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Reversing Paralysis after Spinal Cord Injury

If you were born in the early 80s like me, you might have remembered the exciting TV series called McGyver. I was very inspired and fascinated by such science and technology shows at my early age which led me to pursue my early degrees in physics and electronic engineering. I soon realised that there was more to this fascinating science, and further pursued my higher degrees in bioengineering and neuroscience focusing on rehabilitation after paralysing spinal cord injury (SCI). When I look back, I realise that I was very lucky to have had such an interdisciplinary background of physics, engineering, neuroscience, and rehabilitation. I also feel extremely lucky to have undergone my postdoctoral training under the renowned professor in the SCI field, Dr Reggie Edgerton from the University of California, Los Angeles to study different neurorehabilitation therapies. Finally, I returned to

the Hong Kong Polytechnic University where I’m currently a Research Assistant Professor in the Department of Biomedical Engineering working on different spinal cord repair strategies.

Our goal is to reverse paralysis—simple, yet ambitious. I truly believe that reversing paralysis after a SCI is possible, and we are working hard towards this goal. Recent electrical neuromodulation studies, where the inactive spinal cord is activated by electrical stimulation, have demonstrated restoration of walking function in several severely injured individuals, while the doctors did not have any hope that they would walk again! This treatment, however, requires major surgery to implant an electrical stimulator inside the body. The surgery

involved in this treatment—as with any other invasive therapy—can cause various complications and risks. Our strategy, in contrast, is to develop a non-surgical (non-invasive) pain-free treatment where no such surgeries are required! This will not only save the patient from having to undergo critical surgery and its associative costs, but also increase its access to a larger SCI population worldwide. The technique we use is called transcutaneous lectrical

stimulation (tES), similar to TENS (transcutaneous electric nerve stimulation) but targeting the spinal cord by simply placing the sticky electrodes onto the skin above the spine.

In our latest study, we provided the first evidence of permanent recovery of voluntary movements using non-invasive tES treatment. Our study participant, a 48-year-old woman who had been paralysed for over 21 years from a cervical injury resulting from a motor vehicle accident, regained significant muscle control and mobility in her legs after 16 weeks of tES treatment. The tES treatment was combined with physical training sessions such as standing and treadmill stepping training, three to four times a week.

What we found far exceeded many others’ expectations: after only four months of treatment, our study participant regained significant voluntary movements in her paralysed leg, allowing her to stand on her own and stabilise her knee without assistance. In fact, she even managed to squat without the assistance of a holder which she had never been able to do over her two decades of paralysis! She also regained significant sensation of her previously paralysed body parts. This is the first non-invasive treatment that has resulted in such dramatic improvements of sensorimotor functions in a paralysed individual. We also noted that as the training progressed, the patient became less dependent on the stimulation to control her legs. Furthermore, we observed no loss of function in the weeks following the treatment, which suggests permanent recovery of the neural circuits in the spinal cord.

The overwhelming success of this study sheds light on the future of paralysis treatment. Our study participant is now working hard every day (doing situps, standing, and locomotor training with tES) aiming towards the next steps—regaining overground walking. We look forward to the day when she can independently walk out of our lab! This should inspire many other SCI individuals to work harder on their rehabilitation because we believe that it is not just a hope—it is going to be a reality that paralysis after a SCI is reversible. We all look forward to that day and are working hard to further improve the neuromodulation techniques to improve efficiency and functionality. With our knowledge of engineering, we are also working on developing a small, affordable neuromodulation system which can be easily used at home to boost the rehabilitation of SCI. We wish to publish our design as open source

(free to copy) so that the benefits can reach to all the SCI individuals around the world.

Written by Monzurul Alam

Image credit: The image shows an experimental training session of a patient with Assit/Prof

Monzurul using the technology described.

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