The Will to Walk

Courtney
Jolley
Spinal cord injury: innovative therapies lead to remarkable results

Loretta McRaeAs she typed the words into the Internet search engine, Loretta McRae knew it was a long shot. In the months since the 15-year-old struck her head on an ocean sandbar in Australia, sustaining a C6 level spinal cord injury, virtually every expert said she'd already gotten her miracle. She was alive, she could wiggle her toes, she was regaining sensation in her limbs. But she would probably need to use a wheelchair for the rest of her life.

That answer wasn't good enough for Loretta, an athlete who was scheduled to compete in a swim meet the day after her accident. Amazingly, the first result of Loretta's Internet search was a link to an article about Patrick Rummerfield, the world's first fully functional spinal cord injury quadriplegic. Rummerfield, now a triathlete and racecar driver, serves as a spokesman for the International Center for Spinal Cord Injury (ICSCI) at Kennedy Krieger Institute. Unlike most other spinal cord injury rehabilitation centers, which focus on helping patients with paralysis learn to live with injuries believed to be permanent, the ICSCI strives to help patients actually recover function.

The McRaes began corresponding with Rummerfield and, on his recommendation, Loretta and her mother Debbie traveled halfway around the world so she could begin treatment at the ICSCI in Baltimore. "We liked that the center specialized in children, and were excited by their philosophy that constant movement can help restore the signals between the brain and body," says Debbie.

Loretta, who had surgery and treatment with prednisone in Australia to help relieve the pressure on her spine, entered into aggressive therapy as soon as she arrived at the center in Baltimore. "When someone experiences a spinal cord injury, it stops the connection between the brain and the body," says Dr. Cristina Sadowsky, a spinal cord injury specialist and clinical director of the ICSCI. "The longer you are without mobility, the more the body learns to stay that way. Healing and restoration depend on encouraging activity and repeating it many times. If you only work on this an hour a day, it will take months or years to make even minimal progress."

In addition to affecting a patient's ability to engage in activities of daily life, prolonged paralysis can have an adverse impact on overall health. When mobility is limited, an individual's metabolism changes. They age faster their bones weaken, tissues are stressed, they experience fractures, blood clots, even physical deformities. Individuals with paralysis are also prone to pressure sores, pneumonia, diabetes and heart attacks.

Each day, Loretta spent many hours engaged in a variety of Advanced Restorative Therapies including functional electrical stimulation (FES). Using FES on patients with paralysis helps them "ride" a bicycle with the help of a computer that sends timed electrical impulses, telling their leg muscles when and how to contract. "For Loretta, FES was very effective in a short period of time," Dr. Sadowsky says. "She was engaging in weightsupported walking within two or three weeks of starting the program. To do this, we used a harness to support her trunk, then progressively loaded her body weight onto her legs to help build the strength in those limbs." This technique also assisted in re-training Loretta's muscles to walk with a smooth, even pattern.

Loretta spent five months as an outpatient at the ICSCI. As the time passed, she required less and less assistance with walking. "We did lots of core work to help build up my trunk muscles," Loretta says. "We used stability balls and a gait trainer to help me start walking, first with crutches then a cane. I also received occupational therapy to improve the coordination in my hands."

The intense therapy was hard work, says Loretta, but well worth it. "It was hard to stay motivated, but the therapists at Kennedy Krieger tried so hard to keep us positive. They made therapy fun, which made me want to do it and made it easier for me to stay positive."

Towards the end of her time at the ISCSI, Loretta began to ask physical therapist Jamie Scheer questions about what life would be like once she returned home. "She began worrying about things like how she would carry her backpack while walking with crutches, what to expect from her peers at school," Scheer says. "We encouraged Loretta and her mom to go out and try new things to build confidence and independence in various situations. Loretta soon went shopping and walked with her crutches all day, without bringing her wheelchair as a backup plan."

Today, Loretta, who used a wheelchair when she first arrived at Kennedy Krieger, needs only crutches to walk in her family's new hometown in California. She's swimming again, and she hopes that ongoing therapy will restore most if not all of her physical abilities. "I think that being an athlete made my recovery easier because I was physically fit before, and I was really motivated because I missed being active so much," she states.

She's back in school full-time, a responsibility which makes continuing aggressive therapy at home a challenge. But with nearly a year of school to make up, Loretta knows that juggling her schedule is a must. "I plan to go to college, even though I'm not sure what kind of career I want to pursue," says Loretta. "If there's one thing I've learned in the past year, it's that you never know what the future will bring."