Bully Pulpit: At Last, Progress

By | 2017-01-13T20:43:31+00:00 July 1st, 2011|
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Tim GilmerTruth is, I never thought I’d be saying what I’m about to say: Forty-five years after the first prediction that electrical stimulation would one day help paraplegics stand and walk functionally, we’re on the verge of seeing it happen. And we’re not talking about zombie-robot-Frankenstein walking. We’re talking about the real thing.

I’ve written before about the Los Angeles Times article I read in 1966 that reported on the first para to stand when muscles in his legs were directly stimulated. It was a time when computers took up an entire floor of a building and no one understood the complicated dynamics of walking. A talented young actor named Christopher Reeve was just 13 years old.

They called it bioelectric stimulation, and it was based on the prevailing doctrine that a spinal cord, once injured, was useless forevermore. The electrodes were placed on the peripheral muscles themselves or the nerves adjoining the muscles. Since the spinal cord was thought to be damaged beyond repair, it made sense to bypass it altogether.

Bioelectric stimulation progressed at a snail’s pace, but it has served a useful purpose. Today we know it as functional electrical stimulation. Paired with an exercise bike, FES helps maintain muscle tone, but it has benefited a fraction of a percent of the SCI population, mainly because it is not widely available, and its practical use is limited.

Then in late May of this year came the surprising news that continuous electrical stimulation of the cord itself — below the injury level — in combination with locomotor training, had made it possible for Rob Summers, a 25-year-old para with complete motor paralysis, to stand voluntarily and regain the use of muscles in his toes, feet and legs.

So why did it take 45 years to make what may seem like a modest gain?

First, researchers had to overturn the dogma that the intact spinal cord below the injury level was useless.  Then they had to prove that the cord itself was part of the solution rather than the problem. Now they must map the circuitry in the spinal cord. And they must find the best way to “turn on” those segments of the cord that are waiting to be reactivated.

The path to much-needed research is clearly defined now. That in itself is undeniable progress, and it offers hope that one day others with paralysis or weakness from neurological damage or disease may benefit, not just paraplegics.

I confess I have been skeptical in writing about this topic in the past. Perhaps it comes with more than 45 years of predictions followed by disappointment. At times the prospect of true recovery of functional movement and control has seemed to me something akin to pigs flying.

We have many research scientists to thank for their dedication and work over the years; and we have the Christopher and Dana Reeve Foundation’s NeuroRecovery Network to congratulate and support. But we also need to temper our hopes with renewed patience once again. The work of replicating and advancing what has been learned is just beginning.