[ad_1]
Kelly Thomas woke up in a Florida hospital four years ago without remembering the car accident that had stolen her the ability to walk. Thomas, an active student who had run in rodeos, moved to Kentucky for a year to try a research study that she hoped would allow her to retrain.
In February, a trainer walking on the ground at Thomas' feet, helping her move her legs and position herself as she used a walker, stopped and got up.
"What are you doing?" Thomas asked, alarmed.
"You do it," said coach Rebekah Morton. "You do not need me."
Thomas hesitated, then took a step alone. Then another one. She froze.
"I'm like," It just happened. "I've been working for four years so hard that I'm moved," recalls Thomas.
Thomas, now 23 years old, is one of many people with spinal injuries who is standing, taking steps and – in his case – walking without assistance, thanks to a combined experimental therapy. In a research study at the University of Louisville, Thomas and three other people had a device implanted surgically on the spinal cord to stimulate electrical activity, accompanied by several months of daily physical therapy. In the New England Journal of Medicine, researchers at the University of Louisville announced 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 in ways Autonomous: Thomas and another patient, Jeff Marquis.
A case report published simultaneously in Nature Medicine indicated that only one patient with a complete spinal cord injury at the Mayo Clinic was also able to take steps and walk with the help of a trainer with electrostimulation and therapy. intensive physics.
"The story of spinal cord injury research is that we have 50 years or more of trials having virtually failed, with no positive outcome," said David Darrow, neurosurgery resident at the Faculty of Medicine's Department of Medicine. University of Minnesota, which also implant a pacemaker in people with spinal cord injuries. "It's a kind of new era."
Darrow said the latest studies were subject to reservations, as well as many unanswered scientific and medical questions. It is still only a small number of patients, with varying injuries, so it is impossible to know if the intervention will work well in the broader population of people with spinal cord injuries. There are also many questions about the operation of the technique, which will be unraveled only by an extended community of researchers who will begin to study the approach with a larger number of patients.
The findings constitute a convincing proof of concept, based on a surprising case report written by the Louisville research team in 2011. The researchers designed a medical device designed to manage chronic pain and implanted it. to stimulate the spinal cord of a paralyzed patient. After re-education sessions, this patient learned to stand up and regain some voluntary control of his leg movements.
Susan Harkema, Associate Scientific Director of the Kentucky Spinal Cord Injury Research Center at the University of Louisville, a pioneer in human technique, said the devices are implanted well below the site of the lesion. This is not a case of patients who reconnect with a cut connection in the spine. For Harkema, these studies herald instead a gradual change in the way experts view the spinal cord – as being able to learn new ways of walking, with the right combination of training and electrical stimulation.
"The basis of this work is that spinal circuits are sophisticated and really have the same properties as the brain in many ways, and in the context of this study, what is shown is really that it has the ability to relearn to walk basically in the right conditions, "said Harkema.
The intervention is not like flipping a switch. First, the subjects in the study benefited from about two months of intensive physiotherapy and training, to make sure that only their function would not be restored. Once the device was implanted, they began a rigorous daily treatment, while a team of therapists began to train their body and mind in the process. Thomas said that it was far from intuitive at first because it would have clues such as "raised foot" or "move your weight" or "lifts your knee".
She started walking with her right leg on a treadmill during her third session after the implant. Getting the left leg took longer.
"It was extremely, extremely difficult at first," Thomas said. "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. still not easy, and it's not completely natural. "
Thomas was able to integrate his new abilities into his daily life after his return to Florida. She puts her walker in her sedan, brings the remote control that allows her to operate the stimulator and goes alone to the library, the restaurant and gets her nails done.
Researchers at the Mayo Clinic have achieved similar results with their technique. a patient with a complete spinal cord injury could take steps and walk with the help of a trainer.
In both studies, patients needed the stimulator to walk, which made it possible to dismiss the idea that it was a spontaneous recovery. Steps could only be done when people were trying to move their legs.
"The important point is that this technology can help regain functional control, take a stand, and take independent action, so it gives hope to people with paralysis," said Kendall Lee, a neurosurgeon at the Mayo Clinic.
The hope is that as these techniques begin to be tested in more and more places and patients, the demand will lead to improved technology and its adaptation to l & # 39; action. Researchers readily admit that they are not engineers and hope to see a stimulator developed with this application in mind, instead of finding new uses for a ready-to-use 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 injuries occurred two or three years ago. Many people with spinal cord injuries are elderly and many years have passed since their paralysis.
Darrow implanted the pacemaker in someone whose injury occurred 17 years ago, and the oldest subject in his current study is about 50 years old. He is interested in whether electrical stimulation has effects in itself, without rehab, on voluntary movements and on other health problems, such as low or uncontrolled blood pressure.
"I saw their work and found that it was really cool.There is just a huge potential," said Darrow. "If we could get more effort in the field and get people with the skills to really change that area … you can make a lot of progress."
Source link
