Walking Quads

[angel7]

Not sure if this is the proper place for this poll so feel free to move it. I've noticed that there are quite a few posts from walking quads. I am curious how many are in our community and specifics of regained function thus the poll.

[cpaul]

Hey Deb,

lets do one of these and see how many walking T's or L's there are in the world?? I personally have met many walking C's Don't understand why it is so difficult for lower injuries to get similar results.

Chris

[Jeff]

cpaulm - I think the larger force required to break the spinal cord at lower levels means that when it does happen it's uaually a severe injury. It could also be because gray matter damage in lumbar injuries prevents regaining walking ability. Your observation is correct, though, for whatever reason. Cervical injuries often get more return than lower ones.

~See you at the SCIWire-used-to-be-paralyzed Reunion http://www.stopstart.fsnet.co.uk/smilie/wavey.gif ~

[angel7]

cpaulm,

I don't get it either. Obviously I'm a quad which is why I posted the poll. I'll post one for paras next.

Deb

[civ]

Wow!! Ive never met another walking quad. I was beginning to think I was the only one. Nice to hear from you guys.

[Wise Young]

Debbie, thanks for posting this poll. It is much needed. I also want to encourage all people with cervical spinal cord injuries to vote. Wise.

[Wise Young]

bump up so that more people can vote.

My experience with one walking quad is the main reason that reversed my pessimism concerning the curability of spinal cord injury. In 1981, I took care of Carey Erickson. He was one of the first patients that I gave methylprednisolone. He came into the hospital with almost no function in his arms and leg, with a C4/5 fracture. All he had was some sensation in one leg. I did somatosensory evoked potentials on him every few days for 72 days. In the beginning, he had almost no response on all four limbs. Over several weeks, however, stimulation of his posterior tibialis nerve in his legs showed evoked potentials in his brain on one leg and then the other. His evoked potentials were much better in his legs than his arms. Gradually, these increased in amplitude so that by 72 days, he had responses in all four limbs. He worked hard at recovery and was a "walking quad" by two years after injury. He walked into my office in 1984 saying that he was depressed. I was surprised and said that many people would love to be in his shoes. He said that while he seemed to be functioning well, he was really perhaps 60% of what he was before the injury. In any case, I offered him a job and he worked with me for the following 7 years and was one of the main reasons why almost every patient who came into Bellevue Hospital agreed to be randomized to the methylprednisolone trial. Unfortunately, Carey died of AIDS in 1991, shortly after the paper was published.

Animal studies suggest strongly that about 10% of the spinal cord is necessary and sufficient to support substantial locomotor recovery. I think that the same is true of humans as well. Since very few people with spinal cord injury have severed spinal cords, I believe that most people have some axons that remain in their spinal cords. If a person has 5-8% of the axons in the spinal cord, they are below the threshold for functional recovery. However, if the person regenerates even a small number of axons, it may push them over the threshold. Also, some people may have more than enough axons crossing the injury site but the axons were not adequately remyelinated. In such a case, 4-aminopyridine should help restore function to such people. Finally, because spinal cord injury causes a prolonged period of paralysis, many people may have turned off their neural circuits in the lower spinal cord due to non-use. That is likely to be one of the reasons why intensive ambulation training have been shown to restore function to people, particularly those with severe but incomplete spinal cord injury.

I think that a majority of people with "incomplete" spinal cord injury can become "walking quads". We don't see many of them at forums like this because most may not even consider themselves spinal cord injured. They have recovered from spinal cord injury and are busy working or doing other things.

I often meet people at meetings who walk up to me and tell me that they had spinal cord injury and had been paralyzed for months but gradually recovered and now are walking. One of them is a member of the Kent Waldrep Board. If you meet him, you would never know that he was spinal cord injured. I hope that more people will respond to this poll because it would be very interesting to see what percentage of the CareCure Community are walking quads.

It is true that there are fewer people with thoracic spinal cord injury that are walking. I suppose that they would be called walking paras but because there are so few of them, no name has been created to refer to them.

Wise.

[MADPRODUCER]

Hey Dr.Young , Ok im a c5 inc, why am I not walking yet. I feel the muscles in my leg trying to move. However, the muscles are just too weak. Are there any intense pt programs out there? I took methyl, what else is it I can do? Or im just stuck till a cure come around? Why im not walking? Im inc....
Thanks

[Chris Chappell]

Mad, I know you don't like the people at Project Walk. But intensive "walking" and its related therapies are exactly what they do.

As C5 inc you should pursue your rehab aggressively.

[Jeff]

Mad - The theory of spinal shock and also swelling means that we don't gain full return immediately after our injury. It can take a long time. Unfortunately, this means learned non-use can set in. Viable circuits simply shut off. Extensive exercise, supported ambulation, FES and biofeedback are ways being developed to fight learned non-use. It also helps maximize the built-in plasticity in the CNS. Maybe it's plasticity that is responsible for why incompletes regain walking, or recovery of circuits that have shut off due to learned non-use, or both.

