Charge of Hope


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It all began with a single toe. Doctor Susan Harkema from the University of Louisville remembers her patient’s exact words: “Hey, Susie, look at this – I can move my toe.” Rob Summers had been paralysed from the neck down following a car accident and was told he would never walk again. But within just weeks of Dr Harkema applying an electrical stimulator to his spinal cord, the unimaginable had become possible: Rob was gradually regaining movement in his limbs. Rob was the first of four fully and chronically paralysed patients who have been treated to date with the experimental therapy of epidural electrical stimulation and intensive rehab.

The Therapy explained 
Epidural stimulation involves applying a continuous electrical current to the lower part of the spinal cord. The electrical stimulation is provided by a small electrode chip implanted over the dura (protective coating) of the spinal cord. A remote control roughly the size of a smartphone controls the frequency and intensity of the current. When used in combination with intensive rehab, the electrical stimulation enables paralysed patients to make certain voluntary movements.

Benefits for the Patients
The experimental treatment has produced positive effects on the autonomic nervous system as well as the musculoskeletal system:
Wellbeing – an improvement in the patient’s overall quality of life
Temperature – better regulation of body temperature
Sexual Function – partial recovery of sexual functions
Bladder – improved bladder and bowel function control
Movement – partial movement of the lower limbs

The Mechanisms 
The spinal cord contains networks of nerve connections that are capable of performing certain movements independently of the brain. Reflexes are a good example. Epidural stimulation taps into this ability. Electrical pulses can reactivate the neural circuits and inactive nerve fibres even if the connection to the brain is impaired. It could be that electrical stimulation strengthens the residual signals to meet the required activation threshold. The patient then once again becomes capable of moving his or her limbs to some degree.

The next Step: Clinical Study
Dr Harkema’s research project is now being extended and controlled via a study called the Big Idea, which will involve a larger number of paralysis patients. A special group of eight patients within the study is being financed by Wings for Life directly.There are great hopes that epidural stimulation will continue to be a success and help millions of people like Rob Summers. 

Physicians are trying to rouse inactive nerves using stimulating devices and electrical impulses:


The stimulator is implanted in the lumbar area, where there is thought to be a centralpattern generator (CPG). This is like a small brain that is capable of interpreting sensory stimuli independently.
 


The electrical pulses act as an amplifier and, to some extent, awaken the inactive nerve cells in the spinal cord.

THE BIG IDEA
Project leader:
Dr Susan Harkema
Initiator: Christopher & Dana Reeve Foundation
Study due to start: Early 2016
Duration: Five years
Location: Louisville, USA
Number of patients: 36
Overall cost: at least $15 million

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