News last week that Christopher Reeve could move his fingers and toes gave hope to thousands of patients with complete paralysis.
But nearly half of patients with spinal cord injury are partially paralyzed, and recent advances in rehabilitation are helping hundreds of these patients actually walk.
These less severe injuries are also known as "incomplete," meaning the patients have some type of sensation or motion below where their injury occurred. This differs from a "complete" injury, where there is no sensation in the paralyzed area at all.
"A great deal can be done with individuals who have incomplete injuries, in terms of improving their function," said Dr. John McDonald, director of the spinal cord injury program at Washington University School of Medicine in St. Louis, Mo and also one of Christopher Reeve's doctors. "I think it would be a rare case where something could not be done at all."
Some medical centers across the country even make a point of focusing on treating these patients.
"The kind of movement that you saw with Christopher Reeve, that would not be a goal for us," said Edelle Field-Fote, assistant professor in the division of physical therapy at the University of Miami School of Medicine. "We don't only want patients to be able to move their leg — we want them to be able to move their leg in a way that means that they can now walk."
Making Strides with Small Steps
Rehabilitative therapy has proved successful at improving function in many patients with partial paralysis. The type of therapy that is currently leading the pack is called body weight supported treadmill training. With this system the patient is placed in a harness that is suspended over a treadmill. A therapist then moves the patient's legs to help "reteach" them how to walk.
"This allows us to begin exercising people who do not have enough muscle function to support their weight," said Field-Fote. "In traditional therapy, if the person can't support their own weight, then they can't begin walking training."
While few large-scale, multi-center studies have been conducted to determine the effectiveness of rehabilitation, therapists and patients have been impressed with the changes. Not only does the exercise improve the patient's cardiovascular health and overall well-being, some are even able to take steps and walk short distances on their own after sticking with this extensive program.
However, this treatment is often tiring for therapists themselves who have to be involved manually with every step. For this reason, a new robotic system is being introduced at several medical centers around the country that automatically moves the legs for the patient.
An even more significant problem with body weight supported therapy is that it's not available for all people, since it can only be administered at a medical center.
"What we need to do is to develop therapies that can be delivered in the home that are cost-effective but more importantly time-effective," said McDonald. "Individuals who have a disability don't have time to go down to a center three times a week. They are usually more limited by time than they are by money."
On the Horizon
As for current research, there are several areas that are being explored aggressively in an attempt to regenerate the nerves of the spine in the hope of reversing paralysis.
Naomi Kleitman, program director of spinal cord injury research at the National Institute of Neurological Disorders and Stroke in Bethesda, Md, said there are three areas that hold the most promise in this area: placing fetal tissue in the spinal cord to see if it can act as a relay or a bridge; moving cells from the arm or leg to the spine; and inserting cells from the eye in the spine
"However, none of these concepts has been brought to humans yet," said Kleitman. "The research in animals is promising but still begs questions for how this can safely be brought to humans. We don't want pain to replace the paralysis."
"Very credible places all over the world have shown that you can reconnect areas of the spinal cord [in animals] that are physically disconnected anatomically or are very badly damaged, and you can bring function back," said Dr. Barth Green, president and founder of the Miami Project to Cure Paralysis at the University of Miami. "The challenge that we are facing now is what's the best approach — is it stem cells, is it fetal cells, etc."
The question of how far researchers are from using these therapies in humans is one they are often asked.
"My message to the patients and families is for the first time we can say that we have things in the human experimental pipeline, and that it is going to get better from here," said Dr. Daniel Lammertse, president of the American Spinal Injury Association and medical director of Craig Hospital in Englewood, Colo. "Is it going to happen fast enough for anybody? No. Should we be optimistic? Yes. Is it going to happen tomorrow? Unfortunately, no."