创新医疗装置让残疾移动下肢，装置模拟大脑信号送达全身!

创新难，创新可让残疾人士挪动双腿更不容易！
新医疗装置让四位遭受完全脊髓损伤，腰部以下瘫痪的患者在遭遇事故后首次自主移动了，此装置被植入患者的脊髓中，模拟大脑发出信号送到受伤脊椎下，不断地通过脊柱发送电流，虽然患者仍无法起立和走路，但已能够移动他们的腿、臀部和脚趾了。几位瘫痪病人都遭遇过车祸或摩托车祸，其中有两人腰部以下无知觉。
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曙光：瘫痪人士借新装置挪动双腿
2014-4-11 原文译者   ivorleong
据外媒4月8日报道，幸好有了一种新型装置，四位遭受完全脊髓损伤，腰部以下无法活动的患者在遭遇事故后第一次能够自主移动了。该装置能够模拟大脑发出的通常被送达全身的信号。
有了这种装置，虽然患者仍无法起立和走路，但已能够移动他们的腿、臀部和脚趾了。此装置被植入每位患者的脊髓中，不断地通过脊柱发送电流。几位瘫痪病人都遭遇过车祸或摩托车祸，其中有两人腰部以下无知觉。
这种电极装置已不是第一次发挥作用了。在2011年著名医学杂志《柳叶刀》发表的一篇文章中，研究员苏珊·豪利（Susan Howley）就曾做过关于该装置在一位病人身上试验成功的报道；现在，豪利已经证明，该进展是可以复制的，并最终能够使一度完全瘫痪的病人过上相对正常的生活。豪利在《大脑》期刊上发表的最新研究成果说明了这个事实，即该疗法在全部四名患者身上见到疗效是对未来的深入研究是个好兆头。
“我们如今可以期待有一天，硬膜刺激将会成为鸡尾酒疗法的一部分，用来治疗瘫痪，”她说，“而在目前，除了标准的医疗方法，还没有证据可证明有效的针对慢性脊髓损伤的治疗方法。”
在治疗期间，每位患者的治疗都取得了进展，只需要更少的电流就可以刺激运动，四名患者在该装置的帮助下，都至少可以支撑一些重量了。豪利和其他参与该项目的人员由此认为，这些患者最终将可以重新走路。长期目标为令他们可以在跑步机上行走，这样就能通过移动带带来的感觉加快恢复速度。
加州大学洛杉矶分校的研究员雷吉·埃杰顿（Reggie Edgerton）说，随着试验的进行，大脑有可能重新恢复向以往信号可以到达的地方发送信号：“人体脊髓中的线路是十分有弹性的。一旦你刺激它们令它们重新活跃起来，许多被错搭和休眠的生理系统就能够恢复工作。”
该团队目前正在小白鼠身上进行试验，以确定这种技术是否能恢复更多的小肌肉运动技能；他们同时也在研究，观察是否能用一种类似的方法治疗那些颈部以下瘫痪的人。
许多关于脊髓损伤的研究都聚焦在使用干细胞使受损的神经细胞再生上。这些研究取得了一些成功，但尚未完全应用于人身上。这种方法可能最终将“治愈”瘫痪，但是在那之前，硬膜外疗法也是一种非常令人期待的方法。埃杰顿说。
“我们不必非要把希望寄托在神经的再生上才能恢复功能，”他说，“我们在这四名患者身上看到的结果说明，在那些完全瘫痪的患者身上，这也一定是个普遍现象。”


