Four years ago, a young American Kelly Thomas woke up in a hospital in Florida and realized that a car accident took her ability to walk. But very active up to this point, a student who participated in the annual Rodeo, did not lose heart and decided to move to year in Kentucky, where he took part in a new pilot study, which, it is hoped, will re-teach her damaged spinal cord to walk.
In February of this year, neuroscientist, with Thomas conducting classes in physical training and helps the girl to put one foot, while she holds onto the Walker-support, at some point, just away from its responsibilities.
"What are you doing?", — excitedly asked Thomas.
"She go", — said coach Rebecca Morton. – "I'm not needed".
Thomas hesitated for a second, but then made his first independent step, then another, and then just froze in amazement.
"I couldn't believe what was happening. I worked so hard those four years. This moment was very emotional for me", — says Thomas.
Now the girl is 23 years old. She, like several other people who have received spinal cord injuries of varying severity can now stand and do a few steps. Thus in her case, she can do it without any help — all thanks to a new experimental therapeutic technique – the combination of the new neuroimplant and multiple physiotherapy sessions.
In clinical trials of new treatment methods used by the specialists of the University of Louisville, Thomas, and three volunteer doctors have implanted special devices that stimulate the spinal cord of weak electric discharges. Coupled with physical therapy, which lasted for several months, it gave amazing results.
The New England Journal of Medicine reports that the new experimental method of treatment returned two volunteers to stand and to do a limited number of steps, but two – Thomas and another patient, Jeff Marquis – the ability to walk independently. The study is sponsored by a local charitable Foundation, Hospital of the University of Louisville and manufacturer of neuroimplants, Medtronic.
On a similar treatment method and results also described in the journal Nature Medicine, where a limited recovery of motor function in a patient with spinal-cord damage, the doctors of the Mayo clinic in Rochester (USA).
"the History of research of spinal cord injuries is more than 50 years of clinical trials, different methods, has not shown any significant positive results," — says neurosurgeon David Darrow from the Medical school of the University of Minnesota did not participate in the described research but in his career already implantiruete patients with spinal-cord damage, spinal implants-stimulants.
"these cases begins a new era".
Darrow explains that for the new method, there are numerous scientific and medical issues. For example, the study involved only a few patients with injuries of different severity, so it is difficult to say how effective the new technique will show itself in the more massive cases. In addition, it is not clear how this technology works, which, in turn, should only strengthen the interest of a larger number of specialists to conduct similar studies. But overall, says the specialist, the method proves the viability of the ideas developed a few years before the start of the described clinical trials on patients-the people.
Pacemaker, which the researchers used was originally designed for quite other things, including suppression of chronic pain. However, the course of rehabilitation procedures, in which patients are taught to stand and recover partial control over the movement of legs, really shows its effectiveness.
Susan Harkema, scientific Director of the research center Kentucky spinal cord injury at the University of Louisville, the first to apply this method of restoring motor function in people notes that the device is implanted just under the site of injury. In this case we are not talking about the restoration of the damaged fibers in the spinal cord of the patient. Scientists noticed that even with the most serious injuries of the spinal cord part of a nerve fibers remain intact. These chains of neurons involved in the motor system of the body, but can be switched to perform a new task. Electrical stimulation of these neurons and the specific training in special exoskeleton allowed early experimentation on rats to almost fully recover the mobility of the paws of rodents after partial cutting of spine. Later, scientists conducted the same experiments on monkeys.
"the basis of this work are the experiments that show that my scheme is very complex and in some cases, in the context of this study, has similar inherent properties of the brain, showing the ability in appropriate circumstances to retrain for a fulfilling new tasks," — comments of Harkema.
But it is not so easy as it might seem at first glance. Volunteers participating in the study before the experimentgave two months to the independent intensive physiotherapy and exercise. Thus, scientists became convinced that the usual way motor function to restore will not work. After that people during surgery implanted electrostimulator, and then again resumed daily physical exercise with the help of which, the brain, the patients are again taught to go step by step.
According to Thomas, at first it was very starts with the language syntax: the girl mentally gave the brain commands such as "climb", "move weight", "raise the knee". However, the right leg she began to move independently on the third day after the operation. For the left foot, the training process took longer time.
"at First it was very difficult. I couldn't speak to anyone, couldn't look at anyone. I had to fully concentrate on your body. Now I can walk and talk. Now this is not such a monstrous effort, as it was originally. It's still hard and not quite natural, but easier" — said the patient.
Released from the hospital, Thomas continues daily workout independently. She constantly carries with him the support-Walker, control, allows you to control the stimulator and runs often, causing the spinal cord to get used to the new functions.
Specialists at the Mayo clinic in Rochester got similar results when using this method in the experiment involving 29-year-old volunteer, paralyzed in a fall from a mountain bike in 2013. As a result of fracture of the spine, he lost the ability to walk, while control of the hands and other body parts preserved.
Two years ago, said the head of research Kendall Lee, surgeons implanted a set of electrodes in the damaged part of the spinal cord. When they settled down, the scientists started with a young man the same series of physical exercises that Thomas, re-teaching his brain to control the movement of the feet.
Just two weeks the volunteer has learned to stand and commit random leg movements inside the exoskeleton. More complete recovery, after which the man learned to walk independently without the aid of this device and physiotherapists, demanded another 44 weeks of workouts and exercises.
Now, according to Lee, their ward alone can stand still, walk on a treadmill, leaning on the handrails, and walk for hundreds of meters without the aid of staff using a Walker. New incentive programs and rehabilitation methods, as scientists hope, will help the patient to walk faster and travel longer distances.
"an Important feature of this technology is that it is able to regain functional control of the limb, return the ability to stand and walk without any help. This technology is really able to give paraplegics the hope for return of motor function", — comments.
Researchers have noted the importance of conducting larger-scale trials of the technique on a larger number of patients and indicate the need for developing a separate dedicated device, not the use of stimulant that was originally developed for completely different purposes. In addition, experts noted the need to expand age sampling. The age of all the participants in the current experiments ranged from 20 to 30 years. In most cases, experts say, damage to the spinal cord observed in people older age, so it is unknown how this technique will work on them.
Discuss the implementation of the neurophysiologists .
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