Rüdiger Rupp, Head of the Experimental Neurorehabilitation Section in the Department of Paraplegiology at Heidelberg University Hospital, explains what this means.
What does paraplegia of the seventh thoracic vertebra mean?
In the case of paraplegia, the spinal cord, which runs within the spinal column, is damaged. This interrupts the nerve connections between the brain and the muscles below the injury. An injury in the seventh thoracic vertebra means that the legs are paralysed. The bladder and bowel can also no longer be controlled voluntarily.
What therapeutic options are there?
This depends crucially on how many nerve tracts are interrupted in the spinal cord. The less tissue is damaged, the greater the chance of functional recovery. "If they are completely severed, the chances are very slim," says Rupp. There are currently no causal therapies that stimulate the nerve fibres in the spinal cord to grow again in this case. "However, the spinal cord is only really completely severed in very few cases. Individual nerve fibres are often still preserved."
What does that mean?
Parts of the spinal cord that have been preserved can enable functional gains again. However, this can take several months and is also a question of training. "The spinal cord is not just a kind of cable that connects the brain to the muscles; it is part of the brain and can reorganise itself," says Rupp. Therapies on the treadmill, for example with exoskeletons that support the patient's movements, are important for training. "The technology is now so advanced that the intention to move is recorded by electrodes on the brain and the exoskeleton implements this movement," says Rupp. "This allows us to involve patients more actively in therapy. That's very important. Because if you don't train, you definitely won't regain any function."
Where does therapeutic research currently stand?
Clinical trials are currently underway in which attempts are being made to stimulate nerve growth in the spinal cord. In Heidelberg, a study is due to start at the beginning of next year in which an antibody will be injected into the spinal cord. This should ensure that nerves are stimulated to sprout again. In the USA, studies are being conducted with stem cells. It is possible that patients will be able to feel something again below the injury. "But it is unlikely that people will be able to become wheelchair-independent in the next ten years," says Rupp.
Do top athletes have a better prognosis than other people?
"Athletes generally don't have a greater chance of gaining function," says Rupp. Ultimately, the prognosis depends on many individual factors.
