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Thread: This is must see tonight.

  1. #51
    Quote Originally Posted by rjg View Post
    He seems pretty spot on to me. With no trunk control, my day at work was wrecked a few weeks ago when the back bracket on my Quickie chair broke. I had to go home ASAP, lest the other bracket break and my head go with it. What sort of team would the people at a KLS IV level of walking - with no sensation and no motor control - need to walk over the course of a day at the office? Who would fund such a wasteful endeavor when a chair is clearly more efficient - I could do a mile in the time it takes these guys to do 400 feet? Without motor control or sensory input, it's a party trick and little more.
    A chair may be more efficient than walking around at a score of KLS IV, but there are potential health benefits to being able to walk like that/doing that kind of program that could at least improve one's quality of life.

  2. #52
    We have to start somewhere....This sounds like doing something better than nothing.....Thanks Wise

    I may never walk again but maybe some will in the future.
    Art

  3. #53
    Quote Originally Posted by rjg View Post
    He seems pretty spot on to me. With no trunk control, my day at work was wrecked a few weeks ago when the back bracket on my Quickie chair broke. I had to go home ASAP, lest the other bracket break and my head go with it. What sort of team would the people at a KLS IV level of walking - with no sensation and no motor control - need to walk over the course of a day at the office? Who would fund such a wasteful endeavor when a chair is clearly more efficient - I could do a mile in the time it takes these guys to do 400 feet? Without motor control or sensory input, it's a party trick and little more.
    Ok. You guys can let me have your spot in line then when it comes trial or therapy time. Cool? Just keep your ass planted in that wheelchair.
    A 3 in 4 chance at being able to get to a KLS IV in less than a year and a 1 in 10 chance at being even farther along in less than a year... I think ill take that any day.

  4. #54
    Maybe some hope after all. Thanks Wise for everything your doing
    keep your head up!

  5. #55
    Wow, moving to phase 3 knowing a 75% success rate so far is phenomenal news. Dr Young when you finish getting all sci walking, I have a project for you.
    I have had periodic paralysis all my life. I lost my ability to walk in 2011 beginning with a spinal block, which was used for a hip fracture caused by periodic paralysis.

  6. #56
    Quote Originally Posted by tomsonite View Post
    A chair may be more efficient than walking around at a score of KLS IV, but there are potential health benefits to being able to walk like that/doing that kind of program that could at least improve one's quality of life.
    But at what cost? I would argue that the time, money, and effort needed to get to a Kls iv outweigh the potential quality of life benefits. If your life is at a place where a few plodding steps whilst aided by a team of therapists is going to significantly improve it, then I pity you.
    What's being done in China is significant. Whether or not the sensory and motor improvements ever kick in is something I'll be following closely, and something that will inform future work on "the cure." It will also be interesting to see whether the walking was produced by the cells, the physical therapy, or the combination. But unless significant improvements are seen in the motor scores, sensory scores, and the level of the walking in future check-ups, I just don't see this therapy ever becoming widely available.

  7. #57
    Quote Originally Posted by robyc View Post
    This is great news, maybe it should be posted also on the ChinaSCINet thread.
    Thanks a lot Dr. Wise for all your efforts and dedication.
    robyc,

    Thanks very much. I have been waiting for the final data to be collected in May before posting on the ChinaSCINet update topic.

    Wise.

  8. #58
    Quote Originally Posted by quadfather View Post
    Dr Young,

    Can you elaborate on this sentence?



    Also, has there ever been a trial of the locomotor training alone? I know it would be tough to blind study it, because sham surgery would be required, but has there ever been a trial for 6x6 locomotor training on chronic ASIA As?
    quadfather,

    The subjects that recovered stepping with a rolling frame within 6-12 months after treatment often did not have as much voluntary movements or sensation in their legs as one might expect for such walking behavior. Some have recovered some sensation and some voluntary movements but not as much as we would have expected for such good walking.

    The Kunming group has of course trained many hundreds of patients with the same 6:6:6 walking program. However, most of the patients were during the first 6 months after their injury, which I consider to be very different from the people that we assessed in this trial. They do train some people with chronic spinal cord injury but seldom for so long and so intensely.

    I don't think that they have done a formal trial of ASIA A subjects with chronic spinal cord injury before the current trial. I have been visiting Kunming since 2004 and have known several ASIA A patients who recovered to KLS IV but I don't think that it was more than 10-20% of the cases and I did not examine these patients to confirm that they are ASIA A before they started training.

