How a revolutionary method can restore individuals with spinal twine accidents
Rob Summers was mendacity face down in a Kentucky rehab institute when he realized that he may transfer his large toe. From prime to backside, from prime to backside. It was new – one thing he had not been capable of do since an Elk driver left him paralyzed. 4 years in the past, docs had advised him that he would by no means transfer his decrease physique once more. It was now a part of a pioneering experiment to check the ability of electrical stimulation in individuals with spinal twine accidents.
"Susie, hear, I can wiggle my toe," Summers stated.
Susan Harkema, a neurophysiologist on the College of Louisville, Kentucky, was sitting close by, absorbed by the info saved on her laptop. She was incredulous. Summers' level was shifting, however he was not in management. She was positive of it. However, she determined to amuse him. She requested him to shut his eyes and transfer his proper foot, then down, then up. She moved to the left foot. He executed completely.
"Fuck shit," says Harkema. She was paying consideration now.
"How's it going?" Requested he.
"I don’t know," she replied.
Summers had been a school league participant with main league ambitions earlier than the automobile that hit him broke all of the ligaments and tendons in his neck, permitting one in every of his vertebrae to beat the fragile nerve tissue that she was supposed to guard. The docs categorized the damage as full; the engine connections to his legs had been destroyed.
When Harkema and his colleagues implanted a tiny band of electrodes into his backbone in 2009, they didn’t attempt to restore Summers' capability to maneuver by himself. As a substitute, the researchers hoped to show that the backbone incorporates all of the circuits obligatory for the upkeep and development of the physique. They felt that such an strategy may permit individuals with spinal accidents to face up and stroll, utilizing electrical stimulation to switch the indicators that got here from the mind.
So, when Summers intentionally moved his toes, Harkema was shocked.
The prevailing knowledge has lengthy assumed that spinal accidents signify reduce connections between the mind and the extremities. For many years, researchers have centered their efforts on repairing these connections, for instance with stem cells. However the findings of the Harkema group and different laboratories recommend that some connections stay intact, even for essentially the most severely affected individuals. Electrical stimulation appears to assist amplify the messages despatched by means of the wound and restore these hyperlinks.
Summers' surprising awakening of nerve connections is a part of a sequence of advances that has spurred analysis on spinal twine damage. Final 12 months, laboratories in Kentucky, Minnesota and Switzerland made headlines with a sequence of case research. The stimulators initially designed to deal with continual ache have now helped a dozen paralyzed individuals to wiggle their toes, bend their legs, or stroll with help, as much as a distance of as much as 1 kilometer in some instances. However the units additionally appear to supply wider advantages. Some research members discovered enhancements in blood stress, bowel and bladder management, and sexual operate – talents that folks with spinal twine accidents usually worth greater than the typical. use of their legs. In some instances, these advantages have continued even after powering off the pacemakers. The outcomes strengthened the hope of an improved high quality of life, even for individuals paralyzed years or a long time in the past, and the outcomes go in opposition to standard knowledge relating to the lesions of spinal twine. "It's a brand new ball recreation," stated Reggie Edgerton, a physiologist on the College of California at Los Angeles (UCLA), who was carefully concerned within the work.
Lists of ready to take part in stimulation trials now have hundreds of names. And at the least one hospital has begun providing the experimental process – at a value of tens of hundreds of – with out formal approval or a full evaluation of the dangers and advantages that circulation from it.
For some, the hype appears acquainted. The hunt for paralysis has value a whole bunch of thousands and thousands of and has to date solely resulted in daring predictions and disillusioned hopes. Actor Christopher Reeve, one of the crucial recognizable faces of spinal accidents, firmly believed that he may stroll once more because of the burgeoning subject of stem cells. "I do know there’s a remedy for the kind of damage I’ve," Reeve stated in an interview in 2001, three years earlier than his dying. However almost twenty years later, this long-promised treatment has not but been realized.
