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December 2008 Issue

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'Rehearsal' May Help Spinal Cord Injury Patients Walk Again

Published December 2008

Over the past decade, UC researcher Stephen Page, PhD, has shown that mental “rehearsal” of physical activities improves motor skills in stroke patients.

Now, Page hopes to find out if the same techniques can also help spinal cord injury patients walk again.

Page, associate professor in the College of Allied Health Sciences’ rehabilitation sciences department, has received a multiyear National Institutes of Health grant for a study that will be conducted at Drake Center.

Startup work has already begun, and he expects to begin recruiting participants in January 2009.

Page’s research with stroke patients has shown that mental practice, or thinking about performing physical movements, activates the same muscles and brain regions as actual practice of the same task.

His most recent work has shown that repeated mental practice also causes the brain to rewire itself (called “neuroplasticity”). This phenomenon seems to be a key event that usually coincides with recovery of movements.

As a result, Page’s team has shown that patients who both mentally and physically practice their rehabilitative exercises have significantly better outcomes than those who only physically practice the exercises, as is usually done in most rehabilitative hospitals.

Page hopes that this finding also proves true for spinal cord patients relearning to walk.

“This study is extending our work from stroke into spinal cord injury by testing it in people who have trouble walking,” he says. “Walking is a significant problem after spinal cord injury, and so far few therapies work.”
According to Page, most of the treatments for spinal cord injury involve simply managing the patient with braces or a wheelchair, or administering drugs to ease recovery or regeneration.

“This is exploratory because it’s totally different from conventional treatment and it’s using a mindbody technique,” he says. The study will couple physical therapy with mental practice that can be done in the patient’s home.

“There’s no equipment involved, there’s no drugs involved, there’s no real personnel involved and it’s safe,” Page says, adding that actual walking is unsafe for spinal cord patients to practice at home.

“And about a decade of research shows that this technique is sufficient to activate brain and muscles as if someone is physically performing the task. Thus, they’re getting the same types of practice as they would during rehabilitative therapy.”

This is a two-center study with the University of California, Irvine. Studies there, Page says, have already shown that brain activity increases in spinal cord patients while they are mentally rehearsing.

“So it makes sense that there will probably be some physical effects as well,” he says. “This study is a classic example of translating basic research to bedside, which has been noted as a priority here and nationally,” Page says.

“We are looking not only at how well the patients walk, but also how their brain changes as a result of participating in our intervention. The neuroplasticity models we use are based on locomotion research that was conducted in animal models, but that has so far had limited effectiveness in humans. We hope to change that.”

Noting the need for community- based research, the study is a joint collaboration with Drake Center, where Page’s lab is based.

“We are very excited to have Dr. Page and his colleagues here,” says Karen Bankston, PhD, senior vice president of Drake Center.

“We believe our involvement and support of this clinical research can make a difference not only in the lives of those currently in the study, but in helping rebuild the lives of subsequent patients we serve.”

Page adds: “There has literally been no space available on campus for us to perform our funded, human clinical trials.

And the patients need a place that is accessible, easy to get to and easy to get around.

“Patients love coming to Drake for our studies, and often need some of the clinical services only available there. Our affiliation is very much a win-win.”

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