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Thread: Paralysed patients regain voluntary movement with spinal stimulation

  1. #191
    Quote Originally Posted by Chaz19 View Post
    Paolo, I'm curious what current potential methods of treatment do you support? Please don't take this as a critical question, I know that you are very aware of research and utilize the scientific method ? but what's top on your list?
    My general opinion is that if we want to cure SCI we need to repair the injured spinal cord as without robust regenerations the results at best will be very limited.
    To make this happent we need to support research that is about making the lesion environment permissive to regeneration and get axons to regrow.
    There are several lines of research that fit into this picture, gene therapies, invivo reprogramming, all possible strategies to deal with the inibitors present in the scar tissue, bridging strategies etc.
    All these areas should get priority in my opinion.
    I tend to be a little more oriented toward understanding the lesion site at molecular level as gene therapies alone are unlikely to get axons to cross the chronic SCI lesion, while if we just neutralize the inibitors we might get significant recovery but that's just my speculation that may worth less than 0.01

    I wish I had a better answer.

    Paolo
    In God we trust; all others bring data. - Edwards Deming

  2. #192
    Quote Originally Posted by GRAMMY View Post
    @George78: The prototype is finished. I'm hearing they're in manufacturing of the devices that will be used specifically on the folks enrolling into the trial. I like your enthusiasm, but I believe it's all a bit more complicated than what you're thinking. The unit that is supposed to be tested is a 27 electrode device so it's going to be a bit more complicated and methodical in testing the various perimeters and especially with each patient having different capabilities with various muscle groups and also they're incompletes. (The one in your video link was a only a 4 electrode and the one used subcutaneous was a 16)... Some people will have poor or lesser response in different regions and muscle groups than the next person. In other words, until all the trials are ran and different subjects are zeroed in on their maximum best that the device can do for them, then it's pretty hard to know how it all shakes out. A device that's been calibrated for my spared muscle groups are going to be different than yours. I may need very little stimulation and help on only a few key groups and you may have a lot more deficits than me and need multiple groups activating at different timing and frequency than I would need. It's my understanding that each person in the future would be personally calibrated for their own device according to what their tested need is at the time. I believe this work is in it's infancy yet and there's a lot more that will be discovered along the way with these devices. As far as one experimenting around for fun in the meantime, I'd be a little concerned about that. It may be expensive with no results from it or you may accidently light your hair on fire! (uh oh...just joking)

    Here's a blog post about the upper extremity work...
    Grammy, many thanks for explanations and the link..
    I think we are mixing two totally different things:
    - surgeries implanting electrodes to stimulate spinal cord,
    - transcutaneous stimulation of the spinal cord.
    The first is a long term goal with a lot of steps to go through and I don't believe paras and quads are willing to be involve today in that risky and relatively heavy surgery. Thus it is wise to wait and see where we are going with that. This is the new 27 implantable electrodes you are referring to.
    The second one is much more interesting for us and my previous message was about that. There is no surgeries and we have two clinical trials on their way:
    - one for the quads: http://clinicaltrials.gov/ct2/show/NCT01906424
    - one for lower limbs: http://clinicaltrials.gov/ct2/show/NCT01949285
    Both trials are organized by NeuroEnabling Technologies inc and UCLA..
    I'm interested because today we all have a chance to give a try to that transcutaneous SCS, all we need is a device, tune it as it has to be, and take some time to stimulate our spinal cord.
    That's why I'm asking here help to get informations regarding the devices used in the trials of NeuroEnabling..
    Thanks.
    George

  3. #193
    Does anyone know what's going on with the "Restoring Arm and Hand Function With Non-invasive Spinal Stimulation" trial on clinicaltrials.gov? There it says that the trial is not open yet for participants recruitment, but the estimated completion date is July 2014...

