Beating Pediatric Paralysis
Each year, about eleven thousand people experience a spinal cord injury. The standard approach to therapy has been simply maintenance therapy to improve range of motion and teach daily care. Now, doctors at Washington University in Saint Louis are using a new approach to help kids and adults alike. Christopher Reeve may be the most famous patient receiving this care, but he's not the only one.
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At first glance, Jessica Hill looks like any other 5-year-old.
But Jessica is anything but average. She was born paralyzed from the chest down. Today, she can walk on her own.
Leann Hill
Jessica's Mother
"I truly believed that if we could get some advanced physical therapy, that she could do a lot of things."
Call it mother's intuition, but Leann was right. Searching for more than standard treatment, she sought out the help of Doctor John McDonald.
John McDonald, M.D., Ph.D.
Neurologist
Washington University School of Medicine
St. Louis, MO
"Small children have a much better potential for regeneration. Although there's no proven effective therapy in children and that's the problem."
He uses activity-based therapy with all his patients. The key is optimizing activity.
John McDonald, M.D., Ph.D.
"Although we have tools and machines to do this for adults. We don't have them for children."
Parents like leann have adapted the adult-sized machines for their kids. Weight supported treadmills and electrical stimulation get the legs moving. Doctors hope the constant movement will help regenerate spinal cord function. It's working for Jessica.
Leann Hill
"Now, she feels all the way down. We can put her on the edge of a table, she can kick her feet, she rides her bike." "It's just absolutely incredible that she has made the progress that she has made." "She's determined and that's all that she really needs."
Doctor McDonald has worked closely with Christopher Reeve who, more than seven years after his injury, has recovered limited movement in parts of his body. Jessica was doctor McDonald's first pediatric patient.
BACKGROUND: Each year, about 11,000 people experience a spinal cord injury. According to the National Spinal Cord Injury Association, most of these people are injured in auto and sports accidents, falls, and industrial mishaps. About 60 percent are 30 years old or younger, and the majority of them are men. About 10 percent of spinal cord injuries happen in children younger than 15 years old. John McDonald, M.D., Ph.D., from Washington University in St. Louis, says children may have the best ability to regenerate spinal cord function. He says: "No one really knows all the reasons why, but we know that, as we age, there are other factors that become prominent after an injury in the nervous system that prevent regeneration. Cells don't reasons as well following and they don't quite know what to do like they do in the young nervous system."
TREATING KIDS: Dr. McDonald says, "Children probably have the best capacity to regenerate and perhaps we should be putting our greatest effort into them, really state-of-the-art across the country is doing very little with them in terms of their ability to recover." He and fellow colleagues at the University of Washington in St. Louis are changing that with the advent of their pediatric spinal cord injury program. The pediatric program was developed originally for adults who are more than a year out from their injury with the hope that patients could maximize their recovery function. One important part of recovery is the amount of activity in the neurocircuits. After a spinal cord injury, that activity is dramatically reduced because signals aren't coming in from above or below the injury. Dr. McDonald says: "We know that the nervous system does have some ability to regenerate. Increasing that activity through pattern movement is one way to enhance regeneration." Activity-based therapy has been successful and Washington University in adults with spinal cord injuries. Most notably, Christopher Reeve, one of Dr. McDonald's patients, has experienced benefits from this therapy. Dr. McDonald and his colleagues are now treating children with this activity-based approach.
ACTIVITY-BASED THERAPY: The activity-based recovery program incorporates specially designed rehabilitation therapies and exercises to help individuals with spinal cord injuries improve their overall health, strengthen their bones and muscles, and possible regain the ability to feel and move. The key concept of this approach, says Dr. McDonald, is patients need to optimize activity. Exercises and movements that produce pattern movement and repetition are employed. There are tools and machines that help adults do this, but there aren't any for children. Parents of children with paralysis are taught to think of creative ways to adapt toys and machines to fit the needs of their children, all in an effort to encourage repetition and pattern movement. An average week of this therapy would include weight-supported walking, in which children are held in a harness over a treadmill moving their legs, riding a tricycle that has been adapted to repeat cycling motions in the legs, and learning how to walk with braces and maintain balance. Dr. McDonald says, "We've developed treatments that can be applied in the home, because that's the only way it's going to happen because if people have to take out three-quarters of a day, three times a week, to go down to a center, it's not going to happen."
Linda Schultz, Ph.D.
Spinal Cord Nurse Liaison
Washington University School of Medicine
4444 Forest Park Blvd., Box 8518
St. Louis, MO 63108
(314) 454-7892
schultz@neuro.wustl.edu
Copyright © 2003 Ivanhoe Broadcast News, Inc.
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