The bottom is at a vital stage because it determines translate miraculous outcomes right into a viable remedy, says Keith Tansey, a neurologist on the Methodist Rehabilitation Heart in Jackson, Mississippi. Researchers nonetheless don’t absolutely perceive how stimulation works. "We have to be taught extra about it," he says. "We’ve to ask ourselves much less if we did the quilt of TIME journal and if we are going to actually assist sufferers."
A mannequin of progress
The trail resulting in the Summers stretch started with cats on treadmills.
Within the 1970s, Edgerton started working with a long-studied mannequin of locomotion understanding. The spinal twine of cats whose spinal twine has been sectioned might be hung over a treadmill and skilled to stroll once more by merely guiding their legs in a walking-shaped movement. With follow, animals will modify their tempo to the pace of the treadmill and even change course – with out mind intervention. The spinal circuits that propelled them upfront, known as the "central mannequin generator", managed the actions, and Edgerton tried to grasp the way it labored.
In 1993, when Harkema joined Edgerton's lab, she was not so within the backbone – she stated she selected UCLA for the climate. However when Harkema began working with cats, she turned fascinated by the best way animals discovered so many capabilities. Edgerton commissioned Harkema to prepare an identical experiment in people affected by spinal twine accidents. Maybe an organized coaching meant to awaken a central mannequin generator would additionally permit them to stroll.
It labored to a sure extent. Treadmill coaching with weight help helped individuals with spinal twine accidents, particularly much less critical accidents, to enhance their capability to maneuver. However Harkema and Edgerton wished to see an even bigger impact. Epidural stimulators, which ship present to the decrease a part of the spinal twine, appeared like a superb choice.
The units have been used to deal with continual ache for the reason that 1960s. However the researchers had rapidly discovered that they may do extra. In individuals with spinal twine accidents, for instance, stimulators appeared to scale back the speed of involuntary spasm. In a single study1, researchers examined individuals with spinal twine accidents who had been implanted with a pacemaker because of this. When the scientists activated the stimulation, the members started to maneuver their legs mechanically and rhythmically. "It was, and nonetheless is, essentially the most direct proof of a so-called central generator of fashions for locomotion in people," says Karen Minassian, a medical physicist on the Vienna Medical College. A case study2 even recommended that stimulation may restore the flexibility to maneuver voluntarily, at the least in individuals with incomplete accidents: those that had retained sensation and motion within the decrease a part of their physique.
In 2002, Arizona researchers introduced that that they had suspended a 43-year-old man with a spinal damage on a shifting treadmill whereas stimulating his spine3. He additionally had an incomplete damage. After coaching and stimulation, he was capable of stroll with "a coordinated locomotion scheme nearly effortlessly," in response to the authors.
Harkema and Edgerton started to debate the potential for utilizing the identical strategy. They simply wanted a affected person take a look at to show the precept. Summers was decided to be their man.
Throughout the summer season of 2006, Rob Summers lived and breathed baseball. Launcher from Oregon State College Beavers, he had simply didn’t compete within the Faculty World Sequence championship due to a hip damage. He skilled so laborious to get a beginning place for the approaching season. One night time, whereas he was recovering a sports activities bag from his automotive, he heard a automobile spinning down the road. He simply noticed the headlights earlier than it hit him and moved away at full pace. Summers lay on the bottom, bleeding till the subsequent morning, when a neighbor discovered him.
Summers doesn’t bear in mind a lot of the month he spent within the hospital, however he remembers that the docs waited till he was surrounded by relations to inform him he was paralyzed. They didn’t mince their phrases: "You’ll by no means stroll. You’ll by no means really feel something. Summers refused to imagine him. The docs didn’t know the way cussed he was, how a lot he may work. "I'm going to beat that," he says to his mother and father.
