Saturday, January 29, 2005

Promise of 'Bladder Pacemaker' for People With Spinal Cord Injury

(AScribe Newswire) - Biomedical engineers at Duke University's Pratt School of Engineering have demonstrated for the first time that stimulating a specific nerve in the pelvis triggers the process that causes urine to begin flowing out from the bladder, refuting conventional thinking that "bladder emptying" requires signals from the brain.

Their research, carried out with animals, could lead to a "bladder pacemaker" to restore bladder control for the more than 200,000 Americans living with spinal cord injury (SCI) or disease-related spinal cord problems.

Neural engineer Warren Grill and biomedical engineering doctoral candidate Joseph Boggs found that applying small electrical currents to the pudendal nerve triggered coordinated contraction of the bladder and relaxation of the urethral sphincter, which controls the bladder's outlet. The electrical stimulation emptied 65 percent of the bladder's volume.

In contrast, the bladder overfills without such intervention, triggering spastic contractions that empty only about 32 percent of the volume. The urethral sphincter frequently closes, blocking the flow of urine and forcing the urine back up toward the kidneys. This backup causes the chronic urinary tract infections and kidney problems that typically plague people with SCI.

What's surprising and encouraging about the findings, said the researchers, is that electrically stimulating the pudendal nerve caused the urethral sphincter to function normally and to efficiently empty the bladder.

Boggs, Grill and biomedical engineers Brian Wenzel and Kenneth Gustafson at Case Western Reserve University in Ohio published the findings in the Journal of Neurophysiology. The paper is now available online and will be published later in 2005. The research was sponsored by the National Institutes of Health and the Whitaker Graduate Student Fellowship program.

The researchers used cats in their studies because cats, like humans, empty their bladders through coordinated bladder and urethral sphincter activity. NIH animal care and experimental procedures were followed and approved by the Institutional Animal Care and Use Committee of Case Western Reserve University, where the studies took place.

Until now, most bladder control research has focused on treating incontinence, a major cause of health problems such as urinary tract and kidney infections, and of skin degradation. Other research teams have reported that electrical pulses with low frequencies, about 2 to 20 cycles per second, help control incontinence by calming involuntary bladder contractions, while higher-frequency pulses do not help.

The new research demonstrates that the higher-frequency pulses fail to control incontinence because they trigger bladder contractions. The team found that frequencies in the range of 20 to 40 cycles per second work best for bladder emptying.

"It was a surprise that no one had figured this out yet. But now that we understand the whole picture, we can pursue an engineered solution to help people restore bladder control," Boggs said.

"With this new understanding of the function of the pudendal nerve and the beneficial application of both high- and low-frequency pulses in controlling bladder emptying and incontinence, it should be possible for us to create a 'bladder pacemaker' analogous to a heart pacemaker," said Grill, who previously (in 2004) published preliminary human research that supports his optimism in extrapolating from the new studies with cats. Those earlier studies showed that a similar reflex in bladder contraction exists in people with SCI.

In January 2005, the National Institutes of Health awarded Grill a 5-year, $1.8 million grant to develop a system to sense involuntary bladder contractions and trigger a calming low-frequency electrical signal. The project also seeks to enable patients to generate a high-frequency signal on demand so they can empty their bladders at will.

"More control over bladder function could significantly improve quality of life, such as by allowing people the simple freedom of going to the movies without worrying about an accident," Boggs said.

"Our objective is to complete clinical testing and be able to put bladder control implants in humans by the year 2010," said Grill, who plans to carry out human experiments at Duke to follow up the research with cats.

Today, people with SCI typically manage their bladders with catheters or an implanted device that empties the bladder by stimulating sacral nerves at the base of the spine. However, implanting this "Vocare device" requires doctors to cut sensory nerves and insert electrodes into the spine. Many patients are reluctant to do this because of concerns about losing bowel control or sexual function such as erection in men and lubrication in women.

"Our goal is to create a system that performs as well as existing technology, but that is less invasive to install and preserves as much of the person's remaining function as possible," Grill said.

He envisions a simple system with an electrode on the pudendal nerve attached to an electrical signal stimulator placed in the abdomen. The bladder pacemaker operation would be optimized by a doctor and then run by the patient using a wireless control device.

