Twenty years on, Hansen still in motion

Published: June 5, 2006  |  Source: theglobeandmail.com
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Wheelchair athlete famous for global trek is focused now on injury research

Twenty years ago, Rick Hansen was wrapping up his 40,000-kilometre Man in Motion world tour, “little suspecting that as one long trip was ending, the much longer journey was about to begin.”

The 48-year-old standard-bearer in the battle to find a cure for catastrophic spinal-cord injuries has not slowed down in the past two decades. He will be holding his fourth annual Wheels in Motion national fundraising campaign on Sunday. Details can be found on the Internet at wheelsinmotion.org. At 200 locations, in every province and territory, people will jog or mount bikes, skateboards, in-line skates and wheelchairs in a bid to raise $2-million to be divided between spinal-cord research and improving the quality for life for those already injured.

“Those were the two dreams when I came back, finding a cure and trying to remove barriers so people with spinal-cord injuries and related disabilities can lead a full and productive life,” Hansen said in an interview from Quebec City. “I figure we’re about halfway there.

“Fifteen years ago, there was only a 30-per-cent hope of recovery from spinal-cord injuries, of regaining sensation below the injury, breathing on your own or walking one day. Now, 70 per cent can wind up with some improved level of function as a result of improved standards of care. It doesn’t mean they’re walking, but they have an improved level of function. For instance, a high-Lesion quadriplegic, if he can regain the grasp of a hand, for him that is a life-altering change.”

Hansen’s Man in Motion Foundation raises money to propel advances on several fronts. Ninety per cent of what scientists know about spinal-cord injury and potential Regeneration has emerged in the past decade.

On the research side, there has been a dramatic increase in treatments and advancement of knowledge of the basic mechanisms of spinal-cord injury, said Michael Fehlings, a professor of neurosurgery at the University of Toronto and holder of the Krembil chair in neural repair and regeneration, based at Toronto Western Hospital.

“Our team at Western made a breakthrough in the spring, a significant recovery of function in rats with spinal-cord injuries,” Fehlings said. “We were able to use stem cells from the adult nervous system and we could program them to regenerate the Myelin sheath around nerve fibres and in so doing could get some function.

“On the clinical trials, we had a Canadian success story, which is a collaboration between a Montreal biopharmaceutical company, BioAxone Therapeutic Inc., and our centre here at Toronto Western. We’re conducting a clinical trial with a regenerative approach to enhance recovery. We have 32 patients enrolled in a clinical trial, which is going on at four centres in Canada and four in the United States, and the results look interesting to date.”

A medication known as Cethrin is being tested. It is a recombinant protein designed to penetrate central-nervous-system tissue, and it inactivates a molecule called Rho. If Rho is blocked, the Regeneration of nerve cells is improved, Fehlings said.

While research is going on in laboratories and clinics, until recently there wasn’t a network for scientists to share findings or look at a broader picture of treatment. A registry for spinal-cord cases is another cause Hansen has championed.

“We were running into a problem of statistical power,” said Marcel Dvorak, a spinal surgeon at Vancouver General Hospital and the head of the division of spine in the department of orthopedics at the University of British Columbia.

“Across Canada, we didn’t have enough patients in any one group to draw conclusions and make decisions that would point to standardized treatment.”

The issues doctors and patients needed to survey in a broader way weren’t just medical treatments, but matters of everyday living, “things like bowel and bladder control, sexual function, pain issues. Our ability to address those questions and standardize treatment had been hampered by the fact each centre only sees a few patients. It was a bold initiative to get centres across Canada to report information. We have a larger number of patients and can draw more meaningful conclusions.”

Along the way, doctors had to develop a unified concept of what questions to ask, so in essence they were all talking the same language when the information was reported. That didn’t always go down well with hospital ethics boards because of issues of patient confidentiality and privacy.

“Indeed, we’re asking sensitive questions about surgery and function. . . . Privacy commissioners twitch when they see what we want to ask,” Dvorak said. “But patients appreciate the fact someone wants to know, someone cares about things related to their daily lives that don’t get hit on in a 10 to 15-minute surgeon’s follow-up.”

The practical side of the registry is what is important to Dvorak, who doesn’t hold out hope that a researcher will emerge from a lab any time soon with “a magic goop” that heals spinal cords.

But that doesn’t stop Hansen from pursuing the goal of a cure. He dreams one day of the convergence of the laboratory and clinical science and the registry, and of finding effective treatments and getting them to patients, especially recently injured patients whose nerve paths can still be stimulated.

“Imagine what happens when we standardize the care and infuse the clinical trial system with neural regrowth drugs,” he said. “. . . It will be a wonderful moment and period if we’re ready to go.”

Spinal cord injuries

Number of SCI cases in Canada: 42,000.

New cases a year: 1,050.

Average age of injury 1973-79: 28.7 years.

Average age of injury 2000-05: 37.6 years.

Injured over age 60: 4.7 per cent (pre-1980); 10.9 per cent (since 2000).

Leading causes: Vehicle collisions (55 per cent); falls (18 per cent).

Annual health-care cost for SCI in Canada: $750-million.

JAMES CHRISTIE