“Push to Walk is an organization that provides individualized
workouts and resources to people with spinal cord injuries and other forms of
paralysis to optimize current quality of life and to prepare for future medical
advancements.”
That is the mission statement of Push to Walk, an
organization I have worked at for over three years and have proudly been the
Program Director of for the past year and a half. On the surface, we are a gym that provides
intensive exercise for people with central nervous system injuries and
disorders, including but not limited to spinal cord injury, multiple sclerosis,
traumatic brain injury, and stroke.
Through our intensive training and exercise, we hope to maximize the
health and subsequently, current quality
of life of our clients, as our mission states. The second part of our mission statement, “and to prepare for future medical
advancements”, always seemed like an afterthought, even to the most hopeful
of optimists, such as myself.
While most of our clients may experience functional gains, intensive
exercise is not a cure for any severe neurological injury or disorder. Most scientists and clinicians accept a cure
will be some combination of intensive exercise and physical therapy combined with some kind of regenerative
medicine –i.e., “future medical advancements”.
I used to think that those future medical advancements were a long way
away, and that people of today needn’t concern themselves about things being
studied in the lab right now becoming widely available anytime soon.
Now I think I was wrong.
It is perfectly fitting that it is now 2015, the year that Doc Brown and
Marty McFly travelled to “the future”. I
think the future is now.
Last year, we were introduced to a few significant advances
in the science of treating injuries to the central nervous system. These included:
- Dr. Susan Harkema’s lab in Loiusville, KY published a paper detailing four men who had chronic, complete spinal cord injuries who had electrical stimulators implanted on to their spinal cords. Long story short, after the stimulators were implanted, the published paper showed that the men could voluntarily control their legs, with evidence of voluntary ability to control their trunks as well. Anecdotally (i.e., the information wasn’t in the published paper, but the subjects or scientists talked about it anyway) the men reported that they experienced significant increases in bowel, bladder, sexual, and autonomic function. All four of them are also reported being able to stand as long as they hold on to something for balance, and despite not being able to walk, the muscles in their legs respond to walking training, which did not occur prior to the implantation. The Christopher and Dana Reeve Foundation is currently raising money to get more subjects implanted with epidural stimulators so that they can formally study the autonomic gains that have been reported anecdotally.
- In October, a story was released to the world about a paralyzed man from Poland regaining an unprecedented amount of motor, sensory, and autonomic function. This single subject got was a surgical implantation of his own olfactory ensheathing cells, plus a peripheral nerve bridge across his injury. This trial was based on the work of Dr. Geoffrey Raisman of King’s College London, who has been studying olfactory ensheathing cells for a very long time. Barring some limitations of the research design, we have a proof-of-concept that someone with a spinal cord injury can regain a significant enough amount of function that his life is impacted.
- Another study we learned about in 2014 was a clinical trial recently completed in China by Dr. Wise Young from Rutgers University in the USA. Although his results are not yet published, I mention his study because it is another study dealing with chronically injured, functionally complete spinal cord injuries. While we are all awaiting official publication of the paper, we learned that the majority of the 20 subjects in the trial experienced some significant degree of walking, functional, and/or autonomic recovery. Dr. Young has said that the results of this study only bring up even more questions which warrant further investigation, but at least we are moving in the direction of human clinical trials.
Now at this point, you may be thinking, “So what? These
studies are for ideas that are in their infancy. Who knows how long it will be before
treatments like these become common? I’m not going to worry about any of it
until it becomes widely available and I can get it.” Fair enough.
Hold on to that thought.
We also heard a lot about robotic exoskeletons last
year. While I personally am skeptical
about the neurorehabilitative effects of them, they do allow people to be
upright, out of their wheelchair, and move around their homes/neighborhoods in
a way that is as close to walking as possible right now, which does have plenty
of health benefits.
Last month, ReWalk, the first company to receive FDA approval
for their robotic exoskeletons, came to Push to Walk to evaluate whether or not
an interested customer is an eligible candidate to use a ReWalk. Unfortunately, the customer was not eligible
to purchase and use a ReWalk, because his posture was weak, he lacked adequate
range of motion and strength in his arms to use crutches to balance himself,
and his ankles were too tight to fit into the foot plates.
In a nutshell, whether it is epidural stimulators, olfactory
ensheathing cells, or umbilical cord blood cells, people’s bodies need to be
healthy and strong enough to undergo the intensive physical activity that is
going to be required in conjunction with any kind of regenerative cure that may
be available in the coming years. Even
to take advantage of today’s technology, such as exoskeletons, people must meet
physical standards to be eligible to use them in the first place. If you’re thinking that all I’ve mentioned
thus far is spinal cord injury studies, I will say that the mechanism of
improvement in many of these studies will also have implications for other
neurological disorders, such as MS and stroke.
What is my point with all this? We all know exercise is important, but not
just for health anymore. My point is
that there is technology available today that
offers those who want it, a chance to get up and get out of their wheelchairs,
even if only for a little while. My
point is that there are regenerative medicine techniques that have already been tested and thus fair been
shown safe and effective in humans,
not animals, with functionally complete
spinal cord injuries. Since all of those techniques are, or have plans to be
investigated further, it is no longer unreasonable to believe they will be more
widely available sooner (years) rather than later (decades). My point is keep your body as strong and in
shape as possible so it is ready to function at a higher level.
I will never tell someone to undergo so much intensive
training/therapy that it impacts the rest of their life. Exercise should never interfere with friends,
family, jobs, or come at such a huge cost that you can’t afford other things
you need in your life. With that said,
if you have access to a standing frame, freaking use it. If you have access to
functional electrical stimulation, make time for it. If you can go to a gym, be it a commercial
gym or an activity-based therapy gym, fit as much of it as you can into your
life. Do as much as you can to keep your
body ready for those future medical advancements. Because the future has already begun.
