Picking up the pace in struggle to walk again

Published: May 16, 2007  |  Source: boston.com
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Suspended in a harness over a treadmill, Rich Maloney swung his arms vigorously and propelled his body forward. At his feet, two physical therapists pushed his legs forward and back in a churning windmill motion, straining to align his gait. His movements painstakingly gained pace and fluidity.

For Maloney, the demanding therapy sessions are as close to walking as he has come since the day 21 years ago when he fractured his spine diving into the shallows at Wollaston Beach. Researchers hope that by simulating walking motions and patterns through a cutting-edge Rehabilitation technique called locomotor training, patients with spinal cord injuries can regain sensation and movement, and perhaps even learn to walk again.

Motivation to continue the demanding routine is not a problem for the 41-year-old Bridgewater resident. He feels stronger with each session, he says, and it shows. For years, he could travel from his bedroom to his den only with the help of a rolling platform walker. Now he walks with forearm crutches some 150 feet up and down the hospital hall, his steps slow but increasingly sure.

“This is the biggest advance I’ve had in 20 years,” said Maloney, a Medicare accountant who lives independently with the help of daily home care.

“When I get on those crutches, I smile.”

Maloney began the locomotor training this year at Boston Medical Center, one of seven facilities nationwide conducting the therapy program through the Christopher Reeve Foundation’s NeuroRecovery Network. He arrived with severely limited motion in his arms and legs, and began his work with four specialists for two hours a day, five days a week.

Locomotor training, some specialists believe, could lead to similarly dramatic breakthroughs in spinal cord research. Spinal cord injuries cause paralysis by impairing or destroying communication between the brain and the rest of the body.

But a growing body of evidence suggests that the spinal cord — specifically neural networks called central pattern generators — can be trained to control motion on its own.

By sending sensory cues, repetitive exercise can teach the spinal cord to send out signals to move without the brain’s help, essentially sidestepping the injury, the thinking goes.

“The thought is, there is something other than your brain telling your legs to walk,” said Tom Duffy, a Physical Therapist in the program. “It’s not a magic wand, but the progress we’re seeing is encouraging.”

It is also hard won. As Maloney walks on the treadmill, two therapists labor to flex his knees, lift his toes, force his heels downward, and straighten out his strides, and a third prevents him from over rotating his hips. A fourth mans the computer, which regulates treadmill speed and the amount of body-weight support.

It’s grueling work that causes therapists’ arm muscles to burn from exertion, and they rotate every few minutes to avoid exhaustion. Maloney grits his teeth, and the shared effort creates a strong camaraderie.

“Pick those toes up!” said Sue Donnelly, a physical therapist. “C’mon, Rich!” She held her hand out in front of his right foot and urged him to kick it. With a grunt and slight grimace, he did.

“Let’s go! Got to catch that bus!” she exhorted.

“OK,” he gasped.

At first, he said, the treadmill walking felt forced and unnatural, and his motions were halting and tentative. But with practice, it has become more automatic.

“Each part comes back little by little,” Maloney said. “Now it’s just happening. That’s the whole idea, right?” His therapists nod in agreement. By manually replicating the walking process, they are reminding the nervous system to send the correct signals for walking.

“We’re trying to create an Environment that says ‘ Walk,’ ” Donnelly said.

Four patients with incomplete spinal injuries are participating in the Boston program, but researchers hope the therapy could someday help patients with complete spinal cord injuries. Susan Howley, director of research for the Christopher Reeve Paralysis Foundation, said the program also seeks to improve the overall health of spinal cord injury victims. So far, approximately 100 have undergone the therapy, and all have shown health improvements, from lower blood pressure to substantially improved mobility.

“Enough of that repetition, and in many instances there is a miraculous recovery,” she said.

Steve Williams, chairman of the department of rehabilitation medicine at Boston Medical Center, said researchers over the past several years have discovered that the spinal cord has a hard-wired stepping Reflex that can be recovered and retrained.

Williams said the program aims to convince health insurers that the therapy is cost-effective by promoting many health benefits, as well as creating a valuable database for future research.

The prospect of a more independent life, for himself and others, inspires Maloney — even though he knows there are no promises.

“I’d rather shoot for the stars and hit the moon,” he said. “You know?”

By Peter Schworm, Globe Staff