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Thread: McDonald: High-tech bike helps paralyzed in recovery/Wash U. neurologist out to prove activity can stimulate new cell growth

  1. #1
    Senior Member Max's Avatar
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    McDonald: High-tech bike helps paralyzed in recovery/Wash U. neurologist out to prove activity can stimulate new cell growth

    McDonald: High-tech bike helps paralyzed in recovery
    Wash U. neurologist out to prove activity can stimulate new cell growth
    Margie Manning

    http://www.bizjournals.com/stlouis/s...15/focus4.html

    Research by neurologist Dr. John McDonald III could help spinal cord injury patients recover some of their lost functions by riding a specially designed exercise bicycle in their own homes.




    McDonald, 38, assistant professor of neurology at Washington University and director of the spinal cord injury unit at Barnes-Jewish Hospital, is beginning clinical trials on the Functional Electrical Stimulation (FES) Bicycle. The bicycle, built to hold a paralyzed person, includes a computer that stimulates nerves in key muscle groups, allowing patients to ride the bicycle under their own muscle power.



    McDonald said early data from his clinical work indicates patients who use the bicycle for one hour at a time, three times a week, can avoid many of the physical complications associated with spinal cord injuries, while animal research in the lab shows the activity can stimulate new cell growth and activity.



    "What we've found so far is compelling evidence that this program can enhance recovery of function," McDonald said.



    He has just completed research in a "worst-case scenario" -- a patient who was injured more than five years ago.



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    Until now, it's been accepted wisdom that if patients haven't recovered within two years of the injury, they won't recover. But McDonald's work could change that thinking.



    "In this case we took someone five years out from their injury, with the highest level and worst injury possible, and we showed that we can reverse that person to the point where they are 60 percent to 70 percent of normal," he said.



    He's about to begin a broader clinical trial with 120 patients. They will take part using FES bicycles at McDonald's lab, but he hopes to increase participation by getting some of the bicycles into patients' homes.



    Until now, that's been cost prohibitive. The bicycle was originally designed in the late 1970s for acutely injured people who might be able to recover in the first couple of months, but was not intended for people who have had their injuries for a long period of time. Only about 700 of the bicycles have been produced in the past 25 years, and they cost about $14,000 to $16,000 each, McDonald said.



    McDonald is working with a manufacturing group whom he declined to identify to redesign the bicycle and reduce the cost by as much as 50 percent.



    "The goal is to demonstrate to insurance companies that this is a cost-effective approach, so they will pay for it," McDonald said.



    Currently, insurance companies will pay for rehabilitation on the bicycle in only about half of McDonald's cases.



    But Patrick Rummerfield, director of performance assessment for the spinal cord injury program at Washington University School of Medicine, said there's a huge potential cost savings for insurance companies because of the physical benefits of FES bicycle therapy. Those physical benefits include building muscle mass and preventing skin breakdown, decreasing spasms that are typically treated with medication, building bone density to prevent osteoporosis and bone fractures, and enhancing bloodflow and cardiovascular activity.



    "One bone fracture costs $70,000 for hospital treatment. Skin breakdown can cost $60,000. A bladder infection can run in the tens of thousands of dollars," Rummerfield said. "If you can get the cost down, hopefully the insurance companies will realize this is saving them a lot of money."



    Rummerfield also said the benefits to the patient are "unbelievable." He should know. Rummerfield, injured in a car crash in 1974, is the first quadriplegic to regain full use of his body. Since recovering, he's completed a triathlon and holds the land speed record for an electric car.



    Rummerfield, who incorporated exercise into his recovery but did not use an FES bicycle, said McDonald's work "is light years ahead of anything that's ever been produced."



    Funding for McDonald's work has come primarily from private donations so far. He's just begun to apply for federal grants and for grants from the Christopher Reeve Paralysis Foundation to pay for the research project, which he said will cost about $750,000 a year.



    Researchers who work with McDonald include Dr. Daniel Becker and Charlie Li, who have worked on demonstrating the role of physical activity in cell regeneration; Dr. Christina Sadowsky, a specialist in spinal cord injuries; Linda Schultz, clinical nurse specialist; and Jenny Edrington, who is coordinating the clinical trials.



    More information about the trials is available at the spinal cord injury


    program's Web site, http://www.neuro . wustl.edu/sci.

    mmanning@bizjournals.com

  2. #2
    Good stuff. More evidence that fairly aggressive physical rehab can result in increased motor recovery.

    We should all have an FES bike - no questions asked.

    Onward and Upward!

  3. #3

    I agree with everything but,

    The part about gaining back lost function. Nobody works harder on an FES bike than me, I have not seen any return of function in the year and a half I have been using the bike, but I have seen my legs get bigger, cardio vascular get better and a better body image. I believe once a nerve cell is dead, it is dead until medical science figures a way to make new nerve cells grow again. There are some that say they are doing this (especially in other countrys) but I will not believe it until I see movement in my paralyzed legs that I can control with my mind.

  4. #4
    Senior Member Max's Avatar
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    Dr. Wise

    Could you write me prescription for bike?