脊椎植入装置 瘫痪病人腿能动
2014-04-08 新唐人
脊髓受伤者的福音！刊登在〝大脑〞（Brain）期刊的美国一项研究报告说，有4名胸部以下瘫痪2年以上的瘫痪男子，经过将电气装置植入脊椎后，他们的腿部和脚部已能自行移动。
据中央社报导，美国国家卫生研究院（National Institutes of Health）旗下国家生物医学影像暨生物工程研究所（National Institute of Biomedical Imaging and Bioengineering）所长派蒂葛鲁（Roderic Pettigrew）说：〝这里有一个令人振奋的讯息，那就是脊髓受伤者不必再认为他们已被判处终身瘫痪。〞
派蒂葛鲁说：〝他们可以达成某种程度的自主功能。〞
他称这在脊髓受伤研究上是一项〝里程碑〞。他的研究所提供这项研究的部份经费。
虽然这只是在少数病人身上获得的成功，但却为以根本上全新治疗方式协助600万瘫痪美国人中的许多人，带来希望，这些瘫痪者包括130万脊髓受伤者。
这项结果也令人质疑对脊髓受伤的关键性假设：治疗必须让受损神经原重新生长或以诸如干细胞等加以取代。这两种方式已证明非常困难，且使用干细胞也会引发争议。
科学家说，即使那些被认为毫无希望而不再提供进一步复健治疗的案例也可能受惠。



Paralyzed patients able to move legs again, thanks to Christopher Reeve's legacy

http://www.nj.com/news/index.ssf/2014/04/post_344.html
April 08, 2014

Kent Stephenson,€…the €…second €…person €…to €…undergo €…epidural €…stimulation €…of €…the €…spinal €…cord, €…voluntarily €…raises €…his €…leg €…while €…stimulated €…at €…the €…Human €…Locomotion €…Research €…Center €…laboratory, a €…part €…of €…the €…University €…of €…Louisville's Kentucky Spinal Cord Research Center. (University of Louisville)


Using a medical device invented to treat back pain, researchers have discovered a way for paraplegics to move their legs.

The discovery represents a game-changing shift in the treatment of paralysis, said Peter Wilderotter, president of the Short Hills-based Christopher & Dana Reeve Foundation, which helped fund the research.
"The old dogma used to be that whatever movement you got back in the first couple of months after your injury was all you could expect," he said.
Now doctors have proved that some spinal nerves can be coaxed back to work even years after injury. Those nerves weren’t destroyed, it seems, but merely dormant, Wilderotter said.
"It’s truly a significant breakthrough," he said.
The technique involves surgically implanting the small pliable strip with 16 tiny electrodes against the spinal cord just below the injury site. Very low electrical current is then used to stimulate the spinal cord — mimicking the way the brain sends commands.
"It’s giving the circuitry a little nudge, saying, ‘Remember? This is what you used to do’," said Grace C.Y. Peng, program director of rehabilitation engineering at the National Institute of Biomedical Imaging and Bioengineering, which helped fund the experiment.
A battery pack is placed inside the abdominal cavity, which in turn is activated by a remote control held by the patient.
The four men who participated in the study had been injured in motorcycle or car accidents more than two years before their treatments. During the treatments, they were able to move their legs, hips and toes.
Even better, the participants needed less electrical stimulation in subsequent treatment sessions — a change that meant the spinal network was proving its ability to learn.
Given the experiment’s success rate of four-out-of-four, researchers were hopeful the technique would help many other paraplegics. For that reason, they tested it on four tough cases.
"They picked subjects who were the most injured who were diagnosed as never being able to move again," said Peng.
The ability to walk remains a long way off, however, researchers say. Controlling leg muscles is different from being able to stand up, balance, and bear weight. And all of those skills must be in place before a patient could attempt even a single step.
Thirty years ago, the belief that the spinal cord is smart enough to have some kind of memory of its own was considered "junk science," Wilderotter said. So ingrained is the belief that injury-damaged nerves are gone for good that when visiting researchers see a patient move his legs on his own, he said, "their mouths drop."
The findings were published in Monday’s medical journal Brain. The research was conducted mostly at the University of Louisville’s Kentucky Spinal Cord Injury Research Center.
The device is not commercially available. For now, its use is limited to patients in the clinical trial.
Now that is has been proved that stimulation can reawaken damaged nerves that control the legs, Peng said researchers are now studying whether they can reproduce the same success for paralyzed arms.
"It took us 30 years to reach this point, so it’s an extremely exciting advancement, Wilderotter. "And it’s not going to take us another 30 years to get to the next point."
Christopher Reeve, who played "Superman" and other roles in movies, was left paralyzed from the shoulders down after breaking his neck in a fall from a horse in 1995.
He started a concentrated program of exercise and electrical muscle stimulation in 1999, and doctors later said he had enjoyed a slow rebirth of limited sensation and movement. That type of stimulation was aimed at his muscles, not the spinal cord, as was this newer experiment. The 52-year-old Reeve died in 2004.