Grill is a founding partner in NDI Medical Company, which has exclusive license to the selective stimulation patent relevant to this research. NDI Medical is also the U.S. distributor of the Vocare device.
Read the Full Post!
 

Saturday, January 22, 2005

Device Shows Promise for Spinal Cord Injury

An experimental device designed to regenerate nerve fibers in people with spinal cord injuries shows promise, says an Indiana University School of Medicine study in the January issue of the Journal of Neurosurgery.

The oscillating field stimulator (OFS) creates an electrical field in the area of damaged nerves. It was developed at Purdue University.

In this study, the cigarette lighter-sized device was implanted in 10 people with complete motor and sensory spinal cord injury. It was removed after 15 weeks, and the patients were tracked for the following year.

After six months, all 10 people showed some improvement in sensation. After a year, all nine people who remained in the study showed varying degrees of improvement.

Two people recovered some lower extremity function and one man had restored sexual function.

"This isn't a home run, but it warrants additional investigation. The big question was whether the procedure, which is very invasive and requires two surgeries, is efficacious -- and the initial results indicate that it is," study author Dr. Scott Shapiro, a professor of neurosurgery at Indiana University School of Medicine, said in a prepared statement.

A second clinical trial of the device involving 10 people with severe spinal cord injuries is scheduled to begin early this year.

More information

The American Association of Neurological Surgeons has more about spinal cord injury.

By Robert Preidt (HealthDayNews)
Read the Full Post!
 

Friday, January 21, 2005

Surgery gives new hope to paralyzed teen

BY PATRICIA ANSTETT ~ FREE PRESS MEDICAL WRITER

Every time Cortney Hoffman feels a sensation running from her hips down through her legs to her toes, it is a signal to her that there's a new spark in her injured spinal cord.

And the tingling continues.

"I feel a lot of tingling, all the time," said Cortney, 18, of Temperance, who returned to Michigan on Wednesday from Lisbon, Portugal, where she had experimental stem-cell surgery Jan. 8 to repair her spinal cord.

While recovering in Lisbon last week, for the first time since a July 2002 auto accident left all but her head and uppermost torso paralyzed, Cortney could feel her mother, Tammi Roe, squeeze her foot and knee.

"I'm still very sore in my neck," Cortney said. "The pain is worse than I expected, but I'd do it again in a heartbeat."

Determining whether the surgery was a success requires two years of exhaustive physical therapy so that patients regain more upper body strength and some movement in their legs and arms. Among the first 37 patients who have undergone the procedure since 2001, a few are beginning to walk, haltingly, with walkers. Several have regained bladder control. There have been no deaths; everyone who has undergone surgery and physical therapy has seen some improvement.

The procedure gives hope to paralyzed people.

Cortney's story has captured international attention. The Rehabilitation Institute of Michigan in Detroit, which is collaborating with the Portuguese surgical team, has received more than 100 new inquiries and hundreds of visits daily to its Web site since Cortney's story appeared in the Jan. 4 Free Press. (For more information, go to www.centerforscirecovery.org or call 866-724-2368.)

The surgery offers a glimpse at the future of medicine. It uses a person's own adult stem cells, extracted with tissue from the upper reaches of the patient's nasal cavity. The cells are then implanted in the spinal-cord injury site.

Stem cells are among the body's most versatile components. They can take on jobs of other cells when placed elsewhere in the body, holding out promise for the eventual treatment of still-baffling diseases, from multiple sclerosis and Parkinson's disease to perhaps diabetes. In Cortney's case, the hope is they will create nerve and blood cells.

Spinal cord autograft surgery costs $47,600, often is not covered by insurance and is available only in Lisbon, though the Rehabilitation Institute hopes to gain federal approval by next year to do the surgery in the United States. Only patients 35 and younger and those who have been injured six years or less are eligible.

For now, the questions are pretty basic: How safe is the operation? How effective? Does it last? Do patients experience any complications?

Besides the pain she reports in her neck, Cortney has lost her sense of smell, a common though temporary problem. "I smelled an orange" a few days ago, Cortney said.

She expects to return to rehabilitation in about a month. She looks forward to driving by herself and walking. After spending 15 days in a foreign country, she looked forward to chilling out.

"My doctor told me to be patient," she said. "Everything has gone as well as can be expected."
Read the Full Post!
 

