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Epidural Stimulation Study Allows Three More Paralyzed People to Take Steps

In September, a breakthough in epidural stimulation research made global headlines.  The New England Journal of Medicine published work from The Spinal Cord Injury Research Center at the University of Louisville, which announced that four paralyzed people regained the ability to walk after being implanted with a stimulation device and undergoing months of physical training.
Now, a new study published in Nature and Nature Neuroscience has revealed similar results in three more spinal cord injured subjects.
Epidural stimulation involves surgery that implants a set of electrodes directly on to a person’s injured spinal cord.  A power pack is also implanted underneath the person’s skin.  When the device is turned on, the spinal cord is stimulated and messages are sent to the body that bypass the injury.  (Above photo credit: The Guardian)
Dr. Susan Harkema, Director of the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN), was first behind epidural stimulation 8 years ago that restored function in multiple people with motor complete spinal cord injury.   Over the last several years her research has expanded and major milestones have been met.  First, epidural stimulation provided the ability to stand.  Then, bits of voluntary and task-specific movement were discovered.   Finally, unassisted STEPS took place.
All of these successes were performed in labs, and were combined with an incredible amount of time and repetition, but the results are fascinating, and the knowledge is still in its infancy.
NeuroHope joined the Reeve Foundation NRN earlier this year.  As a result, we are now one of a select number of sites in the world that is using what has been discovered about the unique electrical parameters in the implants, and investigating if it can be translated to Neuromuscular Electrical Stimulation (NMES) over the skin.  NMES is similar to Functional Electrical Stimulation (FES), but uses pre-programmed, task specific activities set at exclusive FDA-approved parameters that are aimed at targeting both the muscle and the circuitry of the spinal cord itself.
It is not yet known if NMES has the ability to promote neurorecovery, but we are proud to begin data collection for the NRN and thankful for the opportunity to offer it in a plan of care for our clients.

Breakthrough in SCI Research Restores Movement – NeuroHope Partners with the NRN

An announcement at Frazier Rehabilitation Institute is sending shockwaves through the spinal cord injury community.  Andrew Meas, a 32-year old man who sustained a complete spinal cord injury in a motorcycle crash in 2006 is showing the world he can voluntarily move his legs.  It is the culmination of a 44-month long research project involving electrical stimulation and extensive therapy led by Dr. Susan Harkema, Director of the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN).

In 2018 NeuroHope of Indiana will become a proud member of the NRN, and 1 of 11 sites in the world collecting data its data.

In 2012, Meas was one of four individuals that Harkema and her team implanted with an electronic device. A stimulator was placed directly on his spinal cord that sent signals straight to his central nervous system. The researchers called it epidural stimulation, and the results made global headlines in 2014. They found that when the stimulation was turned on, VOLUNTARY movement occurred in all four individuals – a totally unexpected result.

In the three years since, Meas has been participating in aggressive rehabilitation and further research using a combination of stimulation from his implanted device and high-speed treadmill training. All of which led to the exciting announcement that after years of training, VOLUNTARY movement has occurred even with the stimulation device turned OFF!

Read the article in Newsweek here, and the official study here.

Dr. Harkema and Andrew Meas talk about the findings in the video below:

Dr. Harkema’s work is based on the physiology of the spinal cord and its capacity to “remember” and recover. She has brought her ideas to the Reeve Foundation NeuroRecovery Network (NRN), a collaboration of rehabilitation centers that focus on exploring the treatment of neurologic injury through activity-based therapies – a very specific form of task-specific interventions below the injury level.

In 2018, NeuroHope will become the 11th NRN affiliate in the world, and one of only 4 independent sites outside of a major rehabilitation hospital system. NRN sites continue to build upon Dr. Harkema’s work in electrical stimulation by exclusively incorporating Neuromuscular Electrical Stimulation (NMES) into some treatment plans. NMES is non-invasive stimulation that uses electrodes on the skin at exclusive parameters to target the central nervous system.

