BY BRIAN PASSEY
bpassey@thespectrum.com

James Loris is walking again. The father of five who owned his own construction business was in a wheelchair, paralyzed from the chest down following an off-highway vehicle accident that fractured his C6 vertebrae.

"When I broke my neck, it pinched my spinal cord," Loris says, adding that the injury disrupted the brain's communication with his body, causing the paralysis. "He just turned the system back on."

Loris is referring to Steven Bennett, a physical therapist at Mountain Land's Southwest Neurological Rehabilitation Center in St. George. Bennett utilizes a neuromuscular training program to restore function to paralyzed or dysfunctional muscles resulting from a variety of medical conditions, including strokes, spinal cord injuries, brain injuries cerebral palsy and other neurological and orthopedic conditions.

The program utilizes electrodes placed on a patient's muscle group to read electrical signals transmitted from the brain to the muscle. An attached computer reads electrical impulses, displaying the signals on a monitor for the therapist and patient to see during treatments.

The therapist then uses a conditioning protocol to teach the brain to use alternate paths to communicate with the muscles. This conditioning is tracked by watching the signals on the monitor.

Once the brain learns to communicate with muscles through new paths it remembers the alternate paths for future use and, in effect, overcomes the paralysis.

That is how Loris came to walk again.

"You have to have determination," Loris says.

He's not quite back to his pre-accident mobility. Loris walks with a limp and has to concentrate on lifting his leg so he doesn't trip over his foot. Bennett says they have not yet been able to restore movement to the muscles in one of Loris' feet.

It's a long way from using a wheelchair because he didn't have any movement from the neck down.

"He'll come back in and we'll tune him up and smooth out that walk," Bennett says.

It's not an easy process. It's hard work. It requires strength. Yet Loris says he was driven because he had to provide for his family. He can even drive a vehicle with a standard transmission, clutch and all.

Bob Mower

The treatment is not just effective for accidents like what happened to Loris. Bob Mower, a retired Dixie State College chemistry professor, suffered a severe stroke in May and was unable to walk because he lost mobility on his entire left side.

"It was a long time before I could even move," Mower says.

Bennett says Mower was not supposed to be able to walk again. That was before he went through the neuromuscular training program.

"We had to turn on his whole left side," Bennett says.

Because Mower had the determination to move again, he checked out of both inpatient rehabilitation and home health before he was supposed to so he could begin working with Bennett.

Mower's wife, Susan, calls Bennett a "miracle worker" and says he's "perpetually optimistic and encouraging."

"Bob's in far better shape than anyone ever thought he would be," she says.

When he first visited the Southwest Neurological Rehabilitation Center, Mower couldn't walk or move his left hand. His goals were to overcome both of those obstacles and he has.

"Now I can walk from the parking lot into the therapy office, from the parking lot into the grocery store, and from the parking lot into church," he says. "I can move my hand and fingers well enough to hold onto things. I can hold the television remote so tightly my wife can't get it away from me."

Mower also likes how Bennett appreciates a good joke, because Mower is full of them.

Richard Cox

He still uses a wheelchair to get around but Richard Cox is much farther along in his recovery than he thought he would be after his injury more than three years ago.

"I had absolutely no movement," Cox says. "I couldn't type. I couldn't write my name. It's been a long 3 1/2 years."

Now he is slowly regaining movement. Although he still needs the wheelchair for everyday movement, he can walk short distances with the aid of a walker and knee brace.

Cox was riding in the back of a Jeep when he hit the roll bar and blood began to flood his spinal cord. Blood clots suffocated the spinal cord and peripheral nerves, leaving him paralyzed.

Then his aunt, who lives in St. George, mailed an article about Southwest Neurological Rehabilitation to Cox in Phoenix, where he lived at the time. About six months ago Cox moved to St. George to pursue treatment.

Like others who have sought Bennett's help, Cox has damage to the pathways normally used by the brain to communicate with his muscles. Because these pathways don't regenerate, Bennett has to work with Cox to teach his brain to follow different pathways.

