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Late Recovery from Spinal Cord Injury:
First Case of Partial Recovery More than Two Years after Spinal Cord Injury
St. Louis, Sept. 10, 2002 - Eight years after severely injuring his spinal cord, one quadriplegic has achieved what was thought to be impossible: He has regained the ability to feel pin pricks and the light touch of a cotton swab over most of his body, and to move some of his joints without any assistance. He also reports improvements in overall health and quality of life.
These slow but progressive results began in 2000. At that point, the individual began a series of evaluations by researchers at Washington University School of Medicine in St. Louis. Based on these evaluations, the individual's therapy was adjusted to promote recovery.
The research team at Washington University published this single-patient case study in the September issue of the Journal of Neurosurgery: Spine. It is the first documented case of partial recovery more than two years after traumatic spinal cord injury.
The American Spinal Injury Association (ASIA) scale is the standard method for assessing spinal cord damage. After three years of treatment, this individual's ASIA classification has been upgraded from A to C on a scale that ranges from A to E. This study is the first documentation of a person improving two ASIA ratings more than two years after being injured.
"In light of science's perception of spinal cord injuries, it's remarkable to recover any sensation or movement whatsoever long after the injury has occurred, particularly in those most injured," says the study's lead author, John W. McDonald, M.D., Ph.D., medical director of the Spinal Cord Injury Program at Washington University School of Medicine. McDonald also is a staff physician at Barnes-Jewish Hospital, the Rehabilitation Institute of St. Louis and St. Louis Children's Hospital.
"In this reported case, this individual feels so much better, both physically and emotionally, and his confidence and outlook on life have dramatically improved," McDonald adds. "However, this study only involved one person, and further research is needed to see if such therapies also are effective for others with spinal cord injury."
McDonald also is an assistant professor of neurology and neurological surgery at the School of Medicine. The research was a collaborative effort between the Department of Neurology, the Division of Bone and Mineral Diseases and the Mallinckrodt Institute of Radiology at the School of Medicine.
In 1995, the individual discussed in this study fractured his neck at age 42. His spinal cord injury was classified as C2 ASIA A, the most severe type of injury with complete quadriplegia, also known as tetraplegia, which is paralysis of all four limbs. Even optimistic specialists believe that recovery is possible only within the first six months to two years after injury. But unlike most patients with this condition, this individual began an aggressive exercise program while he was still in rehabilitation in 1995.
In November 2000, the individual began a series of evaluations at Washington University School of Medicine in St. Louis.
The School of Medicine's approach to spinal cord rehabilitation has three main goals: First, to help paralyzed individuals exercise and thereby receive the strength and cardiovascular benefits of physical activity; second, to help any undamaged nerve cells function as best they can; and third, to encourage new cells to grow. To do so, the team combines several therapies, including functional electrical stimulation (FES), bone density treatments and aquatherapy.
The individual in this study continued to use a specially designed FES exercise bicycle for one hour at least two times per week, which was part of the regimen he began in 1995. A computer sent electrical messages to his muscles, similar to what the brain does normally. This electrical stimulation causes the leg muscles to contract and pedal the bike. FES also was applied to the individual's other muscles, including his arms and abdominals. The research team theorizes that simulating normal motions will encourage spinal cord cells that still are intact to "remember" what it's like to be involved in movement.
Regular exercise also provides basic, physical benefits, including building muscle mass and bone density. By combining FES-assisted exercise with osteoporosis drug treatment, the individual reported in this study successfully reversed his previously severe osteoporosis and now has normal bone density.
Once the individual could make small movements, he began aquatherapy, which is physical therapy applied under water at the Gaylord Rehabilitation Center in Connecticut. Since gravity's effects are drastically reduced under water, movements are enhanced, and it is easier to practice any recovered abilities.
In 1999, this individual still had no sensation or movement below his injury. But as of September 2002, he now can feel light touch and pin pricks on about 65 percent of his body and has regained about 20 percent of motor function. That means that he can move the majority of his joints when gravity is reduced (for example, in a pool) and can move some joints against resistance, the best of which being his right wrist, left fingers and legs. His motor improvement is about four times better than results in patients who receive the drug methylprednisolone within eight hours of injury, which is the only documented way to intervene in these patients.
The individual's ability to feel people and objects has had the greatest impact on his daily life. For example, he now can tell when he should shift his weight and therefore can sit in a wheelchair for up to 16 hours.
His general health and quality of life also have improved dramatically. Before 1999, he experienced nine life-threatening complications and required about 600 days of antibiotic treatment. But in the past three years, he has not been hospitalized and has required only about 60 days of antibiotic treatment. As a result, his ability to commit to work projects and to participate in life have improved, as evidenced by the individual's answers to 13 quality-of-life questions included in the study.
While it is impossible to determine the biological cause of physical improvements in a single case study, researchers at the School of Medicine are conducting laboratory studies to determine whether regeneration and repair of nervous system cells may be responsible for these clinical results. They also are planning a prospective, randomized clinical trial to examine the impact of physical and functional benefits of the therapy.
"Our goal is to make recovery from spinal cord injuries a feasible option for most individuals," says McDonald. "I believe rehabilitation is going to shift to being a home-based, life-long process that almost anyone with determination and proper medical supervision can achieve."
For more information please go to: http://spine.wustl.edu
McDonald JW, Becker D, Sadowsky CL, Jane Sr., JA., Conturo TE, Schultz LM. Late recovery following spinal cord injury; case report and review of the literature. Journal of Neurosurgery: Spine, vol. 97, 252-265, September 2002.
Funding from the Sam Schmidt Foundation, the ALS Hope Foundation, the Kent Waldrep Foundation, the Barnes-Jewish Hospital Foundation and Washington University in St. Louis supported this research.
The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare. Washington University Physicians also work with the newly established Rehabilitation Institute of St. Louis, a joint partnership of BJC HealthCare and HealthSouth Corporation
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