In the coming months NeuroHope staff will be trained directly by Dr. Harkema and her team in the activity-based interventions the NRN performs. We will be sending data to the NRN, as well as collecting outcome and patient satisfaction measures with a researchers from the University of Indianapolis.

The success of the epidural stimulation implant in Andrew Meas and the work of the NRN provides new knowledge and a new diving off point for future discoveries in treating – and someday curing – spinal cord injury. It is an exciting time for neurologic research, and we are honored to be a part of it!

NeuroHope at the NeuroRecovery Network Summit

The NeuroRecovery Network (NRN) held its annual summit at Frazier Rehabilitation Institute in Louisville, Kentucky last week.  NeuroHope is laying the groundwork to join the network later this year, and our staff was invited to attend and learn about the innovative therapy interventions that are being researched and implemented at NRN sites across the country and overseas.

The NRN is a collaboration of clinical sites tied to rehabilitation hospitals (Craig Hospital, Frazier Rehab Institute, Kessler Institute for Rehabilitation, Magee Rehabilitation Hospital, Ohio State University Medical Center) and independent sites aimed to continue aggressive therapy and wellness for patients after they leave the hospital system (Next Step, Courage Kenny, Journey Forward, NeuroKinex).

The inspiration to begin this unique network of sites began through the work of Dr. Susan Harkema and Dr. Andrea Behrman, whose research led to a better understanding of neuroplasticity, which is the ability of nerve cells in the central nervous system to develop new connections and learn new functions.  Their work provided new evidence about the role the spinal cord plays in stepping, standing, and interpreting sensory information to re-learn tasks.

The Christopher and Dana Reeve Foundation (CDRF) helped fund the original research, and in the years since, the Foundation has been devoted to translating results to the clinic to help patients recovering from and living with spinal cord injury.

The NRN revolves around providing Activity-based therapy, a specific technique that activates the nervous system below the injury level and focuses on strengthening muscle weakness and neurologic recovery.  In addition to specific manual techniques, a principle Activity-based intervention is Locomotor Training.  Locomotor Training allows injured individuals to repetitively practice standing and stepping using body weight support.  In a therapy session, the participant is suspended in a harness over a treadmill at a high speed while specially trained therapists move the legs and ankles using specific sensory cues to simulate walking.  As the person gains function, improvements in sitting, standing, core strength, circulation, and bone-density may occur.

Dr. Harkema is also a pioneer in implementing epidural stimulation in her work, which made global headlines in 2011 and 2014 for restoring movement in four spinal cord injured individuals.  Since then, the NRN has incorporated new methods of NeuroMuscular Electrical Stimulation (NMES) at their sites to target upper extremity function, increase movement, and improve neuroplasticity.  NMES uses parameters beyond typical electrical stimulation to excite the central nervous system and activate weakened muscles.

Drs. Harkema and Behrman delivered lectures at this year’s summit and worked with NRN staff members from sites around the country as they practiced evaluation and activity-based therapy techniques.

We were honored to be invited to the summit and learn from some of the best minds in the world of neuroscience.  NeuroHope will soon be one of just 13 sites in the world where these innovative techniques are available.

Learn more about the NRN below:

 

 

 

 

As SCI Research Advances, Therapy Must Be Accessible

It’s an exciting time for spinal cord injury (SCI) science and research.

The last 12 months have seen breakthroughs in laboratories and therapy gyms around country, and have led to papers published in some of the most reputable publications in the world. SCI foundations and medical organizations are aggressively pursing funds to finance research they hope may bring them closer to the cure for paralysis.  Directly linked to that cure, should it ever come, will be the need for an incredible amount of rehabilitative therapy.   Long-term therapy that, in the current health care system, is nearly impossible to receive.

To be clear, the “cure” for paralysis is not around the corner.  The scientific community is nowhere close.   Strides are being made however, in discovering some of ways the nervous system works.  Scientists and doctors are embracing neuroplasticity, the concept that the nervous system is not necessarily irreparable, but in some cases can “learn” to retrain itself over extended periods of time. 

Right now, scientists are witnessing long-distance axon growth (transmission lines of the nervous system) in SCI models.  They’re studying the transplant of neural stem cells into SCI patients.  They’re even investigating ways to use technology to route signals from the brain past injury levels.

