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Thread: This is must see tonight.

  1. #41
    Quote Originally Posted by NowhereMan View Post
    no voluntary movement + no sensation = no practical use
    I think there's room to argue that point but the larger question it raises is important.
    What is the minimal amount of return, and along what dimensions, would a potential therapy warrant being available to the general population? Nevermind the dollars it costs to do the preclinical research and clinical trials...I would think that is dwarfed by the resources that are eaten up once people start getting the therapies in hospitals. Given there is no treatment for chronic SCI would ANY amount of return lead to a new treatment becoming the standard of care? I'm not entirely certain that I would be willing to go through surgery and months of rehabilitation if my return plateaued at nonfunctional, assisted stepping or two or three dermatomes of patchy sensation back.

  2. #42
    I think the important thing to take from this is that its the first successful step towards finding something that can give a decent return. Plus proof that the trial networks work
    T6 complete since 3/21/2012

  3. #43
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    Quote Originally Posted by NowhereMan View Post
    no voluntary movement + no sensation = no practical use
    open your mind. we are witnessing the beginning of something wonderful.

  4. #44
    Quote Originally Posted by ay2012 View Post
    What I kind of don't understand about that is how they would start to activate the central pattern generator to begin with. Would this not require a "fully functioning connection" between the brain and, at the least, some part of the spinal cord containing the central pattern generator? These may be silly questions but: Can these patients or others who walk without voluntary control of individual muscles stand up on their own or do they have to pull themselves up? Can they begin to walk or do they need to have someone start by moving their legs and then they continue? Once they start stepping, can they stop but continue to stand?
    In order to voluntarily activate the CPG, yes, it would take some amount of connection between the brain and CPG. As to whether or not it needs to be 100% fully functional, I do not know. Wise has said that as little as 10% of the spinal cord needs to be intact to allow for locomotion. Perhaps the majority of this 10% needs to be connected to the CPG? I'm honestly not sure. It is possible for connections to still be intact but unusable after the injury, due to the injury itself, disuse from the initial recovery process, or other reasons. Sometimes with intense therapy and other treatments, these connections can be re-awakened, sometimes they can't.

    As far as your other questions, if they're regarding the patients in the ChinaSCINet trials, I don't know. In my limited experience as an SCI exercise trainer, I can give you a few examples of things I've seen:
    -A C5 very incomplete who can perform a sit-to-stand on her own, without the use of her arms, but cannot walk independently due to too much spasticity.
    -A man with C6 transverse myelitis who has decent voluntary strength in his right leg when laying down on a table, but next to nothing in his left leg - I literally have to be touching individual muscles and feeling for a contraction, if it is there at all. However, this same man when sitting at the edge of the table, using a 4-point walker, can essentially "dive" into the walker and then use his arms to push himself up. Once he is up and both feet are on the floor, his legs can support his weight. He just recently took 29 steps using a 4-point walker with no extra assistance, and his left leg steps as well as his right. If you were to see him walking, you'd have no idea his left leg was so much weaker.
    -A man with T6 incomplete who has enough voluntary strength in his trunk and legs to move each leg forward if he's using a walker, yet every individual step requires conscious effort.
    -A woman with a T4 injury who fully recovered independent walking after going through the NRN. However if she stands in place for a long time, sometimes her legs will begin stepping in place out of nowhere, then calm down after about a minute.
    -Most interestingly, a young man diagnosed as a C5 ASIA A complete. When lying on a table, he can "feel the line" at his chest where his body disappears - no movement or sensation at all. However, when we have him standing and fully weight bearing in a harnessed walker, he can feel semicircles on both sides of his body from the bottom of his abs to the top of his hips. If I hold one of his legs back when he's in this position, he can feel the stretch, develop tension in the area he feels, and then when I let go his leg "slingshots" forward, as I call it.

    Sometimes one skill might recover to a certain degree without other seemingly related skills recovering at all. The degree to which some functions can recover is always going to vary greatly across individuals.

  5. #45
    Quote Originally Posted by NowhereMan View Post
    no voluntary movement + no sensation = no practical use
    You obviously have no idea what you are talking about.

  6. #46
    wouldnt plasticity combined with some pt re-wire (reeducate) muscles to obtain voluntary movement?

  7. #47
    Quote Originally Posted by wesmaister View Post
    wouldnt plasticity combined with some pt re-wire (reeducate) muscles to obtain voluntary movement?
    Sometimes, for some people, yes. But you'd have to work specifically on the voluntary movements you're after. If you don't practice movements, you don't learn them. So 6 hours a day 6 days a week of walking = improvement in that one specific movement pattern.

  8. #48
    Quote Originally Posted by tomsonite View Post
    Sometimes, for some people, yes. But you'd have to work specifically on the voluntary movements you're after. If you don't practice movements, you don't learn them. So 6 hours a day 6 days a week of walking = improvement in that one specific movement pattern.
    Tomsoninite, do you have SCI? If yes do you think is realistic the 666 as an SCI?

    As an AB did you ever walk 6 hrs a day for 6 days? If yes you know that you really have to be in a very good shape to do that. Even a common AB person can't do that, how can you believe that and SCI person can do that?

    Paolo

  9. #49
    Quote Originally Posted by Barrington314mx View Post
    You obviously have no idea what you are talking about.
    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.

  10. #50
    Quote Originally Posted by paolocipolla View Post
    Tomsoninite, do you have SCI? If yes do you think is realistic the 666 as an SCI?

    As an AB did you ever walk 6 hrs a day for 6 days? If yes you know that you really have to be in a very good shape to do that. Even a common AB person can't do that, how can you believe that and SCI person can do that?

    Paolo
    Paolo, no, I am able-bodied. I work as an exercise trainer for people with SCIs and other types of paralysis.

    You are right that even an AB needs to be in very good shape to walk 6 hours a day, 6 days a week. Yet, I believe that an SCI person can walk 6 hours a day 6 days a week because that's exactly what's happening in Kunming right now.

    Remember that the only people who do the 6-6-6 program are the ones who have achieved level 4 on the KLS walking scale. Even then, people don't achieve 6 hours of walking on their very first day. 6-6-6 is something they must work up to. And at KLS IV, they are still receiving some assistance.

    I think the 6-6-6 is realistic to work up to as an SCI. However it is not something that anyone could handle their first day of training. I do believe that the higher the training volume one achieves, the higher chance they have of returning some function or at least maximizing health benefits.

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