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Born Again Nerves
Scientists train newborn nerve cells to repair spinal cord injuries.
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at a challenge that just a
few years ago most scientists
would have said is simply
beyond our reach. The
challenge is to repair broken
or damaged nerves
particularly in people who
have suffered a disabling
accident
which has left them
paralyzed. There's now real
progress being made in
stimulating nerves to repair
themselves although it's
still at the lab level and a
long way from being applied
to people.
Then we're going to look at a
different kind of approach to
the same problem. This is a
true marriage of biology and
technology in which actual
hardware is being implanted
in the body
to restore functions that no
longer work. MAN: Go ahead
and stand up. ALDA: Nerves
are being replaced with
computers and wires.
So there's some terrific
science going on in these
areas but we're not going to
lose sight of the fact that
this is all for one thing: to
help the people who need it.
Later on in the program
I'm going to be talking with
Christopher Reeve who, since
his accident, has become an
important advocate on behalf
of disabled patients. But
first we're putting on our
white coats
and heading into the
laboratory. And in the
laboratory we find laboratory
rats. But what a rat! This
one had a crippling spinal
cord injury and it's
literally back on its feet.
This story is about how that
was done. I'm with John
McDonald, a neurology
professor at Washington
University in St. Louis. What
we're going to look at is an
actual
transplantation procedure
where we're going to take the
embryonic stem cells that
have been instructed to
become nervous tissue, and
we're going to put those
into the middle of the
damaged spinal cord of a rat.
ALDA: Repairing damaged
nerves is one of the
possibilities opened up by an
exciting new area of research
using embryonic stem cells.
ALDA: You have stem cells in
here? Yes. Let me show you
how we grow the stem cells.
What we're looking at here if
you look closely...
ALDA: Oh, yeah. You can see
small clusters of hundreds of
cells. In fact, each one of
those very closely resembles
the early embryo after
fertilization. ALDA:
The cells have not yet
started to differentiate into
everything that goes to make,
in this case, a mouse like
bones, muscles or nerves.
ALDA: What kind of stuff
tells them to become nervous
tissue
and how does it work? I don't
get... that's an amazing
idea. What kind of stuff is
it? It's very interesting. In
the early embryo, the
switches-- the major
switches--
are very simple things. And
the expression of a chemical
called retinoic acid is all
that it takes to tell these
cells to become nervous
tissue. And you synthesize
that? You can make
retinoic acid, as much as you
want? Exactly. And you just
squirt it around on that
stuff and they start to turn
into nervous tissue? Yes.
ALDA:
The embryos are treated with
retinoic acid for four days.
Then an inhibiting chemical
is used to stop them from
developing further while they
multiply. McDONALD: If we
begin the week
with one of these flasks, we
end the week with 256. So
it's really an unlimited
supply. The cells divide
almost every 14 hours. So
let's take a look at these.
ALDA:
At this stage, they're called
neural precursor cells.
They're ready to make any of
the three kinds of nerve
cells but while the
inhibiting chemical is
present they just multiply as
precursors.
What we're seeing here are
one individual cell that's
now just finishing division.
The two dark areas are the
DNA. And the cell will cleave
across here. ALDA:
A single transplant needs a
couple of million cells so
there's a continuous
precursor cell production
line running in the lab. Then
when the inhibiting chemical
is removed the nerve cells
themselves grow.
These are neurons, with their
connecting axons. McDONALD:
What we're looking at here is
a culture dish filled with
cells that have now become
neurons.
You can see the little round
circle is a neuron, a cell
body. Uh-huh. And that coming
out of it-- is that an axon?
This is the axon. There are
millions and millions
of the axons and
connections-- those same ones
that need to be repaired.
ALDA: Here's another kind of
nerve cell, called an
oligodendrocyte.
Its job is to wrap the axons
with insulation. McDONALD:
What's showing here in green
is a single oligodendrocyte
in the culture. And these are
all the branches.