After a 12 months of intense re-education, Summers discovered sensations in his limbs, however he nonetheless couldn’t transfer his decrease physique; his damage was thought of a "full motor". Nonetheless, Summers was satisfied that he simply wanted the fitting therapy. Thus, his mother and father and himself have despatched greater than 200 emails to analysis facilities world wide: "Israel, Europe, Russia, Cuba, Japan, China, South America , and so on., "says Summers.
The letter marketing campaign led him to a re-education workshop in Texas, the place he met with Harkema. At the moment, she had began her personal lab on the College of Louisville. In September 2007, Summers traveled together with his father to go to the ability. When Harkema introduced that his staff was contemplating epidural stimulation, Summers was delighted. He needed to return to Portland the subsequent day, however he rented an house and known as Harkema. "I'm in," he says. "I'll see you tomorrow at Eight o'clock."
In Louisville, Summers spent greater than two years in rehab to find out if he had restoration capability with out stimulation. Then, in December 2009, the Harkema staff offered him with an epidural stimulator. They positioned a community of 16 electrodes within the house between his vertebrae and his spinal twine. A wire linked the community to the pacemaker, a half-worth of a card recreation, situated simply above his buttocks. The docs managed the pacemaker from a distance.
When the researchers turned on the stimulator, Summers instantly felt a tingling sensation. Three days later, the staff tried to make him arise. Initially, a harness supported all its weight. The staff step by step started to scale back this help till Summers was standing independently. He watched the muscle tissue of his legs contract within the mirror. "It can’t be actual," he thought. Then he peeked within the room. His mom was in tears. "Folks had been crying and screaming, asking me," How is that this going? "" Mentioned Harkema. "It was a small pandemonium."
Nonetheless, it was nothing in comparison with the bustle that erupted six months later, when electrical stimulation allowed Summers to maneuver his toes. Harkema's staff hoped to have the ability to restart the circuit obligatory to face and stroll within the backbone and legs, however she didn’t anticipate to obtain assist from the mind. Harkema known as Edgerton at his laboratory in Los Angeles to speak to him about Summers' toes. "Oh my God, that may not be true," remembers Edgerton. "Everybody will suppose we’re quacks."
When Harkema and his colleagues printed Summers4 case particulars in 2011, many scientists had been skeptical. "I didn’t imagine it," says Kendall Lee, a neurosurgeon at Mayo Clinic in Rochester, Minnesota. All Lee had taught him, advised him that when the connections to the mind are misplaced, they don’t return.
However, step by step, the proof started to rise. Harkema and his staff printed one other study5 in 2014 involving Summers and three different individuals, two of whom had no motion or sensation of their decrease physique. All have discovered a voluntary motion. Quickly, others have tried the strategy to people and have been wanting into whether or not this might permit take a look at members to take motion exterior the carpet of race.
Gregoire Courtine, a neuroscientist on the Swiss Federal Institute of Know-how Lausanne (EPFL), had additionally studied with Edgerton, beginning at UCLA just a few years earlier than Harkema's departure for Louisville. He moved to Europe in 2008 to review epidural stimulation in rodents and presumably in rhesus macaques.
In 2015, Courtine felt prepared to check expertise in people. Her staff used the identical commonplace ache booster that Harkema had used, however she modified the software program in order that the system may generate stimulation patterns coinciding with the act of strolling. "We’re actually making an attempt to activate the spinal twine because the mind is skilled to do it," Courtine explains. And there was one other main distinction from Harkema's research: Courtine's staff recruited individuals with incomplete accidents, within the hope that it could be simpler to recuperate on this group than in individuals with suffered a whole damage.
In the meantime, Edgerton helped a 3rd group at Mayo Clinic start one other trial. In 2016, Lee, Kristin Zhao, a rehabilitation scientist, and their colleagues started replicating Harkema's findings. They recruited two members who had been on bodily remedy for almost six months earlier than being implanted with the pacemaker, after which one other 10 months with the pacemaker turned on. The intention was to indicate that stimulation and coaching may enhance their capability to face up and transfer their decrease limbs voluntarily. However the first participant reached these targets so rapidly that the researchers determined so as to add the protocol to the protocol.
