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Column: New therapies offer hope to paralyzed patients


Ignacio Montoya pauses, regains his strength, takes a step.

Then another, and another.

With the help of a walker, an exoskeleton suit, and robotic legs that attach to hers and help her propel herself forward, Montoya walks up and down the promenade along the water’s edge at the Marina del Rey pleasure basin, next to Trader Joe’s.

“Christopher Reeve would be amazed,” says Reggie Edgerton, a UCLA scientist, who worked with the late actor and now watches Montoya’s every move.

Walking unassisted is probably not soon, if ever, for people with severe spinal injuries. But some functional improvements, which were believed to be impossible until recent years, are being made.

Montoya was almost killed in 2012 when a minibus passed in his path while he was on his motorbike. At the time, Montoya was studying simultaneously at Georgia State University and Georgia Tech, while working at a bank and training as part of the Air Force ROTC program.

In the violent collision, the nerves in Montoya’s neck were torn apart. His lungs collapsed. His back was broken. A spinal cord injury left him paralyzed in one arm and both legs. Montoya, who turned 22 the day before his injury and is now 30, has learned he may have a 1% chance of regaining sensation.

But Montoya, whose family moved from Cuba to the United States after winning the visa lottery at age 6, is the kind of person who thinks that one in a hundred is reason to be optimistic. . He obtained his business diploma a year after the accident, followed by a master’s degree in biomedical engineering. He then set out to study the state of treatment for spinal cord injury around the world, determined to prove his prognosis was wrong.

This led him to the summer of 2019 at UCLA Lab in Edgerton, a man whose relentless determination allowed him to adapt well to Montoya. Edgerton had polio as a child in North Carolina, but played baseball and basketball. He said he wanted to be seen as another child and treated the same.

“I’m 81,” Edgerton told me, watching Montoya move along the promenade. Edgerton is finally seeing the benefits of painstaking research that he and a handful of other scientists around the world have worked hard on, trying to push the limits of what is possible.

Working with funding made possible in part by the activist efforts of Reeve – who was paralyzed after a fall from a horse in 1995 and died in 2004 – Edgerton explored ways in which the brain and spinal cord can be recycled to work together . With gradual improvements, especially in recent years, he says he has seen patients stand and move with help, regain sensation in the lower limbs, and improve bladder control and sexual activity.

“I just started the same with kids with cerebral palsy, and I don’t mean to exaggerate, but what we’re seeing… is frankly phenomenal,” Edgerton says.

Earlier in his career, Edgerton had no shortage of medical skeptics, and some even scoffed at his theories.

“He’s always been a bit counter-cultural,” says Dr. Richard L. Lieber, scientific director of the Shirley Ryan AbilityLab in Chicago. “Basically he made Christopher Reeve walk and it really rocked the place.”

Ignacio Montoya suffered a spinal cord injury in a motorcycle accident that left him paralyzed in one arm and both legs.

(Carolyn Cole / Los Angeles Times)

Edgerton’s therapy “isn’t the solution for everyone,” says Lieber, who noted ongoing research being carried out by other scientists. But the AbilityLab honored Edgerton in 2019 for what Lieber called “his monumental impact in the fields of neuromuscular physiology and rehabilitation.”

He says Edgerton “spawned a whole cottage industry in rehabilitation and I would say it’s one of the most promising treatments for spinal cord injury in our time.”

Toronto neurosurgeon and researcher Dr Charles Tator says he tried similar therapies a few decades ago, but hasn’t had much success. He now believes Edgerton has made breakthroughs that may one day lead to similar treatment not only for cerebral palsy patients, but also for stroke patients.

“Reggie tries to wake up the damaged nervous system and do things that are not possible without new tricks,” says Tator. “In my opinion, he is a real pioneer.

But it required as much patience as it did perseverance.

About 10 years ago, after years of promising mammalian research, Edgerton used a procedure in which electrodes were surgically implanted into the spinal cord to stimulate the central nervous system. Even with severe damage to the spinal cord, he says, some neurological pathways remain in place.

In recent years, it has moved to a simplified, less invasive form of the same concept, attaching electrodes to the skin on the lumbar portion of the spine.

“We probably allowed half of our subjects who were completely injured to stand up within four to eight weeks of training,” says Edgerton, who does not yet know the full potential, and the limits, d ‘such treatments. The state of spinal cord therapy, he says, is at about the same stage the Wright brothers were in when they first flew in an airplane.

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Montoya remembers his escape from Cuba as a child. Despite being only 6 years old, he remembers a sense of liberation, as well as the beginnings of his desire to become an aviator and serve his adopted country. During his college years and ROTC training, his goal was to become an F-16 fighter pilot. Then came the accident.

