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Walking Again

Reprinted from PN January 2019

A University of Louisville study using a combination of therapies is helping people with SCI relearn how to move

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Walking again years after sustaining a complete spinal-cord injury (SCI) is starting to become a reality for some research participants at the Kentucky Spinal Cord Injury Research Center. 

A recent study funded by the Leona M. and Harry B. Helmsley Charitable Trust, University of Louisville Hospital and Medtronic PLC, was published in last September’s issue of The New England Journal of Medicine. The study enabled all four participants to stand independently and helped two be able to walk again. All participants were diagnosed with traumatic, motor complete SCIs, meaning no voluntary movement below their injury, were at least two and a half years post-injury and couldn’t stand, walk or voluntarily move their legs prior to the study. 

“The spinal cord is a sophisticated circuit, and those circuits are still healthy and they have the capacity to function,” says Susan Harkema, PhD, professor and associate director of the Kentucky Spinal Cord Injury Research Center at the University of Louisville. “The way we think about being completely paralyzed needs to be thought about differently. People aren’t completely paralyzed. There are still anatomical connections, and if we take advantage of these anatomical connections, if we train people in the right way, in the right conditions, even years after injury, we can get a significant level of recovery. And the way that this works is that we understand now how sophisticated the spinal-cord circuitry is, that it can function like the brain does, but it’s the primary controller of movement and that, in the right conditions, it can relearn how to move again.”

Have Patience 

There were three main study components — the stimulator, locomotor training and mental intention. An epidural stimulator surgically attached to participants’  lower spine applied a continuous electrical current at varying frequencies and intensities. Daily locomotor training involved being strapped into a harness while trainers moved participants’ legs in a step-like pattern on a treadmill. Mental intention requires participants to actively think about each movement their body needs to perform to walk, such as flexing, stabilizing and extending specific muscles. 


“What we had discovered was that these people that we thought were completely paralyzed, when we had the stimulator on, they could think about wiggling their toes or moving their ankles or legs and then could voluntarily move their legs,” Harkema says. “What we realize is when the spinal cord is in this excited state, an intense signal can get across and the spinal cord can interpret that. And if we are able to time that with the right stimulation and this practice of walking and then thinking about walking, enough times over and over again, that’s how we got successful walking.”

One participant was Kelly Thomas, 23, a Citrus County, Fla., native, who enjoyed riding horses, raising show cattle and helping her dad on their ranch. Thomas became paralyzed from the chest down after a car accident left her with a C7/T1 SCI.

She applied for the study in 2016 and completed extensive testing in January 2017 before being accepted as a participant in March 2017. For the next three months, Thomas attended therapy sessions twice a day, five days a week that included an hour of standing and an hour of locomotor treadmill training. Her epidural stimulator was implanted later that year in September.

“The very first day we turned the stimulator on was a major shock,” Thomas says. “I felt this tingling vibration running through my abdomen and legs. It was like I was a giant cellphone on vibrate. That first day, I felt the tingling of the stimulation and muscle soreness. I had tears in my eyes later that day because I hadn’t felt muscle pain since my accident. I noticed all kinds of changes and improvements in my body. I was able to step, stand, feel muscle contractions, feel soreness. My circulation improved, my ability to heal improved, I had better bladder control, less neuro pain … the list goes on.”

After three therapy sessions, Thomas could step independently with her right leg on the treadmill. She has the greatest increase in physical abilities from the study that Harkema has seen so far. Thomas can independently use a walker across various terrain. 

“I compare this study to military training,” Thomas says. “You have to be dedicated, resilient and physically and mentally strong. There are days I wanted to give up but knowing the benefits and the potential outcomes kept me driven. It is not a quick fix to being paralyzed. You have to work with the stimulator and have patience. The changes and improvements are different for everyone, but overall it definitely enhances quality of life.”

For more information on the research or to sign up to participate in a study, visit victoryoverparalysis.org.

 

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