Column: One step, then another. With determination and new therapies, there’s hope for paralysis patients

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Ignacio Montoya pauses, gathers strength, takes a step.

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Then another, and another.

With the aid of a walker, an exoskeleton suit and robotic legs that are attached to and propel her self, Montoya is making her way up and down the promenade along the edge of the water in the Marina del Rey boat basin . trader Joe’s.

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“Christopher Reeve would be amazed,” says UCLA scientist Reggie Edgerton, who worked with the late actor and is now tracking Montoya’s every move.

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It may soon no longer be possible for people with severe spinal cord injuries to walk without assistance. But some improvements are now being felt in a task that was thought impossible until recent years.

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Montoya was nearly killed in 2012 after a minivan came his way while he was on his motorcycle. At the time, Montoya was studying simultaneously at Georgia State University and Georgia Tech – as well as working at a bank and training in the Air Force ROTC program.

Montoya’s jugular veins were torn in the violent collision. His lungs broke. His back was broken. Due to a spinal cord injury, one arm and both legs were paralyzed. Montoya, who turned 22 the day before his injury and is now 30, was told he had a 1% chance of regaining any sensation.

But Montoya, whose family immigrated to the United States from Cuba after winning the visa lottery at age 6, is the kind of person who thinks a chance in a hundred is cause for optimism. He completed his business degree a year after the accident, followed by a master’s degree in biomedical engineering. He then set out to study the state of spinal cord injury treatment around the world, determined to prove his prognosis wrong.

It moved him to Edgerton’s UCLA lab in the summer of 2019, a man whose relentless determination made for a good fit with Montoya. Edgerton had polio as a young boy in North Carolina, but he played baseball and basketball. He says that he wanted her to be seen as just another child, and to be treated equally.

“I’m 81,” Edgerton told me, watching Montoya walk along the promenade. Edgerton is finally seeing the benefits of painstaking research, he and a handful of scientists in the world are trying to push the boundaries of possibility.

Working with funds from the active efforts of Reeve—who was paralyzed after a fall from a horse in 1995 and died in 2004—Edgerton has explored the ways in which the brain and spinal cord are damaged. Can be retrained to work together. With gradual refinement, especially over the years, he said he has seen patients move with assistance from standing up, regained sensation in the lower extremities, and improved bladder control and sexual activity.

“I’ve seen the same thing happen with children with cerebral palsy, and I don’t want to exaggerate it, but what we’re seeing … is obviously unprecedented,” Edgerton says.

Earlier in his career, Edgerton had no shortage of medical skeptics, and some even ridiculed his theories.

Dr. Richard L., Chief Scientific Officer of the Shirley Ryan AbilityLab in Chicago. “He’s always been countercultural,” says Lieber. “Basically, they pushed Christopher Reeve to walk up and down and it really shook the place.”

Ignacio Montoya suffered a spinal cord injury in a motorcycle accident, leaving him paralyzed in one arm and both legs.
(Caroline / Cole)

Edgerton’s therapy is “not the answer for everyone,” says Lieber, who noted ongoing research by other scientists. But AbilityLab honored Edgerton in 2019 for what Lieber called “his monumental impact in the fields of neuromuscular physiology and rehabilitation.”

He says Edgerton “bred an entire cottage industry of rehabilitation and I would say it is one of the most promising treatments for spinal cord injury in our time.”

Dr. Charles Tetore, a neurosurgeon and researcher in Toronto, says he tried similar treatments a few decades ago but with little success. Now he thinks Edgerton has had breakthroughs that could one day lead to similar treatments not only for patients with cerebral palsy, but also for stroke patients.

“Reggie is trying to wake up the damaged nervous system and do things that aren’t possible without new tricks,” Tetore says. “In my view, he is a real pioneer.”

But it required as much patience as perseverance.

About 10 years ago, after years of research on mammals proved promising, Edgerton employed a procedure in which electrodes were surgically placed on the spinal cord to stimulate the central nervous system. Even with severe damage to the spinal cord, he says, some neurological pathways remain.