To do this, Cox positions his wheelchair between two horizontal bars in Bennett's office. He uses his upper-body strength to pull himself up to a standing position. From there he slowly puts weight on one leg at a time to send signals to his brain. Through trial and error of placing the weight in different spots he can train his brain to find different communication pathways to the muscles.

"Once the brain sees it a couple of times it will repeat it and repeat it until it's locked into motor memory," Bennett says.

It's not easy.

As Cox puts weight on his leg he groans loudly, almost like he's bench-pressing weights in a gym. Because of his injury, his nerves are more sensitive than normal. Cox says everything is magnified by about 10 times. The process is both painful and exhausting.

Still he's determined to push through and regain mobility.

Cox meets his goal of sending a powerful signal to his brain as tracked on the computer monitor. Yet he wheezes, "One more."

He puts his weight on his left leg again, groaning under the effort once more. He meets another goal and Bennett asks Cox if he has enough energy to go again.

Without hesitation Cox replies: "Yeah."

Then he decides to show off. With Bennett blocking Cox's weaker left leg so it doesn't give out on him, he walks a few steps, using the horizontal bars for some support.

He pulls his hands from the bars, putting his entire weight on his stronger right leg for a few seconds. He is standing without assistance.

"I can, with my right leg, support my weight," Cox says with an optimistic smile.

For about three months after his injury, Cox was one of about 20 patients in the hospital with similar injuries. He got to know the other patients quite well during that time. Now he says they have all given up except one other and him.

That is why he wants to spread the word about this treatment.

"I figure this accident had to happen for a reason," he says.

He didn't know services like this were available until his aunt sent him the newspaper article. Only about a dozen locations around the country offer the neurological rehabilitation services.

Cox has been working with Bennett for less than six months and has seen many successes during that short time. Bennett says he's walked up and down the length of the center's gym with the walker.

Ever the determined optimist, Cox pats his sleek, black wheelchair and says: "I look forward to donating this to someone else."

For more information on Mountain Land's Southwest Neurological Rehabilitation Center, call 628-5194

By Isla Whitcroft
At 23, Richard Gregory had a bright future. He'd just graduated from King's College in London and had won a coveted place at Sandhurst to start officer training.

Then, in November 2003, he was a passenger in a van that was almost completely crushed by a truck. He was pulled from the wreckage alive but had ruptured several organs and, as he arrived at hospital, suffered a major stroke.

'By the time we reached him, Richard was in a coma and doctors were unsure as to whether he would wake up,' remembers his mother Vivienne. 'It was six months before he was taken off a ventilator and started to breathe for himself.

Trapped: Richard Gregory was diagnosed with 'Locked-In Syndrome' after being paralysed in a traffic accident

'Although we never gave up hope, it was almost another year before we really believed he was still conscious and alive inside his paralysed body.

'The first sign was a sort of lopsided smile which doctors said was just an involuntary movement. Then we could see his right eye was moving, which they said was reflex.'
His parents Vivienne and Errol, along with other family and friends, began to ask him questions: to their delight, he responded by twitching his eyebrow. Encouraged by this, doctors sent Richard for tests.

'The results were conclusive - his brain was fully functioning,' says Vivienne. 'He was alert, aware of everything that had happened but unable to talk. The doctors called it Locked-In Syndrome. We called it an absolute tragedy.'

Locked-In Syndrome (LIS) can occur as the result of a stroke, a progressive neurological disorder such as Motor Neurone Disease or, as in Richard's case, a trauma in the brain stem which has irreparably damaged the nerves that control the head and body movement. The stroke he suffered may have also contributed to the damage.

As a result, the patient is paralysed but fully conscious, with normal brain function.
They can breathe unaided but are unable to speak, with their only method of communication through vertical eye movements. It is a dreadful fate, exacerbated by the inability of the patient to communicate their consciousness to the outside world.