    However, we recently saw one subject who was a confirmed ASIA A and is recovering walking to KLS IV after untethering surgery at two years after injury. This case was what convinced us that we need to have not only a locomotor training control but untethering surgery and locomotor training control. This is what we hope to do in the phase III trials around the world.

    Our choice was to either have locomotor training alone as the control or locomotor training and untethering surgery as the control. Motivation is an important component of a prolonged training process. A subject who did not have any surgery but is training to walk will not have the same motivation as a subject who had surgery.

    Furthermore, if we do the trial without a surgical control, I know that many doctors would say that it is the surgery that restored function and not the cell transplant, even though they would not have admitted before that untethering surgery was that effective. It would leave the question whether transplants were effective unanswered and we would have to redo the trial with an untethering control.

    So, by choosing to use an untethering control, we would be able to answer the question whether the untethering surgery and walking training alone restored 75% of the subjects to KLS IV walking, versus whether untethering surgery, transplant, and walking training did it. That question is worthwhile answering, in my opinion. This is a very difficult trial to do.

    If a majority of subjects that received untethering surgery alone plus training walked, I think that it would convince most doctors that we should pay more attention to untethering surgery as a therapeutic approach to chronic spinal cord injury. I am not sure that we would be able to get a clinical trial approved where one group would have sham surgery and the other group has untethering surgery, with or without walking training.

    While I have coined the term 6:6:6 for the training program, I want to emphasize that this is just a term describing a program aimed at getting the patients up and walking 6 hours a day. Before they achieve the KLS IV level, patients cannot walk 6 hours a day. They do stand and engage in bouts of walking with somebody moving their legs. It is very hard work and patients are puffing away.

    Wise.

  9. #59
    Quote Originally Posted by rjg View Post
    But at what cost? I would argue that the time, money, and effort needed to get to a Kls iv outweigh the potential quality of life benefits. If your life is at a place where a few plodding steps whilst aided by a team of therapists is going to significantly improve it, then I pity you.
    What's being done in China is significant. Whether or not the sensory and motor improvements ever kick in is something I'll be following closely, and something that will inform future work on "the cure." It will also be interesting to see whether the walking was produced by the cells, the physical therapy, or the combination. But unless significant improvements are seen in the motor scores, sensory scores, and the level of the walking in future check-ups, I just don't see this therapy ever becoming widely available.
    What if, after this trial, stem cells + lithium + all the walking therapy to get to KLS IV show an improvement in bone density? What if they show a reduction in neuropathic pain? What if they show improvement in bowel and bladder function, or at least increased ability manage it? What if some get more return of sensation than the others? You're right that a few plodding steps with a team of therapists likely won't enhance a person's quality of life, but all the things that can come with the stem cell treatment plus a high volume of exercise might very well improve someone's quality of life. I hear all the time that people would rather get rid of their pain or get bowel and bladder back before walking. Well, the body is designed to move, and functions better when it moves. We don't know what this trial may bring, but it's worth finding out. If it does improve overall quality of life enough, I imagine it would become widely available.

  10. #60
    Quote Originally Posted by Yankman30 View Post
    How is it possible to not be able to walk, then be able to walk but not recover voluntary muscle movement below the injury? These 20 subjects were complete injuries so they couldn't have had voluntary muscle movement below their complete injury before the trial began, right? I don't understand how a quad can begin walking 13 years after his injury with nothing more than a cane in less then 12 months of therapy and this not be huge news throughout the world. Am I missing something? I here from lots of people whenever a rat starts walking after a SCI and we're talking about humans here. Are there videos of this aywhere? Thanks for any help.
    Yankman30,

    I like Tomsonite's explanations in his case examples. Even without all the locomotor training, I have seen cases similar to what he describes, i.e. people who are walking with little or no feeling below their knees (and have to look with their eyes to maintain their balance and walking), as well as people who are walking but cannot lift their legs off the bed when they are lying prone.

    I am surprised by the reactions of people with spinal cord injury to the concept that their spinal cords are capable of movement without direct motor control. Almost everybody who has spasticity and spasms knows that the legs can move on their own. Incidentally, the fact that the legs moved involuntarily does not mean that the brain did not tell the legs to move. For example, when people get excited, this can activate spasms. Many people can also inhibit spasms.

