New therapy helps some regain motion lost to spinal injury

For Joe Beatty, it was a rogue wave in Maui. 

Beatty was body-surfing on Kaanapali Beach in Hawaii in 2014. Long considered a family-friendly beach, Kaanapali is widely thought of as an ideal spot for both children and adults to swim; however, on that day for Beatty, this normally safe environment turned unusually dangerous.

“It was a rogue wave. It really was, that I caught and gave me a header in the sand. I was knocked out for three days,” Beatty said. “It happened on a Sunday, and I didn’t get totally back into consciousness until Wednesday. That’s when I first learned anything had happened. When they brought me to the hospital by ambulance, I was told that the only thing moving was my big toe, and my heart rate was down to nine beats a minute. I was lucky to be alive.”

But Beatty could not  walk, and barely move his arms. Physcial therapy only too him so far, and iimprovement stalled in 2016.

It was the middle of winter, four days before Christmas in 2012. Jessica Owen, an elementary school teacher who was then 27, and her parents, brother, sister and brother-in-law all piled into an SUV, setting out for what they thought would be a quick family vacation in Leavenworth, Washington. Although the road they took was open and clear, the trees were heavily snow-laden, and unbeknownst to the family, unusually so. As they drove over the crest of a mountain, just beyond Stevens Pass, a huge tree near the road toppled from the heavy weight of icy snow on its branches. When the tree fell, it fell hard, smashing squarely onto their car.

Only Owen’s brother escaped serious injury. Owen’s parents passed away instantly, her sister and brother-in-law both had shattered femurs, and Owen herself experienced a spinal cord injury that left her unable to feel her arms and legs. In an instant, her life was forever changed.

Jon Schlueter had lost use of his hands after a diving accident 15 years ago. Schlueter has always had a passion for experiencing life to the fullest, whether it was through traveling, climbing or playing guitar. This changed in 2006 when he dove into a swimming pool and his head unexpectedly hit the bottom. This accident resulted in an incomplete cervical spinal cord injury, which left Schlueter with minimal arm and hand function, and no movement in his trunk and legs.

But now the narrative for all three has dramatically changed, thanks new clinical trials taking place at UW Medicine. These three are now able to use their hands and move their arms in ways that seemed impossible before their treatment began at UW Medicine. 

In a small study of physical therapy combined with a noninvasive method of stimulating spinal-cord nerve cells, University of Washington researchers helped six Seattle-area participants- including Jon, Jessica and Joe - regain some hand and arm mobility. That increased mobility lasted three to six months after treatment ended. The research team published the findings this month in the journal IEEE Transactions on Neural Systems and Rehabilitation Engineering.

"We use our hands for everything — eating, brushing our teeth, buttoning a shirt. Spinal cord injury patients rate regaining hand function as the absolute first priority for treatment ... five to six times more important than anything else that they ask for help on," said lead author Dr. Fatma Inanici. She completed this research as a doctoral student of rehabilitation medicine in the UW School of Medicine.Almost 18,000 Americans experience traumatic spinal cord injuries every year. Many of these people are unable to use their hands and arms and can't do everyday tasks such as eating, grooming or drinking water without help.

"At the beginning of our study," Inanici said, "I didn't expect such an immediate response starting from the very first stimulation session. As a rehabilitation physician, my experience was that there was always a limit to how much people would recover. But now it looks like that's changing. It's so rewarding to see these results."

After a spinal cord injury, many patients undergo physical therapy to try to regain mobility. Recently a series of studies showed that implanting a stimulator to deliver electric current to a damaged spinal cord could help paralyzed patients walk again.

The researchers from the Center for Neurotechnology combined stimulation with standard physical therapy exercises. The nerve stimulation, however, does not require surgery. Instead, it involves small patches stuck like Band-Aids to a participant's skin around the injury site, where they deliver electrical pulses.

The researchers recruited six people with chronic symptoms from spinal injuries. All participants had been injured for at least a year and a half. Some participants couldn't wiggle their fingers or thumbs while others had some mobility at the study's outset.

To explore the viability of skin-surface stimulation, the researchers designed a five-month training program. In the first month, the researchers monitored participants' baseline limb movements each week. In the second month, the team put participants through intensive physical therapy three times a week for two hours at a time. In the third month, participants continued physical therapy training and added neuralstimulation.

"We turned on the device, but they continued doing the exact same exercises they did the previous month, progressing to slightly more difficult versions if they improved," Inanici said.

For the last two months of the study, participants were divided into two groups: Those with less severe injuries received another month of training alone and then a month of training plus stimulation. Patients with more severe injuries received the opposite — training and stimulation first, followed by training-only.

Some participants regained some hand function with training alone, and all six saw improvement when stimulation was combined.

"Both people who had no hand movement at the beginning of the study started moving their hands again during stimulation, and were able to produce a measurable force between their fingers and thumb," said senior author Chet Moritz, an associate professor of electrical and computer engineering and of rehabilitation medicine and physiology. "That's a dramatic change, to go from being completely paralyzed below the wrists down to moving your hands at will."

Some participants noticed other improvements, including a more normal heart rate and better regulation of body temperature and bladder function.

The team followed up with participants for up to six months after training and found that the improvements remained, despite lack of continued stimulation.

For Beaty, it means being able to take pills on his own at home. For Owen, the therapy has helped her recover enough movement to live alone and begin painting. Schlueter can now play the guitar. More on Jon and Jessie's stories can be found on this YouTube video. Download pictures and videos from here.

"We think these stimulators bring the nerves that make your muscles contract very close to being active. They don't actually cause the muscle to move, but they get it ready to move. It's primed, like the sprinter at the start of a race," said Moritz, who co-directs the Center for Neurotechnology. "Then when someone with a spinal cord injury wants to move, the few connections that might have been spared around the injury are enough to cause those muscles to contract."

The results of this study have already informed the design of an international, multisite clinical trial that will Moritz will co-lead. UW Medicine will be one of the sites.

"We're seeing a common theme across universities: Stimulating the spinal cord electrically is making people better," Moritz said. "But it does take motivation. The stimulator helps you do the exercises, and the exercises help you get stronger, but the improvements are incremental. Over time, however, they add up into something that's really astounding."

The paper's UW co-authors are Lorie Brighton, a research scientist; Soshi Samejima, a UW doctoral student in rehabilitation medicine; and Dr. Christoph Hofstetter, an associate professor of neurological surgery.

Engineering communication director Wayne Gillam contributed to this report.  

This research was funded by the Center for Neurotechnology, the Washington State Spinal Cord Injury Consortium and the Christopher and Dana Reeve Foundation. Grant number: EEC-1028725.

[Editor’s note: This story originally appeared on UW News.]

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