Research at this center focuses on precisely these issues that affect SCI patients in their daily lives. Their method is to understand the mechanisms responsible for the problem, and then design an intervention to improve function, applying that paradigm to every organ system.
For example, investigators recently addressed diminished bowel motility, a significant quality-of-life problem for people with SCI, and developed a drug combination that safely and effectively empties the gut. Additionally, it has improved colonoscopy preparation, formerly often inadequate for people with SCI, permitting a more thorough exam with improved polyp detection.
No other entity has supported SCI research the way the VA has, and the rest of the world truly has learned from the medical research on SCI that our group and others have done in the VA system.
Representative examples of current research topics include: interventions to reduce or prevent bone loss after acute SCI, or if marked bone loss has already occurred in those with chronic injury, treatments for osteoporosis; new therapies to preserve muscle; assessing body composition changes and treatments for metabolic abnormalities; evaluating cardiovascular consequences resulting from autonomic nervous system impairment and how low blood pressure adversely affects cognition; development of measures to enhance the ability to maintain a constant core body temperature despite extremes in environmental temperature; assessing the mechanisms for the high prevalence of gastroesophageal reflux disease and effective treatment approaches; improving pulmonary function by strengthening respiratory muscles and reducing the obstructive, asthma-like component in higher cord lesions; and strategies to strengthen nerve connections using specific exercises and combinations of magnetic and electrical nerve stimulation.
Research findings have translated to increased awareness and improvements in standards of care for veterans and all SCI patients. “Knowledge is universal. If you make an observation and you publish it, it’s out there,” said Bauman. “So if you find that an individual can be treated more effectively with one form of therapy, and that work is supported by the VA, it then will quickly be translated to the civilian arena as well.”
“No other entity has supported SCI research the way the VA has, and the rest of the world truly has learned from the medical research on SCI that our group and others have done in the VA system,” Spungen added. “I really would love to see the VA get the credit for this, because they truly have led the way in supporting this kind of research that has helped the entire field of SCI. And our center is truly recognized as the leader in the medical consequences of SCI in the entire world.”
Ambulation Advances
Early efforts for development of exoskeleton devices to assist paralyzed patients to walk appeared in the 1990s, according to Spungen. A milestone occurred in 2014 when the ReWalkTM system received FDA approval for home use. The system, developed by an Israeli bioengineer after becoming a tetraplegic, consists of motor-driven exoskeleton braces that enable ambulation.
Army veteran Gene Laureano utilizes the ReWalk exoskeleton technology to stand and walk. Laureano received his ReWalk training at the James J. Peters VA Medical Center in the Bronx, New York – a leading institution in research and study of exoskeleton technology and the spinal cord injured community. image courtesy of ReWalk Robotics
Spungen had led a VA-funded 2011 pilot study to assess its safety and efficacy. “With those 12 patients, we learned a whole lot,” Spungen said. “We learned how to best train somebody, how to best fit them for the device, who could tolerate what amount of walking in them. We did indeed find that we could get almost everybody up and walking in the device. Some needed more assistance than others; some could go faster than others.”
Spungen utilized standardized ambulation assessment tools – the six-minute walk test, how far a person can walk in six minutes, and the 10-meter walk test, how fast a person can walk 10 meters. The “magic number” is a walking rate of about 0.4 meters per second, equating to about 1 mile per hour. “Studies in the disabled population have shown that an individual who can ambulate with an assisted device or without one at least 0.4 meters per second or greater is likely to ambulate in the community, but when they go much slower than that, it’s too frustrating, it takes too long, it’s too hard, and they’ll use a wheelchair. So that’s a very key component to whether these devices are going to be used as a mobility device out in the community, or as an exercise device,” said Spungen.