Thread: ChinaSCINet Update

  1. #1531
    Hi Dr. Young,
    I see from another thread you're in China right now and likely extremely busy and if this will all be clarified in the paper or a future release and discussion of the data then I apologize: I was just wondering if an in depth discussion of the experiences in the walking program would eventually be given. Obviously, the program is pretty simple and the pictures you've provided give a good indication of the progression. But, for example, what do the patients do on the road to this progression? For example, if they can't lock their knees do they just spend all their time standing at the beginning with a physiotherapist locking their knees for them? Do they cut short on the six hours in such early phases? In the absence of "true" stepping are they using their upper bodies to swing their legs in the non-functional fashion many of us with complete thoracic or cervical injuries may have tried in rehab? I can't imagine how, both physically and mentally, exhausting this might be...

  2. #1532
    Member tritro2085's Avatar
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    From my observation (2hours of reading the last 35 threads), they're a lot of people who are happy things have progressed(me included ), others who are hoping for an overnight success story, & a small group who are so angry & miserable being paralyzed, that Dr. Young being their only Accessible beacon of hope, they feel it's their job to scrutinize his work since they can't easily do so with others. I hate hate being paralyze too but you guys make his time on the forums miserable. People you can always DIY if you "think/know" you can do it better.

    I've never heard of a Doctor or Scientist who gave any type of information and or answered damn near every question asked by his followers NOT colleagues. Have a little more gratitude.

    Dr. Young,

    I was able to see the video from November, I'm happy and ecstatic that you've gathered that much information on the trials thus far. Maybe it's my love of the Sciences but I too see the importance in getting negative data, including the occasional unexpected wild card thrown in the mix.

    I'm not a neurologist or neurophysiologist, maybe the CPG kicking in first is a good thing, most infants and toddlers I knew/know are able to crawl, walk, or squat up & down before being able to successfully manipulate their legs. They're like machines all they know is GO. We've all heard learn to walk before you run right? Well maybe since a form of a connection has been made, "Running" using CPG first is the way to activate (Muscle & Nerve memory) and strengthened the group of muscles, while "walking" is gaining control of voluntary movement so manipulation can be achieved. They learn to walk and run long before they, stomp, jump, or tap their feet. Just an idea.

    Unfortunately me and my dad haven't had a chance to go down to Rutgers in sometime. Nevertheless you and your team(s) have our unwavering gratitude and support. Thank you for keeping all of the community informed. Keep pushing forward Doc.

    Alex
    I do like Johnny Walker says and Keep Walking

  3. #1533
    Quote Originally Posted by Wise Young View Post
    It is so frustrating writing to you because you twist what I said. Please, do not rephrase what I said. Let me emphasize what I said both in answer to your specific comments and below:

    • It is not true that the contusion model that we use to test therapies cause injuries equivalent to ASIA C lesions. We typically use the 25-mm weight drop that causes a severe contusion and 90% of rats DO NOT recover weight supporting locomotion from this injury.

    • While surgeons often expose spinal cords to remove tumors, few surgeons have opened the dura and seen chronically injured human spinal cords. Our study exposed 28 spinal chronically injured human spinal cords. For some surgeons in Hong Kong, this was their first view of chronically injured spinal cords. These are all patients with severe injuries and had recovered little or no function and have remained ASIA A for many years.

    Finally, your answer to C-spine regarding "improved locomotor scores" not necessarily meaning functional or voluntary movement is not only wrong but insulting. You suggest that I tried to sell the concept of locomotor scores improving after I had "runned [sic] out of arguments to answer some questions". That is not true. I presented the findings of improved locomotor scores without changes in motor or sensory scores to an audience of scientists. You just happened see a webcast of my presentation. In that workshop, I hypothesized that this was because regrowing axons are activating the central pattern generators, allowing patients to walk even though they cannot activate the individual muscles. Activation of walking through the CPG is an idea that has long been held by many scientists, i.e. that locomotion can be indirectly activated through the central pattern generator without direct activation of individual muscles. You heard what I said in the workshop but you were ignorant of the concept. I tried hard to explain it to you but you continue to misunderstand. Please, don't foist your ignorance on me.

    In the quotation below, I changed your comments to blue. Mine are in red.

    Wise.
    Wise,

    please don't feel insulted for my answer to C-Spine, I was kidding.

    About your answer where you say:
    In the laboratory, we typically use the 25 mm weight drop injury, which results in an average BBB score of 8. Over 90% of rats do not recover weight-supported locomotion (which require a BBB score of >10) and a 25 mm weight drop contusion causes what is equivalent to an ASIA A at T11. In contrast, the 12.5 mm weight drop injury is a moderate spinal cord injury that usually result in a BBB score of 13-14, an ASIA C at T11.

    According to the MASCIS study you uploaded for me here: http://sci.rutgers.edu/forum/showpos...3&postcount=85

    after a 25 mm weght drop the rat recover an average BBB score of 10.6, not 8 as you say here above.
    Therefore, since as you say weight supported locomotion require BBB score >10
    I deduct these rats after 25 mm drop recover weight supported locomotion which makes them ASIA D.

    Am I missing something?

