Through New Therapy, Some Partially Paralyzed Patients Approach Walking
It takes a body harness, a sophisticated exoskeleton and a quarter-million-dollar treadmill, but Albert Pruitt walks.
Pruitt, who has been partially paralyzed since 1976, is taking small steps, literally and figuratively, at the University of Texas Southwestern Medical Center’s Spinal Cord Injury Lab.
“It’s almost like having a sense of freedom,” says Pruitt, 44, who works for a software design company in Dallas. “It makes me feel better all around. Just feeling the sensation of walking is such a confidence-builder.”
But that’s not all. New research at UT Southwestern shows that the exercise can help regenerate the message system between the legs and the brain.
“We saw improvement in the cerebellum, the part of the brain that plays an important role in motor functions,” says Dr. Patricia Winchester, professor of physical therapy at the medical center. “This suggests the cerebellum has an important role in the recovery of walking.”
Winchester, who led the study published in the December issue of the journal Neurorehabilitation and Neural Repair, is careful not to promise miracles.
In the case of a spinal cord injury where nothing is transmitted to the brain, nothing can help. For spinal cord injuries where patients may have some sensation and movement below the spot of the injury, any progress is usually slow and incremental.
But in a study of four patients suffering from partial paralysis, three showed improvement. Each received a functional magnetic resonance imaging, known as fMRI, to assess brain function, before beginning therapy on a robotic treadmill called the Lokomat.
After three one-hour sessions a week for three months, they underwent another fMRI.
For three of the patients, Winchester said, improved function, such as more mobility and the ability to support more of their own weight, was mirrored by more activity in the cerebellum.
“We think the therapy helps to rewire the brain and learn how to regain function,” she said.
One of the patients in the study was David Cunniff, the Dallas man who was severely beaten in July 2004 by several men in a nightclub. Despite initial fears he would be paralyzed, Cunniff progressed to the stage where he can walk with a single-point cane.
“He did much better than we expected,” Winchester says.
For Pruitt, who is involved in an ongoing follow-up study, the changes have not been so dramatic. It’s just another milestone in a journey he will never abandon.
“You’re not going to wake up one morning and suddenly everything is better,” he says. “It’s something I have to work toward continually.”
He has backed that up for 29 years.
At 15, Pruitt was severely injured in a motorcycle accident in his hometown of Ardmore, Okla. He spent three months in a rehabilitation hospital and came home in a body cast. With a spinal cord injury between his 11th and 12th vertebrae, he had some sensation in his legs but almost no motor control.
“They told me everything I can’t do,” he says. “You’ll never walk again, you’ll never father kids. I kind of took the attitude of trying to prove everyone wrong.”
His parents, who ran a cafe in Ardmore, set up parallel bars in the house to build up his arms and rigged up a stationary bike to exercise his legs, with his dad turning the pedals. He preferred crawling around the house to using a wheelchair.
“I just always stayed active and tried to do as much as I could,” Pruitt says. “My idea was that when new techniques came around, I wanted to be able to take advantage of them.”
The path wasn’t always smooth. He dropped out of high school, married young (“We took off in a `73 Monte Carlo with hand controls”) and had two sons. But he got his GED, took drafting courses and studied computer design in college.
Then Pruitt was recruited by Texas Instruments, which brought him to Dallas in 1982. He got around on crutches, swinging his legs in tandem, and swam and stretched for exercise.
Busy with work and family, he didn’t bother with formal therapy.
“I lived an active life, but maybe I got kind of lazy,” he says.
That changed in 1995, when he was spraying fire ants around his Garland home. He hooked his foot between rocks, fell and broke his tibia and fibula, the two bones in the lower leg.
Doctors sent him to Winchester, who started him on a device called Parastep. The system combines crutches, leg braces and electrical stimulation to enable some paraplegics to stand and walk.
“I can do a reciprocal gait, which means putting one leg in front of the other,” he says.
The system was too bulky and time-consuming to use in daily life, Pruitt says, but the exercise helped his muscle tone and flexibility.
The connection to the clinic took him in another direction.
“I’d never even bought a wheelchair, till somebody said you ought to play basketball,” he says.
That led to a couple of seasons on a wheelchair basketball team, as well as hydrofoiling (a form of water skiing where you sit on a chair), snow skiing and scuba diving.
“They really got me involved in sports,” he says. “It opened up a whole new world.”
Winchester says her goals extend beyond research. “We want people to have as full a life as possible,” she says. “Being in a wheelchair doesn’t preclude that. Albert really took advantage of it a lot.”
After the initial research that was published last month, Winchester added two dozen people to an ongoing study that should last about two years.
Among other things, she hopes to amass data to pinpoint areas of the brain that can be affected by the exercise, and find ways to predict which people can benefit most.
“But new questions always arise, and we’ll probably go off in another direction,” she says.
Three days a week, Pruitt slips on a body harness and is lowered onto the robotic treadmill. The contraptions on his legs mimic a normal walking motion, while computer screens show how much of the work his legs are doing and how much weight he can support.
“I can definitely see improvement,” he says. “It’s really helped my stamina and my cardio ability. I notice a lightness on my feet and a little better movement in my legs. It’s not magic, but it’s a ray of hope.”
Pruitt says he’s never stopped hoping he’ll walk again on his own, but he’s also realistic.
With the current state of science and technology, Winchester says, his injuries are too severe and too much time has gone by to expect a full recovery.
Another part of Pruitt’s dream is to retire early and go back to school to work on the genetic side of spinal-cord research.
But none of his dreams cloud his appreciation of what the day brings.
“I don’t wake up in the morning and say, `I’ll never be better,'” he says. “I wake up and say, `Thank goodness I’m breathing.'”
By: MICHAEL PRECKER – The Dallas Morning News
Posted on January 21st, 2006 in General SCI and Human Interest, Research for a Cure.