And you can see that this
oligodendrocyte reaches out
and wraps only one part of
that axon and then it
continues, unwrapped. Here's
another connection that's
wrapped multiple times in
multiple segments.
So this one oligodendrocyte is
wrapping many different axons
or connections. That's right.
Typically in the spinal cord,
an oligodendrocyte will wrap
up to 15 different axons, or
connections between cells.
ALDA:
Here's an axon wrapped with
its new layers of insulation
like a plastic cover on a
copper wire. Damaging the
insulation is an important
type of spinal cord injury in
people as with this injured
cord of a lab animal.
The cord is not severed but
there's a serious loss of
function mainly because
existing axons have lost
their insulation. By
transplanting about two
million nerve precursor cells
into the injury
an astonishing recovery of
function has been achieved.
The researchers think the
animals' bodies signal the
transplanted cells to make
oligodendrocytes, which
rewrap the exposed axons
with the insulation called
myelin that they need to work
again. ALDA: So, nerves that
don't work anymore simply
because they've lost their
myelin--
you can get them to work
again. Right-- if we can just
simply replace that then we
can get important recovery of
function such as recovering
bowel and bladder control or
improved movement of a hand.
Now, to you and I, that might
not sound like a lot... Oh,
it's gigantic if you're
missing that. Exactly. The
gains in the level of
independence for a person to
be able to control
their own bowel and bladder
function or now to use a hand
are the difference between
living in an institution and
living at home. You know, if
I was trying to figure out
how to do this
I'd say, well, get some cells
and stick them in there. You
know, get some fully grown
cells and stick them in.
You... you put them in at the
right stage so they'll
respond to signals and
actually grow on their own
and grow into the necessary
kinds of cells. Yeah, I think
we've taken advantage of the
power of development and
said, "Jeez, you know "we
don't know the myriad of
signals.
"Let's put them in at an
early stage "where we can
just throw a few switches
"and get them going and let
the body and the nervous
system do the rest.
" ALDA: Remyelination of
existing axons using stem
cell transplants is a
tremendous breakthrough. But
for a complete cure, new
axons need to grow as well so
as to reconnect severed
nerves.
ALDA: How do they know where
to go? How do they know where
to grow to? Why don't they
just grow in every direction?
That's the most difficult
question now.
It's interesting that if you
put in cells they'll tend to
migrate towards the injury
site because the injury site
gives signals to get them to
go there. The most difficult
thing right now
is to get these neurons to
make the appropriate
connections over long
distances. That has not been
achieved yet. ALDA: Several
hundred thousand Americans
could benefit from spinal
cord therapy
and the pace of research is
quickening. Encouraged by
Christopher Reeve, eight
centers around the world have
formed a consortium to swap
ideas and results. Everyone
is feeling optimistic
but here at the University of
Miami, a consortium member
Mary Bunge doesn't
underestimate the challenges
ahead. BUNGE: There are many
different types of nerve
cells. There are millions of
fibers in the spinal cord.
They are traveling in two
different directions. They
are ending in different areas
of the spinal cord. It's a
very complex problem. ALDA:
Here they're developing a
completely different
transplant approach
using not stem cells but what
are called Schwann cells from
peripheral nerves-- the ones
found in arms and legs.
Unlike spinal cords,
peripheral nerves can repair
themselves. The Schwann cells
are cultured
and then soaked up into
little plastic fiber
cylinders. The cylinders are
used to take on the biggest
challenge of all-- to make a
living bridge between
completely severed parts of a
spinal cord.
A section of cylinder
containing about six million
Schwann cells is placed
across the gap in this lab
animal test. The
extraordinary result is that
new axons-- nerve fibers--
are attracted to grow into
the bridge. There the
transplanted Schwann cells
wrap the new axons with the
vital myelin. Once again, the
body has been coaxed into
doing its own thing.