Within the fall of 2018, the three groups launched the outcomes of the primary eight members within the trial6-Eight. In whole, six individuals managed to cross the bottom with help reminiscent of harnesses, crutches or parallel bars. The opposite two additionally had advantages: with the stimulation, they had been capable of sit and stand independently and one in every of them may step on a treadmill with help.
"It's actually solely final 12 months that important mass has amassed," says Chet Moritz, a Rehabilitation Drugs Researcher on the College of Washington in Seattle. "It's actually the place we began to really feel like a breakthrough."
The sector has already skilled "breakthroughs". Reeve argued with ardour and conviction to fund stem cell analysis in hopes of repairing nerve harm. Movies confirmed paralyzed rats that had been injected with thorns of cells miraculously regaining the flexibility to stroll or use their paws. Remedy usually appeared shut.
Reproducing these ends in people although is revealed to be tough. Though human stem cell trials are ongoing, a few of which present promising outcomes, the passion generated by this strategy – from funders, sufferers, and researchers – is Is blurred, stated Tansey. Different high-tech approaches to reverse paralysis, reminiscent of brain-machine interfaces, are nonetheless beneath improvement. Motor exoskeletons are already in the marketplace, however they’re costly. And they don’t cope with the underlying drawback of restoring neural connections. "We've all heard" 5 years later, there shall be a magic tablet, "says Peter Grahn, neuroscientist at Mayo Clinic, who was one of many first authors of the research on stimulation6 and who has a spinal twine. to harm your self. "That's what you hear on a regular basis, as a result of 5 years is lengthy sufficient for everybody to neglect."
However for a lot of viewers, stimulation is a promise that goes past the hype. Matthew Rodreick, govt director of Unite 2 Struggle Paralysis, a spinal twine damage advocacy group based mostly in Hood River, Oregon, has in depth expertise within the therapy of continual ache. "It's a tool that's in the marketplace and has been implanted in a whole bunch of hundreds of individuals," he says. This doesn’t imply that the technique will succeed, however at the least the trail to approval has been cleared, he stated.
There are nonetheless essential questions on how pacing works and why some advantages seem to persist after pacemakers are turned off. It’s turning into more and more clear that for many individuals with lesions thought of full, some neuronal pathways that permit motor management of the mind survive. They’re merely dormant and can’t trigger a response in neurons beneath the location of the lesion. Epidural stimulation appears to make neurons extra excitable – extra more likely to be triggered when they’re confronted with indicators from the mind telling them to maneuver their toes or begin strolling. The electrical present can drive the neurons to fireside and the muscle tissue to contract, however that's not what occurs to those that began strolling. "The particular person doesn’t should take a step," says Moritz. "It's not robotic."
Concerning the explanation why sure advantages persist for some members, a number of explanations are attainable. Stimulation can allow people to take part extra absolutely in rehabilitation by strengthening muscle and nerve connections by means of train. This might additionally promote plasticity, which might assist rewire the circuits across the damage. This can be a significantly engaging risk, because it may imply that there’s potential for enchancment over time.
However, researchers nonetheless want to find out who may gain advantage essentially the most from the process. Harkema says the 20 individuals in Louisville have discovered some mobility. However for Tansey, it appears clear that everybody with a spinal damage is not going to enhance. He needs to discover a solution to monitor individuals as a result of implanting a medical system within the backbone is just not a trivial matter. There are dangers.
Though pacemakers are accepted by the US Meals and Drug Administration to deal with continual ache, they generally trigger unwanted effects, even harmful ones. Recipients report being shocked, burned, or have sustained nerve harm leading to muscle weak spot or paralysis. In response to a 2018 survey by The Related Press, pacemakers have collected almost 80,000 studies of accidents since 2008, greater than another medical system, other than insulin pumps and hip prostheses. steel.
