Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Saturday, August 20, 2016

Neurological Rehabilitation

"It was kind of a shock. And it's really moving now: there's a lot of nerves touching muscles that are getting stronger ... Every iteration, it just gets more and more exciting."
"I still need help from people because they have to, for instance, put a shaver into my hand, but I can now hold that shaver and manipulate it to shave my face."
"I'm not quite at the point where I can get a cup off the table, but I can envision myself doing that. I know I will be able to do that eventually -- so it's exciting to see that."
"It's just a matter of time It's all about independence. It was a long wait, but it was worth it."
Tim Raglin, quadriplegic, Carp, Ontario

"The recovery has been slow, and we have fought some unforeseen obstacles. But he has helped to show us what the recovery for these procedures looks like and how much dedication is required by the patient."
Dr. Kirsty Boyd, surgeon, Peripheral Nerve and Trauma Clinic, The Ottawa Hospital
Ottawa Hospital surgeons Kirsty Boyd performed a nerve transplant in the arm of quadriplegic Tim Raglin at the Ottawa Hospital, February 23, 2015. The first-in-Canada surgery at the Ottawa Hospital is designed to restore some function to his hand. (Jean Levac/ Ottawa Citizen) ORG XMIT: 0228 nerve
Ottawa Hospital surgeon Kirsty Boyd performed a nerve transplant in the arm of quadriplegic Tim Raglin at the Ottawa Hospital in February. (Jean Levac/ Ottawa Citizen)

Tim Raglin one August day in 2007 did what he had done countless times during the summer months. He dove from the dock of his family's cottage. It was a deep dive, and the water level was unusually low that summer. When he hit bottom his head smashed on the sandy floor of the lake, then he floated to the surface, incapable of moving a muscle. Friends and relatives retrieved him from the water. For nine years he has been unable to move his hands and legs.

That diving accident shattered a vertebra in his cervical spine leaving him a quadriplegic. He could flex his shoulders and biceps, but beyond that, he was paralyzed. He has since been entirely dependent on others, his own agency locked up tight. It has taken time, but since a groundbreaking operation he underwent over a year ago, he has gradually and incrementally begun to have his brain-nerve connections restored. He now awaits the arrival of a more complete restoration over time.

As do the surgeons whose intervention on his behalf has reflects a brave new world in neurosurgery. In 2013 Tim Raglin had read of a ground-breaking nerve operation, reported in the Journal of Neurosurgery. He mentioned it to his doctor and was then referred to Dr. Boyd of the Ottawa Hospital, a protege of Dr. Susan Mackinnon, a Canadian-born surgeon who had pioneered the delicate operation where she practises, in St.Louis, Missouri.

Dr. Boyd agreed to undertake the surgery on his behalf, and Dr. Mackinnon came to Ottawa to help. The surgeons rerouted nerves in the man's right arm, taking a functioning nerve that controlled his elbow, to suture it onto a pathway toward his right hand. Damaged nerves regrow, but painfully slowly; about one millimetre daily, and this nerve had to grow 30 centimetres to reach the muscles in Mr. Raglin's hand.

A year later, he can unfold his fingers from the palm of his hand, and he is able to grip everyday implements like a fork, a shaver, a toothbrush. Because his hand muscles have atrophied as a result of disuse, they have to be rebuilt to be useful with physical therapy and practise. His brain must also adjust to the new system now in place, to make that successful connection.

The surgeons had bypassed the spinal cord injury through connecting a nerve still capable of communicating with his brain -- to a nerve that once controlled part of his hand, by a nerve that bent his elbow -- but the brain must recognize that new pathway. Like everything else about the devastating loss of function and the remediative work to restore function, it takes an excruciating amount of time for restoration to take place.

Dr. Boyd co-founded the Peripheral Nerve and Trauma Clinic with Dr. Gerald Wolffe. The clinic was the recipient of two vital research grants to study other nerve transfers in spinal cord injury patients. And that research is set to be conducted together with Washington University in St. Louis. The dream of normalcy so long unanswered for patients with spinal cord injuries appears now to be well established on the horizon of medical science.

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