Common Thread Article: "Moving Results"

Client: St. David's Medical Center

“I couldn’t move at all.” That was Devon Saul’s condition 11 months ago after he suffered a severe spinal injury in an automobile accident. “I started with absolutely nothing.”

Fast forward and today Devon, age 18, is able to walk.

His spectacular progress has been helped by an innovative biofeedback technique now available at the Neuromuscular Retraining Clinic at St. David’s Medical Center. The clinic helps patients with paralysis restore function by developing and controlling new neural pathways through a form of trial and error learning.

The basic concept is fairly simple. If you want to play the piano, it helps to hear the notes you’re playing. Without this immediate feedback, practicing will do little to improve your skills. Similarly, patients working to overcome paralysis also benefit from feedback – in this case, biofeedback – that measures the strength of nerve signals reaching specific muscles.

“Even in people who have severe damage we often find that there are some neurons working,” said Dr. Bernard Brucker, Director of the Biofeedback Laboratory at the University of Miami/Jackson Medical Center. Biofeedback therapy at the clinic is based on Brucker’s pioneering research. “What we are doing is teaching people to use what is there.”

Using biofeedback, Devon is working hard to improve his motor skills. “My main problem is balance and muscle endurance. Right now we are targeting my hip abductors, trying to get one leg stronger, which will improve my balance,” Devon said. “Biofeedback has really helped me focus on certain areas.”

Jared Mallory, a physical therapist at the Neuromuscular Retraining Clinic, agrees. “Biofeedback lets us break movements into smaller components. We can see what parts are missing from functional areas and help patients work on those,” he said. “Biofeedback gives us a window into the body’s abilities that helps us fine tune therapy.”
 
Since biofeedback therapy focuses on undamaged nerve cells, the length of time since the injury isn’t a factor. This is especially promising because it contradicts the common belief that most progress occurs within 6 months to a year after injury occurs. Since 1981, the technique has been applied to more than 9,000 patients, with 98 percent of them showing a clinically significant degree of improvement.

People with paralysis caused by brain or spinal cord damage from accidents, stroke or tumors, cerebral palsy, and certain other neurological conditions are good candidates for the Neuromuscular Retraining Clinic. It is not well suited, however, for patients with degenerative diseases such as multiple sclerosis.

Therapy at the clinic is based on research by Brucker showing that surviving nerve cells can learn to take over the functions of damaged cells. Biofeedback facilitates this learning. Every neuron has a small voltage, so electrodes are carefully placed to capture the neuron activity controlling the contraction and extension of specific muscles. This information is fed into a computer, where it is processed and displayed as a graph on a monitor.

As patients work to raise the signal’s strength, the graph gives them immediate and accurate feedback on the success of their efforts – key elements required for learning.

“Their job is to concentrate on the screen and see if they can make the line go higher. It gets higher when they find more neurons that make it to the muscle. And once they learn how, it is in motor memory and they have it forever,” Brucker said. Motor memory may be an unfamiliar concept, but a good example is learning to ride a bike - once you know how, you never forget.

“What we have done is get a better understanding of how these motor neurons work, get better technology and measurements, process it quickly and accurately and present it to the patient in a meaningful learning model,” Brucker said.

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