In recent years, they switched to a simpler and less invasive form of the same concept, attaching electrodes to the skin on the lumbar part of the spine.

“We probably got half of our subjects, who were fully injured, to be able to stand within four to eight weeks of training,” says Edgerton, who is still at full capacity. Or don’t know the limits. the treatment. He says the spinal cord condition is almost at the same stage as the Wright brothers when they first flew the plane.

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Montoya remembers his flight from Cuba as a child. Although he was just 6 years old, he remembers the feeling of liberation, as well as the beginning of his desire to become an aviator and serve his adopted country. During his college years and ROTC training, he aimed to become an F-16 fighter pilot. Then came the accident.

“I was pronounced dead,” says Montoya, who tells me he was revived in the emergency room. “After a spinal injury, you’re sent home in a wheelchair. It doesn’t matter where you are in the United States or in the world. If you’re lucky they’ll give you a month, two months, three months. And if you’re lucky, you might get a little outpatient therapy.”

But you are not sent home with much expectation.

“Physicians feel obligated to tell them they’re never going to walk again,” Edgerton says. “It’s one of the first things they hear.”

The prevailing consensus, says Edgerton, has been that a year after a severe spinal injury, even the least chance of recovery is not impossible.

“It’s nearly impossible to get insurance to cover any type of treatment,” Edgerton says.

He understands the danger of instilling false hope in patients, but the danger of not giving hope at all, especially as the number of medical devices increases, so does the bank of knowledge of how the nervous system controls movement. Is.

Now she has three other patients undergoing the same treatment as Montoya, who work three days a week and two more days a week at Edgerton’s UCLA lab.

In the laboratory, Montoya is suspended weightless on a treadmill with electrodes attached to his spine to stimulate his nervous system.

“My brain is interpreting these sensations,” Montoya says, and with the aid of therapists, he is able to contract the muscles and move his legs, even after the electrical stimulation has been removed. Even after.

He then lies on his side, is re-suspended, and is able to voluntarily contract the muscles to move his legs, as if he were pedaling a bike.

Montoya says the sensations she feels are not the same as before the accident. But electrical stimulation – and an increased awareness of the communication between his brain, spinal circuitry and muscles – is making the movement possible. It is as if he is learning to listen to the conversation between his brain and nervous system, and is beginning to use that intelligence to learn how to gain some control.

“You can’t be passive,” Montoya says. “You really have to think really hard about every little muscle and every little movement, and when you focus, you’re able to tap into those peripheral nerves. And only then can you contract the muscles.” “

Edgerton says that in terms of bladder control, spinal cord injury patients “know that the bladder needs to be emptied, even if the signal feels different.”

Professor Reggie Edgerton, who treated Christopher Reeve, is working with Ignacio Montoya.
(Caroline / Cole)

Montoya says he is able to contract the muscles in his lower extremities and abdomen, which help him breathe. He says exercise has created an overall feeling of greater physical function. It also seems to relieve chronic severe arm pain, and his bone density has returned to normal levels.

“I’m able to speed up my heart rate, which in turn increases my circulation, and I’m able to relieve neuropathic pain,” Montoya says. “I’m able to regulate my body temperature, I’m sweating the first time I work out, and I’m really hungry and thirsty again.

“I mean, it’s revolutionary, it’s life-changing, and I see it and I see it. And for someone who’s been paralyzed… the last eight years, almost nine years, I feel the sensation. And it’s unbelievable for me to say those words.”

Equally unbelievable is how much energy Montoya has. Despite the demands of his time-consuming therapy sessions, he is also attending Cal State University Los Angeles in pursuit of another master’s degree, this one in kinesiology, so he can understand his own recovery and help him with a company. Capable of giving an edge. He works as the Chief Scientific Officer.

HINRI, the Healthcare Institute for Neuro Recovery and Innovation, is a non-profit organization whose mission is to study medical breakthroughs – particularly in paralysis therapy – and build the support for researchers they need to accelerate new treatments. providing resources.

“The more I put on my schedule, and the busier I am, the better I perform,” says Montoya.

Montoya, like Edgerton, does not know …

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