Locomotor Training – Fact or Fiction for Treating Spinal Cord Injury

It seems that little has changed in the treatment of spinal cord injuries over the last decade. Hope of one day regaining the use of paralyzed limbs rests on the future development of medical technology break-throughs, but where are they?

First, let’s understand that a spinal cord injury (SCI) occurs when the pathway between the brain and limbs and muscles is interrupted. Without the ability to transmit signals, messages to the legs fall silent, and muscles wait idly for instructions that never arrive.

Renowned SCI research centers, Louisville's Kentucky Spinal Cord Research Center and Denver Colorado’s Craig Hospital have been experimenting with a revolutionary approach to treating SCI. Calling it “locomotor training,” injured parts of the body are retrained using electrodes, delivering muscle stimulation while the patient is rigged inside a high-tech exoskeleton that helps structure the patient’s movement.

The thought that a human can walk without the input from the brain seems like science fiction. After all, the brain sends signals through spinal cord, so if the damaged spinal cord cannot relay the signals to the limbs, how can walking occur? In 1911, scientist Graham-Brown theorized that the mammalian spinal cord was capable of generating rhythmic motor patterns independently of the brains input. More recent work done in 2008 by Sten Grillner discovered what he called central pattern generators or (CPGs). CPGs are in essence imbedded circuits in the spine that, when triggered, are able to generate walking patterns without input from the brain. (1) This work has become the foundation behind locomotive training. However, triggering the responses and getting legs to move is just one piece of the puzzle. Walking involves numerous sensory inputs and responses that the uninjured blissfully take for granted. Researchers and practitioners are undaunted by the complexity and challenges.

"There's new knowledge that can attack the results of paralysis and is also leading us down the path of ultimately reaching that cure," said Susan Harkema, a Ph.D. researcher at University of Louisville's Kentucky Spinal Cord Research Center in an interview with the Denver Post last month. The aim of Harkema and other’s using locomotor training is not to provide a cure for SCI but to restore movement in patients who would otherwise remain paralyzed.(1) Denver Colorado, SCI survivor, James Nall’s treatment with locomotor therapy, is being chronicled by the Denver Post. Their series, titled “Stepping Toward Hope” follows Nall through the arduous effort to retrain his body to operate without the typical signals from the brain.(2)

The Christopher & Dana Reeve Foundation, is working with Craig Hospital in Denver and others to advance the work and science of locomotor training. According to Craig Hospital Research Director, Susan Howley, the results so far represent a “potentially phenomenal breakthrough.” Howley, like many experts researching SCI, tempers her optimism and says, "The field is enormously rich in possibilities, but sometimes it seems every time we have a new nugget of information, it reveals how much we still don't know."

The locomotor training work being done might seem like science fiction. But even science fiction may not convey the complexity and intricacy of the spinal cord and it’s role in the task of walking. Regardless of the challenges, more work needs to be done to understand and heal damage to this most central component of our bodies.

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(1) Dietz V, Grillner S, Trepp A, Hubli M, Bolliger M: Changes in spinal reflex and locomotor activity after a complete spinal cord injury: a common mechanism? Brain 2009, 132(8):2196-2205.

(2) The Denver Post - Therapy for spinal-cord injuries helping Coloradans regain mobility http://www.denverpost.com/paralysis/ci_24381471/will-i-walk-again#ixzz2kNRgBKU4