March 1, 2006 Paraplegic patients who still have some active nerve endings in their legs can find major improvements with a new therapy. During rehabilitation on a bicycle, special pads send electrical pulses that cause neurons to grow and create new nerves. The specially-fitted bicycle can be used at home, and has helped patients regain function years after an injury.
BALTIMORE--Their injuries left them paralyzed. Now, however, one doctor is giving new hope to patients suffering from spinal cord injuries.
Sometimes, all it takes is a fall, a car accident, or even a dive into a pool to cause a sudden spinal cord injury, leaving paralyzed patients with an uncertain future. Now, with the help of John McDonald, a neurologist at the Kennedy Krieger Institute in Baltimore, the future is looking brighter for some patients.
Dr. McDonald is a neurologist on a mission to give paralyzed patients their best chance to walk again. "If you're diagnosed with spinal cord injury, you're pretty much written off. They tell you that it, it's over, you know, you're going to live your life in a wheelchair. We can change that," he says.
His innovative rehabilitation methods have already changed Ali Ashai's life. He was left paralyzed from the waist down after falling off a bridge. Ali says, "I remember waking up after the operation thinking I was going to be able to feel my legs and not being able to do that, and then I was a little worried."
Ali isn't worried anymore, using Dr. McDonald's activity-based therapy approach he is now walking. Part of the therapy uses electrical stimulation, in which special pads stuck to the skin send electrical pulses through still-intact nerve endings causing nerve cells to grow and creating new nerves. Coupled with bike riding to strengthen muscles, patients can see major improvements.
"A major effort that we're working on is using the concept of patterned activity in order to optimize someone's ability to self repair their own nervous system and recover function," Dr. McDonald tells DBIS.
According to Dr. McDonald, patients can regain function years after an injury. Ali is proof: he's on his way to a full recovery, letting nothing stand in his way. "Who knows, even maybe in a couple of years I'll run a marathon or something, you know? I'll do whatever I can," Ali says.
The electrical-stimulation bicycle is also designed for home use, so patients can optimize their workouts three or more times a week. Dr. McDonald also helped the late actor Christopher Reeve regain some sensation and movement.
BACKGROUND: John McDonald is a neurologist and director of the International Center for Spinal Cord Injury at the Kennedy Krieger Institute, an independent affiliate of the Johns Hopkins University School of Medicine in Baltimore. Best known for having treated paralyzed actor Christopher Reeve, Dr. McDonald has developed an approach called Advanced Restoration Therapies that is giving hope to people suffering from spinal cord injuries and paralysis.
WHAT IS RESTORATION THERAPY? Dr.McDonald's specialty is activity-based restoration therapy that combines rehab therapies and advanced restoration technologies to help patients recover more quickly. He says that this approach demonstrates that patterned physical activity, such as cycling or walking movements, helps regenerate stem cells and help patients' bodies "remember" how to move. For instance, one method uses a computer to send electrical messages to a patient's legs, signaling the leg muscles to contract and pedal a specially designed bike. In normal development of the nervous system, cells are born and differentiate themselves through patterned neural activity; injury to the spinal cord interrupts this vital process.
WHAT'S NEXT: The next step for spinal cord injury researchers is to evaluate the results of several clinical trials designed to measure the efficacy of the therapies. One such trial, focusing on pediatric spinal cord injuries, is already underway as part of a new collaboration between KKI and Philadelphia's Shriner's hospital. Dr. McDonald is also exploring new ways to perform cell transplantation. Current techniques involve expensive, complex procedures and require a long-term hospital stay, and the cell supply is limited. He is using animal models to develop a new transplantation process that can be done on an outpatient basis using nuclear transfer of embryonic stem cells.
ABOUT THE SPINAL CORD: The spinal cord is the longest nerve in the human body; it is a bundle of nerves that carry electronic signals to and from the brain to the rest of the body. The brain and spinal cord together constitute the central nervous system. The spinal cord is surrounded by rings of bones called vertebra, which make up the spinal column (back bones), and the vertebra are named according to their location. Spinal cord injury results when damage to the spinal cord leads to a loss of function, such as mobility of feeling. Where the damage occurs determines what parts of the body are affected by the injury. Generally, the higher in the spinal column the injury occurs, the more dysfunction a person will experience.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.