It's amazing what medical science can do. Here's a technology that is giving hope to people who have been paralyzed by spinal cord injuries.
Electrodes help reroute nerve signals around trouble spots
By Laura Sanders, SCIENCE NEWS AUGUST 3, 2022 AT 7:00 AM
By his count, Michel Roccati is on his third life, at least. In the first, he was a fit young man riding his motorcycle around Italy. A 2017 crash in the hills near Turin turned him into the second man, one with a severe spinal cord injury that left him paralyzed from the waist down. Today, the third Michel Roccati works out in his home gym in Turin, gets around with a walker and climbs stairs to visit a friend in a second-story apartment. Today, he says, his life is “completely different than it was before.”
Roccati, age 31, is one of three men who received experimental spinal cord stimulators as part of a clinical trial. All three had completely paralyzed lower bodies. The results have been a stunning success, just as Roccati had hoped. “I fixed in my mind how I was at the end of the project,” he says. “I saw myself in a standing position and walking. At the end, it was exactly what I expected.”
WHAT IT IS: The technology that Roccati and others use, described in the February Nature Medicine, is an implanted array of electrodes that sits next to the spinal cord below the spot severed by the injury. Electrical signals from the device replace the missing signals from the brain, prompting muscles to move in ways that allow stepping, climbing stairs and even throwing down squats in the gym.
Today, Roccati spends time working at the consulting company he owns with his brother and sharing his ongoing physical accomplishments with researchers. “Every week we get a WhatsApp from Michel doing something new,” says study coauthor Robin Demesmaeker, a neural engineer at NeuroRestore, a research and treatment center in Lausanne, Switzerland.
These results and others prove that, with the right technology, people with severe spinal cord injury may be able to stand up and walk again. It’s a remarkable development.
But the really big news in this area goes far beyond walking. Many people with spinal cord injuries deal with problems that aren’t as obvious as paralysis. Low blood pressure, sexual dysfunction and trouble breathing or controlling hands, arms, bladder and bowels can all be huge challenges for people with paralysis as they navigate their daily lives. “These are the things that actually matter to people with spinal cord injuries,” says John Chernesky, who has a spinal cord injury. He works at the nonprofit Praxis Spinal Cord Institute in Vancouver, where he makes sure the priorities and voices of people living with spinal cord injuries are heard and addressed in research.
By figuring out the language of the spinal cord, researchers hope to learn how to precisely fill in the missing commands, bridging the gap left by the injury. The work may pave the way to treat many of these problems flagged by patients as important.
“The research field is changing … embracing all these other aspects,” says neuroscientist Kim Anderson Erisman of MetroHealth Medical Center and Case Western Reserve University in Cleveland. Already, early clinical trials are tackling the less obvious troubles that come with spinal cord injuries. Some of the same scientists that helped Roccati recently showed that similar spinal cord stimulation eased a man’s chronic low blood pressure. Other researchers are improving bladder and bowel function with stimulation. Still more work is focused on hand movements. The technology, and the understanding of how to use it to influence the nerves in the spinal cord, is moving quickly.
Not coincidentally, the way the research is being conducted is shifting, too, says Anderson Erisman, who has a spinal cord injury. “Scientists know the textbook things about spinal cord injuries,” she says. “But that’s not the same thing as living one day in the life with a spinal cord injury.” Involving people with such injuries in studies — as true partners and collaborators, not just subjects — is pushing research further and faster. Such collaboration, she says, “will only make your program stronger.”
These efforts are in the early stages. The stimulators are not available to the vast majority of people who might benefit from them. Only a handful of people have participated in these intense clinical trials so far. It’s unclear how well the results will hold up in larger trials with a greater diversity of volunteers. Also unclear is how attainable the technology will be for people who need it. For now, the research often requires large teams of experts, typically in big cities, with patients needing surgery and months of training the body to respond.
Still, the promise of spinal cord stimulation extends beyond spinal cord injuries. Stimulating nerves on the spinal cord could help people with symptoms from strokes, Parkinson’s disease, multiple sclerosis, cerebral palsy and other disorders in which signals between the brain and body get garbled. Initially, “hardly anyone wanted to believe these [improvements] were happening,” says V. Reggie Edgerton, an integrative biologist at the University of Southern California’s Neurorestoration Center and the Rancho Los Amigos Rehabilitation Center in Downey, Calif. “But now, they’re happening so regularly that it’s undeniable.”
A turnaround Not so long ago, a serious spinal cord injury was a death sentence. “Prior to World War II, the life expectancy of a person with a spinal cord injury was measured in days or weeks,” Chernesky says. If the injury didn’t kill a person directly, they’d often succumb to respiratory distress or blood poisoning from a bladder infection. “If you lived six months, that was impressive,” he says.
The spinal cord ferries signals between brain and body. Signals from the brain tell leg muscles to contract for a step, blood vessels to expand and the bladder to hold steady until a bathroom is within reach. Signals from the body to the brain carry sensations of moving, pain and touch. When the spinal cord is injured, as it is for an estimated 18,000 or so people each year in the United States alone, these signals are blocked.
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