HyperMED Spinal Cord Injury

Information pertinent to HyperMED Protocols treating Spinal Cord Injury can be reviewed at the following link:

• HyperMED/HyperMED Newsletter Spinal Cord Injury 2009.pdf

USA ARMY.MIL Retrain Injured War Veterans with Spinal Cord Injury Using Lokomat  - After the crash of his helicopter, Crew Chief Spc. Mark Lalli is learning to walk again with the aid of an advanced set of robotic legs, a team of doctors, nurses, specialists, and...his mother. www.army.mil ... army soldiers health technology lokomat robotic legs walk wounded warrior helicopter crash

The following is extracted from the HyperMED Newsletter Spinal Cord Injury

What Happens Following Spinal Cord Injury?

• Spinal Injury may result in either complete or incomplete injury. Many patients informed they are 'complete' presume that their cord is severed. The term complete is defined by total or near-total loss of motor function and sensation below the area of injury. However, even in a complete injury, the spinal cord is almost never completely cut in half. Doctors use the term ‘complete’ to describe a large amount of damage to the spinal cord. It's a key distinction because many people with partial spinal cord injuries are able to experience significant recovery, while those with complete injuries are not. However many spinal patients classified as ‘complete’ may still re-gain some functional responses. This is evident with assertive therapeutic interventions designed to activate damaged nerve cells and re-train function

• The scientific literature on spinal cord injury predicts that most recovery will occur in the first six months after injury and that it is generally complete within two years. However Christopher Reeve’s recovery commenced five to seven years after his injury - this defies these medical expectations and had a dramatic effect on his daily life. Why did he get better so long after his injury? Reeve believed his improved function was the result of vigorous physical activity to re-train function and awaken dormant nerve pathways – the brain and spinal cord needs to reconnect! [Source: American Association of Neurological Surgeons, Craig Hospital, Christopher and Dana Reeve Foundation, The National Institute of Neurological Disorders and Stroke]

• Surgical strategies are primarily orthopedic focused with emphasis on reduction and stabilization of bony dislocation. All spinal patients require additional MRI within the following months to determine the integrity of the surgical procedure. Many spinal patients suffer additional complication due to scar formation, bony fragments and lack of plate and screw integrity. These additional factors not only inhibit recovery but often contribute to additional cord complications

• Laceration, extensive bruising, and massive swelling results in extensive cord hypoxia (inadequate tissue oxygen) which fosters destructive cellular apoptosis (programmed degeneration). Hyperbaric Oxygenation impacts tissue hypoxia enhancing capacity to rescue damaged tissue and salvage back the destructive process. This is exactly how Hyperbaric Oxygenation works with a patient suffering a 'gangrene foot' that would otherwise without the benefit and impact of Hyperbaric Oxygenation require amputation! We often describe the impact of Hyperbaric Oxygenation is like 'getting more fizz into a flat can of coke'! The objective of Hyperbaric Oxygenation is to get more oxygen (fizz) into the hypoxic damaged cord accelerating recovery and preventing further destructive spread due to apoptosis

• Hypoxic damage causes destructive Apoptotic cells from the immune system to migrate to the injury site causing further damage to some neurons and death to others that survived the initial trauma. Immediate strategies are must be implemented to minimize this cascade of programmed cellular destruction. Hyperbaric Oxygenation impacts tissue hypoxia minimizing the cascade effects of progressive damage

• Within weeks of the initial spinal injury a fluid-filled cavity surrounded by glial scarring is left behind. Localized myelomalacia emerges (morbid softening at the injured site due to hypoxic necrosis of the spinal cord). Early HBOT intervention potentially has the greatest impact to the destructive spread of cord hypoxia

• Continuing progression of spinal cord apoptosis due to hypoxia results in progressive hemorrhagic myelomalacia - spread of myelomalacia progresses above and below the injured site due to progressive intramedullary hemorrhage of the spinal cord. This can potentially lead to further loss of neurologic function and cord atrophy (wasting and thinning of the cord) severely inhibiting the capacity to regenerate and recover function. Comparison MRI post surgical stabilization is critical within the early months to evaluate this destructive process – functional changes an injured spinal patient may be getting does NOT rule out the potential cascade of secondary complications. Advanced Functional BOLD (Blood Oxygen Level Dependency) MRI measures progressive hypoxic damage and apoptosis spread. Functional BOLD MRI also measures the impact of Hyperbaric Oxygenation

• Experiments conducted on spinalized cats demonstrate that spinal circuitry (reflex generators) below the level of injury remains active (even years after injury) and functional neuronal properties can respond to peripheral input from below the level of injury. Treadmill cats can be trained to walk

• Lack of appropriate and 'accurate' stimulation induces functional incapacity called the ‘learning non-use’. Simply stated if you teach the remaining active spinal circuits to sit they will sit! Refer to the 'rat study'  Do Wheel Chairs Inhibit Recovery?