The Schwann cells manage to
give the right signals for
new axons to grow and then
make new myelin as well even
though repair doesn't
normally happen in the spinal
cord. BUNGE:
One, two, three, four, five,
six. What has happened here
is that the fibers grew into
the bridge and then the
Schwann cells that had been
transplanted there
then formed myelin around the
axon. This is the outline of
the Schwann cell here. Here
is its nucleus. The Schwann
cell became related to this
axon. The myelin sheath
appears as a dark ring. ALDA:
They can get new nerves to
grow into the bridge but not
out again. BUNGE: A challenge
now is to improve the amount
of growth of axons from the
bridge into the cord. ALDA:
The latest approach is to
take cells from the nose--
the nose of a lab animal
again. In all mammals the
nose constantly renews its
nerve connections to the
brain so the nose cells are
injected into the spinal cord
close to the bridge. The hope
is that the nose nerve cells
will somehow attract the new
nerves out of the bridge so
they can make new connections
in the spinal cord. And
that's in part what the nose
cells did
with new axons showing up an
inch away from each end of
the bridge. But right now, we
don't know if there were new
connections and
disappointingly there was no
significant improvement
in the experimental animals'
function. So, what does all
this add up to for people?
There's no doubt that
practical treatments for
injured spinal cords are
still years away.
But at the same time you
won't find a scientist in the
field who'll say we're not
going to win this battle
before long. ALDA: I've come
to see Christopher Reeve
I Might Walk!
Christopher Reeve talks with Alan Alda about his 'realistic optimism' that he may walk again.
Select text to jump ahead in the clip:
at his house not far from New
York City. It used to be
woods. ALDA: Chris is now
quadriplegic and confined to
a wheelchair. He breathes
with the aid of a ventilator.
In 1995, Chris suffered a
severe fall from his horse
during a competitive jumping
event in Culpeper, Virginia.
With an injury at what's
called the C-2 level he lost
control of his body below the
neck. REEVE:
I was injured at the second
vertebrae level but my spinal
cord was not cut. What
happened was I had a
hemorrhage right in the
middle of the cord at C-2.
And then it caused atrophy.
So right at C-2 the cord is
one-quarter of its normal
size. So think of it as a
kinked garden hose. ALDA:
Chris Reeve, seen here with
his wife, Dana, and son Will
prepared for a lifetime of
paralysis. But soon he was to
discover that for the first
time, there was hope that
science could tackle spinal
cord injuries. ALDA: Were you
encouraged
to have this kind of hope
when you first had the
accident when you, say, were
in rehab? Or were you
encouraged to accept and
adjust to, uh...? No, at
first I was encouraged to
accept and adjust.
And in fact, I remember one
researcher saying that, uh,
"Well, in the beginning, one
always hopes but over time,
hope ebbs.
" You know, and this is a
researcher who now is at the
forefront of the solution to
the problem. Now we're at a
stage where leaders in the
field
have discovered that exercise
is absolutely essential. Now,
for what? Exercise is
essential to get you ready
for the time when your nerves
may be able to be
regenerated? Or just in
general, just...?
Well, there's of course just
immediate benefit in that you
avoid infections,
antibiotics, et cetera. And
the other is think of it as
the transcontinental
railroad-- that the patient
starts on the East Coast by
doing his exercise
and improving and heading
west while the scientists
start from the west and go
from the Petri dish to the
monkey or the rat and then
into the human and hopefully
they meet in the same place,
in Utah or wherever. ALDA:
Chris exercises three to four
hours a day using specialized
equipment-- equipment he
wants insurance companies to
provide for all patients, by
the way. There's a bicycle
used in conjunction with
electrical muscle stimulation
and a table that tilts
upright. REEVE: We loosen the
straps and somebody stands in
front of me so that I don't
fall over-- but actually I
have good equilibrium-- and
what we do is I mentally
think, "Lean to the right"
and my body does it. Wow. And
then I mentally think "Lean
to the left" and I go left
and put all my weight on my
left foot. And that is
something
where the brain is telling
the cord to shift weight.
ALDA: Work on a treadmill is
intended to stimulate the
spinal cord's own memory of
walking patterns. We'll have
a story about this idea later
on.