    I also don't understand why you first say that rats to recover weight supported locomotion (ASIA D in humans) need a BBB score >10 and then you say that rats with a BBB score of 13-14 are like ASIA C.
    I am confused

    Paolo
    Last edited by paolocipolla; 01-13-2013 at 09:49 PM.
    In God we trust; all others bring data. - Edwards Deming

  4. #1534
    Senior Member Imight's Avatar
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    Quote Originally Posted by Wise Young View Post
    Cspine,

    We observed that patients showed improved locomotor scores but did not improve their motor or sensory scores. Motor scores represent voluntary activation of muscles on a scale of 0-5, where 0 indicates no movement when the subject is asked to move the muscle, 1 indicates trace or flicker movement, 2 indicates muscle movement only when the influence of gravity is removed, 3 indicates ability to counteract the effects of gravity, 4 indicates ability to move muscle against resistance but not normal, 5 indicates normal muscle strength.

    The walking is voluntary in the sense that the subjects are initiating and maintaining walking. Many of the subjects are supporting most of their weight (they are leaning on a device that has wheels on it). The walking is also functional in the sense that some subjects taking steps and moving around with devices, something that they could not before the therapy. People are stepping with their legs even though they may not show improvements in their ability to wiggle their toes (extensor hallucis longus), move their ankles (anterior tibialis/gastrocnemius), straighten their knees (quadriceps), or flex their hips (psoas) on command.

    Many people who have recovered walking after spinal cord injury will tell you that they can walk but they don't have good control of the individual muscles or have feelings in their feet. This is common.

    Wise.
    Since 64% of patients are incomplete it would have been very interesting to see what the therapy could have done for a walking Asia c and how the cells react to the existing crossed axons

  5. #1535
    Quote Originally Posted by Imight View Post
    Since 64% of patients are incomplete it would have been very interesting to see what the therapy could have done for a walking Asia c and how the cells react to the existing crossed axons
    I volunteer.
    "I'm manic as hell-
    But I'm goin' strong-
    Left my meds on the sink again-
    My head will be racing by lunchtime"

    <----Scott Weiland---->

  6. #1536
    Quote Originally Posted by ay2012 View Post
    Hi Dr. Young,
    I see from another thread you're in China right now and likely extremely busy and if this will all be clarified in the paper or a future release and discussion of the data then I apologize: I was just wondering if an in depth discussion of the experiences in the walking program would eventually be given. Obviously, the program is pretty simple and the pictures you've provided give a good indication of the progression. But, for example, what do the patients do on the road to this progression? For example, if they can't lock their knees do they just spend all their time standing at the beginning with a physiotherapist locking their knees for them? Do they cut short on the six hours in such early phases? In the absence of "true" stepping are they using their upper bodies to swing their legs in the non-functional fashion many of us with complete thoracic or cervical injuries may have tried in rehab? I can't imagine how, both physically and mentally, exhausting this might be...
    Bump!

  7. #1537
    Quote Originally Posted by ay2012 View Post
    Hi Dr. Young,
    I see from another thread you're in China right now and likely extremely busy and if this will all be clarified in the paper or a future release and discussion of the data then I apologize: I was just wondering if an in depth discussion of the experiences in the walking program would eventually be given. Obviously, the program is pretty simple and the pictures you've provided give a good indication of the progression. But, for example, what do the patients do on the road to this progression? For example, if they can't lock their knees do they just spend all their time standing at the beginning with a physiotherapist locking their knees for them? Do they cut short on the six hours in such early phases? In the absence of "true" stepping are they using their upper bodies to swing their legs in the non-functional fashion many of us with complete thoracic or cervical injuries may have tried in rehab? I can't imagine how, both physically and mentally, exhausting this might be...!
    Please be patient. The program is not "pretty simple". Perhaps my description had oversimplified it but every patient is different and the practice has evolved over the years that I have visited Kunming (since 2004). I have been trying to arrange for the locomotor program to be published. This will take time because there is no manual for the program and each patient is assessed and provided with his or her own customized program, depending on level, severity, the availability of family and aides, etc.

    When I last spoke to Dr. Hui Zhu about when her program will be ready and able to take large numbers of patients, she mentioned 2 months from now. Several American families are already there. I am hoping that one of them will actually write down their description of the program and work with Zhu Hui to get some kind of official description and video presentation of the various stages of the training out.

    Wise.

  8. #1538
    Great, thanks for the info Dr. Wise. I didn't mean to denigrate the system but you yourself had previously described it as, I believe, a remarkably simple method of walking. Fantastic to know its on its way to being exported from Kunming!

  9. #1539
    Dr. Young,

    How does the Kunming rehab program work with those who started the 6-6-6 intensive rehab program in chronic stages? Is it as effective compared to patients that started at acute stage? I'd assume probaly not, but still patients making good improvements.

    Thanks!

  10. #1540
    Quote Originally Posted by Skipow View Post
    Dr. Young,

    How does the Kunming rehab program work with those who started the 6-6-6 intensive rehab program in chronic stages? Is it as effective compared to patients that started at acute stage? I'd assume probaly not, but still patients making good improvements.

    Thanks!
    Skipow,

    I am trying to find out this information. Most of the patients that did the 6:6:6 program are acute or subacute. While they have some experience with chronic spinal cord injured patients, there was no formal clinical trial or careful followup of chronic patients. It is very difficult to get patients to come back to the hospital for followup. My impression is that chronic patients do not recover as much or as well as acute patients. We will be testing this in formal clinical trials in the coming year because our phase III trial will randomize patients to the Kunming rehabilitation in comparison with standard outpatient rehabilitation in other institutions.

    Wise.

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