• Motor cortex centers in the brain also show signs of functional loss due to spinal cord injury. Functional BOLD MRI demonstrate that the motor cortex and cerebellum parts of the brain 're-allocate functional capacity lost through spinal cord injury' – it is imperative to keep this ‘window open’

• Body Weight Support Treadmill Training (BWSTT) and more recent studies on Lokomat (Robotic Gait Assisted Walking) demonstrate the potential of functional neuroplasticity - the ability to re-learn and re-organize function. Functional BOLD MRI measures the capacity to retrain function in both the brain and spinal cord neural pathways. The injured spinal cord has capacity to 'wake-up' - salvage back tissue damage, re-activate and re-train dormant neural pathways improving functionality

• What happens with SCI?  Review Page 2 Spinal Research UK 2009 - HyperMED/spinalresearchUK.pdf

For additional information on Lokomat NeuroRecovery refer to

• HyperMED Australia : Beyond Therapy - Treatment Program

• HyperMED Australia : Lokomat NeuroRecovery

• HyperMED/HyperMED Lokomat 2009.pdf

• HyperMED/Lokomat - Australian Experience HyperMED NeuroRecovery.pdf

• The economic cost of spinal cord injury and traumatic brain injury in Australia (1.31Mb)

Lokomat (Robotic Gait Assisted Walking) Gait Training

For the past 15-years bodyweight supported treadmill training (BWSTT) has become a prominent gait rehabilitation method in leading rehabilitation centers throughout the world.  

Experiments conducted on spinalized cats demonstrate that spinal circuitry (reflex generators) below the level of injury remains active and functional neuronal properties can respond to peripheral input from below the level of injury. Treadmill cats can be ‘trained to sit, stand and walk’

Lack of appropriate stimulation induces functional incapacity called the ‘learning non-use’. Simply stated if you teach the remaining active spinal circuits to sit they will sit! Motor cortex centers in the brain re-allocate functional capacity lost through spinal cord injury – it is imperative to keep this ‘window open’. Body Weight Support Treadmill Training (BWSTT) and more recent studies on Lokomat (Robotic Gait Assisted Walking) demonstrate the potential of functional neuroplasticity - the ability to re-learn and re-organize function.  

This type of locomotor training has many functional benefits but the labor costs are considerable. To reduce therapist effort, Robotically Gait Assisted BWSTT (Lokomat) has been shown to be more accurate and financially feasible, compared to the other BWSTT modalities. Currently 45+ Lokomat systems are in use in large Neurorehabilitation hospitals in the USA and approximately 150 Lokomat systems found in 31 Countries.

Internationally Lokomat (Robotic Gait Assisted Walking) and Body Weight Support Treadmill Training programs are payable under Third Party Insurance for spinal cord injury and a range of neurodegenerative and neurodevelopment gait disorders.

• HyperMED/University of Michigan Spinal Cord Care.pdf

Lokomat (Robotic Gait Assisted Walking)  Gait Training

Patients receiving Lokomat (Robotic Gait Assisted Walking) are scheduled daily; initially 1-hour session and then as the patient builds we recommend up to 2-hours each day attending.

Lokomat is NOT passive involvement. The Lokomat is constantly adjusted to best assist the functional responses of the patient. Patients commence with passive assistance however as the patient compliancy builds the Lokomat settings and various programs are tailored to the patient performance and capabilities. Some patients have high level spasticity and others a complete loss of tone. Each patient's presentation is different - Lokomat provides excellent opportunity to 'best-fit' the patients specific capabilities and capacity to re-train function. And this is replicable on every separate training session!

In addition the support harness treadmill system are utilized independent of the Lokomat to promote functional changes. Functional changes being driven by 'man and machine' are then put to the test with the patient then able to implement strategies being focused on during each Lokomat session.

This combination effect is both unique and significant towards each neurologic patient developing a sense of supportive assistance whilst focusing on improving functional independence.

Walking requires a 'fluid like connection between spinal reflex generators and higher brain centers'. The combined approach is invaluable to promote functional changes - neuroplasticity (the ability to salvage back what has been damaged).

Please also take the time to watch the following National Geographic Documentary on Professor Ed Cooper pioneering work on Median Nerve Stimulation and its roll in spinal cord recovery.

• National Geographic Documentary (VIDEO) - Professor Ed Cooper - Median Nerve Stimulation

The key message by Prof Cooper is the fact that  'awakening is the result of  accurate repetition many thousands of times that tells the brain and spinal cord  – wake-up, wake-up, wake- up, wake-up, wake-up ….’  

Median Nerve Stimulation (MNS) is an integral part of the HyperMED Protocol - application is recommend for all patients with neurologic disorders. The Cerebral Palsy and Brain Injured child have vast regions of the brain that remain underdeveloped and immature causing inadequate metabolic and signal responses resulting in 'learned non-use'.

MNS provides a cost effective yet simple home application that enables parents to continue the benefits of HyperMED saturation and training. Equally Spinal Cord patients, victims of neurologic trauma and elderly patients suffering dementia related illness can also benefit from Median Nerve Stimulation. Science supports the fact that many disabled patients have intact but non-responding dormant neural pathways. These dormant pathways need to 'wake-up!'

Do Wheelchairs Hinder Spinal-Cord Recovery? Acquired Non-Use!

"Our data suggests that wheelchair restriction definitely impairs functional recovery in rats, and logically it would seem to apply also to humans," says David Magnuson of the Kentucky Spinal Cord Injury Research Center, University of Louisville; National Neurotrauma Society Symposium in Orlando, Florida 2008.

'Learned non-use' is a major contributor to progressive acquired disability. Median Nerve Stimulation can assist to 'keep the therapeutic window open - (alive)'. Mal Hooper_HyperMED