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Electrical implant puts people back on their feet
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Three people whose legs were paralyzed for years can stand and take steps again thanks to an electrical implant that zaps the injured spinal cord 鈥 along with months of intense rehab, researchers reported this week.
The milestone, reported by two teams of scientists working separately, isn鈥檛 a cure. The patients walk only with assistance 鈥 holding onto a rolling walker or with other help to keep their balance. Switch off the spinal stimulator and they no longer can voluntarily move their legs.
But during one physical therapy session at the Mayo Clinic, 29-year-old Jered Chinnock moved back and forth enough to cover about the length of a football field.
鈥淭he walking side of it isn鈥檛 something where I just leave my wheelchair behind and away I go,鈥 said Chinnock, of Tomah, Wisconsin.
But, 鈥渢here is the hopeful side of, maybe I鈥檒l gain that 鈥 where I can leave the wheelchair behind, even if it is to walk to the refrigerator.鈥
The work is part of a quest to help people with spinal cord injuries regain function, and specialists say while it鈥檚 only been attempted in a few people, it鈥檚 a promising approach that needs more study.
鈥淚鈥檓 really excited about this,鈥 said Johns Hopkins University rehabilitation expert Dr Cristina Sadowsky, who wasn鈥檛 involved in the new research.
It tapped into 鈥渞esidual connections that are not being used鈥 after a spinal cord injury.
Still, 鈥渘ot everybody who has a similar injury will respond the same,鈥 cautioned Sadowsky, who directs spinal cord therapy at Baltimore鈥檚 Kennedy Krieger Institute.
Severe spinal cord injuries leave the brain鈥檚 鈥済et moving鈥 instructions unable to reach the nerves that activate muscles. Researchers have tried other technologies, such as encasing patients in robotic-like exoskeletons or implanting muscle stimulators, to help move paralyzed limbs.
With the new approach, the three patients are taking steps under their own power 鈥 intentionally moving, according to the reports published on Monday by Nature Medicine and the New England Journal of Medicine.
How does it work? One theory: Circuits of nerves below the injury site are dormant, but still living. Applying electrical current in customized patterns could wake up some of those circuits and, with rigorous rehab to revive the rusty connections, eventually enable them to receive simple commands.
鈥淩ecovery can happen if you have the right circumstances,鈥 said University of Louisville professor Susan Harkema, who co-authored the New England Journal study. The spinal cord 鈥渞elearns to do things, not as well as it did before, but it can function.鈥
鈥淭his study gives hope to people who are faced with paralysis that functional control may be possible,鈥 said Dr Kendall Lee, a Mayo neurosurgeon who treated Chinnock and co-authored the Nature Medicine report.
Four years ago, Harkema鈥檚 team made headlines when a few patients implanted with spinal stimulators 鈥 originally developed to treat pain 鈥 were able to wiggle their toes, move their legs and briefly stand. But they didn鈥檛 walk.
Lee and Kristin Zhao, who directs Mayo鈥檚 assistive and restorative laboratory, decided to repeat the experiment 鈥 and Chinnock鈥檚 success surprised them.
He鈥檇 been paralyzed in a 2013 snowmobile accident, with no movement or sensation below his mid-back. He underwent 43 weeks of intense physical therapy and stimulator adjustments. At first, trainers positioned his knees and hips to help him stand, swing his legs and shift his weight on a treadmill.
But eventually, watching in a mirror, he learned to move his legs and propel himself forward with a walker, albeit with a trainer behind in case he loses his balance.
He can tell his therapists when he鈥檚 going to start, stop or speed up, Zhao said: 鈥淚t鈥檚 very much a thoughtful, intentional movement.鈥
Meanwhile in Louisville, Harkema鈥檚 team was working with four more paralyzed volunteers eager to test the approach 鈥 and this time, two eventually walked with assistance. In one training session in the lab, Jeff Marquis, 35, of Louisville made it almost the length of a football field without stopping for a rest.
鈥淥ne day we were walking and they were helping me as usual and then they stopped helping me and I took maybe three or four steps in sequence,鈥 Kelly Thomas, 23, of Lecanto, Florida, recalled in a video provided by Louisville researchers. 鈥淢y eyes got teary and I was like, 鈥極h my god, that just happened, I just took steps.鈥欌
It鈥檚 not clear why the other two Louisville, Kentucky participants weren鈥檛 able to take independent steps. But that report illustrates an important caution about safety: One fractured a hip during a rehab treadmill exercise even while carefully supported and upright.
The approach will need larger and longer studies not just to see if it can help other patients but to delineate risks. It鈥檚 also not known how much such care would cost, as researchers work to improve the stimulators.
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