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Andrew M. Ball, MS, PT -> Re: SCI patient (February 7, 2001 2:03:00 PM)
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Not so fast . . .
To say that there is "NO any chance for you to be able to gain muscle movement below the lesion" is certainly the prevailing thought in physical therapy these days, unfortunately it's not entirely correct. Be careful of sweeping generalizations, they are usually wrong.
It IS appropriate to use E-stim to prevent atrophy until a program incorporating some of the following fairly new (5 year old) basic science research can be incorporated into your patient's program.
Despite the tradition of PT, and what most of us were taught in PT school, some amazing things are happening in basic science research folks. Between the Partial Weight Bearing Gait Training research (See Hesse et al, 1995, and Schindal & Hesse 2000), and the article written by researchers at Yale and published a few months back month in the Journal of Nature Technology (Nature Technology 2000; 18: 949-953, 925-927) I’ve come to two conclusions:
First, when Christopher Reeve says that he’s going to walk someday . . . he may be right. Second, Chistopher Reeve seems to understand more about basic science than most PT’s.
I’ve already gone over the PWB-GT/BWS-GT research, so if you missed that, please review the article in STROKE, available ONLINE, for free, in full text:
[URL=http://stroke.ahajournals.org/cgi/content/full/26/6/976?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Hesse&searchid=981593519379_1486&stored_search=&FIRSTINDEX=&search_url=http]http://stroke.ahajournals.org/cgi/content/full/26/6/976?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Hesse&searchid=981593519379_1486&stored_search=&FIRSTINDEX=&search_url=http[/URL] %3A%2F%2Fstroke.ahajournals.org%2Fcgi%2Fsearch&journalcode=strokeaha
Or check out Paul Hansen, PhD, PT's bibliograpy at [URL=http://www.litegait.com.]www.litegait.com.[/URL] It's full of articles on incomplete SCI, and will soon be updated with a few zingers examining positive effects in complete SCI too . . . combined with one or more of the expirimental procedures.
As for the OEC cell research, the researchers genetically re-engineered olfactory ensheathing cells (OEC’s) harvested from pigs, greatly enhancing the regrowth of COMPLETELY SEVERED spinal cords WITHOUT GENERATING A REJECTION RESPONSE (in rats)!!!
OEC’s have previously been shown to enhance neurogenesis, but there are obvious problems with tissue rejection when cells are transplanted from different species. Noting this, the researchers created pigs whose OEC’s and Schwann cells carried a blocker of human compliment (which is a key initiating agent of human rejection reactions).
Now here’s the kicker . . . the nerve conduction velocities (NCV’s) across the lesioned rats was even FASTER then those had never been injured (rats who were lesioned and received no graft were of course unable to transmit an impulse over the gap).
Your patient may not do well with a BWS-GT + new complete SCI drug program because of her age . . . not because it isn't possible and your client doesn't have a chance.
Before making blanket statements, it's best to check the facts first. To do otherwise solidifies MD's perceptions that we are mere technicians that don't even understand our own domain of practice, much less how we fit into the big picture. Let's do better than that. Medportal (http://www.medportal.com/) now offers both MEDLINE search and full text retrieval of most articles . . . FOR FREE. It used to be that getting an article from a medical school library was difficult. There is no longer an excuse for not being informed and up to date regarding issues relevant to our patients. To do otherwise is clearly medically negligent.
Andrew M. Ball, MS, MBA, PT
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