Medical Breakthroughs: Beating Pediatric Paralysis

BACKGROUND: Each year, about 11,000 people experience a spinal cord injury. According to the National Spinal Cord Injury Association, most of these people are injured in auto and sports accidents, falls, and industrial mishaps. About 60 percent are 30 years old or younger, and the majority of them are men. About 10 percent of spinal cord injuries happen in children younger than 15-years-old.

John McDonald, M.D., Ph.D., from Washington University in St. Louis, says children may have the best ability to regenerate spinal cord function.

"No one really knows all the reasons why, but we know that, as we age, there are other factors that become prominent after an injury in the nervous system that prevent regeneration. Cells don't reasons as well following and they don't quite know what to do like they do in the young nervous system," said Dr. McDonald

TREATING KIDS: "Children probably have the best capacity to regenerate and perhaps we should be putting our greatest effort into them, really state-of-the-art across the country is doing very little with them in terms of their ability to recover," Dr. McDonald said.

He and fellow colleagues at the University of Washington in St. Louis are changing that with the advent of their pediatric spinal cord injury program. The pediatric program was developed originally for adults who are more than a year out from their injury with the hope that patients could maximize their recovery function. One important part of recovery is the amount of activity in the neurocircuits. After a spinal cord injury, that activity is dramatically reduced because signals aren't coming in from above or below the injury.

"We know that the nervous system does have some ability to regenerate. Increasing that activity through pattern movement is one way to enhance regeneration," said Dr. McDonald.

Activity-based therapy has been successful and Washington University in adults with spinal cord injuries. Most notably, Christopher Reeve, one of Dr. McDonald's patients, has experienced benefits from this therapy. Dr. McDonald and his colleagues are now treating children with this activity-based approach.

ACTIVITY-BASED THERAPY: The activity-based recovery program incorporates specially designed rehabilitation therapies and exercises to help individuals with spinal cord injuries improve their overall health, strengthen their bones and muscles, and possible regain the ability to feel and move. The key concept of this approach, says Dr. McDonald, is patients need to optimize activity. Exercises and movements that produce pattern movement and repetition are employed.

There are tools and machines that help adults do this, but there aren't any for children. Parents of children with paralysis are taught to think of creative ways to adapt toys and machines to fit the needs of their children, all in an effort to encourage repetition and pattern movement. An average week of this therapy would include weight-supported walking, in which children are held in a harness over a treadmill moving their legs, riding a tricycle that has been adapted to repeat cycling motions in the legs, and learning how to walk with braces and maintain balance.

"We've developed treatments that can be applied in the home, because that's the only way it's going to happen because if people have to take out three-quarters of a day, three times a week, to go down to a center, it's not going to happen," Dr. McDonald said.


Linda Schultz, Ph.D.
Spinal Cord Nurse Liaison
Washington University School of Medicine
4444 Forest Park Blvd., Box 8518
St. Louis, MO 63108
(314) 454-7892

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