  4. #194
    Quote Originally Posted by paolocipolla View Post
    My general opinion is that if we want to cure SCI we need to repair the injured spinal cord as without robust regenerations the results at best will be very limited.
    To make this happent we need to support research that is about making the lesion environment permissive to regeneration and get axons to regrow.
    There are several lines of research that fit into this picture, gene therapies, invivo reprogramming, all possible strategies to deal with the inibitors present in the scar tissue, bridging strategies etc.
    All these areas should get priority in my opinion.
    I tend to be a little more oriented toward understanding the lesion site at molecular level as gene therapies alone are unlikely to get axons to cross the chronic SCI lesion, while if we just neutralize the inibitors we might get significant recovery but that's just my speculation that may worth less than 0.01

    I wish I had a better answer.

    Paolo
    Hey Paolo,

    I couldn't agree more - there seems to be a lot of focus on exoskeletons and making a neural bridge. I'd rather have the spinal cord heal - but it seems researchers are more interested in having a patent to their name, and just generally conducting lab tests on rats. Whilst I also agree that we have to start somewhere, I want to regain my bodily functions and heal as much as I can, rather than be in a clunky, noisy, stare inducing exoskeleton - whilst switching a stimulator on and off.

    Hands-down I'm all for the Phase III UCB/Lithium trial. I'm not saying it's THE cure, but it's pretty damn close. I just can't wait for the Phase II data to be published, and Phase III to begin.

    Regards

  5. #195
    Quote Originally Posted by taymas View Post

    Hands-down I'm all for the Phase III UCB/Lithium trial. I'm not saying it's THE cure, but it's pretty damn close. I just can't wait for the Phase II data to be published, and Phase III to begin.
    Regards
    I think we need to be very careful when using the word 'cure.' I wouldn't say the ChinaSCINet Phase II results are close to the cure. Although the subjects are showing recovery, this was just a phase II safety study in a small number of subjects. This needs to be confirmed in a phase III in many subjects.

  6. #196
    Senior Member lynnifer's Avatar
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    Aha! Here's the thread I need to read! Thanks Grammy for all that you do - you've held the researchers' feet to the fire, questioned EVERYTHING and brought us so much hope.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  7. #197
    I agree that Grammy is super knowlegable and a real worker towards trying to get some sort of organization amoungst the scientists.
    "Life is about how you
    respond to not only the
    challenges you're dealt but
    the challenges you seek...If
    you have no goals, no
    mountains to climb, your
    soul dies".~Liz Fordred

  8. #198
    Thank you dear friends for your kind comments. Hopefully we'll learn a whole lot more about all of this when Reggie comes to the Working 2 Walk Symposium in Seattle to give a presentation and answer more questions. I'll ask questions and take as many notes as possible in the breakout sessions as others will be doing also after the large videotaped session.

  9. #199
    Quote Originally Posted by taymas View Post
    Hey Paolo,

    I couldn't agree more - there seems to be a lot of focus on exoskeletons and making a neural bridge. I'd rather have the spinal cord heal - but it seems researchers are more interested in having a patent to their name, and just generally conducting lab tests on rats. Whilst I also agree that we have to start somewhere, I want to regain my bodily functions and heal as much as I can, rather than be in a clunky, noisy, stare inducing exoskeleton - whilst switching a stimulator on and off.

    Hands-down I'm all for the Phase III UCB/Lithium trial. I'm not saying it's THE cure, but it's pretty damn close. I just can't wait for the Phase II data to be published, and Phase III to begin.

    Regards
    I am not surpised you are so positive about the UCB trial considering the positive info that have been given about it here on CC.
    In the beginning I was an active supporter of the trial but as I digged into it I was very disappointed to find out that there are no animal studies that show significant recovery using UCB +Li.
    If you like to understand better why I have very low expectations about UCB you can read the china SCI net thread starting from June 2012.

    A cure could happen soon if more money were spent on finding a cure for chronic SCI by honest and smart resarchers instead of on developping exoskeletons and other compensative approaces that at the end of the day will leave us paralized.

    Paolo
    In God we trust; all others bring data. - Edwards Deming

  10. #200
    Heres a link to a study conducted on ASIA C, with Epidural Stimulation from 2002. Some positive results were observed. Interesting.

    http://www.ncbi.nlm.nih.gov/pubmed/11926417

    Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured.
    Herman R1, He J, D'Luzansky S, Willis W, Dilli S.
    Author information


    Abstract
    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.

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