And there could also be particular dangers for individuals with spinal twine accidents, who’re extra vulnerable to infections and who usually have low bone density. A participant within the Harkema staff's final study8 fractured his hip, which required a number of surgical procedures resulting in an an infection.
Some reported issues are tough to clarify. In 2015, Xander Mozejewski, a spinal damage, joined one in every of Edgerton's trials to check the impact of non-invasive "transcutaneous" stimulation by which electrodes are positioned on the floor of the pores and skin. . Later, he started to expertise spasms and ache in his decrease physique, which continued to worsen. In 2016, the docs implanted an epidural stimulator to attempt to management the spasms, however the system appeared to worsen the scenario, and Mozejewski was lastly eliminated. In 2018, he sued for medical malpractice in opposition to UCLA, Edgerton, NeuroRecovery Applied sciences – the corporate in San Juan Capistrano, California, co-founded by Edgerton – and others. The case is ongoing, however in a press release to Nature, Nick Terrafranca, CEO of NeuroRecovery Applied sciences, stated, "The pacemaker was used with greater than 60 research members. No hostile occasions have been reported which might be immediately associated to the usage of the system developed and Terrafranca provides that the hostile results recorded by the corporate, together with muscle spasms, "had been transient in nature".
Harkema's analysis has additionally been criticized. In 2015, one in every of her colleagues despatched letters to the Institutional Evaluation Board of the College of Louisville, its Human Topics Program, and the Nationwide Analysis Institute of Incapacity, Unbiased Residing, and Rehabilitation (NIDILRR), which funded a part of its work. Harkema research. An inner investigation revealed that scientists had failed to trace and monitor hostile occasions, deviated from research protocols, and had misplaced information. Because of this, NIDILRR canceled one of many research, a $ 914,000 investigation into the results of a muscle relaxant and treadmill coaching on individuals with spinal twine accidents. The US Workplace of Human Analysis additionally carried out an investigation however didn’t impose sanctions on Harkema. The company additionally acknowledged that the corrective actions taken by the Harkema staff had adequately addressed the non-compliance.
Harkema acknowledges that her staff didn’t maintain her information to perfection, however she denies all allegations of significant wrongdoing, significantly the accusation that her staff would put sufferers in danger. "Anybody who visits our analysis program is definitely shocked by every thing we now have put in place to guard our analysis members," she says.
His analysis continued rapidly. The Christopher & Dana Reeve Basis of Quick Hills, New Jersey, is supporting work to check epidural stimulation in 36 different individuals on the Louisville Laboratory. In July, 11 individuals had been implanted with stimulators.
Past the primary steps
In societies constructed for non-disabled individuals, the march has turn into immeasurably essential. "Strolling and standing is horny," stated Jennifer French, co-founder of the Neurotech Community, a nonprofit group based mostly in St Petersburg, Fla., Devoted to serving to individuals with disabilities to assist individuals with disabilities. entry to neurotechnological units. "It excites individuals."
However strolling is just not every thing, says Kim Anderson, a researcher at Case Western Reserve College in Cleveland, Ohio, and president of the North American Spinal Twine Damage Consortium. In 2004, she carried out a survey of almost 700 individuals with spinal twine accidents. Restoring the operate of arms and fingers was by far the very best precedence for individuals with quadriplegia, adopted by restoration of sexual operate. For individuals with paraplegia, essentially the most wanted enchancment was sexual operate, adopted by bowel and bladder management and decreased threat of autonomic dysreflexia, a life-threatening illness characterised by elevated blood stress. and a drop within the coronary heart fee.
After Stefanie Putnam broke her neck in a pool, the least of her issues had been to stroll. The wound left her immobilized from the neck down and she or he couldn’t breathe alone. "I didn’t suppose, we'll stand up, we'll stroll," she says. "I assumed, 'Let's depart life'."