    Seriously I do remember gratefully how your, Bill Johson & other good rehab Dr.(forgot his name) letters of support helped me tremendously to get new computer...along with articles about benefits of computing for quads...

    It took me numerous appeals & one year(I divorced faster
    but Im up for another challenge ...

  5. #5
    Good point Curtis.

    Hopefully, if nothing else this study will help to confirm or deny functional recovery from a "complete" vs "incomplete" perspective. It seems that there is such a thin line between the two and the relative recovery potential.

    This is one of the things that concerns me regarding Project Walk. How "incomplete" does one need to be in order to regain function? Does the ASIA scale have anything to do with it? And is Dr. McDonald's study addressing this?

    My limited experience has indicated that most of my friends who are para are more "complete" and most quads "incomplete", at least sensory. I think it largely has to do with the impact (speed, force) related to the injury.

    Furthermore, after talking with an sci research pro I was told that the intense physical therapy approach has been going on for over forty years. I would imagine in many different approaches / applications.

    But how different is today's aggressive therapy approach like the above and lets say a laufband treadmill training or PW technique different from the past? Longer duration? better equipment? better PT's? better understanding of spinal cord plasticity?

    Part of me agrees completely with you Curtis concerning medical science and nerve regeneration. The other part of me wants to believe that if I practice walking or riding enough that I will recover function naturally even two years post.

    Are they (therapy vs. science) mutually exclusive or are they intertwined?
    I wonder what the answer is?

    I guess time will tell.

    Onward and Upward!

  6. #6
    Here are some articles going back many years on FES bicycle training effects on people with spinal cord injury.

    • Leeds EM, Klose KJ, Ganz W, Serafini A and Green BA (1990). Bone mineral density after bicycle ergometry training. Arch Phys Med Rehabil. 71 (3): 207-9. Summary: The effect of functional electrical stimulation (FES) cycle ergometry on bone mineral density (BMD) was investigated in six spinal cord injury (SCI) quadriplegic men. Each subject trained three days a week for six months on an FES cycle ergometer. Pretraining and posttraining BMD measurements of the proximal femur were performed using dual photon absorptiometry. Mean pretraining BMD (percent norm) for the femoral neck, Ward triangle, and trochanter were 66.65, 57.43, and 57.67, respectively. After six months of FES cycle ergometry, mean BMD measurements were 66.15, 57.07, and 55.13, respectively. There was no statistically significant difference between the pretraining and posttraining BMD measurements. All subjects were found to have osteoporotic proximal femurs when BMD was expressed as a percent of their age-matched controls. Bone mineral density measurements were subsequently performed on three additional men with SCI who had exercised for three years with the FES cycle ergometry modality. Their mean BMDs were not significantly different from the experimental group. This study demonstrated that six months of FES cycle ergometry did not produce an increase in BMD. University of Miami School of Medicine, FL.
    • Mohr T, Dela F, Handberg A, Biering-Sorensen F, Galbo H and Kjaer M (2001). Insulin action and long-term electrically induced training in individuals with spinal cord injuries. Med Sci Sports Exerc. 33 (8): 1247-52. Summary: PURPOSE: Individuals with spinal cord injuries (SCI) have an increased prevalence of insulin resistance and type 2 diabetes mellitus. In able-bodied individuals, training with large muscle groups increases insulin sensitivity and may prevent type 2 diabetes mellitus. However, individuals with SCI cannot voluntarily recruit major muscle groups, but by functional electrical stimulation (FES) they can now perform ergometer bicycle training. METHODS: Ten subjects with SCI (35 +/- 2 yr (mean +/- SE), 73 +/- 5 kg, level of lesion C6--Th4, time since injury: 12 +/- 2 yr) performed 1 yr of FES cycling (30 min x d(-1), 3 d x wk(-1) (intensive training)). Seven subjects continued 6 months with reduced training (1 d x wk(-1) (reduced training)). A sequential, hyperinsulinemic (50 mU x min(-1) x m(-2) (step 1) and 480 mU x min(-1) x m(-2) (step 2)), euglycemic clamp, an oral glucose tolerance test (OGTT), and determination of GLUT 4 transporter protein in muscle biopsies were performed before and after training. RESULTS: Insulin-stimulated glucose uptake rates increased after intensive training (from 4.9 +/- 0.5 mg x min(-1) x kg(-1) to 6.2 +/- 0.6 mg x min(-1) x kg(-1) (P < 0.008) [step 1) and from 9.0 +/- 0.8 mg x min[-1) x kg[-1) to 10.6 +/- 0.8 mg x min[-1) x kg[-1) [P = 0.103) [step 2)). With the reduction in training, insulin sensitivity decreased to a similar level as before training [P > 0.05). GLUT 4 increased by 105% after intense training and decreased again with the training reduction. The subjects had impaired glucose tolerance before and after training, and neither glucose tolerance nor insulin responses to OGTT were significantly altered by training. CONCLUSIONS: Electrically induced bicycle training, performed three times per week increases insulin sensitivity and GLUT 4 content in skeletal muscle in subjects with SCI. A reduction in training to once per week is not sufficient to maintain these effects. FES training may have a role in the prevention of the insulin resistance syndrome in persons with SCI. Department of Medical Physiology, The Panum Institute, University of Copenhagen, Copenhagen, Denmark. t.mohr@dadlnet.dk.
    • Mulder AJ, Hermens HJ, Janssen F and Zilvold G (1989). A low-cost FES exercise bicycle for training paraplegics at home. J Med Eng Technol. 13 (1-2): 90-2. Summary: The success of FES exercise programmes for training paraplegic muscles at home depends highly upon the availability of reliable, easy-to-use and inexpensive training equipment. For endurance training, FES bicycle exercisers are well accepted. However, they are not suited for home use due to the high expense of commercially available equipment. This paper describes the development of a FES exercise bicycle for use at home. It consists of a standard bicycle ergometer with minimum modifications. The exerciser can be used by the patient sitting in the wheelchair, and may be used with any two-channel muscle stimulator. Rehabilitation Centre Het Roessingh, Enschede, The Netherlands.
    • Pacy PJ, Evans RH and Halliday D (1987). Effect of anaerobic and aerobic exercise promoted by computer regulated functional electrical stimulation (FES) on muscle size, strength and histology in paraplegic males. Prosthet Orthot Int. 11 (2): 75-9. Summary: The influence of anaerobic and aerobic exercise, promoted by computer regulated functional electrical stimulation (FES) was evaluated in four paraplegic males. Quadriceps muscle bulk was monitored by serial computerised axial tomography (CT) scanning and histology by muscle biopsies from the vastus intermedius. Anaerobic exercise consisted of 60 degree straight leg raising against increasing weights (range 1.4-11.4 kg) over a period of ten weeks. Aerobic exercise consisted of pedalling a modified Monark bicycle ergometer at 50 rpm against a fixed load ranging from 0-3/8 kilopond (0-18.75 watts) over a period of eight months. In both exercise studies the same work was not achieved by each paraplegic. FES was regulated by a closed loop system which is not presently commercially available, the frequency of the sequential muscle stimulator was 40 Hz with a pulse width of 300 microseconds. Quadriceps muscle area of both legs increased 62.7% (p less than 0.01) after anaerobic exercise; similar but less pronounced effects followed aerobic exercise. Histologically two distinct patterns were noted from the outset, one had normal fibre type distribution the remainder had marked Type 1 loss. Both exercise regimens failed to change these although the number of internal nuclei per 100 fibres steadily increased (from 7.0% to 13.8% to 26.0%) as did the % of fibres with internal nuclei (5.4% to 10.5% to 25.7%) throughout the exercise periods. The significance of these observations is not immediately apparent but may signify continuing damage which may be due to the eccentric rather than the concentric nature of FES promoted muscular contraction. Nutrition Research Group, Clinical Research Centre, Harrow, United Kingdom.

