In SCI Research

“If it was just about the walking, spinal cord injury would be easy.”

This statement by an SCI BC Peer Coordinator is consistent with what buy college essays the majority of people with SCI have been telling researchers for years – that walking is not the most important return of function to them. Return of sexual function, hand and arm mobility, bladder and bowel function and trunk stability have all been reported as higher priorities than walking (for example, click here see Kim Anderson’s research findings on this topic).

However, being able to walk again is clearly on the priority list and has long been a focus of spinal cord injury researchers: walking may not make living with SCI easy, but it most certainly would make it easier.

Until recently, researchers have focused on strategies to promote neural regeneration (often involving stem cell treatments) in order to restore movement after SCI, but new research out of the University of Louisville, the Pavlov Institute of Physiology and UCLA is shedding light on a whole new approach to restoring voluntary movement – even in those living for years with clinically complete motor SCI.

SCI BC has been in touch with the research teams behind this groundbreaking research and is preparing an in-depth article on the subject for the Summer 2014 issue of The Spin magazine. However, given the excitement the study is generating, we provide a brief summary of the findings and what they might mean here.

To be clear, the research does not represent a cure for SCI. It does not restore walking. What it demonstrates is that voluntary movement can be restored when it was previously thought not to be possible.

Epidural Stimulation

The research examined the effects of epidural electrical stimulation of the spinal cord in four men who have been living for years with paraplegia. This involves sending electrical signals through electrodes over the spinal cord below the level of injury. The electrical stimuli mimic neural signals normally transmitted from the brain to initiate movement. All four men involved in the study had their spinal cord injury for at least two years and had injuries ranging from C7-T5. You can learn more about the 4 participants by clicking here. The four men underwent a home-based electrical stimulation protocol in which they practiced intentional movement daily for one hour.

What Happened?

Epidural stimulation with  training led to voluntary movement in the legs of the participants. According to lead author, Dr. Claudia Angeli, senior researcher at the Human Locomotor Research Center at Frazier Rehab Institute, and assistant professor, University of Louisville’s Kentucky Spinal Cord Injury Research Center, “Two of the four subjects were diagnosed as motor and sensory complete injured with no chance of recovery at all. Because of epidural stimulation, they can now voluntarily move their hips, ankles and toes. This is groundbreaking for the entire field and offers a new outlook that the spinal cord, even after a severe injury, has great potential for functional recovery.”

Key Findings

  • Through repetitive epidural stimulation and training, neural pathways involved in voluntary movement can be restored in people diagnosed as clinically motor complete SCI.
  • Although the researches don’t know exactly how this works, it may mean that some neural pathways persisted in a “silent” state in the four paraplegic men after their SCI.
  • Aspects of quality of life were improved through the treatment (see below).
  • Epidural stimulation on its own is not a cure but could be part of a multi-faceted treatment approach to restore functional movement after SCI.
  • Enhanced technology and training may lead to even more robust voluntary movement and the potential to make that movement more functions (eg, for stepping) – future research will no doubt focus on this.
  • The treatment may be applicable to restoring neural function for other aspects of SCI, such as bladder and bowel function – research needs to be done to see if this is a possibility.

Enhanced Health and Quality of Life

Not only did epidural stimulation restore voluntary movement, it also had a positive effect on the participants’ health and state of mind. Increases in muscle mass and improved regulation of blood pressure were reported, along with reduced fatigue and positive changes to their sense of well being.

What does the results of the research mean?

“We have uncovered a fundamentally new intervention strategy that can dramatically affect recovery of voluntary movement in individuals with complete paralysis even years after injury,” said Susan Harkema, Ph.D., University of Louisville professor and rehabilitation research director at KSCIRC, Frazier Rehab Institute, director of the Reeve Foundation’s NeuroRecovery Network and primary author of The Lancet article. “The belief that no recovery is possible and complete paralysis is permanent has been challenged.”

Reggie Edgerton adds, “This research brings up an amazing number of possibilities for how we can develop interventions that will help people recover movement they have lost. The circuitry in the spinal cord is remarkably resilient. Once you get them up and active, many physiological systems that are intricately connected and were dormant come back into play.”

It is important to remember that the research was conducted on a very small number of subjects and much more research will need to be done to better understand how epidural stimulation is reviving voluntary movement and how this might be utilized in a clinical setting. However, Edgerton says “This is a wake-up call for how we see motor complete spinal cord injury. We don’t have to necessarily rely on regrowth of nerves in order to regain function. The fact that we’ve observed this in four out of four people suggests that this is actually a common phenomenon in those diagnosed with complete paralysis.”

 Find out More

  • Look for our article in the Summer 2014 issue of The Spin magazine (out in June).
  • In the meantime, you can learn more about the participants, the researchers, and the research by visiting the Christopher and Dana Reeve Foundation website (they helped fund the research).
  • Check out the research article in the journal, Brain by clicking here.
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