Spinal Cord Shock Helps Paraplegic Move Legs

http://abcnews.go.com/blogs/heal ... raplegic-move-legs/
Apr 8, 2014 ABC News


Dustin Shillcox was told he could never move or walk again. With the flick of a switch, that all changed.
“It was so incredibly amazing for me,” said Shillcox. “[My family] cried as well… they were very excited and happy.”
The switch turned an electric stimulator, which had been implanted into his spine. And even after two years of being paralyzed from the chest down, he noticed almost immediately that he could voluntarily move his right leg, toes and ankle.
The injury that had led to Shillcox’s paralysis was brutal for him to recall. A tire blew in the van he was driving, and was thrown from the vehicle at high speed. The accident broke his back and injured his spinal cord, causing complete paralysis and sensory loss below his injury.
Shillcox spent 16 days in intensive care, followed by nearly 5 months in the hospital. But none of the care he received would promise to help him move his legs again, until he saw an advertisement for the Christopher and Dana Reeve Foundation seeking participants for a clinical trial.  The ad featured another young man with a similarly serious injury, who had regained the ability to move his legs after having an electrode stimulator implanted along his spinal cord. He was the first patient with complete motor paralysis to recover voluntary movement of paralyzed muscles.
“I knew I wanted to do anything possible to regain mobility back,” Shillcox said. He applied for the clinical trial and was accepted.
After surgery and hundreds of rehabilitation sessions, Shillcox has since learned to bear weight on his legs and take some steps with support. Perhaps even more importantly, he has regained control over many of his bodily functions. And he can have sex again.
“It changed my quality of life, my self-confidence,” Shillcox said. “When I go out in public… to be able to use the restroom and be able to do that yourself improved my quality of life 100 percent.”
In addition to Shillcox and the case that inspired him, two other young men with complete paralysis have undergone the same procedure. All have gained voluntary movement in their legs, according to a new study published in the journal Brain Tuesday.
Previously, scientists believed such recovery to be impossible. Dr. Claudia Angeli, one of the authors on the Brain study and Assistant Professor and University of Louisville’s Kentucky Spinal Cord Injury Research Center, said that the discovery that this device, already being studied in a paralysis patient for other reasons, could restore leg function was largely a surprise.
“[One day], he was kind of bored during testing and decided to start trying to move and noticed he could move his toes,” Angeli said. “That was a big ‘wow’ moment for us.
“This makes me get up and go to work every day because I know it’s going to make a difference in someone else’s life.”
Neurological experts not involved with the research were similarly impressed.
“In the past, there was a prevailing idea that if you had motor-sensory complete spinal cord injury, you didn’t have any circuits that are left,” said Dr. James Guest, associate professor in the Department of Neurological Surgery at the University of Miami Medical School. “This research shows there are some circuits left … that can be modulated by conscious choice.”
Dr. Hazem Eltahawy, assistant professor of neurosurgery at Wayne State University, said the finding “invites optimism that this is not a complete injury that has no prognosis for recovery.”
“If this is true and reproducible, I think that would be the first time to demonstrate you can achieve some voluntary control across an injured spinal cord,” he said.
The scientists cautioned, however, that the research is still in early stages. Moreover, the four young men in the study engaged in literally hundreds of rehab sessions – something that may not be possible for all patients.
However, they are hopeful that these techniques can be applied sooner after recovery, and perhaps in combination with other technologies, or earlier in the recovery process, to see even greater results.
As for Shillcox, he’s now moved back home. And while he can’t walk yet, his strengthened core muscles already allow him to go jet-skiing.
“Definitely walking is a goal in my eyes, and I am going to continue doing everything I can to make that happen,” he said.
“It’s exciting to me to know if this is happening for me, and it’s exciting for other people out there with spinal cord injuries.”