Sunday, January 16, 2005

Stem cell treatment does not bring results hoped for

It was supposed to be a life-changing trip to a beautiful locale, but Karen Pollack said a family visit to the ITL Clinic in Freeport, Bahamas, did little to help her daughter.

They went there in June for a stem cell transplant for daughter Karly, 5, who was born with a disease similar to multiple sclerosis. The family desperately hoped the experimental procedure would help Karly walk.

They were told results should be apparent in six to eight months, but the procedure did not work for Karly.

"We saw a tiny bit of improvement, and then nothing," said Karen Pollack, who spent $20,000 on medical treatment and travel. "It hasn't done anything for her."

Karly was born with demyelinating disease, meaning she did not have a natural coating on her spinal cord, which is needed to help relay messages from the brain for vision, walking, talking and memory.

Through therapy, Karly has learned to sit up on her own, but over time the disease worsens and there is no cure. The disease got the Hollywood treatment in the film "Lorenzo's Oil."

Dr. David Steenblock, a controversial osteopathic physician who runs the Brain Therapeutics Medical Clinic in Mission Viejo, Calif., believes stem cells, harvested from newborn's umbilical cords, could be coaxed to repair spinal cord problems.

There's no published medical evidence to support Steenblock's claims, although stem cells do work in therapy for leukemia and blood diseases. It's stem cells gathered from embryos that may hold promise for spinal cord injury and Parkinson's disease.

Karen Pollack is reticent to discuss what happened since her family went to the Bahamas for the treatment.

"We've had stressful results after talking to the press," said Pollack, who said they got calls from reporters in California and the Bahamas for information about their stem cell quest.

By: Shantell M. Kirkendoll
Read the Full Post!
 

Saturday, January 15, 2005

Electrical Device Promising for Spinal Cord Injury

Early tests are raising hopes that a new device can help people who've injured their spinal cord.

Implantation of an oscillating field stimulator, which generates an electrical field, is a safe, well-tolerated treatment that may improve motor and sensory function in such patients, findings from a pilot study suggest.

The device, which was developed at Purdue University, is placed near the site of injury and is designed to stimulate nerves to regenerate and, it's hoped, restore some degree of function.

After seeing encouraging results in dogs with spinal cord injury, Dr. Scott Shapiro, from Indiana University School of Medicine, Indianapolis, and colleagues tested the device in humans. The researchers' findings appear in the Journal of Neurosurgery-Spine.

The early-stage trial involved 10 patients with a complete spinal cord injury but no evidence on an MRI scan that the nerves had been actually severed.

Average pain-scale scores were 8 at the time the device was implanted. After six months, the scores had dropped to 2, and in most patients remained there after a year.

Treatment with the oscillating field stimulator was associated with significant improvements in sensitivity to light touch, pinprick sensation and motor function.

"This isn't a home run, but it warrants additional investigation," Schapiro said in a statement. "The big question was whether the procedure, which is very invasive and requires two surgeries, is efficacious and the initial results indicate that it is."

Based on these findings, the US Food and Drug Administration has approved another trial of the device, which should begin early this year, the researchers note.

SOURCE: Journal of Neurosurgery-Spine, January 2005.
Read the Full Post!
 

Friday, January 14, 2005

Tingles are signs of promise for teen who hopes to walk

BY PATRICIA ANSTETT

LISBON, Portugal - Cortney Hoffman woke up with a pain in her butt.

But that's a good thing.

"My butt tingles," she said two days after undergoing five-hour experimental surgery to repair a spinal cord injury from a 2002 auto accident that paralyzed her from the upper arms down.

"I never felt it before. It's like little pokey needles," she said.

Mostly, she felt groggy from anesthesia and pain medicine she received after the spinal cord autograft procedure Jan. 8 at Hospital de Egas Moniz in Lisbon.

The operation, performed only at that hospital, used Cortney's adult stem cells, harvested in tissue extracted from the upper reaches of her nose, and implanted over her injury site, high in her back.

Olfactory mucosal tissue from the nasal cavity is rich in stems cells, as well as nerve cells. Stems cells are cells in their infancy. They are capable of becoming nerve cells, and forming new neural connections and blood vessels when implanted in a spinal cord injury site.

The success of the operation is highly dependent on patients undergoing two years of aggressive rehabilitation to trigger new signals in the spinal cord.

