Imagine not being able to move your body beyond a wag of the elbow or shrug of the shoulder. You can't pick things up, or grasp things. This makes it difficult to even operate your own wheel chair. This is the life of many quadriplegics, many of whom have suffered spinal cord injuries that stop the brain from sending commands to the rest of the body.
But new research is slowly figuring out ways to restore some motion for these quadriplegic patients. A new study, released today, demonstrates how rerouting some nerves could give patients some grasping motion back.
The patient in question could only move his elbow and shoulder. Now, he can bend his thumb and index finger. This might not seem like a lot of progress, but when you're paralyzed from the neck down a little finger wiggle is a big deal. And with that little motion, he can now feed himself small pieces of food, and write with some assistance.
“Many times these patients say they would like to be able to do very simple things,” Ida K. Fox, a surgeon from Barnes-Jewish Hospital where the surgery was done said in a press release. “They say they would like to be able to feed themselves or write without assistance. If we can restore the ability to pinch, between thumb and index finger, it can return some very basic independence.”
This is also the first time someone with an injury like this has been able to get some motion in their thumb and index finger.
What they did was try to reroute the nerves that travel from the hand up into the spinal cord. The patient in this case had an injury in what's called the C7 vertebrae - which is the lowest bone in the neck. Basically, any nerves that connect to the spinal cord below C7 can no longer send signals to the brain - the impulse gets stopped at that broken vertebrae. So patients with injuries lower in the spinal cord often have use of their arms, but not their legs (think Christopher Walken). Patients with injuries at C7 often have elbow and shoulder function, but no hand function. Those with injuries above C7 often have no working arms at all.
Here's an image of how they reworked the nerves:
You can see the injury at C7, and the way the nervier impulses usually go. If I want to move my hand, a signal comes down from my brain would travels along that red line to my hand. But in this patient, the signal gets stopped at the broken C7 vertebrae. So they rerouted signals that would travel along the red line to move along that green line you see there.
This sort of thing isn't often done in quadriplegics, Fox said. "We do not attempt to go back into the spinal cord where the injury is,” she said. “Instead, we go out to where we know things work — in this case the elbow — so that we can borrow nerves there and reroute them to give hand function.”
Of course, restoring the hand's function took work not only by surgeons, but by the patient too. He underwent intense physical therapy to retrain his brain which nerves to look for when trying to move his hand.