Cortney Hoffman is walking.
In 2002, when she was 16, she rolled her car. She woke up staring at a perfect summer sky, wondering why she didn’t just stand, walk to the road, and call for help.
After a frantic Life Flight ride, with the confused Temperance girl asking attendants, “Why? Why? Why? Why?” and begging for a window seat, she learned her spine was crushed. She will never walk again, she was told, never regain the use of her hands, never recruit the voluntary cooperation of her bladder.
Eighteen months ago, she flew to Portugal for an unproven surgery that some believe can restore function to people with damaged spinal cords. And now, with great effort, she walks.
It is nothing like the fluid movement she had before her accident. There is no ease here, no forgetting what it takes to shift weight, to move one’s leg, to fall forward into the next step.
Nor is there any way to tell if Cortney’s walking is the result of surgery, or the fruit of an unusual and intense Rehabilitation program at the Rehabilitation Institute of Michigan in Detroit, or maybe a little of both.
That doesn’t mean this isn’t a big deal.
“I’m thankful. I look in the mirror, and say, ‘Oh my God! I haven’t been able to stand that straight since the day I got hurt, since the day I walked out of the house.’ It’s great to be able to see how far I’ve come.”
Cortney takes another step, braced in a sort of giant walker, and pushes her long hair, now damp with sweat, from her face.
“I get frustrated sometimes — a lot of times. Walking is not one of my favorite things.”
Not that she would ever give it up. She’s worked too hard to think about quitting. So three times a week, she’s at rehab for a three-hour workout that would make hard-body gym rats applaud.
But struggling to regain command of her body is only one of the fights she wages. The other, every bit as grueling, is coming to terms with being the woman in the wheelchair.
In the small living room of the double-wide mobile home where she lived with her mother, two noisy little dogs, and a chocolate lab, Cortney executes perfect three-point turns amid the furniture her wheelchair dwarfs. The family moved to a new home in Riga last week.
“I was always scared of that first day of school, of being by myself. I hate being the new girl,” she said. “But now, I’m scared of being the new girl and being in a wheelchair.”
So she waits for her best friend to start college next year. Then they can go together, and she can be the new girl in the wheelchair who has friends.
She rolls into the office where her two other wheelchairs take up most of the real estate and turns on the computer. Evidence of a life filled with friends appears on the screen. Here’s the guy she’s interested in right now — if only she had been a little nicer to him last time they talked. Oh, but here she is at the party she throws each year on the anniversary of her accident. That’s when she met him. And there she is dressed up for Halloween, 2005, as a crash-test dummy.
Still, each new social situation is a new reckoning, a fresh shiver of insecurity.
“I’m just scared they’re going to look at me and stare at me. If I’m with a crowd of people, I don’t care …,” she said. “I feel nervous when I go places when there’s young guys, young people around. I think that’s why I’m scared of school, too, because it’s all young people.”
But when it comes to her workouts, she’s fearless.
Kerrie Walker, Cortney’s trainer at rehab, wraps Cortney’s hands carefully and then helps the 20-year-old pull on red boxing gloves. Hiring athletic trainers to work with physical therapists is one of the innovations at the Detroit center that allows patients three-hour workouts at the same cost of the one-hour programs available at most rehab facilities.
Boxing is Cortney’s favorite exercise. The satisfying punch, the release of pent-up frustration, the sense of power.
Then she loses her balance.
It’s almost impossible to understand what Quadriplegia means until this moment. Cortney is seated, but her torso wobbles as if her spine rests in a Jell-O bowl. Muscles that once effortlessly kept her erect will not stabilize the seasick motion of this momentary lapse.
She catches herself and quickly resumes punching, her gloves beating a pleasant thwak-thwak counterpoint to the loud echo of the busy rehabilitation center.
The improvements she describes since surgery are subtle but important.
She can undress by herself. She can move herself easily from her chair to the bed. She can reach for things without falling over, and she has far less pain.
“It always hurt,” she said. “I always had some tingling, but the tingling was kind of like someone poking you with pins. As soon as I woke up from surgery, it was kind of like, I still have tingling, but it was different. You know how you feel after you go to the dentist, after you have novocaine? That’s what it feels like now.”
