Milos Popovic, a biomedical engineer at the Toronto Rehabilitation Institute, uses functional electrical stimulation (FES) to activate nerves connected to muscles affected by paralysis. Popovic developed a Walkman-size FES system as a training tool to help patients with limited walking ability regain voluntary control of weakened or paralyzed leg muscles.
After regular FES sessions on a treadmill for three to four months, the patient’s ability to walk is greatly improved, even without the use of the electrical stimulation device. With repeated electrical stimulation of the leg muscles, the nervous system relearns how to move those muscle groups. “The nervous system has some plasticity, so you can retrain it with FES,” explains Popovic.
John Haddad, 39, is one of five patients with a chronic incomplete spinal cord injury who participated in a 2005 pilot study published in Spinal Cord. In 1996, John had a benign tumour removed from his spine. After the operation, he could only walk a short distance using braces and two canes, and he needed his wheelchair to go to the store. Seven years after the operation John began FES treatment.
“The FES has made my mobility much better. I walk up stairs all the time now, and I can go a lot farther than before. It’s taken me from using my wheelchair to not using it,” says John, who continues to use two canes because he has no feeling in his legs. “The canes tell me where the ground is.”
This therapy is particularly exciting because it helps patients with chronic spinal cord injuries – most of whom are not expected to recover more movement. “I’ve proven that you can improve a lot. It’s given me drive because I’ve got more mobility,” says John.
Intensive rehabilitation helps to retrain circuits in the brain and spinal cord to maximize movement. Researchers believe that intensive rehab methods, such as FES therapy and partial body-weight support treadmill training (please see “Training the Spinal Cord to Walk,” page 106), will have an even greater impact when combined with neuroprotective and regenerative treatments, such as minocycline, Cethrin and anti-Nogo, or with cell transplants.
“You want to combine a new medication with rehab to get an enhanced benefit,” says Dr. Mohan Radhakrishna, a specialist in physical medicine and rehabilitation at McGill University Health Centre in Montreal.
Page 5 of 6