Even after regaining the flexibility to breathe, she nonetheless had issues, particularly with sustaining a traditional blood stress. The medicines and three units of corsets couldn’t maintain him excessive sufficient to forestall him from fainting. She fainted six or seven instances a day. She couldn’t drive a automobile. She couldn’t be alone. And when she began attending college courses, her mother and father needed to stick an indication on the again of her wheelchair, advising passers-by to tilt the again of Putnam once they had been there. discovered unconscious. "I used to be so fed up with the docs telling me time and again, 'That's the best way it's going to be,'" she says.
In 2017, Putnam moved to Louisville to affix one other Harkema research – centered not on strolling, however on the cardiovascular system. For Putnam, the results of the stimulation had been speedy and profound. She has not fainted for months. She now not wants 24-hour care and she will drive once more. The opposite three members within the research additionally confirmed vital enhancements of their blood pressure9.
David Darrow, a sixth-year resident neurosurgist on the College of Minnesota's Faculty of Drugs in Minneapolis, has been the sufferer of numerous accidents, reminiscent of these of Putnam and Summers. "It was a little bit of the worst a part of my job," he says. He would restore the construction of the backbone understanding that he may do nothing to revive his operate. So, when he heard Edgerton speak concerning the promise of epidural stimulation at a convention in 2015, "I used to be blown away," he says. "I simply didn’t perceive why there weren’t twenty or so facilities working on this space."
Darrow suspected that the conclusions is perhaps fallacious, however he wished to seek out out for himself. Il a donc décidé de concevoir un sort d'étude totalement nouveau. D'autres groupes ont testé la stimulation épidurale en affiliation avec une rééducation intensive avant et après l'implant. Darrow voulait savoir quel effet la stimulation aurait par elle-même.
L’étude diffère des autres essais d’une autre manière importante: les expériences ne sont pas centrées sur la place debout ou la marche. Son groupe s'intéresse plutôt aux mouvements volontaires et aux améliorations de la fonction cardiovasculaire, de la fonction vésicale et intestinale et de la fonction sexuelle.
Darrow et son équipe ont implanté des stimulateurs sur dix personnes. En mars, ils ont publié les résultats des deux premiers members10. Tous deux ont retrouvé des mouvements volontaires, tels que se tortiller les orteils et lever le bas de leurs jambes. Ils ont également constaté une amélioration de la fonction intestinale et vésicale. La stimulation a également aidé à réguler la pression artérielle chez une personne et lui a permis de retrouver son aptitude à avoir un orgasme pendant les rapports sexuels. Darrow prévoit d'implanter dix personnes supplémentaires et de lancer les prochaines études dans le however de fournir le traitement aux sufferers aussi rapidement que attainable. La stimulation épidurale n’est pas une panacée, mais cela n’a pas d’significance, dit-il. «Je ne crois pas vraiment à la guérison dans le cadre de ma pratique. Je veux vraiment améliorer la vie des gens progressivement. "
Focus vers l'avant
La demande de nouvelles thérapies a donné naissance à une industrie du tourisme médical pour les lésions de la moelle épinière. À Bangkok, le World Medical Heart Hospital offre une stimulation épidurale – avec ou sans cellules souches – à toute personne qui remplit ses critères et qui peut se permettre un prix de plus de 70 000 USD. En juillet, l'hôpital, affilié à la société Distinctive Entry Medical (UAM), avait réalisé 70 implants, a déclaré Henning Kalwa, responsable des providers aux sufferers. «Tandis que d'autres collègues du domaine de la neurologie font encore tourner des études, des essais et la bureaucratie de la FDA à la recherche d'un traitement curatif contre la paraplégie et la tétraplégie, UAM traite avec succès des sufferers», a écrit Kalwa dans un message public publié sur LinkedIn.
