MAKING A WORLD OF DIFFERENCE … IN SPINAL CORD INJURY AND NEUROLOGICAL CONDITIONS

An innovative therapy is offering people with spinal cord injuries and other neurological disabilities hope of better mobility and functional independence and, for some, the possibility they may one day walk again.

The therapy is known as FES [Functional Electric Stimulation], which works by applying electricity-conducting electrodes connected to a hand-held computer across the patient’s thighs and lower legs. At the touch of a button, the computer activates the muscles via low-current electrical stimulation in a patterned sequence to mimic the exercise benefits of, say, riding a bicycle, walking, standing up and sitting down or climbing stairs.

“The technique of using electricity to improve health is not new – in fact, it can be traced back as far as 46AD,” said Associate Professor Glen Davis, who is Director of the Rehabilitation Research Centre at the University of Sydney’s Faculty of Health Science.

“A Greek physician, Scribonium Largas in the Roman era, was described as using a torpedo fish (an electric eel) to relieve pain of Gout and stimulate the muscles of people with certain spinal injuries.”

“Even in the early 18th century it was known that electrical stimulation could move muscles that were paralysed. The most famous demonstration took place at the Royal College of Surgeons in London in 1803, where electrical currents were applied into a freshly dead corpse, and the medical audience observed, “the jaw began to quiver, the adjoining muscles were horribly contorted, and the left eye actually opened.” (1).

“A 21-year old contemporary of the era, Mary Shelley, inspired by her husband who had once accidentally killed the family cat whilst trying to give it electrotherapy, was so inspired as to write her famous book – Frankenstein – in 1818” he said.

Today, vigorous, repetitive exercise involving FES therapy can be used by spinal cord, stroke and head injury patients to improve their general cardiovascular health and fitness; allow better recovery times from some illnesses; reduce the incidence of pressure sores; and improve the general appearance of the legs.

However, recent ground-breaking evidence suggests that the use of FES ‘Activity-Based Therapy’ may also lead to the natural recovery of function. If so, this would represent an immeasurable improvement in the quality of life for people with spinal cord injuries.

This hypothesis will be tested in large-scale clinical trials later this year by a multi-disciplinary research team led by Professor Davis, whose worldwide reputation in this small but highly visible field of research has attracted significant numbers of overseas students and Postdoctoral Fellows. This year alone he has research students from Brazil, Iran, Malaysia and Switzerland under his tutelage, and Postdoctoral Fellows from Korea, New Zealand, and Austria.

The theory that neurological recovery - as a result of FES activity-based therapy – might be possible was borne from the remarkable progress made by the famous American actor, Christopher Reeve, before his death in 2004 from a rare infection.

Professor Davis said Reeve – under the medical treatment of Dr John McDonald III, a well-known American clinician – devoted his energies to an intensive program of activity-based therapy, which involved a combination of aquatic movement therapy, FES-cycling and FES treadmill walking. The intention was to improve Reeve’s general aerobic fitness and build muscle mass in his legs.

Reeve was neurologically stable, without much change in his condition as a high-level quadriplegic, when he commenced this FES exercise-based therapy more than eight years after his injury, yet his progress within just twelve months surprised even his doctors.

“After a little over a year he was able to come off his ventilator and breathe unaided for more than 90 minutes,” Professor Davis said. “He had new sensations in his legs and was able to make small movements with his wrists and fingers. This exceeded any progress for people with high-level spinal injuries had previously documented in the medical literature.”

“Further imaging scans revealed that Reeve actually had some neuro-regeneration in the damaged area of the spinal cord injury in his neck,” he said.

Professor Davis said FES-based exercise had been used for several years in Australia before Reeve’s improvement which allowed him to visit Australia in 2003. But the suggestion that it might have not only improved his health and fitness, but restored some nerve functioning, highlighted the urgent need for research into the benefits of FES Activity-Based Therapy.

He said a large-scale trial – one of a number of spinal cord injury research projects funded by a $1 million, four-year NSW Office of Science and Medical Research Program Grant – would involve chronically-injured patients who were considered to be neurologically stable.

“If we can demonstrate an improvement, a recovery of neurological function in someone who is more than five years past their injury, with exercise and the FES technology we can absolutely say for sure it’s not just the body’s natural recovery after an acute injury,” he said.

The use of FES Activity-Based Therapy, for some years employed to improve the health and fitness of patients, now has exciting new directions for the recovery and rehabilitation of patients with neurological disabilities, and may eventually combine with stem cell treatments to promote a cure for these people.

(1) Giovanni Aldini, An Account of the Galvanic Experiments Performed by John Aldini […] on the Body of a Malefactor Executed at Newgate (Cuthell & Martin, London, 1803).