  7. #7
    Dr. Young,

    No offense, but the studies you sited have to do with FES and: bone density, relativity to diabetic potential, expense of the units and a muscle density test on paras.

    How do these correlate to Dr. McDonald's cell regrowth strategy?

    Maybe I'm missing your point.

    Onward and Upward!

  8. #8
    Senior Member glomae's Avatar
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    dr young

    i've always felt somewhat thankful to have survived my accident with only a T12 injury instead of a much higher injury. lately however i find myself wondering if i'm better off after all. it seems that most of the trials i've inquired about have an exclusion after T10, i know it has something to do with the motor neurons, but can you explain more to me about why this is?

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    Senior Member rdf's Avatar
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    ""In this case we took someone five years out from their injury, with the highest level and worst injury possible, and we showed that we can reverse that person to the point where they are 60 percent to 70 percent of normal," he said."

    Is he saying that a complete quad, (worst injury possible, highest level), regained 60-70% of his preinjury function/sensation?? I must be reading that wrong.

  10. #10

    Glomae

    Unfortunately with a lower injury FES does not work as well or at all in some cases, this is due to the lack of reflex arc, you should still be evaluated to find out if FES will work for you, I understand that sometimes with increased Amplitudes that it still may be possible.

    Chris, I believe the vigorous excercise program will definately help you as if nothing else you will maximize what you have left to a much greater extent. And of course being incomplete and a fairly new injury means there still is hope for neurological improvements, I guess I was mainly speaking for completes when I made the statement in my previous post.

    I do remember one of the spinal nurses (I believe plg) stating that she knew of a complete injury who after 3 years of vigorous FES training starting getting use of his abs back, I believe she said he was same as me, t-4 complete. I keep monitoring myself to see if this is happening with me, but so far I am not able to contract any of my abs. Getting some abs back would be nice, it would help me go faster on the Handcycle thats for sure.

    Rdf, I was kind of confused about that 60% figure also, not sure if it meant increase in muscle bulk by 60% or what? I know 60% increase in muscle bulk is possible for sure, I have experienced at least that. In some ways it is bad as my legs are heavier and harder to move around, especially in bed, and it slows me down a little more on the handcycle due to an increase in my overall wieght as muscle is pretty darn heavy. I wonder if I could have my legs amputated, Frozen and then re-installed when the Cure comes along?, lol. I would be winning all kinds of races on my handcycle and it would be easier to move around.

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