Courtine met en garde les personnes atteintes de lésions de la moelle épinière contre toute poursuite de la stimulation épidurale en dehors des essais cliniques. Il a vu des stimulateurs implantés au mauvais endroit et il souligne que même les plus grands scientifiques ne sont pas encore d’accord sur la manière de configurer la stimulation et de faire la formation. «C’est trop tôt», dit-il. Tansey craint que se précipiter vers un traitement puisse envoyer la stimulation épidurale à la place des cellules souches. Des cliniques pourraient alors apparaître offrant des thérapies non assistées qui ne fonctionneraient peut-être pas, et des recherches sérieuses pourraient échouer.
Pour les scientifiques, l’accent est toujours mis sur la recherche. Chaque groupe semble avoir ses propres idées sur la manière de faire progresser la science.
L’équipe de Harkema proceed de recruter des members pour l’étude financée par Reeve. Elle a également lancé un projet sur les effets de la stimulation et de la formation sur la fonction intestinale et vésicale.
De son côté, Courtine a cofondé une société appelée Etsx Medical medical à Eindhoven, aux Pays-Bas, afin de développer un stimulateur sur mesure pour les personnes souffrant de lésions de la moelle épinière. Il espère que la technologie sera prête dans quelques années. Son équipe lance également une étude visant à tester la stimulation épidurale chez 20 personnes qui ont moins d'un mois de récupération. Chez ces personnes, «il existe un réel potentiel de récupération neurologique», dit-il, et peut-être même de croissance de nouvelles fibres nerveuses.
L'équipe Mayo vient de lancer une étude comparant la stimulation transcutanée à la stimulation épidurale. Et Darrow recrute toujours des members pour son étude. «Si cela fonctionne, même quelque peu, nous avons la responsabilité de l'explorer de manière scientifique et rigoureuse et également de le livrer rapidement», a-t-il déclaré.
Summers, quant à lui, cherche à mettre un pied devant l'autre. Après la fin de l’étude initiale, il a quitté le Kentucky et s’est déplacé aux États-Unis. Puis, en 2018, il est retourné à Louisville pour participer à une autre étude centrée sur la place debout, la marche et le mouvement volontaire. Il est maintenant sur son deuxième stimulateur, et la différence a été profonde. Les impulsions sont "plus nettes et plus propres", dit Summers, et chaque jour, il a l'impression de franchir une nouvelle étape. Un mardi matin d'avril, il allume le stimulateur, l'attache dans un harnais suspendu à une construction en métal sur des roulettes, et start à descendre le lengthy couloir du lengthy couloir du douzième étage de l'Institut Frazier de réadaptation de Louisville.
Sa petite amie, Julie Grauert, porte un t-shirt Reeve de l’équipe et s’installe dans le fauteuil roulant de Summers, diffusant des mélodies de Disney sur son téléphone. "Vous l'avez, bébé", dit-elle. Leur chien de service en formation, un golden retriever nommé Bear, les swimsuit.
Certaines étapes semblent faciles. Les Nikes grises de Summers se tournent avec confiance vers l’avant et atterrissent véritablement. Mais l'entraînement prend un péage. Ses jambes tremblent et, de temps en temps, son pied gauche se pose sous des angles bizarres. Un prompt, les jambes de Summers se voilent et le harnais le rattrape. "Je suis juste fatigué et frustré", dit-il.
La model de Summers de la marche représente un progrès incroyable, et il proceed de s’améliorer. Mais c'est toujours une expérience en cours. Il ne peut pas encore se promener dans le parc ni même se promener dans son appartement.
Summers optimiste, Summers considère que la stimulation n’est rien de moins qu’un remède. Pour lui, les avantages les plus importants ont été les moins visibles: améliorations de la pression artérielle, contrôle de la vessie et des intestins, fonction sexuelle et régulation de la température. Et il y a les sensations les plus insignifiantes, telles que l'appréciation profonde des chaussettes neuves. «Je peux sentir la douceur», dit-il. "C’est fou les petites choses dans lesquelles je trouve de la joie."