There is plenty of anecdotal evidence of patients being written off by medics as being in a vegetative state or a coma; even of hearing doctors discussing switching off their life-support machine before someone notices that they are trying to communicate that they are very much alive.

'We could tell by the look in his eyes that Richard was trying to communicate with us,' says his godmother Dawn, who's been closely involved in his care. 'He just didn't have the means to do so.'

Mind-reading miracle: Richard is pictured here with Dr Paul Gnanayathum, who developed a device which interprets the brainwaves of paralysed patients, enabling them to communicate
After his accident, Richard spent the next three years in an NHS specialist head injuries unit until it became clear that his medical condition was not going to improve. Today, he lives in a dedicated care home in Birmingham.

His inability to communicate was extremely disheartening, says Dawn. 'Richard had always been chatty, with a big smile on his face, and we knew that he wanted to communicate with us.'
Computer program that 'reads' their minds

Then, last year, she read about a computer program which offered the family fresh hope. It effectively 'reads' the patient's mind to help them communicate. Using electrodes attached to the forehead, the program picks up electrical signals in the brain and from any muscles around the forehead which are not paralysed.

These electrical signals are then fed into a 'de-scrambler' which converts them into a command to move a cursor on a computer screen - for instance, to point at words such as yes or no.
The system was designed specifically for locked-in patients by Dr Paul Gnanayutham, a lecturer in computing at Portsmouth University.

This is not the first time scientists have found a way of using a person's brain waves to navigate a cursor, but Dr Gnanayutham is one of the first to use the technology on real people with serious brain injuries.
Furthermore, he has made a real breakthrough. One of the main barriers to the expansion of this technology had been that as well as the cursor-moving brain waves, there are lots of other brain waves creating background 'noise' which can confuse the computer.
It took him three years, but Dr Gnanayutham managed to write a sophisticated computer program which cuts out this 'noise'.

Since building the machine in 2001, he has worked with more than 30 patients.
'We use any signals we can to help patients to communicate,' he says. 'Some, like Richard, can frown a bit, which means his forehead muscles are not paralysed - so he can use those muscles to help along the cursor. He can also move his eyes.
'Some people can't move anything, and in that case we just work with brain waves.'
Dawn got in touch with Dr Gnanayutham, who went to see Richard last September.
Skateboarding computer game test
'He chatted to Richard and explained what he wanted him to do,' says Dawn. 'He put six pads on Richard's forehead, which were wired up to a box and a screen. We all waited with bated breath to see what would happen.'
Dr Gnanayutham had loaded up a computer game based on skateboarding. As the family watched, Richard concentrated hard and suddenly the skateboarder began moving - jumping obstacles and sliding up and down cliffs.
'It was an amazing moment,' says Dawn. 'We were nearly in tears. I remember sitting there watching with shivers running down my spine. At last Richard was able to break out of his prison, if only for a few minutes.
'I could tell Richard was really pleased. What the doctor didn't know was that Richard had been a really good snowboarder. He couldn't have picked a better game for him.'
Dr Gnanayutham, too, was astounded. 'I had never seen anything like it. To see someone playing a computer game using just brain waves, and playing it so well, was amazing.
'To do something like that takes a huge amount of effort and concentration, and people with head injuries tend to tire easily anyway. Richard is clearly a very clever man.'
Dr Gnanayutham first conceived the idea of the programme when singing in a choir which toured hospitals around London.
He says: 'We visited a neurological hospital in Putney and I saw people who were locked in. It seemed so unfair that they couldn't tell us if they were sad, happy, or wanted to go to bed late. I kept wondering if there was something I could do to help them to communicate.
'I knew the computer technology to use brain waves was out there, but my challenge was to adapt that so it was suitable for people with that condition.'