Whatever the case, advanced rehab techniques and lots of sweat are what give us return. If you've got the time and money you should definitely go for it.

BTW, 4-AP might help you, too.

~See you at the SCIWire-used-to-be-paralyzed Reunion http://www.stopstart.fsnet.co.uk/smilie/wavey.gif ~

[MADPRODUCER]

What are some good intense programs? I know pheb said pjw http://sci.rutgers.edu/forum/images/smilies/rolleyes.gif. I should be soon getting my fes bike. I sent a prescrip to biofeedback in fl, I havent heard nothing yet, Ill give them a call.

I know I will need alot of money. What about the robot walker, I cant recall the name its the ambulator, it cost like 150k. They have one at the miami rehab center. Is there any place you can pay to use it. MIAMI say there only for trials, not personal use.
http://sci.rutgers.edu/forum/images/smilies/smile.gif

[Jeff]

Mad - Unfortunately, exercise based recovery is only now coming to the forefront. Supported ambulation studies are confirming its validity. Christopher Reeve has shined a lot of light on it with his remarkable recovery. Many others agree based on their own results. Carl Kao's patients undergo extensive exercise after his operations. John McDonald is seeking to do a study that will show the benefts of extensive exercise post injury.

In spite of all the activity, there are few options beyond traditional rehab. The only two I know of that really believe they can help people recover lost function through exercise are PW, which you're aware of, and The Neuro Institute, Arnie Fonseca's shop. Their web site is http://www.theneuroinstitute.com/ .

I would whole-heartedly recommend either of these two. I also know Miami Project is doing studies on the Lokomat but I think you have to be Asia C [already] to participate.

Dragon's Way existed for a while and I'm sure there are others. I think Albert Bohbot combines extensive exercise with his Laserponcture program. Maybe there's something good close to you.

It's the wave of the future in SCI recovery, that's for sure.

~See you at the SCIWire-used-to-be-paralyzed Reunion http://www.stopstart.fsnet.co.uk/smilie/wavey.gif ~

[Wise Young]

Mad, many of the centers are restricting the intensive ambulation trials (such as lokomat, etc.) to people who are ASIA C (motor incomplete, "non-useful") but this is because these are the people who are mostly likely to show measurable benefits from short-term training (e.g. 3 months). Because the treatment is very labor-intensive and therefore quite expensive, most centers obviously want to focus on those patients who are most likely to show measurable voluntary walking resulting from the treatment. This, however, does not mean that ambulation training is not useful for people who are ASIA A. In fact, many animal studies and some human studies indicate beneficial effects of ambulation training for "complete" spinal cord injury, particularly injuries that do not involve the lumbosacral cord. Many doctors, including myself, believe that ambulation training has to be an important part of clinical trials seeking to regenerate the spinal cord.

Why treadmill? A treadmill is one way in which the person can get all the motor and sensory inputs from walking. The goal of ambulation training is to activate the neurons in the lower spinal cord and getting the locomotor reflexes re-established. This requires repetitive motions and weight-supported ambulation will provide this in a well-controlled and measurable environment. At the present, the most effective way of doing such training is for therapists to move each leg manually to step on the treadmill until the reflexes and movements re-established themselves in the spinal cord. There is an effort to develop and utilize devices that would reduce the manual labor and thereby the costs. Please note that these devices are still experimental in the sense that they are being tested in clinical trials to see if they can replace manual manipulation.

There are probably other ways of training the legs to walk again. For example, many people with spinal cord injury have braces and have engaged in "walking" with the braces. Others have been walking in the swimming pool where the water supports their weight. Functional electrical stimulation (FES) on bicycles is used by many people to build muscle. Finally, there are several programs that utilize biofeedback techniques. There is not much data to document the efficacy of each of these approaches, especially data that compare the various techniques to each other. For example, it is not clear whether or not FES bicycling at the same time will facilitate ambulation training and vice-versa although common sense would suggest that this should be so. Likewise, it is not clear whether or not FES can be utilized during ambulation training. There is one study that suggests that stimulation of the locomotor generator in the spinal cord (L2 stimulation) can greatly facilitate and allow more efficient locomotion.

In my opinion, it is really crucial that clinical trials be carried out to evaluate and compare the different methodology so that the more efficient and effective methods be identified. We need to know whether the treatments are useful when started early after injury, how long the training needs to be, the optimum duration of training, the gait speed, and other parameters... These issues are being studied in rehabilitation centers around the world. Much more information should be coming out in the next year about such training, particularly from European centers that have been testing different ambulation training paradigms since the early 1990's.

Wise.