Overall, the point is to use
to the full the few remaining
spinal connections so he's
ready to meet the scientists
when they get to "Utah.
" One short-term goal is
simply to breathe naturally.
He can already do this half
an hour at a time. REEVE:
What I'm trying to do is get
off the vent and I do that
with certain breathing
exercises
but also the treadmill
therapy is helping that.
What's the connection? How
does that help? Well, you're
activating the cord, you're
taking advantage. You take
advantage of an automatic
breathing response?
Of what's left. I'm not yet
able to breathe
automatically. Is your
diaphragm working? My
diaphragm works which is
really a miracle because I'm
injured at a level way above
the diaphragm
but by exercising very hard
over the last five years I've
improved, so I'm going up
rather than down. Now,
psychologically and
emotionally that makes a
tremendous difference.
Oh, I can imagine. You know,
this old saying: Give me the
strength to do something
about what I can do something
about and to accept what I
can't do anything about and
the wisdom to know the
difference.
Your recent life has been
kind of a vivid example of
how hard it is to strike that
balance, to find that wisdom.
How do you do it? I mean, you
must have to accept a certain
amount. I don't buy into it
at all.
You don't accept any of it?
No. Who knows what the
horizon is? Yeah. You know,
who knows how far we're going
to go? Why should we put
limits on it? You know, you
know that pigs aren't going
to fly...
but I might walk, you know? (
Alda laughing ) ALDA: Chris
Reeve's accident had
compromised a highly
successful acting career. And
he decided that he should use
his celebrity for all it was
worth
to further the cause of
research into spinal cord
treatments. REEVE: The main
idea is to put a vision out
there and then I even went so
far as to do a commercial
last year.
I didn't see the commercial.
Well, what happens in the
commercial is that I'm seen
walking to give a prize to
scientists who, sometime in
the future, had cured spinal
cord injuries.
And it was very upsetting to
some people very uplifting to
others but five months after
the commercial was on the air
people are still talking
about it. So that's great.
You want that debate you want
that controversy, you want
people to be agitated. But I
checked with all the major
scientists in the country
that I, you know, have a
relationship with
and they said, "No, there's
no reason "not to put that
vision before the public
because it will happen.
" ANNOUNCER: And in the years
since the new millennium the
world has seen such progress.
In 2004, the tide was turned
against AIDS two years later,
great strides against cancer
and tonight-- tonight we
celebrate a remarkable
breakthrough in spinal cord
injuries made possible by
countless researchers and
contributors. And to present
this award, we have some very
special guests.
In the future so many amazing
things will happen in the
world. What amazing things
can you make happen? What do
you think your main
contribution is? Is it
raising money?
Is it focusing attention?
Being the person who gets
everybody in the boat to row
together? What do you
think... what do you think of
as your main contribution?
Well, my responsibility is
all of the above.
You know, I'm president of a
club I didn't want to join
but, uh, nevertheless I have
to take some responsibility.
Not to do so would be really
immoral. And I have the
chance to speak up for a lot
of people
you know, who could never get
to a congressman or never
testify before a Senate
committee or influence a
budget. So, I actually... You
know, I can't say it's my
favorite thing to do
but nevertheless, uh,
psychologically, emotionally
it really helps me that, you
know, I can be of some use.
ALDA: And when he does get
back to work he's still
trying to be of some use.
In this remake of the
Hitchcock classic Rear Window
he wanted to help change the
widespread stereotype of
disabled people as isolated
and embittered to something
different-- to an image of
people who could be, in fact,
of some use.
Achilles... bring up
telephone. Dial 911.
OPERATOR: 911 operator. I
need to report a domestic
altercation. OPERATOR: Can
you describe what's
happening, sir? ALDA:
Christopher Reeve could
hardly get much further from
the stereotype. He set up a
foundation which helps fund
and coordinate the world's
best research in spinal cord
injury and he's a tireless
advocate.
What was an immensely
creative life before the
accident only seems to have
become more so since in both
public and private life.