Cause? Richard suffered a major stroke as he arrived at hospital, which may have contributed to his brain damage
'What he has done is quite remarkable,' says Professor Gilbert Cockton, head of research into human and computer interaction at the University of Sunderland.
'He has solved a very complex problem and chosen to apply it to a worthwhile and moving cause.'
Indeed, Dr Gnanayutham could probably sell this programme to the computer gaming industry and make a fortune. Instead, as a committed Christian, he has chosen to devote what little spare time he has to visiting as many locked-in patients as possible and using the machine on them.
'Learning how to navigate using eye movement and brain waves isn't easy,' says Dr Gnanayutham. 'I worked for eight months with one young man whose mother knew he was "there" - but nothing happened until he started using the brain wave system. Finally, he could "talk" to her again.'
Dr Gnanayutham doesn't-always bring good news: there are times when people's loved ones are no longer conscious, and he cannot work with patients who are heavily sedated.
Wherever possible, he tries to have a medical doctor witnessing his work. 'I can't just walk into a hospital and start treating patients,' he says. 'While most care homes are sympathetic, hospitals are less so. My dream is to use my system within the NHS, so this is something I need to address.
Dr Gnanayutham has two machines, each containing a laptop, screen and head pads.
'I would like to create one single unit with all the component parts in it which could be operated by a carer, as there are so many dozens of people who want to see me and I can't be everywhere.
'Sadly, I'm not a businessman and have no idea about raising funds.'
Richard's mother says: 'We are just so grateful to Dr Gnanayutham. It's like a miracle. The next step is for us to purchase a machine just for Richard, so he can communicate all the time.'
• For more information, or if you would like to make a donation to help Dr Gnanayutham's work, email Paul.Gnanayutham@port.ac.uk

New robotic walking system gives hope to people with paralysis

By BRITTNI REINERTSEN

Bellevue Reporter Contributor Jan 12 2009, 5:30 PM · UPDATED

Pushing Boundaries, Washington’s only exercise-therapy center for people with paralysis, is gearing-up to introduce the state’s first robotic walking system, the Lokomat, early next year. The machine will be available for public use and may help those with paralysis regain strength and, in some cases, learn to walk again.
The Redmond-based facility held a luncheon at Bellevue’s Meydenbauer Center Nov. 6 to raise funds for the much-anticipated machine. Together with friends, family, and clients, Pushing Boundaries raised close to $90,000. The total cost for a Lokomat is $300,000.

