This is must see tonight.

[Johnnie Walked]

Hi Dr. Young

Is this a untethering surgery ?

http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Citation

[paolocipolla]

Paolo, no, I am able-bodied. I work as an exercise trainer for people with SCIs and other types of paralysis.

You are right that even an AB needs to be in very good shape to walk 6 hours a day, 6 days a week. Yet, I believe that an SCI person can walk 6 hours a day 6 days a week because that's exactly what's happening in Kunming right now.

Remember that the only people who do the 6-6-6 program are the ones who have achieved level 4 on the KLS walking scale. Even then, people don't achieve 6 hours of walking on their very first day. 6-6-6 is something they must work up to. And at KLS IV, they are still receiving some assistance.

I think the 6-6-6 is realistic to work up to as an SCI. However it is not something that anyone could handle their first day of training. I do believe that the higher the training volume one achieves, the higher chance they have of returning some function or at least maximizing health benefits.

Ok so you are in the rehab business...

I think anyone in the rehab business love Wise for coming up with the 6-6-6 thing.
Lots of money to make and lots of people's wallets to empty .

Just my personal opinion.

Paolo

[paolocipolla]

Hi Dr. Young

Is this a untethering surgery ?

http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Citation

That's it, it's well known and in some cases (one I know of) people can get worse.
Sometimes nothing change.
Sometimes they get better.

Dr. Reis does not talk about the cases that got worse.

Paolo

[ay2012]

The larger point is a fair one: insurance (both private and public in my experience) cut off acute stage rehabilitation when a patient ceases to continue to progress substantially.
If this therapy and the rehabilitation don't show continued improvement beyond the KLS stage IV (more functional walking, improved motor and sensory, bladder and bowel or sexual function) I would have a hard time believing that insurance companies would fund the six-12+ months it takes to get there.

[Curt Leatherbee]

I just don't really understand this whole thing? I'm not trying to be cynical or anything but for a person to even stand without leg braces there has to be nerve connections, it takes a lot more than just central pattern generator. To walk they'd have to be getting back a lot more than just "spacticity reactions created by central pattern generator" This whole thing is very confusing to me. If there were no direct nerve connections being created they would try to stand up without leg braces and just flop to the ground, unless they were incomplete injuries to start off with?

[Barrington314mx]

I just don't really understand this whole thing? I'm not trying to be cynical or anything but for a person to even stand without leg braces there has to be nerve connections, it takes a lot more than just central pattern generator. To walk they'd have to be getting back a lot more than just "spacticity reactions created by central pattern generator" This whole thing is very confusing to me. If there were no direct nerve connections being created they would try to stand up without leg braces and just flop to the ground, unless they were incomplete injuries to start off with?

The other thing that confuses me Curt, is awhile ago when Wise very first talked about the patients that had fractures in their legs. From what I remember gathering, they found those fractures because the patients complained of pain. Further more, the claim is that the fractures were actually sustained prior to the trial. But regardless of when it happened, how does one feel the pain of a fractured leg?

[NowhereMan]

*This is my opinion, riddled with assumptions, and I may be incorrect.

A chair may be more efficient than walking around at a score of KLS IV, but there are potential health benefits to being able to walk like that/doing that kind of program that could at least improve one's quality of life.

I agree it might be good for muscles/bones. However, can a person walk without another person right behind them? Or will it require someone walking behind them every time they walk (highly impractical)? I think people will just hurt themselves if they’re alone. Eventually they would fall and break a hip. That would negate any health benefits. Without ANY sensation below injury it’s almost impossible to walk, even with a cart. You’d have to be hanging on to the cart for your dear life and constantly looking at your feet. A person would be f---ed if for some reason their legs stopped going in the middle of walking and they’re by themselves.

Ok. You guys can let me have your spot in line then when it comes trial or therapy time. Cool? Just keep your ass planted in that wheelchair.

With the information/results thus far presented you couldn’t pay me to take the treatment.


a) Dr. Young believes the therapy is regenerating axons in the spinal cord (I don’t). If so, then most axons are missing their targets past the injury site. How would that affect any future attempt to successfully regenerate one’s spinal cord with a different future therapy? I personally wouldn’t risk success from a future (still non-existent) therapy for the ability to walk only when knees are locked by external force, hanging onto a rolling cart, without any voluntary muscle control or sensation in my paralyzed body, or bladder/bowel/sexual function.

However, if it is proven that the therapy is truly regenerating axons then that is a highly significant feat in itself that should be further looked into.

b) I personally don’t think the activation of central pattern generator is due to axon regeneration, so I doubt it would affect any potential future therapy. I still wouldn’t take the treatment because it would not be worth my time, money, or effort. KLS IV waking without sensation would serve of no use to me.

c) Even if I wanted to, as a c6/7 quadriplegic I don’t think I would have the upper body strength to balance my entire body on a cart if I was by myself. Maybe if I had 2 physical therapists helping, but that wouldn’t help me in the real world.

[Wise Young]

Hi Dr. Young

Is this a untethering surgery ?

http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Citation

Yes, this is untethering surgery. Wise.

