One theory: the nerve circuits below the site of the lesion are dormant, but still alive. The application of an electric current, in custom models, could awaken some of these circuits and, with careful rehabilitation to revive rusty connections, eventually allow them to receive simple commands.

"Recovery can happen if you have the right circumstances," said Susan Harkema, a professor at the University of Louisville and co-author of the New England Journal study. The spinal cord "is learning to do things, less well than before, but it can work".

"This study gives hope to people facing paralysis that functional control is possible," said Dr. Kendall Lee, a Mayo neurosurgeon who treated Chinnock and co-authored the Nature Medicine report.

Four years ago, the Harkema team made headlines when a few patients implanted with spinal stimulators – originally developed to treat pain – were able to move their toes, move their legs and stand briefly. But they did not work.

Lee and Kristin Zhao, who runs Mayo's Food and Beverage Lab, decided to repeat the experiment – and the success of Chinnock surprised them.

He had been paralyzed in a snowmobile accident in 2013, with no movement or sensation below his mid back. He underwent 43 weeks of intense physical therapy and stimulator adjustments. At first, trainers positioned their knees and hips to help them stand up, swing their legs and move their weight on a treadmill.

But finally, looking in a mirror, he learned to move his legs and propel himself with a walker, although with a trainer back in case he lost his balance.

He can tell his therapists when he will start, stop or speed up, Zhao said, "It is a thoughtful and intentional movement."

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Meanwhile, in Louisville, the Harkema team was working with four other paralyzed volunteers eager to test the approach – and this time, two of them finally walked with help . During a laboratory training session, Jeff Marquis, 35, of Louisville, almost reached the length of a football field without stopping to rest.

"One day we walked and they helped me as usual, then they stopped helping me and I followed three or four successive steps," said Kelly Thomas, 23 years old, from Lecanto, Florida. "My eyes started crying and I thought," Oh my god, it just happened, I just took steps. "

It is unclear why the other two participants in Louisville, Kentucky, were unable to take independent action. But this report illustrates an important warning about safety: a hip fracture during a re-education treadmill exercise, even if it was supported and straight. The approach will require longer and longer studies, not only to see if it can help other patients, but also to determine the risks. It is also not known how much it would cost because researchers are working to improve pacemakers.