REEVE: You find alternate
ways to accomplish and to
express...
your needs, your desires, et
cetera. For example, I
taught, when I was on my feet
my big kids how to ride a
bike and, you know, taking
the training wheels off. But
my young son, Will, was a
little afraid
to take the training wheels
off. But I actually sat out
in our driveway in a
wheelchair. Somebody took the
training wheels off and I
talked him through how to do
it. Now, isn't that cool?
And who would have thought?
It's great, you're
relentless. I mean, you
really don't give up. No,
because now we need a way to
connect. Yeah, yeah. And so
many ways of connecting have
been taken away.
You know, I haven't been able
to give him a hug since he
was two years old, and he's
almost eight. But he's got to
hear it through my voice and
through my eyes and just from
being there.
So I have to find ways to
give him what he needs. And
one of my jobs-- and this is
the paradox of having a
debilitating injury or
disease--
is that you have to find a
way to be more generous than
you ever were before when you
were on your feet. And what I
mean by that is that you have
to set people free so they
don't spend their life
worrying about you.
Do you think about... do you
let yourself think about how
long it will take before
they'll be able to get to the
point where you can walk
again? No, I don't... I don't
measure it in terms of
months, days or years.
I measure it in terms of how
hard people are working. So
sometimes if I see a
scientist at, you know, too
many dinners... or, you know,
out at too many meetings
I say, "Go back to the lab,"
you know? "Get out of here.
"Go put the white coat on,
get to work.
" You know, so I have a
reputation as sort of an
amiable pest. ALDA: We're
back at the University of
Miami to look at a remarkable
study that's just getting
under way. Rudolfo Stecco has
been partially paralyzed
Moving Memories
Going through the motions sparks remarkable progress in paralyzed patients.
Select text to jump ahead in the clip:
since a car accident two
years ago. He's one of 200
patients who, over the next
five years will test the
effects of intensive exercise
but exercise during which
only about one-third of the
body's weight
has to be supported by the
legs. Put it at 88. 88? ALDA:
There's a fascinating story
behind this study. It all
began six years ago with a
patient who was exercising
hard
in an attempt to improve his
walking which was very
limited. Blair Calancie, the
study director, takes up the
story. CALANCIE: He could
walk about 75 feet in one
45-minute session.
Clearly it was nonfunctional
with such small distances.
The fourth year he'd come
down, he decided he was going
to go all out. He was going
to embark on a very strenuous
physical conditioning program
under his own direction and
worked out for four hours on
the Monday four hours on the
Tuesday standing, exercising,
a lot of strenuous work. On
Wednesday he comes in and
says to one of our therapists
"I'm getting these weird
spasms when I lie down; it's
like I'm walking.
" She then responded, as was
her way "You're a spinal cord
injury, you have spasticity.
Get used to it.
" ALDA: Fortunately, Blair
Calancie decided to take a
look for himself anyway and
what he found was a
completely unknown
phenomenon. CALANCIE: Just as
he had described to us
the moment we took him from
his wheelchair and he laid
out flat on his back his legs
began an involuntary stepping
pattern. What was intriguing
was and what really set us
out on this whole area of
research
is that at the same time the
involuntary stepping started
at night his ability to walk
in the daytime, volitionally
improved by an order of ten.
So he went within a week from
walking 75 feet in a session
to 500 and 600 and 700 feet
in one session. ALDA:
Conventional therapy after a
spinal cord injury is
something like this-- mild
stretching and gentle
movement.
But suddenly here was the
possibility that intensive
exercise would dramatically
improve walking even 17 years
after the injury in this
case. CALANCIE: An important
consideration for this study
is that everybody has to be
at least one year
post-injury. And under
today's current approach with
managed care it's not at all
unusual for an individual
with an acute-- they've just
had a recent spinal cord
injury--
to be discharged from
hospital at six weeks, seven
weeks, eight weeks. Maybe
they'll get rehab for another
month to six weeks after that
and beyond that, it's over.
