Spinal Cord Injury

A joint research study between Mayo Clinic and UCLA has yielded results, showing that the networks of neurons below a spinal cord injury still can function after paralysis.

On the Mayo Clinic Radio podcast, Kristin Zhao, Ph.D., director of Mayo Clinic’s Assistive and Restorative Technology Laboratory, explains the spinal cord stimulation research from the rehabilitation perspective. Megan Gill, a Mayo Clinic physical therapist, also joins the discussion. This interview originally aired Oct. 6, 2018.

Welcome back to Mayo Clinic radio I’m Tom Shives, M.D. And I’m Tracy McCray. Tracy as we just discussed with the neurosurgeon, Dr. Kendall Lee, Mayo Clinic researchers have made a truly exciting breakthrough in the treatment of spinal cord injuries. Through electrical stimulation on an injured spinal cord and intense physical therapy, the first patient implanted with this device at Mayo Clinic is now strong enough to be able to stand and make movements that are resembling steps. The patient can exert some control over his legs again. Legs that were completely paralyzed.

Tracy McCray:
The latest update on this research was recently published in Nature Medicine. We’ve heard about this exciting advancement from the neurosurgeon’s perspective, but an equally important part is the role played by physical medicine and rehabilitation. In here to tell us about it is Kristin Zhao, Ph.D. and Megan Gill. Dr. Zhao was the director of Mayo Clinic’s assistive and restorative technology laboratory and Megan is a physical therapist in Dr. Zhao’s lab. Welcome both of you to the program.

Tom Shives, M.D.
Good to have you both. This must be exciting for both of you to work on this project. Who’s most excited?

Megan Gill:
Being a clinician and having the experience of working at this population for 14 to 15 years now, it’s really exciting to be able to finally have something that we can tell our patients and our patients’ families. That we’re making progress towards recovery for those who have such a devastating injury, such as a complete spinal cord injury. So, it’s life-changing for me as a professional but also the experience to be able to tell our patients that there’s hope on the horizon. It’s really amazing.

Tom Shives, M.D.
Did you know for a while that this was coming? Something like this would ultimately become available.

Megan Gill:
Yeah, I had been kind of following the literature that had been coming out from UCLA, our collaborators from UCLA, as well as the University of Louisville. So, I was aware of this type of intervention and what was available to individuals with spinal cord injuries and what their outcomes were, which were really promising. But I think this paper and our results really kind of are a home run compared to where it started. So, you know we knew there was a possibility but what was the level of ability and what was the level of recovery was beyond my belief at that point. So, it’s amazing to see the progress that we’ve made to this point.

Kristin Zhao, Ph.D.:
I would like to just add that I think it’s exciting that we at Mayo get to have a team that is able to replicate this work and push it forward. And now we’re excited, because we have this great team together and the possibilities are sort of endless now for what we can do next.

Tom Shives, M.D.
So what role does this therapy play and rehabilitation play in this whole process? And how important is that? We know about the implant, we know about the stimulation, but didn’t this patient also have a significant amount of therapy before the implant was ever inserted?

Megan Gill:
So, part of the trial was for the first five to six months, we did physical therapy alone and just worked on the type of activities that were specific to standing, stepping and balance training. Which is what we continued with after the surgery. But we really wanted to do the physical therapy intensively, just to find out what kind of recovery is possible with just the therapy alone.

This individual that we published in the paper had very little physical therapy after his injury, three years prior, other than the traditional conventional compensatory strategies. So, it wasn’t to the level of what we introduced in the rehab program with this trial. So, he did five to six months of intense therapy with maybe minor improvements in terms of his endurance and his conditioning, but no recovery below his level of injury.

Tom Shives, M.D.
So how do you do, and what sort of physical therapy do you do on someone whose legs are paralyzed?

Megan Gill:
So our goal was to regain volitional activation and movement which means to be able to intently move their legs or activate their muscles.

Tom Shives, M.D.
So you were trying to get him to be able to move something that wouldn’t move? You can do that?

Megan Gill:
We were using strategies that we use with other individuals with neurologic conditions to try to engage the neuromuscular activity of the legs and the trunk, by loading them and by going through the repetition of the flexion extension moments of the leg.

So, it’s a standard of care that we typically follow for people who have some motor and sensory activation, but it’s not the standard of care for people who have a complete paralysis injury, such as these individuals.

Tom Shives, M.D.
So you were trying to strengthen the muscles that you knew the patient would need to walk?

Megan Gill:
Partially, yes. I remind you that when there’s a spinal cord injury, there is no damage to the muscles. The damage is to the spinal cord. So, our purpose was to try to send sensory information up through the nervous system by loading the legs and providing tactile cues and movements of the legs that can be sent up through to the central nervous system to then try to make the connection in the nerves to then send a motor output to the muscles.

Please see part 2.

Keywords: Spinal Cord Injury, paralysis injuries, spinal cord stimulation, spinal cord injury law firm, spinal cord injury lawyer

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