spinal cord stimulation, stem cells, robotics/neuroprosthetics
Spinal Cord Stimulation
Spinal cord stimulation (SCS) is most commonly used as a pain-relief technique that delivers a low-voltage electrical current continuously to the spinal cord to block the sensation of pain.
As many as 50,000 neurostimulators are implanted worldwide every year. SCS is a widely accepted, FDA-approved medical treatment for chronic pain of the trunk and limbs (back, legs, and arms).
Studies dating back to the early 1980’s have demonstrated that spinal cord stimulation may also have a role in reducing spasticity and improving function in patients suffering from upper motor neuron weakness. In particular, this has been well demonstrated following spinal cord injury and with patients suffering from multiple sclerosis.
Are You A Candidate For Spinal Cord Stimulation?
At the Paralysis Center, we are developing a program using this technology to reduce spasticity and to enhance motor function. This technology has been shown to be effective in a number of patients with spinal cord injury over the past couple of decades. It remains “off-label” and research into who are the best candidates and how effective the treatment will be for each individual is still ongoing.
We are now instituting a program of external transcutaneous stimulation coupled with rehabilitation. That is, electrodes can simply be placed on the back and stimulation applied through the skin to provide some of these effects to the spinal cord. This is a much less expensive way of testing the effect and rehabilitation with this alone can sometimes be enough to provide the boost needed for better movement that is sustained. If this is effective, but the effects do not remain when the stimulation is stopped, you may be a candidate for implantation of a stimulator unit.
Your surgeon at the Paralysis Center will select spinal cord stimulation, selective peripheral neurotomy, tendon transfer, nerve transfer or other treatment based on your condition and which techniques offer you the very best chance of recovery.
Stem Cell Treatment For Paralysis
Understanding Stem Cells As A Treatment To Reverse Paralysis
At the Paralysis Center, we think about stem cell research in two ways:
1) what is actually working today as a proven treatment, and
2) stem cell therapy as a viable treatment in the future.
Today stem cells are a powerful tool for scientists to use as they explore the underlying causes and mechanisms of injury and disease. Stem cells can help reveal how organisms, including human beings, develop. This, in turn, enables scientists to better understand how the body might repair itself after injury and disease.
In the future, innovative stem cell therapies will very likely be developed to treat disorders such as spinal cord injury and diseases like diabetes, heart disease, and Parkinson's. Cells from a patient’s own tissue can now be used to develop useful stem cells.
Despite the Paralysis Center having access to some of the most ground-breaking research on stem cell therapies, we do not recommend this as a proven treatment for our patients at this time. While we are excited about the future potential, this is not one of our primary treatments today.
When we treat patients at the Paralysis Center with any of our medically proven treatments – such as nerve transfer, for example – one of the most common questions we are asked is whether this treatment will disqualify the patient from participating in any future stem-cell based therapy or ruin their chances for a normal recovery should stem cells become a way to simply wake up the nervous system. The answer, resoundingly, is NO!
Getting a medically proven treatment today to help you will not “ruin your chances” of being a candidate for stem cell therapy sometime in the future once an effective FDA approved-treatment is made available.
The Paralysis Center offers patients a range of treatment options that are both proven to work and can help the patient recover function today. A person who receives an unapproved treatment is unlikely to achieve functional benefits related to the treatment, while risking unknown and potential harm. Conversely, participation in a stem cell trial or any clinical trial may prevent you from being eligible for future trials.
Be Hopeful But Very Cautious
There is a great promise regarding stem cells. Between newspaper headlines and “testimonials” across the web, it is tempting to believe a cure for paralysis is right around the corner. But the stem cell field is still early in its development. We don’t yet know enough about how stem cells can repair the nervous system or their potential complications.
There are many clinics outside the United States and outside mainstream medicine that offer unproven stem cell therapies in return for extremely high fees. None of these clinics can back up their claims of recovery with published, credible science. They typically tell a couple stories that sound amazing without having data of numbers of patients treated and exactly the changes, both positive and negative, that resulted from the intervention.
Stem cell tourism is a big business, targeting patients who might feel they have “nothing left to lose.” There are also numerous reports of stem cell scams and fraud. Before you or someone you know considers stem cell treatment, please understand the risks by asking lots of questions.
Please visit a Closer Look At Stem Cells from the International Society for Stem Cell Research.
Essential Questions To Ask A Stem Cell Clinic
1. Is the treatment FDA-approved, and if not, why not?
2. Will this affect whether I can get into another clinical trial?
3. What benefits can I expect and are those benefits lasting?
4. How will this be measured, and how long will it take?
5. What other medications or special care might I need?
6. How is this stem cell procedure done?
7. What is the source of the stem cells?
8. How are the stem cells identified, isolated, and grown?
9. Are the cells differentiated into specialized cells before therapy?
10. How do I know if the cells are delivered to the right part of my body?
11. If the cells are not my own, how will my immune system be prevented from reacting to the transplanted cells?
12. What do the cells actually do, and is there scientific evidence that this procedure could work for my disease or condition? Where is this published?
Robotics And Neuroprosthesis
A Neuroprosthetic is a device that supplants or supplements the input and/or output of the nervous system.
Today, several different types of surgical brain implants are being tested for their ability to restore some level of function in patients with severe sensory or motor disabilities. The most visible recent demonstration of the power of neuroprosthetics was a spinal cord–injured patient using a brain-controlled exoskeleton to kick off the 2014 World Cup in Brazil!
How Does A Neuroprosthetic Work?
Researchers have demonstrated that brain or nerve signals can be used to control computer cursor movements and robotic arms and enable the reanimation of paralyzed limbs. At Mass General, our researchers have made great strides in this area. Dr. Leigh Hochberg of Braingate and the Center for Innovation and Neurotechnology has developed a sophisticated system which, in early clinical research, has provided intuitive control over advanced prosthetic limbs, and provided people with paralysis with easy control over powerful assistive movement and communication devices. They are working toward enabling naturally-controlled movements of paralyzed limbs in patients whose conditions are not amenable to nerve transfers.
It is important to note that information transfer via Neuroprostheses is not a one-way street. Some systems can convert environmental stimuli into perceptions by capturing an external input and translating it into an appropriate stimulus delivered directly to the nervous system. Such reversal of information transfer can also be beneficial for limb prostheses.
Under normal circumstances, meaningful movements of the body can only be accomplished in conjunction with appropriate sensation of the limb or body part. It is this sense of pressure and joint position that enables a person to lift a paper cup without crushing it, for example, or allows someone to walk without injuring the joints of their feet.
An absence of sensory feedback leads to significant clumsiness and inefficiency of movement. Building such feedback into brain-controlled devices, whether visual, tactile, or proprioceptive in nature, enables a more elegant and effective control of the device. While this area of research is still young, researchers at Mass General have made significant progress with the creation of “bidirectional” brain-computer interfaces. By linking a device to muscles in a patient’s chest to which both motor and sensory nerves from the shoulder of a lost arm have been rerouted, a robotic arm prosthesis can be used that incorporates tactile feedback.
Is A Neuroprosthetic Right For You?
Your surgeon at the Paralysis Center will select free functional muscle transplant, tendon transfer, nerve transfer, nerve graft, nerve release or other treatment based on your condition and which techniques offer you the very best chance of recovery. If you are not amenable to our typical techniques, but appear to be a candidate for a research neuroprosthetic, we will refer you for enrollment in such a study.
Schedule a consult with the Paralysis Center today (844) 930-1001.
Tips to help you get the most from a visit to the Paralysis Center
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your Specialist tells you.
At the visit, write down the name of your diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your specialist gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your Paralysis Specialist if you have questions.