    The concept of threshold of activation in walking is also not new. Many people who are incomplete have limited voluntary activation of their legs when they are lying down. However, once they are standing, they can often step. But, they may not have enough connections to activate the central pattern generator without some help. Walking itself provides sensory feedback to the central pattern generator, lowering its threshold of activation.

    It is possible to lower the threshold of central pattern generator activation by electrical stimulation. In 2002, Herman, et al. described a case of a person with ASIA C spinal cord injury and who was a very limited walker. Walking exercise alone was not sufficient to allow useful walking. However, when combined with epidural stimulation, the subject was able to do "well-organized, near effortless functional gait with a walker". I append an abstract fo the article below:

    Herman R, He J, D'Luzansky S, Willis W and Dilli S (2002). Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured. Spinal Cord 40: 65-8. Good Samaritan Regional Medical Center, Phoenix, Arizona 85006, USA. DESIGN: This paper describes a treatment paradigm to facilitate functional gait in a quadriplegic, ASIA C spinal cord injured (SCI), wheelchair-dependent subject who presented with some large fiber sensation, sub-functional motor strength in all lower limb muscles, and moderate spasticity. The study utilizes partial weight bearing therapy (PWBT) followed by epidural spinal cord stimulation (ESCS) with the assumption that both treatments would be necessary to elicit a well organized, near effortless functional gait with a walker. Function is defined in terms of accomplishing task-specific activities in the home and community. OBJECTIVES: To demonstrate the feasibility and benefits of combined PWBT and ESCS therapies aimed at promoting functional gait in a wheelchair-dependent ASIA C SCI subject. SETTING: The Clinical Neurobiology and Bioengineering Research Laboratories at Good Samaritan Regional Medical Center, Phoenix, Arizona, USA, and the Department of Bioengineering, Arizona State University, Tempe, Arizona, USA. METHODS: The study began with the application of PWBT. The subject walked on the treadmill until a plateau in gait rhythm generation was reached. Subsequently, ESCS, applied to the lumbar enlargement, was utilized to facilitate PWBT and, later, over-ground walking for a standard distance of 15 m. Gait performance was analyzed by measuring average speed, stepping symmetry, sense of effort, physical work capacity, and whole body metabolic activity. RESULTS: PWBT led to improved stereotypic stepping patterns associated with markedly reduced spasticity, but was insufficient for over-ground walking in terms of safety, energy cost, and fatigue. ESCS with PWBT generated immediate improvement in the subject's gait rhythm when appropriate stimulation parameters were used. When compared to the non-stimulated condition, over-ground walking with ESCS across a 15 m distance was featured by a reduction in time and energy cost of walking, sense of effort, and a feeling of 'lightness' in the legs. After a few months of training, performance in speed, endurance, and metabolic responses gradually converged with/without ESCS at this short distance, suggesting a learned response to these conditions. However, at longer distances (eg, 50-250 m), performance with ESCS was considerably superior. The subject was able to perform multiple functional tasks within the home and community with ESCS. CONCLUSION: We propose that ESCS augments the use-dependent plasticity created by PWBT and may be a valuable adjunct to post-SCI treadmill training in ASIA C subjects. We also conclude that ESCS elicits greater activation of an oxidative motor unit pool, thereby reducing the subject's sense of effort and energetic cost of walking.
    Our hypothesis is that the treatment is resulting in a similar enhancement of walking function as an epidural stimulation would, allowing the subjects to activate their central pattern generator in the lower spinal cord so that their walking motions are organized and sequential. Our hope is that the therapy is making the patients more "incomplete". The regrown fibers are very likely to be different from what use to connect to the lower spinal cord. Subjects must exercise intensely in order to "learn" how to activate their spinal cord.

    If the above is true, it would have a very significant effect on how rehabilitation of spinal cord injury should be carried out, don't you think? But, it is too early to go around proclaiming that we have a therapy that restores function in spinal cord injury. We are now going to the next stage of confirming these results and making sure that the results can be replicated. The upcoming trials are amongst the most difficult ever done because they require a combination of surgery and intensive rehabilitation.

    Regarding videos, I have shown several videos when I give talks but don't want to publish any of the videos before we get the papers submitted for publication in good journals.

    Wise.

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