Paralyzed men move legs following spinal shock treatment
Tuesday 8 April 2014 - 3am PST


With the help of an implanted device that delivers an electrical current to the lower spinal cord, four young men who have been paralyzed for years are now able to move their legs voluntarily.
All four men were completely unable to move their legs before being implanted with the device, which sends the lower spinal cord a continuous electrical current similar to signals transmitted by the brain.
The treatment, called epidural stimulation, delivers an electrical current of varying frequency and intensity to specific parts of the lumbosacral spinal cord, which is connected to dense bundles of nerve fibers that control movement in the hips, knees, ankles and toes.
Life scientists from the University of Louisville, Kentucky, and the University of California-Los Angeles, both in the US, and the Pavlov Institute of Physiology in St. Petersburg, Russia, report the groundbreaking achievement in the journal Brain.
The achievement 'offers a new outlook' on recovery following spinal cord injury
Lead author Claudia Angeli, an assistant professor at the University of Louisville's Kentucky Spinal Cord Injury Research Center (KSCIRC), says two of the men "were diagnosed as motor and sensory complete injured with no chance of recovery at all," and adds:
"Because of epidural stimulation, they can now voluntarily move their hips, ankles and toes. This is groundbreaking for the entire field and offers a new outlook that the spinal cord, even after a severe injury, has great potential for functional recovery."
One of the participants, Rob Summers of Portland, OR, was the subject of an earlier study published in the Lancet in May 2011, which reported how the shock treatment helped him recover a number of motor functions so he could stand, step with assistance and move his legs voluntarily.
This new breakthrough builds on that work. The Brain paper documents the effect of epidural stimulation in a total of four participants, including new tests on Rob Summers who was paralyzed after being hit by a vehicle.
The other three men - Kent Stephenson of Mt. Pleasant, TX, Andrew Meas of Louisville, KY, and Dustin Shillcox of Green River, WY - were paralyzed as a result of auto or motorcycle accidents.

Participants able to move legs immediately after receiving stimulator implant
The scientists say what is remarkable about this latest work is that the three new participants were able to move voluntarily as soon as the stimulator was implanted. They were surprised at the results - especially how quickly the men recovered. This made them think perhaps some of the voluntary movement control pathways may be intact after injury.
The results were even better when electrical stimulation was coupled with physical therapy. The team noticed that the men were progressively able to move their legs with less stimulation, showing that the spine was learning and improving nerve function.
As well as being able to move their legs and bear their weight, the participants are showing a wealth of other improvements in their overall health. These include increased muscle mass, blood pressure regulation, reduced fatigue and significant increases in self-reported well-being.
In the first part of the video below, participant Kent Stephenson demonstrates voluntary training with stimulation and training with an ankle weight. In the last segment, Rob Summers tosses a medicine ball.




Offering hope to millions of paralyzed people
The news offers hope to 6 million Americans living with paralysis, including nearly 1.3 million with spinal cord injuries. The four men's paralysis ranged in neurological level from C7 to T5, and they had been paralyzed for at least 2 years before the treatment began.
Two of the men were classed "A" in the system used by the American Spinal Injury Association, meaning they had absolutely no sensation or awareness below the site of injury. In fact, the team doubted whether the treatment would work at all in those two participants.
Susan Howley, executive vice president for research at the Christopher and Dana Reeve Foundation, who, along with the National Institutes of Health, contributed funds to the study, says the new study shows the findings of the earlier Lancet study were not an anomaly, and adds:
"At the present time, other than standard medical care, there are no effective evidence-based treatments for chronic spinal cord injury. However, the implications of this study for the entire field are quite profound, and we can now envision a day when epidural stimulation might be part of a cocktail of therapies used to treat paralysis."
The team is optimistic that the men will continue to improve with treatment. They believe with further enhancements, the epidural stimulator will one day be helping others with complete spinal cord injury to stand up, balance and work toward taking steps.