Resiliency of Body Amazes Health Workers
Nothing seems more hopeless than paralysis. But there are indications of hope, thanks to the body’s resiliency.
One of the saddest parts of work for many health workers is to have to tell a patient there’s no hope. That’s what they told Rob Summers, a man who loved baseball and dreamed of the big leagues, until he was hit by a car and left paralyzed. Nature relates the story.
Summers doesn’t recall much about the month he spent in hospital, but he does remember that the doctors waited until he was surrounded by family to tell him he was paralysed. They didn’t mince words: “You’re never going to walk. You’re never going to feel anything.” Summers refused to believe it. The doctors didn’t know how stubborn he was, how hard he could work. “I’m going to beat this,” he told his parents.
Rob’s determination to overcome his fate certainly played a part in what followed. Much of it is due to medical science and the loving care of his health care workers. But most of the hope-filled article by Cassandra Willyard, “How a revolutionary technique got people with spinal-cord injuries back on their feet,” is due to built-in resiliency of the human body. Without that, no amount of will power, love or technology could have made a difference.
There are no miracle cures in this story. Nobody stands up and carries his bed like the man at the pool of Bethesda in the Gospel of John, chapter 5, or leaps up and dances like the lame man in Acts 3:8. Doctors possess no such miracle-working power, and Rob Summers has a long, long way to go. “Electrical stimulation has promised huge gains for people with paralysis,” Willyard subtitles her article. “Now comes the hard part — getting beyond those first steps.”
It’s evident that the body’s resiliency was key by the reaction of the doctor when Rob found he could move his toes.
Susan Harkema, a neurophysiologist at the University of Louisville in Kentucky, sat nearby, absorbed in the data on her computer. She was incredulous. Summers’s toe might be moving, but he was not in control. Of that she was sure. Still, she decided to humour him. She asked him to close his eyes and move his right toe up, then down, and then up. She moved on to the left toe. He performed perfectly.
Her expletive is not repeated here; suffice it to say, Harkema started paying attention. Rob asked her how that was possible that he could move his toe. “I have no idea,” she replied.
Rob, true to his determination not to give up, had searched far and wide for new treatment avenues, finding Harkema’s clinic as the most promising. The doctors at Louisville did not think Rob would ever stand and walk again, but since they knew that nerves in the extremities take on some of the patterns of walking in a semi-autonomous manner apart from the brain, they reasoned, maybe those patterns could be revived with stimulation. Neural signals were not supposed to get past the point where Rob’s vertebra had severed his spinal cord, however.
When Harkema and her colleagues implanted a strip of tiny electrodes in his spine in 2009, they weren’t trying to restore Summers’s ability to move on his own. Instead, the researchers were hoping to demonstrate that the spine contains all the circuitry necessary for the body to stand and to step. They reasoned that such an approach might allow people with spinal-cord injuries to stand and walk, using electrical stimulation to replace the signals that once came from the brain.
So, when Summers intentionally moved his toes, Harkema was dumbfounded.
Up until Rob’s surprise, doctors were focusing on stem cell therapies or surgery as possible avenues to rebuild broken connections. Others have been working on expensive robotic “exoskeletons” that could allow paralyzed patients to walk by using their hands or voice. No one expected that the body could repair itself to any noticeable degree. Now, they are realizing that some connections might still exist, even in the most severe cases, and could be strengthened with electrical stimulation.
Rob’s team had been brought to tears and shouts of joy at some early successes with electrical stimulation that allowed him to stand and move his legs while suspended in a harness. They certainly did not expect a spontaneous recovery of the ability to consciously move a toe, far removed from the brain below the injury site. Willyard recounts two eruptions of celebration, first when electrical pulses stimulated Rob’s legs to move.
He looked at his leg muscles contracting in the mirror. “That can’t be real,” he thought. Then he looked around the room. His mother was in tears. “People were crying and yelling and asking me ‘how is this happening?’” Harkema says. “It was a little pandemonium.”
Still, that was nothing compared with the commotion that erupted six months later, when electrical stimulation allowed Summers to wiggle his toes. Harkema’s team hoped to kick-start the circuitry required for standing and stepping in the spine and legs, but they weren’t expecting to get any help from the brain. Harkema called Edgerton at his lab in Los Angeles to tell him about Summers’s toes. “Oh God, this can’t be true,” Edgerton remembers thinking. “Everybody’s going to think we’re quacks.”
The rest of Willyard’s article concerns how stories like this have caused a sea change in treatment research. Many labs are now using this knowledge to explore new avenues of treatment. There’s a long way to go, with many problems to solve, and no guarantees of major recovery. She describes emotional ups and downs as Rob makes slow, modest gains. But at least science is catching up with the realization that there’s a lot more resiliency in the body than they had expected. Even for a victim of paralysis, there are moments for hope and joy.
A perpetual optimist, Summers views stimulation as nothing short of a cure. For him, the biggest benefits have been the least visible — improvements in blood pressure, bladder and bowel control, sexual function and temperature regulation. And there are the more trivial sensations, such as a deep appreciation for brand new socks. “I can feel the softness,” he says. “It’s crazy the little things that I find joy in.”
Most physiologists were taught that once connections to the brain are lost, they don’t come back. At least in some tentative cases, that belief has been falsified by Rob and some others.
Another California Boondoggle Coming?
Speaking of stem cells, Nature also reports that another stem-cell initiative is coming to California. Residents of the Golden State, who regularly fall for expensive ballot initiatives, might well remember the tear-jerking commercials by Christopher Reeve hoping that embryonic stem cells would cure his paralysis that occurred when he fell off a horse, long after his “Superman” movies. Actor Michael J. Fox also pleaded with Californians in 2004 to support the $3 billion initiative drafted by Robert Klein, implying that miracle cures were just around the corner. It passed over the objections of ethicists who warned that embryonic stem cells require killing and harvesting human embryos. President Bush had outlawed research on embryonic stem cells except for cell lines that were already in existence, but California rushed ahead, expecting everyone in the state, even those who objected, to support it. Also, in the interim, Yamanaka discovered induced pluripotent stem cells (iPSC), which not only avoid the ethical issues of killing embryos but also work better.
The agency that resulted from the actors’ emotional pleas, CIRM, has been long on hype and heavy on spending, but poor on results. The article relates a few promising leads here and there—nothing approaching the hyped promises. Reeve died, and Fox is not cured. And now, that $3 billion is almost gone. So Klein is back with another initiative, this time asking California taxpayers for almost twice as much – $5.5 billion dollars! Is this time for the “Fool me once, fool me twice” proverb? If embryonic stem cells had actually worked, no taxpayer funds would have been needed. Drug companies themselves would have rallied to fund the research. To this day, embryonic stem cells haven’t provided any real cure. All the progress is being made using adult stem cells and iPSCs.
Adult stem cell research could supplement the work on electrical stimulation and robotics, offering treatments singly or in combination to give victims of paralysis hope of regaining personal autonomy and bodily control again.
If you can walk, never take that for granted. Rob Summers was an active baseball player, but his life changed in seconds. Joni Eareckson Tada has been in a wheelchair for 52 years after a diving accident (watch her touching video released July 30, and consider supporting her ministry to the disabled, Joni and Friends). The right attitude can do amazing things, as both Rob and Joni have demonstrated. We are endowed with wonderful resources within the body and brain to promote healing as far as possible. More is going on all the time, even in our sleep, than we know. When repairs are not possible human beings are uniquely capable of joy in spite of hardships. Give God thanks for whatever endowments you still have, and support research into allowing the disabled to amplify the built-in resiliency God put into our bodies in these promising new ways. The world could use a lot more gratitude, awe, and joy.