Getting back in the game Oct. 31, 2011

Spinal cord injury victims enjoy better health, thanks to the research of neuroscientist Lisa Griffin and Kinesiology and Health Education collaborators

After Gary Krutsinger T-boned his truck in a wreck just outside Austin in 2009, he couldn't feel his arms or legs. Thinking it was a temporary problem, he told the rescue workers to just leave him alone for a few minutes – he'd be fine, he said.

The paralysis wasn't temporary, though, and after doctors evaluated him, Gary found out he was a quadriplegic.

There would be no more workouts at the gym six days a week, lifting weights and running. There would be no more walking into the front door of his house or into the kitchen to grab a snack. He'd be confined to a wheelchair, unable to move his arms or experience feeling in about half of his body, he was told.

A year and a half later, Gary is making broad gestures with his hands as he speaks animatedly. He's using his arms to move himself around in his wheelchair. And he's cycling an hour at a stretch on a recumbent bike at Seton Healthcare's Brain & Spine Institute in Austin.

Gary's already exceeded what the majority of patients with his injuries can attain, and he has no plans to stop.

Research from The University of Texas at Austin has led to major technological and pharmaceutical advances over the past decade which are making it possible for spinal cord injury (SCI) patients like Gary to live lives closer to "normal" than ever before.

Patients with partial paralysis, and those with full paralysis who graduate to partial paralysis, may regain muscle control and some feeling and movement. With intensive rehabilitation and the right adaptive devices, it's possible for some to resume their jobs, finish up college degrees, go to the gym, play tennis, swim, travel — in short, live life.

These improvements are a direct result of the innovative research done by scientists such as Professor Lisa Griffin, director of the university's Spinal Cord Injury and Neuromuscular Physiology Laboratory.

"Spinal cord injury causes immediate paralysis," said Griffin, an associate professor in the College of Education's Department of Kinesiology and Health Education, "and, even though that paralysis itself is a major focus, of course, the patient faces a host of additional health problems that are the result of reduced physical activity. There's an increased risk of heart disease, muscle atrophy, bone degradation, obesity and Type II diabetes, among other things. That's not surprising in that these are health concerns you might find in anyone who's sedentary for an extended period of time."

As of 2009, there were about 260,000 people in the U.S. with spinal cord injuries and about 13,000 new cases are added each year, Griffin says. About 42,000 of these are soldiers injured in combat, often from bomb blasts in Iraq or Afghanistan, and who survived because of improved body armor.

"Thanks to much better medical care, more people, both military and non-military, are surviving injuries that would have resulted in death even 20 years ago," Griffin says. "That creates a significant and pressing need to improve quality of life for this sizable population of people with paralysis from an SCI."

And the majority of that population is young. Spinal cord injuries tend to occur in males between 18 and 30 years of age, many of whom led vigorous, active lives prior to injury.

Over the past five or six years, Griffin has examined the effects of exercise on spinal cord injury patients by having study participants cycle on computer-programmed recumbent bikes at The Brain & Spine Center at Brackenridge Hospital in Austin.

Electrodes hooked up to patients' glutes, hamstrings and quadriceps fire specific patterns of electrical stimulation into their muscles (referred to as functional electrical stimulation, or FES). The appropriate patterns of stimulation, which Griffin's research has helped determine, cause muscles to contract and pedaling to occur. It also helps the brain "talk" to the body.

While the patient pedals, Griffin and her team collect data that reveal how the central nervous system adapts to fatigue and the optimum patterns of electrical stimulation for reducing fatigue and achieving overall health improvements.

Collaborating with Dr. John Ivy, chair of the Department of Kinesiology and Health Education, Griffin found that 10 weeks of FES cycling can increase a patient's muscle mass, pedaling power and endurance, and improve glucose tolerance, insulin resistance, and motor and sensory abilities.

With the help of Amy Lam, a doctoral candidate in kinesiology, and Bharadwaj Muralidharan, a doctoral student in electrical engineering, Griffin also is developing more advanced operating systems for FES stationary bikes and FES treadmills that patients can use at home. The team is coordinating with an Ohio based company called Therapeutic Alliances, Inc., on this project.

"Right now there's a real need in the marketplace for FES-cycling and -standing systems that allow patients to work out longer before the muscles become too tired," said Muralidharan, who's designing the software and hardware for the machines, "and that allow a person with paralysis to stand and receive FES stimulation to the legs, while the arms are left free. Currently, there's no FES system that allows stationary standing without major arm support.

Along with this, Griffin is creating new protocols for hospitals and clinics to use. The protocols serve as guidelines that specify the number of muscles, and which muscles, you need to put electrodes on, level of electrical stimulation and intervals of stimulation that are needed to keep the patient from getting fatigued so quickly.

In addition, Griffin and kinesiology colleague Dr. Hirofumi Tanaka recently completed a study that indicates a possible connection between blood flow to the lower body and muscle spasticity, which is an undesirable side effect of paralysis from spinal cord injury.

"Muscle spasticity just refers to muscle activity that makes a limb unexpectedly twitch or jump," said Tanaka. "Muscle spasticity causes fatigue, can cause falls and obviously can be very embarrassing for the person who suffers from it."

Griffin is also collaborating with a textile engineering company called Weadapt and researchers at MIT to develop a mattress with embedded sensors that will help prevent bedsores, which are a major health concern for people with spinal cord injuries. Such developments could help people who have health concerns other than SCI.

"Even though the majority of people with spinal cord injuries are wheelchair-bound, around 95 percent have incomplete damage and experience partial movement," said Griffin. "Nobody knows exactly how intact the nerve pathways are between the brain and the body, a knowledge gap that actually is encouraging.

"Impairments fall within a broad range. I don't believe we've discovered the full extent to which brain and spine communication can be regained, and that's precisely the reason it's so important to keep patients in good health and ready to take advantage of advancements that I think we'll be seeing over the next several years."

— Kay Randall, Office of the President, 512-232-3910

Photos of Dr. Lisa Griffin and Ph.D. students Amy Lamb and Bharadwaj Muralldharan: Marsha Miller
Home page banner photo: Wheelchair marathon racers. © iStockphoto.com.