Even today, most people would tell you that once someone suffers a spinal cord injury, they won’t ever walk again. Thankfully, the Walk Again Project is working to prove otherwise.

First Step: Virtual Reality

In a new study published in Scientific Reports on the 11th of August, 8 individuals with injuries more than 3 years old participated in a rehabilitation program to improve neurological function.

Patients underwent the multi-phase rehabilitation program over 12 months, with total training time reaching 1,958 hours over all 8 participants. The first stage took 178.5 hours on average, where they had to make a virtual reality set of legs walk. Sleeves on their arms provided sensory feedback. This was repeated for another 30 hours while standing.

Participants “passed” these stages when EEG readings (when electrical activity is measured in the brain) could pick up that the individual’s brains remembered how to walk.

Then the Real Walking Began

Here is how the real walking timeline breaks down.

  • First with a robotic exoskeleton and body weight support (BWS) on a treadmill (109 hours);
  • then BWS on the ground (51 hours);
  • then just the exoskeleton and a treadmill (143 hours);
  • and finally just the exoskeleton (70 hours). A total of 581.5 hours.

After months of training, sensory and motor improvements were found in all patients. On average, the Zone of Partial Preservation (ZPP), which is the spinal levels retaining some sensory function, improved by 5 levels. Some improvements, such as the ability to sense where their legs were and what they were doing, only began to appear after several months.

Clinical improvement of motor function also took months to appear.

All participants also improved in the Walking Index (WISCI). One went from a score of 0 to 6; another went from 1 to 5; another 3 individuals improved from 1 to 6; two went from 6 to 9, and the last patient went from a score of 6 to 12.

What does all this mean?

  • a score of 0 means no ability to walk
  • 1 means able to walk with parallel bars, braces, and with the help of 2 people for under 10 meters
  • 6 means the patient can walk a walker, braces, and with the help of 1 person for 10 meters
  • 9 means walking with a walker and braces for 10 meters
  • 12 means the ability to walk with 2 crutches and braces.

The reductions in improvements that most patients saw after taking a break for 30 days were quickly reversed.

Taking long breaks reversed some of the improvements, but could they ever be permanent? Other research on people learning to read Braille on weekdays showed that their brains’ “maps” for the Braille-reading fingers initially grew during the week, but shrunk back to “normal” by Mondays. The “map” sizes on Monday didn’t start to keep growth until 6 months, and then slowly improved over the next four months.

In terms of hours of practice, it was 600 hours – 2-3 hours per day, 5 days per week for 10 months. This is similar to the paraplegic patients’ training time, but walking may take longer to be permanently re-learned.

Maybe home-based programs, so people with spinal injuries could train every day, would be best to prevent the setbacks caused by breaks. There are already exoskeletons available for purchase, with a variety of products going up and costs going down; however, suitability comes down to the individual’s needs.

We’re seeing that there is hope – practical hope – for people suffering from spinal cord injuries, and improvements are happening now.

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