ALDA:
Ida Fisher, for example, has
been partially paralyzed for
four years. CALANCIE: Ready
to fire up? Let's go. ALDA:
She's testing the treadmill
and like all the subjects,
she's partially suspended.
She'd barely be able to move
at all otherwise. Christopher
Reeve does his treadmill
workout regularly by the way.
Nice, smooth steps.
ALDA: After six weeks in the
study Ida's seen a dramatic
improvement. FISHER: Before,
I walk less; I walk only half
an hour. Now I walk an hour.
ALDA:
The study is recording many
such improvements. The
intriguing possibility is
that the spinal column itself
contains some of the
instructions for walking.
This central pattern
generator, as it's called
is known in animals but has
never been seen before in
humans. Hard exercise-- only
possible with these subjects
when partially suspended--
somehow restimulates the
central pattern generator.
CALANCIE:
We're seeing dramatic
improvements in individuals
who are at least one year
post-injury and often cases
five, six, ten years
post-injury which suggests
that there's a great deal of
untapped potential
in these individuals. It's a
very strong argument to the
managed-care companies, to
physicians that the common
phrase of "Whatever you have
at one year post-injury is
what you've got for the rest
of your life"
needs to be rethought. ALDA:
And it's an unexpected new
source of hope for people
with spinal cord injuries.
ALDA: Don Crago is paralyzed
from the waist down.
Nerves of Steel
Artificial electric stimulation helps the paralyzed stand, walk, and use their hands.
Select text to jump ahead in the clip:
But using artificial
electrical muscle
stimulation, he can walk. Dr.
Byron Marsolais started this
project. MARSOLAIS: He has
absolutely no control of his
legs at all. He is totally
and completely paralyzed
and every bit of motion that
happens is coming through the
electrical stim. Don, do you
get all your balance from
holding on to this walker?
Yes, I do, Yes, I do. Does
that put
a lot of pressure on your
arms? No, not really. Most of
the pressure's on my legs.
Actually, I prefer to let my
legs do the work because if I
did it with my arms, I would
be tired out.
Yeah. How tiring is it to take
it... uh, every step? Uh, not
too bad. It's comfortable,
you know? But after the end
of the walk, I will breathe
heavy. Yeah.
Standing takes a lot of
energy because you have to
stimulate the muscles for a
prolonged period? Right-- he
is standing by stimulating
the flexors and the
extensors,
the antagonistic muscles, all
at the same time. So he's
stiff as a board. And that
charge just has to be
constant. It's constant... If
you let up on it, he's liable
to tip one way or another.
Oh, he would, for sure. And so
he looks good standing tall
and stiff... ALDA: But you
feel the strain? MARSOLAIS:
But he's got strain. Yeah, I
feel strain. ALDA: My
introduction
to the functional electrical
stimulation or FES, program
was eight years ago. What I'm
trying to get to is his
gluteus maximus muscle-- the
big seat muscle. ALDA:
Dr. Marsolais showed me how
he implants wire electrodes.
What you're inserting into
the muscle is... that's not
the electrode itself?
No, this is just a little
probe... Right. A very tiny
probe. And the reason you're
doing this is to see if you
can get the muscle to react
to give its greatest
response? Exactly. And I want
just the right muscle. That's
the muscle that we want-- it
goes right down here into the
femur
which is the big leg bone.
And you see how it's
beginning to jump there? It's
starting to do what we want.
I think I can do better...
And in order to do better I
have to get it right beside
the nerve. ALDA:
Dan Kemp, paralyzed in a car
accident is on the table.
Now, Dr. Marsolais looks like
he's found the spot here.
That looks pretty good here,
yup.
That's getting a pretty good,
tight... I can see it. See
how that... jerks things
together there. It looks like
about an inch and a half from
where you were first
searching for it. Yes, that's
right,
although we're angled a bit
down. We started about here,
and now we're about here so
we were a good inch away.