But early on, paralyzed patients look for any sign, any new sensation, any change in the same-old, same-old routine.

SOME POSITIVE SIGNS

"Cortney is doing very well," says Dr. Carlos Lima, chief of the surgical team, after examining Cortney on Monday morning in her modest sixth- floor room in this aging public hospital.

Other positive signs that Cortney's recovery has begun is she has no postoperative bleeding from her nose or surgery site; no infection, and no drainage of spinal fluid onto a bandage over the six-inch incision in her back.

To determine whether Cortney lost any sense of smell - one temporary loss many patients experience after the surgery, sometimes for several months - Lima tells Cortney to close her eyes. He takes a film canister from his white lab coat, pulls off the cover and puts it under her nose.

"Can you smell this?" he asks.

Cortney pauses and tells him she can't.

"It's coffee," he tells her.

Lima then asks Cortney: "So what are your main complaints?"

"I want to feel better," she says. She is hot, groggy and feels pain in her nose, back and shoulder, despite pain medication.

Lima tells her family that Cortney should be sitting up in a day, and perhaps will be able to sit in her wheelchair in another day or two. She and her mother, Tammi Roe of Temperance, Mich., north of Toledo, Ohio, have booked a Jan. 19 flight out of Lisbon.

Cortney misses her two dogs - a Chihuahua named ChiChi and a black Labrador named Buck - and American food. She passed on a hospital meal Sunday because she thought it looked like earthworms, she says. When her sister, Krystal Hoffman, 21, talks about fast food, Cortney tells her: "Bring me something."

As an indication of what may be ahead for Cortney, in the room next door, Amy Foels, 20, of Elkader, Iowa, who had the same surgery Friday, reports constant tingling, from her legs to her toes.

"It's really intense in the toes," says Foels, who also was injured in a 2002 auto accident. "I'm seeing it as a good sign."

Cortney says she looks forward to completing driver's education next month. A Dodge Caravan equipped for her wheelchair waits for her at home.

And for the future?

She wants to live on her own someday.

And, most importantly, she wants to walk down the aisle at her own wedding.

First, it appears, she'll be part of her sister's wedding party.

A PROPOSAL IN LISBON

On Jan. 8, as Cortney slept at the hospital, Brandon Baker of Adrian, Mich., got down on one knee and proposed to Krystal along Lisbon's riverfront.

Asked if he got down on one knee or two, he quips: "One knee. I was asking her, not begging her."

Cortney's family had been told of the proposal before her sister knew about it. One of the first things Cortney asked after waking up from surgery was, "Did Brandon propose to Krystal?" The girls, nearly four years apart, have grown closer since Cortney's accident and Krystal helps Cortney's mother with care giving.

Cortney's dad, Doug Hoffman, her grandfather Norman Schmidt, and her friend Rachel Scanlon, also came with Cortney to Lisbon.

Lima tells Cortney's mother not to expect too much too soon. "The main things take months. It takes months, even years," he said.

"You have to be patient and Cortney has to be patient and determined."

When she asks whether Cortney can undergo the procedure again, Lima said: "If she's doing well, why would you want to do that? If it works for three years, why wouldn't it work for longer?"

He explains that, with rehabilitation, Cortney first will develop better strength in her fingers, arm and trunk, then after perhaps four months, be able to begin doing more leg exercises and possibly, taking a few steps with leg braces and help.

Cortney will resume three days a week of aggressive rehabilitation at the Rehabilitation Institute of Michigan in Detroit, where she's been going since the fall.

The institute is collaborating with the hospital team in Lisbon to evaluate and follow up patients and hopes to become the first U.S. medical center to offer the procedure, perhaps as early as next year. Soon, a hospital in Colombia and a hospital in Panama are likely to begin the operation, Lima says.

"We want others to learn how to do the procedure," Lima says. So many patients want the $47,600 surgery that the team in Lisbon is booked through the end of May. They have done the procedure 37 times.

Cortney suddenly stirs from her slumber and says: "I want to go home. I am ready to begin a new life."
Read the Full Post!
 

Spinal Cord Injury Patients Show Improvement in Early Device Study

Treatment for spinal cord injury leading to paralysis continues to stymie physicians but a clinical trial at the Indiana University School of Medicine reported in the January issue of the Journal of Neurosurgery - Spine may point researchers in a positive direction.

