Hey, I know this man from the 2012 Working 2 Walk program. He’s from the University of California at San Diego Paralysis Center
He does surgery for treatment of functional loss due to injuries of:
- peripheral nerves
- spinal cord injury
- brain injury from stroke, TBI, tumors, etc
They work by looking at what’s been lost, asking what’s most important to get back, what they have that’s still working, what besides surgery might help . . .
They do this: tendon transfers, nerve transfers, muscle transplant . . .
If you have an upper motor neuron injury, stimulating the muscles will make them move. If you have a lower motor neuron injury, you get nothing from stimulation. That’s how you can tell.
How do you fix a lower motor neuron injury? You transfer axons. He’s showing an example of a young man whose face was paralyzed (:( ) And a little girl, same thing. Nerve transfers to original muscles. The concept here is always the same:
The body has a certain amount of built in extras. Extra axons bundled into nerves, which can be spared to get to work in places that aren’t their original places.
Can this work even years out? Showing the right arm of someone whose injury is c6/7. Very atrophied. Fingers useless. After nerve transfer and rehab, he’s got pinch, but hard to tell how effective b/c no video.
A chronic young woman who had a syrinx that destroyed her function in wrists and biceps. They took muscle from her back and she’s on a video flexing her guns.
What about flaccid legs with no spasticity? Got nothing for those injuries yet.
Okay, all that was lower motor neuron stuff — flaccid injuries that don’t respond to stim.
Next part is about upper motor neuron injuries . . . axon transfer works here. Showing a video of a young woman who’s a year post her surgery on one arm. She’s flexing her elbow quite nicely. It works. The other one, nothing.
Video of a guy’s hand . . . he was 10 years post and got function back in his hand. (audience claps — there are lots of people in this room who’d give a lot to move their fingers like the guy in the film clip).
Justin’s talking about strategies for every level of cervical injury. Worth checking out if you’re up for the surgery and the long rehab. How about spasticity? Wow. Video of a guy who had so much spasticity in his shoulder that he couldn’t get his hand to his face. They trimmed some of his nerves and within 3 days he was able to do it.
In summary . . . they’ve been working for several years to figure out the best ways to do this for every single person who lives with any kind of dysfunction due to SCI, and they’re able to help almost everyone in the upper body. It means surgery. It means — in some cases — long, long rehab.
Q: Talk about the choices patients are being asked to make . . .
A: Nerve transfers in sci patients are not well understood by everyone who is trying to do them . . . it’s an early field and we don’t have the necessary standardization. Tendon transfers work reliably. Nerve transfers are a lot more iffy.
Q: Does insurance pay for this?
A: Yes. All of them except one so far.
Q: What about neuropathic pain?
A: Anecdotally, the more function you get in the limbs, the less neuropathic pain.
Q: (couldn’t hear it)
A: I can do what botox does a whole lot more efficiently with this kind of surgery.
Q: Talk more about “trimming nerves”
A: You can take 4/5 of the axons and what’s left will still be effective.
Q: Can muscles get overused?
A: Our bodies adapt to the needs that are placed on them . . . of course when you’re older it takes longer and doesn’t work as well.
Q: Do people lose function over time?
A: There is some loss with age — decades later.
Q: Is there return of sensation?
A: Not with what we’re discussing here.
Q: What’s changed since your last presentation?
A: More experience. Recognition that both muscle transfer and nerve transfer have their place.