And, in April, researchers from the University of Louisville and UCLA announced the biggest news of all.  In a study that made headlines worldwide, four men who had been paralyzed for years (pictured above) shocked their own scientists when they re-gained bits of voluntary movement as a result of epidural stimulation of the spinal cord.  Each man had a stimulator surgically implanted in his spinal cord, that when turned on, mimics signals from the brain.  Movement was expected.  Electricity stimulates the cord, which stimulates the muscle.  Voluntary movement, however, was what shocked the world.   With the device turned on, all four were able to move muscles in their hips, ankles, and toes on command.

As exciting as these breakthroughs are for the SCI community, they still don’t represent a “cure”.  The four men only experience movement when the stimulation device is turned on, and that movement is minimal.   Much more research is needed, and the study resulted in more questions than answers, but it is without question the start of something exciting in the field.

But, lost in the headlines of the results, is the time, preparation, and access to therapy that the four men needed to be eligible for the procedure and for the procedure to be successful.

These are not four guys plucked out of their chairs 3 years post injury. All four had been participating in unique and aggressive wellness programs at facilities in the Christopher and Dana Reeve Foundation NeuroRecovery Network. 

DustinCrop2Dustin Shillcox is one of them.  I met Dustin shortly after his spinal cord injury, two  years before he was selected to be one of the fortunate four in the study.  Dustin and I were both injured in 2010.  Like myself, he attended Neuroworx in Utah, one of the few places in the country where aggressive, long-term therapy is accessible after injury. Dustin and I rehabbed together at Neuroworx nearly every day for the better part of 2011 and 2012.  And, we both participated in the 2012 Kentucky Derby Mini-Marathon by walking / rolling segments of the race with the Reeve Foundation.

Dustin, and the other three individuals selected, had to meet specific criteria (injury level, motor complete, time after injury, etc.) to be eligible for the study.  Once selected, they were also required to participate in 80 Locomotor Training sessions before the procedure.   Eighty sessions! Just to prepare.

After the devices were implanted in their spinal cords, therapy ramped up.  For more than a year, daily sessions lasting for hours were underway.  Different areas of their legs and core were alternately stimulated.  Voltage and intensity changed.  Controlled movement and standing was practiced.  A myriad of tests and exercises were repeated over and over again.  In time, with the stimulation turned on, movement and endurance improved.DustinLiftingLeg

When the results hit the media last spring, most spinal cord injured people had the same thought: “How do I get that implant?!”

But, in spite of what it may sound like, this study and the results were never about a “cure”.  It was, and continues to be, experimental research exploring how the nervous system works. It won’t be anytime soon, but maybe someday implanting electrodes into the spinal cord will be a part of the rehabilitation process.   That sounds promising – but there’s a glaring problem.

Remember that Dustin had to take part in 80 intense therapy sessions before the procedure, and continued daily visits after the procedure for more than a year. To put it in perspective, most SCI patients receive a grand total of 30 outpatient physical therapy visits per year  – if they’re lucky.   Therein lies the problem. 

Even if epidural stimulation, or any other neurologic breakthrough, advances to a point it becomes commonplace, a complete change in the policy of outpatient therapy needs to take effect.

Maybe advances in stem cell research will continue, and methods to safely re-grow neurons will be discovered.  Maybe technology will advance to the point signals from the brain can be routed straight to the extremities. 

Even if a magic wand made a cure available tomorrow, long-term rehabilitation programs would need to be available for there to be a benefit.

Right now those programs do not exist in most communities.   

Fortunately, a paradigm shift is coming.  There are a handful of facilities around the country that understand the need for long-term rehabilitation and wellness for individuals with neurologic injury.  

NeuroHope is creating one in Indiana. 

Not only so programs are in place for discoveries in the future, but so programs are in place for those that need it now. That’s our mission.  With your help we will get there.

Learn more about epidural stimulation, and other SCI research here.

Photo courtesy: Christopher & Dana Reeve Foundation, Esquire.com