The first thing we have today is a little older article, but it is the background work for the news item I saw a few days ago that had me jumping for joy. As my history teachers/profs always said, unless you study the past, you won’t understand the present or future. So we’ll start here.
The reason I got excited about this is because this is the neuroprosthesis coming to life that I talked about in this post. These people took an C6 AIS C fellow and made him walk. This is how. First he went through some training before having the implantation surgery on this:
This is the Lokomat– a robot assisted body weight support treadmill training device. They also combined surface functional stimulation. This was to prep the body and muscles to do the functional goal: walking.
So then they implanted a 8 channel receiver stimulator with intramuscular electrodes in the muscles which the patient needed to achieve a gait pattern. Of course they took several attempts to tweek the stimulator to get to make a correct gait pattern for this patient. Then he had an HEP combined with 2-3 gait training sessions in the clinic.
As for results, the researchers sound very happy and hopeful. But honestly, I’m a bit more reserved. The patient ended up with a 0.2 m/s gait speed (a little over 1 m/s is “normal”) using a walker which the researchers describe as “limited community mobility” when the stimulator was turned on. That is entirely too slow for a community ambulatory; however, it could be just fine to ambulate at home! Without turning the stimulator on, the patient was basically as he was previously. I also noticed that the hip extensors actually lost strength in the study. And everything else I’ve read has emphasize the hip extensors as the key muscle group to neurologically facilitate the gait pattern at the spinal cord level (CPG). So in summary, although this study is very exciting, I am personally reserved in it’s meaningfulness for function.
Now, in comes this video and article:
First of all, I really appreciated in the methods section, that the way these people were trained to stand including equipment and method of manual/tube cuing is well described. This is often lacking in many studies, so little clinician me goes, “Oh, this is great, but I didn’t learn how to replicate this for my patients. So my reading this has been completely useless!” Not so here. And I’d also like to point out that these were more severely involved SCIs: AIS A and Bs. Again they had to tweek the parameters around a bit to find the perfect setting for each patient. The key difference between this stimulator and the one above is that in this one, the patient has volitional control of their sit to stand! Cue the choice of angels! Not only that, but these fellows reported improved sexual, bladder and bowel function. Shoot, just to be able to perform those daily tasks makes this idea totally worth it to me! In the article, they said that there are plans to implant more patients. The Reeve Foundation is currently trying to raise several million dollars to do and there’s a waiting list of several thousand people. All I have to say is: GO RESEARCHERS, GO!!
And on a blogger’s side note: I thought I had completely lost this post and I nearly had a heart attack. So I’m done now. 🙂