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What’s Inside Learning to walk...again Intense training Strengthening complex connections A lifelong interest Research Views Responding to the reader Fatigue and illness Adolescent nutrition and lifestyle Basic research: the foundation for medicine At the Forefront Researchers in the making Heritage Youth Researcher Summer (HYRS) Program 2006 Reader Resources Learning to walk...again Human motion is complicated, to say the least. Many of us take for granted the ease with which we move; we grumble about walking the dog or having to park the car at the far end of the parking lot. But for those suffering from a spinal cord injury, walking can be a daunting task, if not an impossible one. AHFMR Senior Scholar Dr. Monica Gorassini works to help people with spinal cord injuries walk again. The ability to walk is the result of special circuitry; output from the brain travels through the spinal cord to stimulate the relevant muscles. In order for a person to recover the ability to walk after a spinal cord injury, some connections between the brain and the muscles via the spinal cord must remain intact. Partial spinal cord injuries are the research focus of Dr. Gorassini, an assistant professor at the University of Alberta. Her work indicates that, while retained connections may be enough to promote recovery of some walking ability, specialized training can significantly increase the amount of movement that patients with partial spinal cord injuries can regain. Intense training “I like to compare those recovering from partial spinal cord injuries to athletes,” says Dr. Gorassini. “If you want to see results, you have to train hard. The type of training that we do with these patients is very intensive. Treatment typically consists of surgery followed by a four-month stay at the Glenrose Rehabilitation Hospital. After the patients have been released from the Glenrose, the therapy and the contact they have with physical therapists are limited. This is where we have some ability to help.” Dr. Gorassini and her colleagues typically work with patients who have received some physical therapy but are no longer improving. They put these patients through a demanding program of specialized treadmill training to strengthen connections and improve walking ability. Strengthening complex connections “Does intense motor training on a treadmill, using assistance from therapists, increase the strength of the residual connections from the brain to the spinal cord? The answer is yes, it does,” says Dr. Gorassini. “Even if someone has been injured for 20 years, we can train them and increase the strength of the residual connections from the brain by about 50 percent.” In fact, the number of spared connections relates directly to the extent of functional improvement these patients achieve. For maximum recovery, the descending connections from the brain to the spinal cord need to be enhanced. While treadmill walking can increase connection strength and may even help to form new connections, stimulating the brain itself may be the secret to helping these patients recover the greatest possible movement. Dr. Gorassini uses a specialized piece of equipment called a transcranial magnetic stimulator. Resembling a metal hat, the stimulator generates a current in the brain when placed on a patient’s head. “Essentially we want to put the brain into a state of excitability that makes it most responsive to motor training,” says Dr. Gorassini. “By using a combination of treadmill training and brain stimulation, we may be able to get motor recovery that is better than [what we can achieve] with training alone.” A lifelong interest Dr. Gorassini’s fascination with the workings of the nervous system began at an early age. An avid baseball player in her youth, she would frequently dislocate her thumb. “My mom used to send me to a chiropractor who was really busy,” she remembers. “I would usually end up sitting in the waiting room studying a poster of a human body with the nervous system all mapped out. I remember thinking, ‘I would love to figure out how all of that works.’” The memory of that poster spurred Dr. Gorassini to pursue a career in neuromuscular research that began at the University of Guelph, then took her to Europe, and ultimately led her to the University of Alberta. Her work with treadmill therapy began in 1999, shortly after she attended a meeting on regeneration and rehabilitation where she saw a presentation by a researcher named Anton Wernig. His amazing videos showed patients with spinal cord injuries who had been trained, and demonstrated the extent of their recovery—far above and beyond what could be achieved in standard rehabilitation care. “I thought, ‘I have to try this!’” says Dr. Gorassini. “And the long-term benefits it has had in the lives of the people we’ve trained are immeasurable.” To date, Dr. Gorassini has been involved in training 40 patients. Many who were wheelchair-bound before the training can now walk with canes or crutches. The real challenge of transferring this research to the clinic lies in the cost of the equipment and of the staff who carry out the training. “There are people out there who want this therapy. It is a lot of work for them, but they are willing to do it. Unfortunately cost is often the limiting factor,” says Dr. Gorassini. “The bottom line is that these patients need more rehabilitation, and they should be receiving the best care.” Dr. Monica Gorassini is an AHFMR Senior Scholar and an assistant professor in both the Department of Biomedical Engineering and the Centre for Neuroscience within the University of Alberta Faculty of Medicine and Dentistry. In addition to her Heritage support, she receives funding from the Canadian Institutes of Health Research (CIHR), the National Institutes of Health (NIH) in the United States, and the Canada Foundation for Innovation (CFI). Selected publication Thomas SL, Gorassini MA. Increases in corticospinal tract function by treadmill training after incomplete spinal cord injury. Journal of Neurophysiology 2005 Oct;94(4):2844-2855. Back to Top