“It (the luncheon) turned out really well, better than we could have hoped for,” said Shawna Hanson, the Event and PR Coordinator for Pushing Boundaries.
Featured at the event were client testimonies, a video describing the machine and its use, as well as a speech from co-founder Sharon Northrup.
“Pushing Boundaries started as a result of an injury Allan (her husband) sustained while we were both driving over I-90 seven years ago,” Northrup explained. The accident left Allan paralyzed from the mid-chest down.
They decided to move to San Diego where their daughter had discovered a new type of exercise therapy. Eventually, Sharon and Allan returned to Washington and founded a similar facility.
The mission of Pushing Boundaries is to improve the lives and health of people with paralysis through intensive and creative exercise-therapy programs, whether the condition is recent or long term.
The Lokomat is an example of the creative therapy that Pushing Boundaries emphasizes that could reverse “learned non-use” in affected muscle groups.
Here’s how it works. A person strapped into a harness is suspended over a treadmill, where they are attached to robotic sensors. They help move the legs in a natural walking pattern that is even, consistent and can be sustained over long periods of time.
According to the Rehabilitation Institute of Chicago, it is believed that this repetitive walking pattern helps the brain and spinal cord work together to re-route neural signals that may have been damaged due to illness or injury. The resulting “re-connection” helps the body regain mobility that has been lost due to injury, stroke or other neurological disorders such as Multiple Sclerosis.
The institute, which began clinical trials of this therapy in March 2002, claims other benefits that may include regained muscle strength and improved circulation. The weight-bearing nature of the machine may also help strengthen bones at risk for osteoporosis.
“Locomotion therapy is becoming something that’s more widely accepted,” said Hanson. “Doctors are learning that there are things that can build around the site of the injury to make a new connection.”
Jerry Daniels, an exercise therapist and certified personal trainer at Pushing Boundaries, explained how exercise therapy, like gait-training, helps to improve mobility. He compared the spine to a “super-highway.”
“Just because the highway’s been choked off, doesn’t mean we can’t go around the back roads. The body is always trying to fix itself; it wants to get better! If you help it by being active, it will work with you.”
Devin Givens, a young man and client at Pushing Boundaries, is an example of this concept.
In August 2007, Givens was in an all-terrain vehicle accident while vacationing with his family in Canada. Despite wearing all the required safety gear, the crash left him with three broken vertebrae. Luckily, Givens’ spinal cord was not severed and he maintained sensation throughout his body. However, he was left unable to walk.
“Virtually, he had a little bit of movement and a lot of spasms,” said his mother, Shannon Vernerey.
Both Givens and his mother were told that what mobility he could regain in the first 12 to 18 months following his accident would be it.
“I was told by the doctor in Canada that there was nothing we could do for him,” Vernerey said.
Then in December 2007, they came to Pushing Boundaries. There, Givens and his mother encountered an optimistic atmosphere where the vision is to inspire hope for those living with paralysis to do things they never thought possible.
At first, Givens could only stabilize himself while sitting on the edge of a mat.
“Today, he is standing at the parallel bars and taking some steps. He’s still regaining movement, he hasn’t plateaued at all,” said Vernerey.
She and Givens look forward to the boundaries they will continue to break through when the Lokomat arrives.
“As soon as I get on it, I’ll take off. Connections will be made,” said Givens.
Vernerey said she is totally convinced that the machine will help her son.
“With the success of this machine, how it helps the body reconnect and regenerate the nervous system. … I am totally 100 percent believing that he will walk again in his lifetime. There isn’t one doubt in my mind.”
William Holmes is another Pushing Boundaries client who is “psyched” for the Lokomat to arrive.
“You get to exercise. It’s going to be amazing! To have something that’s going to walk you. I mean, I haven’t walked in seven and a half months,” Holmes said.
He became paralyzed from the chest down as a result of a motorcycle accident along Seattle's Lake City Way last February.
Mike Buckel, one of Holmes’ trainers, is looking forward to the Lokomat as an alternative method of gait-training exercise. Clients currently practice walking on a light gait treadmill where they rely on trainers to set the pace and place their feet. The process is often slow and difficult.
“I think it’s going to be so much easier having a machine that walks somebody with the proper gait pattern rather than us doing it in cadence. Five minutes of doing that thrashes your body,” Buckel explained.
Another benefit of having a Lokomat at Pushing Boundaries is public access.
“We identified that this type of therapy was not available to anyone in the state of Washington,” said Tricia Lazzar, director of Pushing Boundaries.
“That’s the benefit of having it here; anybody who has the ability to go through gait-training would have the opportunity to use it,” she said.
Lazzar explained that there is a Lokomat in Portland at the Oregon Health Sciences University. However, it is used for stroke rehabilitation and not available for public use.
There will be no extra cost for client’s to use the Lokomat at Pushing Boundaries. An hourly fee of $80, some of which can be subsidized by the facility, includes the use of all equipment during one-on-one therapy sessions with a qualified trainer. Clients are required to come in for two-hour sessions at a minimum of two days a week.
“Bringing the Lokomat to Pushing Boundaries will impact literally hundreds of people in the state of Washington that are affected by paralysis each year,” Northrup explained at the luncheon.
The numbers alone reinforce her statement. According to Northrup, there are almost two spinal cord injuries a day in Washington state.
Northrup ended her speech by saying that whether "we want to believe it or not, tomorrow, the next day and every day there will be people who have things happen to them who will need us.
“We cannot change how many are injured,” she said, “but we can change how many we can help.”
For more information on the Lokomat or to make an appointment for a tour of the Pushing Boundaries facility, visit its Web site at www.pushing-boundaries.org or send an e-mail to info@pushing-boundaries.org.
Brittni Reinertsen is a student in the University of Washington Department of Communication News Laboratory.