Last week Fergus Walsh, on the BBC’s Panorama program, reported on the work of neuroscientists endeavouring to repair the spinal cord of a paraplegic. The neuroscientist in question believes that the sense of smell is the only part of our nervous system that continually renews itself and that new nerve fibres grow and connect to the olfactory bulbs at the base of the brain. He further believed that if the cells responsible for this were transplanted into a damaged spinal cord then they may bring about the regeneration of that spinal cord. To this end they removed the olfactory bulb from a paraplegic and cultured it in a laboratory to produce the required cells. The cells were then transplanted into his damaged spinal cord.
Below is a letter I sent to Panorama following their program.
I watched with interest your program, ‘To Walk Again’, about the work of neuroscientists endeavouring to ‘repair the spinal cord’ in a paralysed man. The program followed the progress of a paraplegic who undertook an intensive physiotherapy regime lasting two and a half years. Six months into the regime there were no noticeable improvements and at this point an operation was conducted with a view to ‘repairing the spinal cord’. Three months later, and nine months into the physiotherapy regime, marginal improvements began to be made. After two and a half years of intensive physiotherapy, still only marginal improvements had been made, which would be expected in many paraplegics undertaking such an exercise regime and yet the scientists were claiming the breakthrough that may ‘cure paralysis’.
I have no doubt that Panorama reported honestly the facts of the matter and the opinions of those involved, but the program was also made in such a way as to suggest that the man walked again, which is quite frankly preposterous. All he achieved was the flicker of a muscle that could produce a wobble in his dangling lower leg and many paraplegics achieve far more than this. The exercises appeared to show him moving his legs and yet all these movements, including the cycling, were driven by weights and only initiated by the body; something that could well be achieved through muscular effort above the level of nerve damage. The twisting of the body to produce movement was obvious in some cases. The dramatic shot at the end showing him walking along a gangway, was nothing more than a circus act and a world away from walking. His legs were braced in callipers and he had a frame to support himself with his arms. Motion was activated by using his upper body to swing one leg through at a time. With practice, anyone with complete paralysis from the waist down can accomplish this and so no recovery is necessary. I do not want to diminish the gentleman’s efforts, this, after all, is an achievement in its own right, but is no indication of any advancement made through neuroscience.
What was interesting was the MRI scans showing the spinal cord before and after the operation. The improvement in structure was quite clear and this may have improved the capacity of the spinal cord to re-establish nerve pathways. However, the notion that the spinally injured have their spinal cord severed is misleading. The gentleman in question was stabbed in the spine and his spinal cord was actually cut with a knife. This is rare and the vast majority simply squash, bruise, or pinch their spinal cord. In my case, which was fairly extreme, my body was folded in half, crushed under two ton of dumper truck, and two of my vertebrae were shattered. According to the surgeon who operated to stabilise my spine, my spinal cord was impregnated with shards of bone and yet with the right approach to rehabilitation we are proving that functional improvements can be made, showing that there is the capacity for the re-establishment of nerve pathways even with such a badly damaged spinal cord. I would like to suggest that nerve damage is rarely, if at all, the barrier to overcoming a spinal injury and that the neuroscientists are failing to see the bigger picture.
If we forget for a minute the function of the spinal cord as a communication cable and view the body from a bio-mechanical point of view, then we see the spinal cord as the very centre of our body. Just as a tree has a tubular centre surrounded by annual growth rings, so does a human body have a spinal cord surrounded by many layers of tissue, arriving finally at the outer layer of skin. Damage to the spinal cord, at the core of our body, will inevitably affect every surrounding layer of the body, causing enormous structural depletion. This structural depletion of the body has very little to do with nerve damage, but a great deal to do with the condition of paraplegia (and tetraplegia). Of course the initial paralysis through shock or damage to the spinal cord is a factor in the structural depletion of the body, but so too is the trauma of an accident, the period of bed rest and the following ways of rehabilitation. It is as though, in the immediate trauma of an accident, resulting in spinal injury, the light switch is turned off and all the systems of the body shut down. If we were able to stand up afterwards and shake ourselves off then everything would start up again, but of course we can’t. Instead a period of prolonged bed rest is entered into in which absolute stillness is not only of great importance in order for a damaged spine to begin healing, but largely inevitable due to core damage to the body and paralysis of the lower regions. As a result of this, the body, that was never started up again after the shut down in the immediate trauma, slowly enters into a state of dormancy. I am not thinking here of the skeletal muscles or any connection to nerve damage, but of the core structures of the body, centred around the damaged spinal cord. Consequently, when the paraplegic finally gets out of bed and begins his rehabilitation, the core structure of his body is of too low intrinsic capacity to support walking. With no use of the skeletal muscles from the waist down, due to nerve damage, he has little ability to improve this lack of intrinsic capacity and with such low intrinsic capacity there is no chance of capacity overflowing into the lower regions to stimulate the regeneration of nerve pathways. The body therefore remains in a state of dormancy and this is how the condition of paraplegia is arrived at.