“I was pronounced dead,” said Montoya, who told me he had been resuscitated in the emergency room. “After a spinal cord injury, you are sent home in a wheelchair. It doesn’t matter where you are in the United States or around the world. They can give you inpatient therapy for a month, two months, three if you’re lucky. And you might get a little outpatient therapy if you’re lucky.

But you are not sent home with a lot of hope.

“Clinicians feel pressured to tell them that they will never work again,” says Edgerton. “It’s one of the first things they hear.”

The prevailing consensus, Edgerton says, is that a year after sustaining a serious spinal cord injury, even minimal recovery is highly unlikely, if not impossible.

“It’s almost impossible to get insurance to cover any type of treatment,” Edgerton says.

He understands the danger of creating false hope in patients, but also the danger of giving no hope, especially as the number of medical tools increases, as does the knowledge bank on how the nervous system controls. movements.

He now has three other patients who are on the same treatment regimen as Montoya, who trains at the marina three days a week and two more days a week in the UCLA lab in Edgerton.

In the lab, Montoya hangs weightless on a treadmill with electrodes attached to his spine to stimulate his nervous system.

“My brain interprets these sensations,” Montoya says, and with the help of therapists, it is able to contract muscles and move its legs, even after the electrical stimulation is removed.

He then lies on his side, suspended again, and is able to voluntarily contract muscles to move his legs, as if he were pedaling a bicycle.

The sensations he feels are nothing like what he felt before the accident, Montoya says. But electrical stimulation – and a growing awareness of the communication between his brain, spinal circuitry, and muscles – makes movement possible. It’s as if he’s learning to listen to a conversation between his brain and his nervous system, and use that intelligence to start learning to take back control.

“You cannot be passive,” says Montoya. “You have to think really, really hard about every little muscle and every little movement, and when you focus you are able to tap into those peripheral nerves. And that’s when you can contract the muscles.

Edgerton says that in the case of bladder control, the patient with a spinal cord injury “knows the bladder needs to be emptied even though the signal is different.”

Column: New therapies offer hope to paralyzed patients

Professor Reggie Edgerton, who treated Christopher Reeve, works with Ignacio Montoya.

(Carolyn Cole / Los Angeles Times)

Montoya says he’s been able to contract the muscles in his lower limbs and abdomen, which helps him breathe. He says the exercise produced a general feeling of greater physiological function. It also appears to relieve severe chronic pain in his arm, and his bone density has reached normal levels.

“I was able to speed up my heart rate, which in turn increases my circulation, and I am able to get rid of the neuropathic pain,” says Montoya. “I am able to regulate my body temperature, I sweat for the first time when I exercise and I feel hungry and thirsty again.

“I mean, it’s revolutionary, it’s life changing, and I see it and I witness it. And for someone who’s been paralyzed… for eight years, almost nine years, I feel a sensation. And for me, saying these words is amazing.

Equally incredible is the amount of energy Montoya has. Despite the demands of his long therapy sessions, he also attended Cal State University in Los Angeles with the goal of earning another master’s degree, this one in Kinesiology, so that he would be better able to understand his own recovery and. to give him an edge with a business. he works as scientific director.

HINRI, the Healthcare Institute for Neuro Recovery and Innovation, is a non-profit organization whose mission is to study medical breakthroughs – especially in the treatment of paralysis – and to support researchers, giving them the necessary resources. to accelerate new therapies.

“The more I put forward in my schedule and the busier I am, the better I perform,” says Montoya.

Montoya, like Edgerton, doesn’t know what further recovery he is capable of. It is too early to know, and the promise is tempered by reality. There is no cure for serious spinal cord injuries, Montoya says. But there are interventions, like the ones he undergoes, that can help treat “mental paralysis” as well as the physical one. “The mental paralysis of seeing no hope.”

When it comes to theft, Montoya now has a variation of his original dream. With space travel expanding in recent times, he is raising his hand for a seat at the next launch, hoping for the chance to be what he calls “an accessibility ambassador” for people with disabilities. .

Montoya says he is grateful for Edgerton’s inspiration and the chance to help “continue the legacy of Christopher Reeve”. And he’s enjoying life in California.

At the water’s edge, the curious study Montoya, who tells the short version of his life to those who ask. He gets a thumbs up and a “good luck” as he takes one step, then another, then another.

“I told Reggie I’m not leaving here unless it’s on my feet, walking,” Montoya said.

Steve.lopez@latimes.com

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