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Spinal-cord research earns national honor

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Dr. Anthony F. DiMarco, a physician at Metrohealth Medical Center in Cleveland, is making a difference in the lives of patients with spinal-cord injuries.

His two decades of research in that area have earned the Solon resident national recognition from the American Spinal Injury Association. A professor of physical medicine and rehabilitation, medicine and physiology at Case Western Reserve University in Cleveland, Dr. DiMarco was honored with the Apple Award of excellence from the association.

The award, named in honor of Dr. David F. Apple, founding member of the ASIA, was presented to Dr. DiMarco during ASIA’s annual scientific meeting in Nashville, Tenn.

The award recognized Dr. DiMarco for his manuscripts entitled “Lower Thoracic Spinal Cord Stimulation to Restore Cough in Patients with Spinal Cord Injury: Results of a National Institutes of Health-Sponsored Clinical Trials — Parts I and II.” The papers appeared in the journal “Archives of Physical Medicine and Rehabilitation” and present the results of a new technique to restore an effective cough in spinal cord injury patients.

Lack of cough is the reason why many of these patients are at high risk for the development of respiratory tract infections, Dr. DiMarco said. In fact, “the major cause of death in these patients are pneumonia, bronchitis or other respiratory illnesses.

“Patients with spinal-cord injury experience paralysis of the abdominal muscles which is the major muscle group normally used to generate a cough reflex,” Dr. DiMarco said.

The new technique, which Dr. DiMarco said has been used on patients for nearly five years now, involves the placement of stimulating electrodes near the surface of the thoracic spinal cord. Electrical stimulation of these electrodes is then used to activate the abdominal muscles, which allows these patients to develop a near normal cough.

This technique was developed by Dr. DiMarco and colleagues, and implemented on about a dozen patients thus far. He works alongside team members Dr. Robert Geertman, a neurosurgeon, Dr. Kris Kowalski, a neurophysiologist, and Ms. Dana Hromyak, a respiratory therapist. Other participating spinal-cord physicians included Dr. Gregory Nemunitis, Dr. Frederick Frost and Dr. Graham Creasey.

In every case, the technique has been applied, “patients have noticed improvement in their ability to handle secretions and coughs more normally to clear their throat.” This treatment also lessens patients’ fears of eating and aspirating food, he said.

“As a result, their lives are more comfortable and their mobility is improved as well,” he said. In addition, the application of this technique has resulted in a reduction in the rate of respiratory tract infection and need for caregivers to assist these patients, Dr. DiMarco said.

He said that spinal-cord injury interrupts the nerve signals from the brain to all of the muscles below the level of injury, resulting in paralysis. However, the muscles and nerves below the level of injury remain functional and therefore amenable to electrical stimulation techniques, he said. “With our technique, we replace those nervous signals that would come from the brain to activate the muscles responsible for cough.

Dr. DiMarco said the technique was tested on animals for about 10 to 12 years before being applied to people with spinal-cord injury. Currently, Dr. DiMarco said, he and his colleagues are working to make this technique less of an invasive procedure that can be done on an outpatient basis.

“There are wire electrodes which can be placed less invasively and would avoid major surgery,” he said. “We want to improve the technique, making it easier for patients.”

Dr. DiMarco said he finds gratification being on the research end of spinal-cord illnesses.

“There is not a lot of research done on this particular group of patients because the population is so small,” he said. Projects with a profit potential get greater attention, Dr. DiMarco said.

“It’s really gratifying to see patients living better and preventing infections and reducing rates of hospitalization.” The technique “makes a big difference,” he said.

Dr. DiMarco has spent the past 25 years researching the area of restoration of respiratory muscle function in patients with spinal-cord injuries, including restoring breathing through the use of a diaphragm pacing in patients requiring mechanical ventilators. One of his patients at Metro was the late actor Christopher Reeve. Dr. DiMarco applied the diaphragm stimulation in his case, which allowed him to breathe without the need for mechanical ventilation.

At Metrohealth Medical Center, Dr. DiMarco recently received a grant from the National Institutes of Health to further improve methods of diaphragm pacing.

Dr. DiMarco sees patients at Geauga Medical Center in Claridon, where he serves as director of respiratory therapy and vice chief of staff.

Board certified in pulmonary and sleep medicine, Dr. DiMarco is also director of a sleep disorders laboratory on Station Street in Solon. He received his medical degree from Tufts University in Boston.

He said he is honored to have been recognized by ASIA.

“They review all papers that have to do with spinal-cord injury, and this was selected as the top paper for the year,” Dr. DiMarco said. “I felt honored that they distinguished our research team in that way.”


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