Interestingly, those that are paralysed through disease or spinal operation often go on to walk again as they don’t have that immediate trauma of an accident and so tend to retain intrinsic capacity to the body giving them the capacity to overcome the nerve damage. In your program, the consultant at Oswestry Spinal Injuries Unit was filmed telling a man that, in all probability, he may well walk again. This man had a cyst on his spine that burst, causing paralysis, but he did not have the trauma of an accident.
Having established how the condition of paraplegia is arrived at, which is different from mere paralysis that can be naturally overcome, it must be understood that the brain no longer recognises either those paralysed regions of the body nor the dormant structures above the level of paralysis from nerve damage. Capacity has fallen to too low an ebb for them to register within the brain. Life is maintained in these regions through processes that operate deep in the subconscious, but even this can struggle at times. Once we see that the brain cannot register the existence of the lower paralysed regions, then we can see the futility of attempting to repair the spinal cord. Even if the perfect spinal cord transplant could be conducted then there would still be the same lack of capacity resulting in the lack of registration in the brain. If the brain does not register the existence of muscles then in its eyes there is nothing to send a signal to to operate. Only through improving the capacity of the body can we take steps to overcome paraplegia.
It is true that paraplegia can be defined by nerve damage and that the level of the spine at which the injury occurs defines the extent of the paralysis. People talk of being a T12 paraplegic or a C5 tetraplegic (12th thoracic vertebrae or 5th cervical vertebrae), but when we wish to see the true nature of the injury, and how to overcome the condition, then defining a spinal injury in this way is not helpful. It is far better to define paraplegia as a ‘condition in which the back is missing’. When viewing a paraplegic from the front you may well see what appears as a well formed body, but when viewed from the side it will be obvious that that body has no depth to it. It is as though the entire back third of the body has been sliced off. The volume is simply missing and this is above the level of paralysis from nerve damage. The damage is obviously far more compounded and extends to far more than the missing back, but this ‘missing back’ is truly the defining feature of paraplegia. If there is to be any hope of conquering paraplegia then this structural deficiency must be addressed first and foremost.
I was injured in 1996 and spent seven months in the Spinal Unit at Salisbury District Hospital. When I left hospital I had a slight flicker of a muscle in my right quadriceps and an even fainter flicker in my left quadriceps. After four years I had managed to build upon this to create slight movement at the knees. Basically, if I leaned back in a sitting position and braced my quads I could raise my lower leg slightly. This was as far as I was ever going to get through conscious muscular effort (the conventional physiotherapy approach). It was then that I came across Leonid Blyum and the work that he was doing in Advanced Bio-Mechanical Rehabilitation, focused on serious neurological conditions. He introduced me to a new approach in which we slowly but surely rebuild the damaged structure to the core of the body. By delivering mechanical inputs into the system, by hand and through many hours of repetitive work, we can reawaken the dormant structures and rebuild the missing volume. By addressing the weaknesses in the trunk and bringing the body back into balance we find that the increased capacity of the core structure of the body eventually overflows into the legs. In very simplistic terms, by rebuilding the missing volume of the back we can regain the capacity to support the legs and functional use of the legs begins to return.
For thirteen years I have been pursuing the way of ABR Therapy and have made predictable improvements throughout that time by addressing the structural weaknesses in the system. The progress I have made is truly staggering and although walking is still some way off, I barely resemble the paraplegic I once was. Recently I have begun to stand again, in the true sense of the term supporting my weight through my legs, with hand holds for balance only and this has been achieved eighteen years after injury. What is more, I am making as much if not more progress now than anytime since my injury and there is no reason why I should not continue to improve, to hopefully walk again.
I am glad that you refrained from talking of the work of the neuroscientists as a ‘miracle cure for paralysis’, but unfortunately others in the media are not so restrained and such talk is not helpful. It misleads the general public and gives false hope to the spinally injured. There is no quick fix for a spinal injury and no miracle cures, but there is an approach that can rebuild a body as badly depleted as that of a paraplegic. Perhaps you would like to report on the progress I am making and the work of Leonid Blyum in the field of bio-mechanical rehabilitation.