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Kelly Thomas, 23, suffered a spinal cord injury that deprived her of the ability to walk in 2014. Now, thanks to experimental therapy, she can walk alone. (Kelly Thomas) (courtesy Kelly Thomas)
Kelly Thomas woke up in a Florida hospital four years ago without remembering the car accident that had made her lose the ability to walk. Thomas, an active student who rode barrels, moved to Kentucky for a year to try a research study that hoped to recycle her spine on how to walk.
In February, a trainer who was lying on Thomas's feet helped her move her legs and put her feet up while using a walker. She stopped and got up.
"What are you doing?" Thomas asked, alarmed.
"You do it," coach Rebekah Morton told him. "You do not need me."
Thomas hesitated, then took a step alone. Then another one. She froze.
"I tell myself that it just happened. I have been working hard for four years. I was moved, "said Thomas.
Thomas, now 23, is one of the people with spinal cord injuries who are standing, walking and – in her case – walking unassisted, thanks to combined experimental therapy. In a study conducted at the University of Louisville, Thomas and three other people had implanted a surgical device on their spinal cord to stimulate electrical activity, accompanied by months of daily physical therapy. in the New England Journal of Medicine, researchers at the University of Louisville reported that two of the subjects could stand up and take limited steps at the end of the study and that two were able to walk independently – Thomas and one other patient, Jeff Marquis. The research was supported by a charitable foundation, the University of Louisville Hospital and the Medtronic appliance manufacturer.
A simultaneous case report published in Nature Medicine reported that only one patient with a spinal cord injury at the Mayo Clinic was also able to take steps and walk with the help of A trainer in electrical stimulation and intensive physical therapy.
"The history of spinal cord injury research is that we have 50 years or more of mostly failed trials, with no positive results," said David Darrow, resident in neurosurgery at the Faculty of Medicine at the University of Toronto. 39, University of Minnesota. implant a stimulation device in people with spinal cord injuries. "It's kind of a new era."
Darrow said there were caveats regarding the most recent studies and a host of unanswered scientific and medical questions. It is still a small number of patients with varying lesions, so it is impossible to know how much intervention will occur in the wider population of people with spinal cord injuries. There are also a lot of questions about how the technique works, which will only be unraveled as an extended community of researchers begins to study this approach in a larger number of patients.
But the results are a powerful proof of concept, based on a surprising case report from the Louisville research team in 2011. The researchers took a medical device developed to manage chronic pain and implant it to stimulate the spinal cord of a paralyzed patient. After the re-education sessions, this patient learned to stand up and regain a voluntary control of his leg movements.
Susan Harkema, associate scientific director of the Kentucky Spinal Cord Injury Research Center at the University of Louisville, who has been the pioneer of the technique in humans, said the devices are implanted well below the site of the injury. This is not a case of patients who have connection problems in the spine. Instead, Harkema views these studies as heralding a gradual change in the way experts think about the spinal cord – as being able to learn new ways to walk, with the right combination of workout and electrical stimulation.
"The basis of this work is that the spinal circuit is sophisticated and has the same properties as the brain in many ways. As part of this study, what is actually demonstrated, is that he has the ability to relearn how to walk good conditions, "Harkema said.
Susan Harkema, left, associate scientific director of the Kentucky Spinal Cord Injury Research Center at the University of Louisville, with Kelly Thomas, who was paralyzed in a car accident and learning to walk with a trainer and an implanted device. (University of Louisville) (tom fougerousse)
The intervention is not like flipping a switch. First, the subjects in the study received about two months of intensive physical therapy and training to ensure that only the function would not be restored. After implanting the device, they began rigorous daily therapy, a team of therapists having begun to train their bodies and minds in the process. Thomas said that it was far from intuitive at first, as it would get clues like "toe" or "move your weight" or "pull your knee up".
She started walking with her right leg, on a treadmill, at her third session after the implant. Getting the left leg took longer.
"At first, it was extremely difficult," said Thomas. "I could not talk to anyone, I could not look at anyone – I was completely focused on my body. Now I can walk and talk, and it's not so difficult. It's still not easy and it's not entirely natural. "
Thomas was able to integrate his new abilities into his daily life after returning to Florida. She puts her walker in her car, brings the remote control that allows her to operate the stimulator, and goes alone to the library, restaurants and nails.
Researchers at the Mayo Clinic have seen similar results with their technique; a patient with a complete spinal cord injury was able to take action and walk with the help of the coach.
In both studies, patients needed the stimulator to walk, which eliminated the idea that it was spontaneous recovery. Steps could only be taken when people were trying to move their legs.
"The important point is that this technology can be able to restore functional control, stand up and take independent action. So, this really gives hope to people facing paralysis, "said Kendall Lee, a neurosurgeon at the Mayo Clinic.
The hope is that as these techniques begin to be tested in more places and in more patients, the demand will lead to improved technology and its adaptation to the intervention. . Researchers readily admit that they are not engineers and hope to see a stimulator developed with this application in mind, instead of finding new lenses for a standard device.
The technique should also be tried in more diverse people; the subjects in the study were in their twenties and early thirties, and their wounds had lasted two or three years. Many people with spinal cord injuries are older and more and more years have become paralyzed.
Darrow implanted the pacemaker in someone whose injury occurred 17 years ago, and the oldest subject in his study is in his late fifties. Darrow is interested in whether electrical stimulation has effects in itself, without re-education – on voluntary movement and on other health problems, such as low or uncontrolled blood pressure.
"I saw their work and found that it was really cool. The potential is huge, "said Darrow. "If we could get more effort in the area and get people with the skills to really change that area. . . you can make a lot of progress.
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