Ten patients with complete motor and sensory spinal cord injury were implanted with an experimental device designed to regenerate nerve fibers, promoting some degree of functional recovery. The device, an oscillating field stimulator or OFS, creates an electrical field in the area of injury.

All 10 trial participants implanted with the OFS showed some improvement in sensation at six months and the nine patients who remained in the trial also showed improvement one year post surgery, although the degree of improvement varied by patient.

Two of the patients recovered some lower extremity function, and one man had restored sexual function. All patients participating in the trial had sustained complete motor and sensory spinal cord injury within 18 days of the surgery.

"This isn't a home run, but it warrants additional investigation," said Scott Shapiro, M.D., professor of neurosurgery at the Indiana University School of Medicine. "The big question was whether the procedure, which is very invasive and requires two surgeries, is efficacious and the initial results indicate that it is."

The cigarette lighter-sized oscillating field stimulator was developed at Purdue University and first tested in more than 100 dogs crippled by naturally occurring spinal cord injuries. The prognosis for severely injured paraplegic dogs, even with current treatment techniques, remains poor.

"The results of these various animal studies were positive and somewhat mirrored what was later observed in humans, including recovery of sensation and other important functions," said Richard Borgens, Ph.D., professor of biomedical engineering in the Center for Paralysis Research at Purdue.

In the IU School of Medicine study, the OFS was surgically removed at 15 weeks and patients were followed for one year.

Three tests were used to evaluate sensory recovery: pinprick sensation, light touch sensation and motor function. Patients recorded a net improvement at one year of 20.4 points (maximum 112) pinprick sensation, 25.5 points (maximum 112) light touch sensation, and 6.3 points (maximum 100) for improved motor function.

The patients had no sensation below the level of their injury prior to the implantation of the OFS, said Dr. Shapiro. Afterwards, the patients' sensation was almost back to normal in the immediate area affected by their injury where nerve regeneration occurred.

"This was a pilot device trial," said Dr. Shapiro, the lead author of the journal article and chief of neurosurgery at Wishard Memorial Hospital. "Some patients did regain sensation and motor function in their lower extremities but not enough to stand unassisted. However, the improvement experienced by the patients is encouraging and deserves more study."

The Food and Drug Administration has approved a second clinical trial involving 10 additional patients with severe spinal cord injuries. It is expected to begin at the IU Medical Center in early 2005. This trial will again explore the efficacy of the OFS device and could lead to a larger randomized trial for spinal cord injury patients.

The initial study was supported by a special appropriation by the Indiana General Assembly.

(Dr. Shapiro can be reached through the IUSM Office of Public and Media Relations at 317-274-7722. Dr. Borgens can be reached through the Center for Paralysis Research at Purdue at 765-494-7600.)
Read the Full Post!
 

Tuesday, January 04, 2005

CELL STUDY: Blood cells may boost healing of spinal cord injuries.

A study using a person's own blood cells to boost healing within the first two weeks of a spinal cord injury is under way at the Rehabilitation Institute of Michigan and six other U.S. centers.

The cells are isolated from a person's own blood, treated in a laboratory to enhance them, then injected in the site of the spinal cord injury. Small pilot studies in the United States and five other countries show that spinal cord patients obtained movement or feeling after the therapy.

The therapy involves using a type of white blood cell that removes cell debris within 14 days of an injury. The cells, called macrophages, are part of the body's healing process, releasing growth factors that help to begin healing.

The study is open to people ages 16 to 65, with specific levels of injury. Those eligible for the study include those with injuries from the biceps or lower, which are defined as complete injuries, Asia Grade A, C-5-T-11. Complete injuries are those that leave a person without feeling or movement below the level of injury.

Two patients of every three in the study will receive the blood therapy, but all patients in the study will receive free rehabilitation therapy and follow-up testing for one year.

The therapy was developed by Proneuron Biotechnologies Inc., of Los Angeles, in conjunction with an Israeli researcher.

To refer a patient to the study, call Markyta Armstrong, at the Rehabilitation Institute, at 313-745-0204, ext. 92822.

Nationwide, contact the Proneuron Patient Recruitment Call Center, 866-539-0767 or visit www.proneuron.com.
Read the Full Post!
 

