Brain; Orthopaedics and Rehab

What's possible in spinal cord rehab today and stem cell therapy in the future

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Kiara Connley
Kiara Connley was an athlete at the peak of her college career when a rare autoimmune disease robbed her of her vision and her ability to walk. After UT Southwestern neurologists identified her condition, Kiara made amazing progress in her recovery. (See video below.)

Patients with spinal cord injuries often inquire about stem cell therapy. Great strides are being made in this promising treatment, and our team at UT Southwestern is at the center of this developing science. 

Spinal cord injuries (SCI) can lead to paralysis, loss of independence, respiratory failure, and increased mortality. These functional impairments are currently irreversible.

Stem cells, which are characterized by self-renewal and the potential to become any type of cell, may help limit cell death and potentially replace injured cells. Ample research is being conducted in this area, including at the UT Southwestern Hamon Center for Regenerative Science and Medicine.

A team of UT Southwestern scientists led by Dr. Chun-Li Zhang created new nerve cells in the spinal cords of laboratory mice without cell transplants. A follow-up study further successfully boosted the regeneration of mature nerve cells in the spinal cords of these animals by tenfold.

In addition, the Zhang lab has identified specific “checkpoints” that may be targets for manipulation after SCI to boost regeneration. Other types of SC cells can be converted to neuroblasts, which can then mature into functioning neurons.

UT Southwestern’s Dr. Benjamin Greenberg is testing an innovative treatment that injects paralyzed patients affected by transverse myelitis with progenitor cells (from glia, another type of SC cell) engineered to repair their spinal cords. Transverse myelitis causes inflammation in the spinal cord that damages the myelin, a protective coating around the neurons. The damage inhibits communication between nerve fibers in the body and the spinal cord, resulting in paralysis.

This study is expected to start enrollment in 2020. The clinical trial, which has been 15 years in the making, could lead to similar therapies for more common conditions such as multiple sclerosis. If successful, it offers real hope to patients with spinal cord injuries.

However, we caution patients and our fellow healthcare professionals that much stem cell research is still in the early experimental stage. While it provides tangible progress, there are still many questions to answer before we can consider clinical translation.

'Trying to make this person whole again'

At UT Southwestern's Inpatient Rehabilitation Center, our dedicated team of specialists help patients get their lives back and recover functions that they have lost due to a severe injury, illness or stroke. "There are miracles here every day!"

Advanced rehabilitation technology and strategies

Simultaneously, great advancements have been made in post-trauma management and rehabilitation of SCI. Our Physical Medicine and Rehabilitation team is among the most respected in the nation and the only program in North Texas conducting both translational and clinical research in SCI, brain injury/concussion, burn rehabilitation, stroke, ambulation and falls, and epilepsy.

In our interdisciplinary program, specialists collaborate with referring physicians to help patients set appropriate expectations and return to the highest level of function and independence possible. To achieve these goals, we design customized treatment plans that utilize the latest technologies in rehabilitative medicine, such as the EKSO Exoskeleton and Lite Gait.

Compensation

Rehabilitation used to focus almost exclusively on compensation, or helping patients learn how to develop “work arounds” for impaired functions. But today, along with teaching compensatory strategies, we also attempt to restore lost function.

I often use the example of faulty wiring in your home. If a light is flickering, it means a signal is going through, but it's not as strong as it could be. In the body, some amount of nerve or movement response in a limb or tissue indicates we can potentially strengthen that pathway. One way to do that is remediation through repetitive exercise.

Neurorehabilitative devices

At UT Southwestern, we use neurorehabilitative devices specific to treating SCI that are not found at many rehabilitation centers. Two of these are the EKSO Exoskeleton and Lite Gait. These tools are used to retrain the body’s ability to walk using body-weight supported treadmill training. Repetitive locomotor training may promote spinal and supraspinal learning, reorganizing or strengthening the neural circuits that control movement.

Remediation

Every patient deserves access to therapies that both promote neural remediation and functional compensation, with realistic expectations. Some may never be able to fully return to baseline mobility. While we motivate them to work toward restoring lost functionality, we also teach them to live active lives with the functionality they currently have. This might mean learning to use mobility equipment or training an unaffected limb to take over functionality of an affected one. It is important to remain active and healthy as we hope for eventual success in regenerative therapy.


Specialized expertise for a special patient population

Some patients with SCI have difficulty trusting physicians who do not have a lot of experience with injuries such as theirs. They don’t feel like people understand what they are going through. 

I don’t have a spinal cord injury, but I have cared for a high volume of patients who do. My team and I have an idea of where they are coming from – patients can't always find that experience at other centers.

Spinal cord injuries can be physically and emotionally devastating. Patients who lose the ability to walk must mourn that loss, and sometimes surmounting grief is the most difficult challenge in the rehab process.

Our neurological rehab team includes skilled professionals who address patients’ physical, mental, and emotional well-being, including:

Rehab 500 px
Patients benefit from a multidisciplinary team of caregivers and specialists.
  • Physiatrists
  • Neurologists/neurosurgeons
  • Orthopedists/orthopedic surgeons
  • Physical and occupational therapists
  • Recreational therapists
  • Speech/language therapists
  • Psychiatrists/psychologists
  • Social workers
  • Chaplains
  • Support groups

Our team is dedicated to helping patients with spinal cord injuries live functional and fulfilling lives. Using today’s best practices and pioneering advancements such as stem cell therapy, we optimize rehabilitation to help patients return to the highest quality of life possible and, if necessary, master new mobility strategies

Our mission is as complex as it is simple: We give patients the tools and support to get their lives back. 

To learn more or make an appointment, please visit our website.

 

Kiara's comeback

Kiara Connley was an athlete at the peak of her college career when a rare autoimmune disease robbed her of her vision and her ability to walk. After UT Southwestern neurologists identified her condition, Kiara made amazing progress in her recovery. 

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