To reactivate the cord with electrodes: arrived to Spain a pioneering study against paraplegia

So he came back to walk Jered five years after becoming a paraplegic The implant has been released from the wheelchair to three paraplegics walking Again

To reactivate the cord with electrodes: arrived to Spain a pioneering study against paraplegia

So he came back to walk Jered five years after becoming a paraplegic

The implant has been released from the wheelchair to three paraplegics

walking Again after years of sitting in a wheelchair. Back to take steps even when the doctors gave lost all hope. In the last four months, what seemed a dream became reality for Jered (29 years), David (28 years old), Gert-Jan (35 years) and Sebastian (47 years). Four fortunate that, despite his paraplegia, have passed not to move even a toe of the foot to travel the length of a football stadium. All thanks to an experimental treatment focused on electrical stimulation of the spinal cord and therapy of intensive rehabilitation. Two clinical trials that were done at the Mayo Clinic (Rochester, Usa) and at the University Hospital of Lausanne (CHUV, Switzerland).

Now, in Spain a group of scientists from the Guttmann Institute is finalizing preparations to start the new year with a pioneering study in Spain, also based on the electrostimulation spinal cord combined with a protocol for physical rehabilitation. "We look forward to the approval of the Spanish drugs Agency -Aemps - by the end of 2018 or beginning of 2019," says Jesus Benito, principal investigator.

unlike the trials in Switzerland and the united States, instead of using electrodes surgically implanted in the epidural space, the English will opt for a system that's less invasive. The electrodes on the skin, at the height of the damaged area that is intended to stimulate. In a first phase, he argues, the specialist in Physical Medicine and Rehabilitation at Institut Guttmann, "we propose to work with patients with sci at the cervical level (tetraplegia) with the objective of recovering the most of the functionality of their upper limbs". Later, "we will continue with electrostimulation at the lumbar level, to try to recover the mobility of your legs."

Marc (20 years) could be one of the participants in this second phase of the project. A little over four months, exactly the 28 of July, had an accidental fall from 12 meters of height which left him a paraplegic. "At first, I believed that I would walk again because the damage spinal cord did not affect my touch sensitivity, but the doctors explained to me that the motor was completely damaged. This means that I can not move the lower limbs and that I need a wheelchair". Read news stories like that of Jared, David, Gert-Jan and Sebastian "gives a point of hope, and what we talked about at informal level, between room-mates, family, and therapists," says Marc. "The possibility of participating in a trial similar and regain mobility would be the best thing that could wait".

One of the patients of Lausanne, described the milestone of walking again as "an incredible feeling". An achievement that encourages scientists from all over the world to continue working in this same line: stimulation spinal cord with an electric current attached to the intensive rehabilitation. "During many years of research there have been many lines of research with a timely reply, but this is the first time that different centers use electrostimulation spinal cord and results are visible and encouraging. It is a line promising that you need to keep studying," says Benito.

The last four cases collected from scientific journals in the prestige of Nature, Nature Medicine and Nature Neuroscience) were subjected to electrostimulation spinal cord through an implant wireless placed in the epidural space. The electrode is connected to a device that generates electrical pulses under the skin of the abdomen, communicating wirelessly with an external controller. Knowing that electrical stimulation of the spinal cord has therapeutic potential in humans to facilitate muscle contractions are voluntary (although the use of this device requires the express permission of the U.s. Agency of the Drug), after recovery from surgery, the electrical pulses were adjusted and modulated while the physical therapists were helping the patient to mobilize the muscles with specific tasks. That is to say, it is not that these impulses gave rise to the movement but, with a lot of training, were able to generate the necessary learning to walk without the need of the brain to intervene.

somehow, these impulses manage to mimic the signals that the brain sends natural way to the muscles to execute movements voluntarily. Even it was observed that with special programming, you could also activate the proprioceptive system, responsible of the brain receives information about the position and the movement of the various parts of the body. This is what causes the changes that occur in the brain during the stimulation of the walk is to consolidate and at the end there is functional recovery, in such a way that when you shut down the electrical impulses, the patient to continue with the voluntary control of his muscles.

"The fact that there are changes in the cerebral cortex during this training run suggests that electrostimulation may be used in the process of rehabilitation to train a physiological function which then will endure", explains Antonio Oliviero, a neurologist of the National Hospital of Paraplegics of Toledo, although it is worth remembering that for the moment, these experiments are not a treatment for any person.

Marc Vidal, of 20 years, one of the injured spinal cord chosen for the clinical trial. JAVIER LUENGO

however, the path begins to be drawn, it is encouraging and the group of Spanish scientists of the Institute Guttmann added with your next project. Motivated by the work of the neurobiologist, Reggie Edgerton, of the University of California (Los Angeles, California), Jesus Benito and his team used for the first time in Spain the electrostimulation medullary external, "with electrodes placed on the area that we want to encourage, and by this electric current and intensive rehabilitation, we intend to promote the recovery of spinal cord injury".

The stimulator (about 20x20 inches), developed in the US, is already prepared in the Spanish centre, waiting to receive the green light from the Aemps. As explained Benito, "through a series of parameters, to identify the electrical stimulus in each of the 30 patients in the study so that, by means of two electrodes placed in the cervical area, reaching to the spinal cord, bridging the damaged area and transmitting signals to promote the mobility of the upper extremities, in this case". The plan includes a proprotocol training with robotic systems. "When a patient with cervical spinal cord injury will ask for the function that most would like to recover, always choose the mobility of the hands," says the expert.

One of the researchers who worked on electro-medullary in the US was Spanish, and returning to Barcelona, we got in touch and started working on this line," says Benito. The reality is that "the external stimulation is more affordable, has fewer risks and is easier to apply". Further, "if the studies, in general, are giving good answers, the next step will be to implant to make the result more definitive. We think that the pacing surface could provide an extra to conventional rehabilitation".

On the same line, the president of the Spanish Neurorehabilitation Society, Manuel Murie, is confident that "in the next 15 years is going to be a revolution in the treatment of the nervous system, because we are achieving results that were unthinkable".

new technologies, "a story in Spain"

The research opens up a future immense to a group of patients are increasingly thickened. "As it happens in other countries, the population is increasingly ageing, we live more years, have more chronic diseases that we are controlling but gradually decreasing our functional ability and we generate some greater or lesser degree of disability", he argues Roser Garreta Figuera, president of the Spanish Society of Physical Medicine and Rehabilitation (Sermef). Taking advantage of this international Day of persons with Disabilities, the specialist recalls that there are more than four million people affected in Spain (data from the National Institute of Statistics, 2008) and that it is desirable that the Ministry of Health to give a response to your request of updating of the portfolio of basic services of the National Health System". The current regrets, "is obsolete, does not take into account the actual resources of our specialty (volume, specialist, distribution, number of hospitals...) and the new opportunities in technology and treatment that are emerging". And he adds: "as Well as the robotics and virtual reality are implemented in most european hospitals, in Spain is absolutely anecdotal. We like 15-20 years behind". The goal is to "equalize as far as possible the opportunities in Spain with those of Europe". However, the technology is not the only challenge. Employment is another big challenge.

According to the Adecco Foundation, the labour inclusion of people with disabilities will not occur until the year 2249. In the same line, the Observatory on Disability and the Labour Market (Odismet) of the once Foundation, says that only one out of every four people affected have jobs. In terms of their gross annual salary of these people, is situated in 19.2989 euros, 3.976 less than the rest of the population. So, as stated the Odismet, 30.9% of persons with disabilities are at risk of poverty or social exclusion.

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Updated Date: 05 December 2018, 08:02



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