STEADY AS SHE GOES: Spinal cord patient Erica Nader makes progress after experimental stem cell surgery

BY PATRICIA ANSTETT - FREE PRESS MEDICAL WRITER
January 4, 2005

A world of patients with spinal cord injuries is watching Erica Nader.

Her recovery may be theirs, too, someday.

Nader, 26, of Farmington Hills was the first American to travel to Portugal, in March 2003, for experimental surgery for a spinal cord injury.

She was injured in July 2001 in an auto accident as she and her brother headed out on a fast-food run after their parents' 25th wedding anniversary celebration. The car flipped off the dark, winding road in the subdivision and the air bag went off. She was paralyzed from the top of her arms down.

Nader and her father, Fred, spent months checking out a Portuguese procedure before she underwent the five-hour surgery.

In the procedure, which is performed nowhere else in the world, a team of doctors opened Nader's spinal cord to clear out any scar tissue or debris at the site of the injury.

Then, using a long tube, they took a sample of olfactory mucosal cells from the ridge inside her nose, the same cells that provide the sense of smell. These cells are among the body's richest supply of adult stem cells and are capable of becoming any type of cell depending on where they are implanted. In this case, these adult stem cells were to take on the job of neurons, or nerve cells, once implanted in the spinal cord at the site of an injury.

Animal studies show that the cells "express developmentally important proteins," says Dr. Steven Hinderer, specialist-in-chief at the Rehabilitation Institute of Michigan in Detroit, which is collaborating with a team at Lisbon's Egas Moniz Hospital to evaluate and follow up with patients such as Erica. And after three years, magnetic imaging resonance tests (MRIs) show that the cells indeed promote the development of new blood cells and synapses, or connections between nerve cells, says Dr. Carlos Lima, chief of the Lisbon team.

Because the cells are most plentiful in younger people, the Portuguese team limits the surgery to people no older than 35, six months to six years after a spinal cord injury.

The surgery is "feasible, safe and beneficial," Lima told a Detroit audience last fall as he answered questions from people interested in the procedure. There have been no deaths or infections, he added.

Dr. Pratas Vital, one of two neurosurgeons on the team, calls the transplanted cells spinal cord autografts, a term that indicates the cells come from a person's own body, not fetal or embryonic stem cells used in experimental procedures elsewhere.

The team has performed 30 operations -- about three a month -- since July 2001. But aggressive rehabilitation is as important, if not more so, than the surgery, Lima says.

"One thing we know already," Lima says. "This is a very slow recovery process. We thought it would take a year, now we're thinking it's at least two."

Two of the biggest drawbacks to the surgery are the cost and lack of published results, though the Portuguese team expects to take care of the latter this year. For now, the 300,000 people in the United States with spinal cord injuries rely on Internet chat rooms and media reports for answers. They gobble up every scrap of information they can find. Some people e-mail Nader or call her at home. She chooses the few she believes she can help the most. For the rest, she's agreed to let a Free Press reporter follow and report on her progress, so others will know what to expect from the surgery and afterward.

The operation costs $47,600 and often is not covered by insurance, leaving it as an option, at least for now, for those who can afford it or who have lawsuit awards from accidents sufficient to pay for the surgery.

Dr. Wise Young, director of the W.M. Keck Center for Collaborative Neuroscience at Rutgers University in New Brunswick, N.J., updates visitors periodically on the Portuguese procedure at his Web site, www.sciwire.com.

"Several people on these forums who have had the surgery appear to be recovering some function," Young wrote recently about the Portuguese procedure. "Unfortunately, to date, there has not been a publication of the results so that we do not know what proportion of the people recover function, to what extent, and for how long. . . . I have not heard of any case where there has been loss of function or death, but the lack of information does not necessarily mean that these have not occurred."

Gaining strength
Erica Nader's recovery has been slow but steady. She has been tireless and patient, demanding more of herself each week.

She works out like an Olympian in training: five hours three days a week and at least two hours a day the rest of the week.

She can sense the days when she can push a little more and others when she shouldn't press too much.

To stand, let alone walk, Nader demands that every muscle in her body feel just right.

Her hips must be centered, her feet spaced apart just right, her back straight. And when she moves, her weight must land on her heels, not her toes.

Too much tingling is a sign not to push too much. She waits, minutes sometimes, before taking another step, her physical therapist in front of her, a close friend behind.

