Kelly Thomas and Jeff Marquis learn to walk again thanks to a spinal cord implant. They participated in a study from the Kentucky Spinal Cord Injury Research Center at the University of Louisville.
The Kentucky Spinal Cord Injury Research Center at the University of Louisville has reported the results of a new study. The summary of the report, recently published in the New England Journal of Medicine, begins with a bleak statement of a harsh medical fact. “Persons with motor complete spinal cord injury, signifying no voluntary movement or sphincter function below the level of injury but including retention of some sensation, do not recover independent walking.”
But that’s no longer true. A few “persons with motor complete spinal cord injury” have now recovered independent walking. And the report’s conclusion indicates that many more previously paralyzed people will recover independent walking in the near future.
There are about 1,275,000 people in the US who are paralyzed from spinal cord injury. The cost generated by these injuries is estimated at $40.5 billion. According to David Darrow, a neurosurgery resident at the University of Minnesota Medical School, “the history of spinal cord injury research is we have fifty years or more of essentially failed trials, with no positive findings.”
All that negativity, generated by fifty years of failure, is now turning in a positive direction. This is due to an innovative convergence of tried and true rehabilitation methods with modern technology.
In 2014, when Kelly Thomas was 19, she lost control of her truck while driving home. The truck rolled, and her head hit the roof. The impact severely compressed her spine, causing complete paralysis of her lower body. Thomas’ surgeon told her she had “maybe a 1%” chance of ever walking again. Two years later, when Thomas was offered the opportunity to take part in a paralysis research study at the Spinal Cord Injury Research Center, she figuratively leaped at the chance.
Thomas was the last of the four patients who enrolled in the study. She and Jeff Marquis were the only subjects who retained the ability to perceive some limited sensation below the level of their injury. They were also the two who actually regained the ability to independently walk over ground.
After the participants recovered from their respective injuries, they underwent conventional clinical rehabilitation. After completion of their rehab, none of them were able to stand, walk, or voluntarily move their legs.
Each subject then underwent intense physical rehabilitation training. Two hours a day, five days a week, for eight or nine weeks. Then spinal implants, incorporating an array of 16 electrodes, were installed just below the sites of their injuries. The electrode arrays were then connected to a spinal cord stimulator surgically implanted in the patients’ abdominal walls.
The patients had a 20-day post-surgical respite after their spinal implant surgery. This time off allowed the incisions for the spinal implants and abdominal stimulators to heal. Then the researchers began experimenting with thousands of combinations of signal amplitude and frequency. They needed to learn which stimulus combinations enabled the patients to make movements approximating standing and stepping.
It took Jeff Marquis 278 training sessions to walk again. His therapy was spread over a year and eight months. Finally, he achieved the ability to independently walk over ground, using only balance poles.
Kelly Thomas was the star pupil. It took her only 81 sessions of electronic stimulation, over about 3 ½ months, before she was able to walk over ground with no assistance other than a walker.
“It was extremely, extremely hard at first,” Thomas said. “I couldn’t talk to anybody, couldn’t look at anybody – I was completely focused on my body. Now, I can walk and talk, it’s not as much of a struggle. But it’s still not easy, and it’s not completely natural.”
The other two participants did not achieve independent walking over ground. But they did improve significantly in their ability to stand, hold themselves upright, and move their legs.
It seems the spinal cords of both Thomas and Marquis retained some ability to transmit signals from the brain past the site of their injuries. Their stimulators pick up those faint signals, amplify them, and direct them to the relevant muscle groups. “It is like the spinal cord is more aware, it can actually listen to that little whisper from the brain that is still there and it can generate the motor pattern,” said Claudia Angeli, a co-author of the study.
When the stimulator was turned off, none of the participants were able to replicate the new abilities they possessed while the stimulator was activated.
The electrical stimulation devices were made by Medtronic. They were designed to inhibit pain signals going to the brain, not to amplify the signals from the brain which control walking. The researchers anticipate even more significant progress when future devices are purpose built, dedicated solely to the amplification and transmission of neural signals from the brain.
In the meantime, Kelly Thomas is flourishing in her new freedom. She returned home to Florida. Whenever she feels the need to wander, she puts her walker into her car, makes sure she has the remote controller that allows her to operate the stimulator, and goes out on her own to – – well, to wherever she wants.
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