[Wise Young]

I just don't really understand this whole thing? I'm not trying to be cynical or anything but for a person to even stand without leg braces there has to be nerve connections, it takes a lot more than just central pattern generator. To walk they'd have to be getting back a lot more than just "spacticity reactions created by central pattern generator" This whole thing is very confusing to me. If there were no direct nerve connections being created they would try to stand up without leg braces and just flop to the ground, unless they were incomplete injuries to start off with?

Curt,

Why are you assuming that there is no nerve connections? Even in so called "complete" spinal cord injuries, there are likely to be some connections. Also, I did not say that patients have no voluntary activity or sensation, only that the motor and sensory scores are not sufficient to explain the walking.

Many people do stand without leg braces, just with their spasticity. You may be thinking of people with flaccid paralysis. In that case, they may flop to the ground. However, most people with spastic paralysis are able to stand, even people with cervical spinal cord injuries.

I hope that we are making people more "incomplete" with our therapy and that is why some are walking.

Wise.

[KK11]

a) Dr. Young believes the therapy is regenerating axons in the spinal cord (I don’t). If so, then most axons are missing their targets past the injury site. How would that affect any future attempt to successfully regenerate one’s spinal cord with a different future therapy? I personally wouldn’t risk success from a future (still non-existent) therapy for the ability to walk only when knees are locked by external force, hanging onto a rolling cart, without any voluntary muscle control or sensation in my paralyzed body, or bladder/bowel/sexual function.

.

Regeneration is a slow process. To be honest , you dont really try to tell us that you know things better than Wise?? C'mon......when would you be satisfied?? When someone jumps out of bed after treatment and plays soccer??

[rjg]

Regeneration is a slow process. To be honest , you dont really try to tell us that you know things better than Wise?? C'mon......when would you be satisfied?? When someone jumps out of bed after treatment and plays soccer??

Dr. Young and Dr. Silver are both respected experts in the study of spinal cord injury, yet they espouse opposing views on a number of essential "facts" of sci. In other words, there are a number of unknowns in terms of sci. I know it feels better to believe Dr. Young knows all - because he is very optimistic - but that doesn't mean he's perfect. Do try to keep that in mind.

[rjg]

*This is my opinion, riddled with assumptions, and I may be incorrect.



I agree it might be good for muscles/bones. However, can a person walk without another person right behind them? Or will it require someone walking behind them every time they walk (highly impractical)? I think people will just hurt themselves if they’re alone. Eventually they would fall and break a hip. That would negate any health benefits. Without ANY sensation below injury it’s almost impossible to walk, even with a cart. You’d have to be hanging on to the cart for your dear life and constantly looking at your feet. A person would be f---ed if for some reason their legs stopped going in the middle of walking and they’re by themselves.




With the information/results thus far presented you couldn’t pay me to take the treatment.


a) Dr. Young believes the therapy is regenerating axons in the spinal cord (I don’t). If so, then most axons are missing their targets past the injury site. How would that affect any future attempt to successfully regenerate one’s spinal cord with a different future therapy? I personally wouldn’t risk success from a future (still non-existent) therapy for the ability to walk only when knees are locked by external force, hanging onto a rolling cart, without any voluntary muscle control or sensation in my paralyzed body, or bladder/bowel/sexual function.

However, if it is proven that the therapy is truly regenerating axons then that is a highly significant feat in itself that should be further looked into.

b) I personally don’t think the activation of central pattern generator is due to axon regeneration, so I doubt it would affect any potential future therapy. I still wouldn’t take the treatment because it would not be worth my time, money, or effort. KLS IV waking without sensation would serve of no use to me.

c) Even if I wanted to, as a c6/7 quadriplegic I don’t think I would have the upper body strength to balance my entire body on a cart if I was by myself. Maybe if I had 2 physical therapists helping, but that wouldn’t help me in the real world.

I'd add that hanging on to the cart for months on end can only speed the decline of one's shoulders. Anyone willing to sign up for a costly major surgery and 6-12 months of rehab for a few Frankenstein steps with a pvc cart and a team of towel holders- "See, I told you sci wouldn't beat me" - is bound for a major crash once it becomes apparent that the door leading out of the hospital has a raised threshold. And there's both a speed-bump and gravel between the door and your handi-capable van.

[NowhereMan]

Regeneration is a slow process. To be honest , you dont really try to tell us that you know things better than Wise?? C'mon......when would you be satisfied?? When someone jumps out of bed after treatment and plays soccer??

Appealing to authority is not a valid argument when there are dissenting views in the expert community. Regeneration has not been undeniably proven yet. Until then it is just conjecture.

When will I be satisfied with a treatment that I would actually take? I can't answer that. My threshold depends on a function of time and scientific progress. If I were older I would accept far less recovery than I would now at 25 years old.

If KLS IV walking is acceptable to you then you have my full blessing. To each their own.

[void]

No one is claiming it's a cure. Maybe is it a step towards one...

[rjg]

No one is claiming it's a cure. Maybe is it a step towards one...

No one is claiming that anyone is claiming it's a cure.