Walking is her goal. For now, she settles on knowing that she is much stronger and much more capable of lifting her arms, bending her knees on a slanted exercise board and standing erect. She works for every inch of her recovery.

"It seems, just when I get discouraged, I feel or experience something new" that tells her more gains are ahead, she says.

Once, she was paralyzed from her biceps down.

Now, she can push herself off an exercise ball, do arm lifts and help raise herself off a floor mat.

Three years ago, she had no finger movements.

Now, she can lift a water bottle to her mouth for a swig, or feed herself.

In the last six weeks, she's started to walk in leg braces with a walker or on a treadmill, tasks assisted by a therapist, friend or family member. She uses full-length mirrors to gain visual clues to assist her movements.

Some days are better than others.

"It's hard work," says Bill Thornton, her physical therapist at the Rehabilitation Institute. Typically, gait patterns take three to seven years to learn, he says.

Nader left Dec. 30 for San Diego to continue her rehabilitation in the warmer climate preferred by many other people with spinal cord injuries.

But she stays in close touch with the institute and the work she and her father, a technology consultant, started there. They have helped raise thousands of dollars for spinal cord research at the institute as well as set up a scholarship program to help pay for rehabilitation therapy, often uncovered by insurance.

She also takes time to e-mail a few of the many people who want to communicate with her. "I look for someone I think I may connect with," she says.

The biggest question she's asked: Should I have the surgery?

"I can't make that decision for people," she says. "There are a lot of things to look into. There are always risks, but there are rewards, too."

Fred Nader, whose life has been consumed by his daughter's recovery since her accident, is studying ways to steamroll spinal cord advances. And he calls Erica a stimulant, a champion.

"It takes a spark for progress to happen, and that's what she is," he says.
Read the Full Post!
 

HELP FOR PARALYSIS: Cortney's wish is to walk again

BY PATRICIA ANSTETT - FREE PRESS MEDICAL WRITER
January 4, 2005

Cortney Hoffman, 18, of Temperance and her cousin Cassie Adney, 5, of Toledo shop last week at a dollar store.

Cortney Hoffman admits the painful truth. She wasn't wearing a seat belt the day her car flew off the road less than a month after she received her driver's license on her 16th birthday.

She was just going a few miles to her cousin's house. She insists she wasn't speeding, sleepy, drunk or stoned, but she has no idea how her 1996 Cutlass Supreme landed in a ditch on July 30, 2002.

She recalls calling for help from the ditch after being thrown from her car on a freshly resurfaced gravel road.

About 10 minutes later, a man driving by heard her muffled plea, followed her voice, found her and called for help.

Hoffman awoke in a Toledo hospital, paralyzed from her shoulders down.

Six days later, she was told she'd never walk again.

Today, she departs on a plane to Lisbon, Portugal, for experimental stem-cell surgery Saturday.

Her goal is to walk at her own wedding some day. "I'm not getting married until I can walk down the aisle by myself," said Hoffman, an upbeat 18-year-old from Temperance, north of Toledo, who likes to hunt, sing and shop, particularly for jewelry. She is 5 feet, 6 inches tall with bright blue eyes and blonde hair, a 21st-Century version of the girl next door, with a big smile and ear piercings.

Her strongest attributes are an upbeat personality and persistence, said her mother, Tammi Roe, a divorcee who lives with her daughter. She quit her job as a furniture maker to take care of Cortney after the accident.

"She always has a smile on her face every day," Roe said. "She has just rolled with the punches. She missed her whole junior year in high school but graduated on time. That's the kind of girl she is."

Hoffman will be among the first 40 people in the world to undergo the so-called Portuguese procedure. It uses her own stem cells, extracted from the tissue that provides her with a sense of smell, surgically implanted into the site of a spinal cord injury.

Second chance at mobility
Detroit's Rehabilitation Institute of Michigan plans to request federal approval to perform the surgery this spring. Approval wouldn't come until 2006 at the earliest. A half-dozen approaches using stem cells are under way worldwide for people with a variety of conditions, including Lou Gehrig's and Alzheimer's diseases and spinal cord injuries. There are no legal hurdles, but plenty of scientific reservations that so far have stood in the way of anyone applying to do the surgery in the United States.