So far, about 100 people have had the same surgery as Cortney in Portugal. But the surgery is not approved in the United States. It involves harvesting tissue from high in the nasal cavity and placing it at the site of spinal cord damage. This tissue, called the olfactory mucosa, includes two types of cells that may be important for spine repair. One is a cell type with stem cell-like properties; that is, they have the potential to become other types of tissue.
When these cells are transplanted into a chick embryo, they give rise to heart, muscle, and brain cells, among others. The other cell type in the mucosa encourages nerve growth and the production of Myelin that insulates nerves.
Earlier this year, The Journal of Spinal Cord Medicine published a report on the first seven patients to undergo this surgery between July, 2001, and March, 2003, at the Hospital de Egas Moniz in Lisbon.
Dr. Carlos Lima, who developed the procedure, reported that all seven patients saw at least some slight improvement following surgery. Many now can sense touch to their legs and show improved muscle function below the site of their injuries. Two of the patients reported increased bladder sensation and were able to dispense with catheters. One of these two patients also regained bowel control.
But in the same journal, Dr. Steven Kirshblum, director of spinal cord injury services at the Kessler Institute for Rehabilitation in West Orange, N.J., points out the research shortcomings.
The gold standard for medical research is the double-blinded, placebo-controlled study. This means neither the patients nor those conducting patient evaluations know who received the experimental surgery and who received a sham treatment.
In this study, there was no sham surgery, and those evaluating the patients knew of their surgery, Dr. Kirshblum writes.
Dr. Kirshblum also criticized a lack of animal data. Typically, research on humans follows animal research.
“It is surprising that human studies would be undertaken without reported animal model findings to define the Functional or neurological benefits of the intervention,” he wrote.
Wayne State University researcher Jean D. Peduzzi-Nelson, PhD, one of the paper’s authors, said Dr. Lima conducted limited animal experiments in the early 1990s before beginning work in humans, but those results were not published.
Ms. Peduzzi-Nelson began animal studies on rats with spinal injury in 2003 after a visit from Dr. Lima.
“Much to my surprise, the rats did better than with any other treatment I was trying,” she said. “We’ve now done three preclinical trials in rats. We’re just finishing up the tissue analysis before we publish.”
While Ms. Peduzzi-Nelson agreed that evaluators in the human trials should not know about the surgery patients receive, sham surgery will probably not be introduced in future trials.
“I have a problem with that as a moral issue,” she said. “It’s an invasive procedure. I’m not sure that’s possible to do.”
Improved bladder function in these patients convinces some people that the surgery is producing effects even the most innovative rehabilitation couldn’t accomplish.
“That’s not something we can directly facilitate,” said Steven Hinderer, medical director of the Center for Spinal Cord Injury Recovery at the Rehabilitation Institute of Michigan. “Usual physical activity doesn’t access those muscles.
“Those are more likely from surgery. No one anticipated they would occur,” Dr. Hinderer said.
Just how far Cortney will progress is anyone’s guess.
The injury has changed her life in ways profound and simple. It’s made her semifamous — she was on the Montel Williams show in September. It altered her goals and made her retrofit her dreams to match a new reality.
“When I think about my wedding — you’re a girl, you dream about your wedding day — it scares the crap out of me. I don’t want to be wheeled down the aisle. I want to walk down the aisle,” she said. “I think, ‘How are we going to dance? How am I going to dance with my Dad?’–”
But she knows she’ll find a way to adjust. She always figures it out.
“Before I got hurt, I wanted to be a teacher. Then I wanted to be an X-ray technician. Now I can’t be. I just want to give back a little. I can’t be an Occupational Therapist. My arms don’t work. I can’t be a physical therapist because my legs don’t work. But my mouth works just fine.” So she’ll be a speech therapist, she said.
“But I’m happy with what I have so far, just being able to stand with little assistance and being able to look at myself in the mirror and say, ‘I haven’t been able to do that since when I was normal, since before the accident.’–”
By Jenni Laidman, The Blade, Toledo, Ohio
Contact Jenni Laidman at 419-724-6507.
Copyright (c) 2006, The Blade, Toledo, Ohio