Therapeutic Treatment Updates

Posted by Nurse Linda in Life After Paralysis on May 26, 2021 # Health, Rehabilitation

Many individuals and families ask about advanced therapeutic treatments for paralysis. These include stem cells, electrical stimulation, and aquatic therapies. This is a brief update of these therapies to see how they are developing.

Where you have paralysis in your body, messages to and from the brain are not being transmitted to make the movement and/or sensation connection. However, your body is still waiting for those messages. There is often a specific delineation above the injury where your body functions and below where your body is not getting any or full messages in spinal cord injury. After a stroke, one side of your body may perform while the other side does not. In other neurological diseases, the body may have areas where function is occurring and areas where it is not working. These areas typically relate to where your nervous system is affected by the disease.hand on wheelchair

It is important to remember that your body still works. It is just not getting the messages to do so. That is a huge mind shift for many individuals. Some people think of paralysis as that part of your body being nonfunctional. However, it is functional. It is just not getting the needed input. These therapies are all about providing input to the body where it is not receiving messages. The goal is to reeducate the body and to stimulate neuroplasticity, the ability for one part of the nervous system to take over for the part that is not working well. Some might say neuroplasticity is a re-learning or reorganization of the nervous system.

Stem Cell Therapy

New cells are formed in the body to replace old or worn cells. When new cells are formed, they are not yet determined as to what kind they will be. Chemical processes in the body modify the new cells into skin cells, liver cells, eye cells, blood cells, neurological cells or whatever cells are needed. In 1998, stem cells were discovered, and processes were developed to ensure stem cells into nervous system cells or other types of cells that an individual needs.

There were issues such as ensuring the stem cells developed into nerve tissue in the nervous system and not cardiac or other tissue, how to get the cells into the area of concern and where to get stem cells. Processes were developed to ensure stem cells in the nervous system always became nervous tissue. Other cells cannot work inside the nervous system. Inside the area of nervous tissue injury, a cyst-like structure forms with a boundary around it. How to get the stem cells inside the cyst without creating more damage and how to get stem cells to grow through the cyst boundary were issues. Internal body ‘scaffolding’ has been developed to deal with these issues. Since stem cells are found in fetal tissue, groups combined stem cell treatment with antiabortion issues. However, stem cells from fetal tissue led to immune issues, so this was not viable. Stem cells are derived from the individual who needs to avoid rejection issues and immunosuppressant medication. Methods to develop stem cells harvested from skin, nose and other areas of the individual’s body were developed to create stem cells of the person’s own genetic makeup.

The use of stem cells to treat spinal cord injury is still being developed. All the issues above are still being refined. Studies in laboratories are actively conducted. There is no approved use of stem cells for the treatment of spinal cord injury by the FDA (US Food and Drug Administration) because foundation and safety studies have not been completed. Injecting or placing a substance into your nervous system is an extremely serious issue. Therefore, establishing safety and efficacy (the ability for successful outcomes) are being refined. But that has not stopped the intense study of this option.

There are many opportunities for stem cell treatment available on the internet. Some people have participated with complications or even outcomes that create more issues. If treatment for spinal cord injury is not FDA approved or in an FDA approved study, it is not to your advantage to take part at the present time. Stem cell treatment options will become available as this is an active area of research.

Electrical Stimulation

Stimulation of the nerves and muscles is a currently available treatment option for individuals with neurological issues. This can be provided by electrodes placed on the skin to transmit signals to the nerves and muscle where the function is interrupted. Many individuals take part in these therapies in the rehabilitation setting with bicycling, supported walking and upper extremity stimulation. Some individuals have requested the equipment for home therapy, but this can be challenging to obtain due to high cost. However, the prices are lowering due to market competition.

Local skin surface nerve stimulators can be used to supply input to a single or few muscle groups. More success is being discovered using surface stimulation. One study is underway at the University of Washington in Seattle. This was for individuals with tetraplegia (quadriplegia), where an electrode is applied to the neck to improve hand function. The study information is here.

Implanted devices are currently being used to improve functional gains. Electrodes placed on the peripheral nerves of the cauda equina or tail end of the spinal cord are used to improve bowel, bladder, and sexual function in men. This is typically used in individuals with lower-level spinal cord injury. Implants aiding in hand use for individuals with tetraplegia (quadriplegia) have also been used.

Today, everyone has been following implants that bridge the area of spinal cord injury to improve function. Studies have been funded by the Christopher & Dana Reeve Paralysis Foundation. These studies are underway, but preliminary data reveal functional gains in movement, bowel, bladder, cardiac and respiratory function, among other areas. This is another area to follow as this research is advancing rapidly.

Aquatic Therapy

Using water as a medium for therapeutic treatment is a process that has been ongoing for years. It recently has become more available to individuals with functional issues as more pools are becoming available to individuals requiring adaptions.

In the water, buoyancy helps support the body. A person who has challenges with movement might not be able to move a limb or have difficulty doing so because gravity holds us all on earth. However, in the water, a gentle movement supported by the buoyancy of the water can allow movement to be discovered. Sharp movements in the water resist movement, but gentle motions facilitate movement. Individuals who try this therapy find the comfort of the support of the water to help them find skills they did not realize were there.

There are some precautions to take with aquatic therapy. Episodes of autonomic dysreflexia (AD) can be triggered from the pressure of the water on the body. Water should be warm, or a heated pool should be used to avoid triggering spasms (tone) and to help relax the body. An educated professional should help you set up an aquatic therapeutic program to ensure safety as well as to maximize and establish a plan to advance treatment.

Resources are available in many areas for aquatic therapy. Many pools have designated times for heating the pool for individuals who require this service. Check with your local agencies to find a qualified pool therapist. The Christopher & Dana Reeve Paralysis Foundation website has a ‘find near me’ resource app that will help you locate aquatic therapy near your home. Also, many rehabilitation centers are installing therapeutic pools because of the recognition of the value of pool therapy.

It is frustrating to hear about many of these therapies that might not be available to you. However, it is wise to know what is on the horizon or just to know about them so you can be sure to have your body ready for when they become available. Following the research can lead to thinking about therapies that you can do now, like aquatic therapy, that perhaps you just did not think about before. Nurse Linda

Pediatric Consideration: It is important to keep track of research for opportunities for your child. Following adult research can help you plan for the future for when your child becomes an adult or to integrate the ideas into your child’s life. Research usually follows the study of adults and then is adapted to the physiology of the pediatric individual.

Although stem cell therapy is not quite ready, electrical stimulation and aquatic therapies are available for the pediatric individual. Investigating these therapies is particularly helpful in stimulating the developing nervous system. Checking payment options should be attempted if you are interested in these options for your child. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

This project was supported, in part, by grant number 90PRRC0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.