Of all the stem-cell operations, the Portuguese procedure stands the best chance of coming to America, said Dr. Steven Hinderer, specialist-in-chief at the Rehabilitation Institute. "There are no ethical problems with this one," Hinderer said, theorizing that because the procedure uses a person's own stem cells it shouldn't attract the controversy associated with operations now being conducted in China, Australia, Brazil and Russia that use stem cells from aborted fetuses or frozen embryos from fertility procedures.

For now, patients in wheelchairs get on planes for long, arduous trips abroad for experimental surgery. The other challenge is finding ways to pay for the surgery, which costs $47,600 and often is not covered by insurance. Some patients, including Hoffman, have no-fault auto insurance that covers the expense. Her family raised $1,800 in a benefit last summer to help pay for the airfare for several family members joining her for this week's trip.

The Rehabilitation Institute has a formal agreement with the team at Lisbon's Egas Moniz Hospital to evaluate and follow patients for the surgery, and to provide the aggressive rehabilitation it requires for at least two years.

The Detroit program, expanding almost monthly for the past year, is attracting patients worldwide, and pushing a city known for cars and music into the center of attention in the spinal cord community.

"I'm from Detroit now," said Harold Bostick , 35, who moved recently from Los Angeles to participate in the Rehabilitation Institute program.

A law student, Bostick was injured while working out at a gym and the equipment toppled over on him and crushed him.

"I'm trying to manage my expectations," Bostick said, stopping as he lay on his back pushing hand and foot pedals on equipment known as a Giger machine. "I've had no new movement since May 2001."

Bostick already walks haltingly with leg braces and a walker. So, too, does William Vickers, 23, of Holly, who underwent surgery in Portugal Nov. 12.

The Rehabilitation Institute's crowded Center for Spinal Cord Recovery, where they all work out, is a room of hope and questions. Some of the biggest, which patients here are providing answers for, are:

- Just how much progress will a person make after undergoing one of the stem-cell procedures?
- Has anyone gotten worse or died as a result of the operations?
- Will having a procedure now rule a person out for advances down the road?

The Lisbon surgical team traveled to Detroit last fall to confer with Rehabilitation Institute staff and patients and to summarize results of the first 30 spinal-cord autograft operations, as they call them.

There have been no deaths or infections, and none of the patients has lost function as a result of the surgery, said Dr. Carlos Lima, the neuropathologist and lead team member. The operation could mean that a person wouldn't qualify for some other advance down the road, he said.

"It is feasible, safe and beneficial," Lima said in a one-hour interview with the Portuguese team. Magnetic resonance imaging tests of the patients up to three years after surgery show the stem cells integrate well at the site of a spinal cord injury, forming both new blood and nerve cells and neural connections.

Several Portuguese patients now can swing their legs or walk with a walker, Lima said. Several others have regained bladder control. Only one has plateaued, which Lima attributed to an unwillingness to continue weekly therapy. At least two years of rehabilitation is essential to the best outcome, the team said.

The Portuguese team prefers to operate on people who are 35 years of age or younger because stem cells are more plentiful in these younger patients. In older patients, the cells change function and take on more respiratory properties. The candidates' injuries must not be more than six years old.

Cortney Hoffman made up her mind to have the surgery after reading a story in the Free Press last year about Erica Nader, a Farmington Hills woman who was the first American to undergo the Portuguese procedure. Now, they work out next to each other.

"The thought of other cures coming down the road came to mind," Hoffman said. "But that could be 10 or 20 years. I have to think about right now. A cure may not happen."

She prepared for the surgery by undergoing aggressive rehabilitation three times a week. One machine requires her to be strapped with cloth bandages to hand and foot pedals of a bicycle-like machine for an hour. She can't use headphones because "we're supposed to concentrate. It's really boring," she said. She's so tired afterward she sleeps all the way home.

The work has paid off. Hoffman can put on her makeup, brush her teeth and hair and can help put on her coat.

But she knows she has several years, at least, of hard work ahead.

"I've done my hardest to get where I am and I can't walk yet. I'm not expecting to wake up from surgery and walk. I'm expecting to gain smaller functions first."

"I've got to take this chance."

For further information, visit or call the Rehabilitation Institute of Michigan's Spinal Cord Recovery Web site, www.centerforSCIrecovery.org, or call 866-724-2368.
Read the Full Post!