ALDA: Once he's found the
best stimulation point for
the muscle
a hair-thin, permanent wire
implant is slid into place.
Dan was one of many
experimental subjects who
volunteered for the program.
In his case, he received
eight electrodes in each leg.
Now we just bring this down
to exactly the position that
we were before. ALDA: The
patients and Dr. Marsolais
were literally stepping into
the unknown. How do you feel
going through this? Do you
feel like a guinea pig? KEMP:
Yeah, I do, but it's well
worth it.
You know, down the road,
people will be able to look
back and say if it wasn't for
people like me that they
wouldn't have got as far as
they've got in the new
procedures. So, you know, it
goes down the line.
Everybody helps everybody
else, whether they realize it
or not. ALDA: Eric Bellamy,
paralyzed in a motorbike
accident agreed with Dan that
it was worth being a guinea
pig. He saw simple, basic
ambitions for himself and for
the program.
BELLAMY: I see being in a
chair always but I see being
able to go up steps and knock
on a friend's door and say,
"Hey, I'm down here!
" instead of running around
the house and screaming,
"Hey, I'm here, I'm here!
" I see being in a convenience
store as one step, you know?
Uh, so... Being able to get
up and go through a narrow
door to go get into the
bathroom-- just for them
answers. And if they can come
up with that right there...
Your life's in a chair but
being able to overcome
difficulties would be a
tremendous step and that's
what we're working on right
now. ALDA: Eric was one of
five volunteers who received
the most complex
of the experimental systems,
with a total of 40 implanted
and eight external
electrodes. The computerized
control box could handle 48
electrodes simultaneously
with connections made through
the skin on his thigh.
One big goal was to establish
how many muscles needed to be
stimulated for effective
standing and walking. Working
out how to sequence the
firing of the electrodes was
another challenge.
Okay, go ahead and stand up.
ALDA: In this trial, 20
muscles per leg were being
stimulated compared to the 50
per side that are involved in
natural walking.
Eric was able to walk
relatively smoothly although
he still needed to use his
arms to balance. Developing
an artificial balance
mechanism is still one of the
goals, but they have been
able
to reduce the number of
muscles needed for walking to
only eight per side-- as in
the latest system we saw Don
Crago using earlier. But
Eric's muscles had to work
constantly at full blast.
MAN:
They're using tremendous
amounts of muscle mass. Their
quadriceps are on 100% their
gluteal muscles are on 100%
their hamstring muscles are
on 100% their back muscles--
everything's just blasted.
Whenever they do something
they're using 100% of all
their strength. Whether it's
one step, two steps they're
using everything they got.
Like when you stand,
everything goes right into
it, 100%, bam!
Okay? ALDA: With tough,
motivated subjects like Eric
they were eventually able to
work out how to reduce the
high levels of muscle
stimulation
and they also figured out the
best design philosophy. It's
that simpler is better. They
realized that even the most
complex systems were going to
get tripped up by the real
world sometimes.
Stop! Stop altogether. ALDA:
Better instead to go for
simpler standard systems that
can bring basic benefits to
the largest number of people
quickly.
Many of the pioneers in FES
research have now dropped
out. Eric got a bad
infection. Dan couldn't keep
up the long commutes to the
hospital. But today, many
people with spinal cord
injuries
have good reason to be
thankful for the pioneers'
efforts. This is an easy
introduction to the real
world, I guess you could say.
ALDA: Jen Penko is one of the
beneficiaries.
She's showing me a rehab area
at Cleveland Metro Medical
Center-- the first of three
centers around the country to
be working with the
simplified standard systems.
PENKO:
For instance, there's curb
cuts and those types of
things. It takes a little
extra energy to get up that,
doesn't it? A little bit, but
you'll get curbs in the real
world
that are a lot more difficult
than that. You can just set
it right there because I'll
get myself set up. ALDA: Jen
has a simplified system th
just does one thing-- allows
her to stand. PENKO:
So, the light by the "stand"
means that it's ready to
stand and all I need to do is
press this button to go and