SINGAPORE: Singapore has witnessed a significant advancement in medical research, bringing hope to individuals with spinal cord injuries. Pioneered by a local research team, a groundbreaking study combining electrode implantation and physical therapy has yielded promising results, enabling patients with lower body paralysis to regain their motor skills.

This novel procedure, the first of its kind in the region, is currently being trialled by the National Neuroscience Institute (NNI), Tan Tock Seng Hospital (TTSH), and the Agency for Science, Technology and Research, with support from the National Medical Research Council and the Ng Teng Fong Healthcare Innovation Programme.

The clinical trials for spinal cord neurostimulation therapy began in December of the previous year, with the team actively recruiting patients suffering from spinal cord injuries.

The clinical trial encompasses three stages: prehabilitation for a month prior to implant insertion, the implantation of electrodes into the patient’s bone marrow to stimulate nerve connections between the brain and spinal cord, and seven months of personalized rehabilitation following the surgery.

Dr Wan Kai Rui, a neurosurgeon from the National Neuroscience Institute (NNI), explained that the implantation operation takes approximately two to four hours and is considered safe, with only a 1% chance of infection or complications compared to other spinal cord surgeries. The postoperative rehabilitation plan focuses on motor imagery, core training, and the utilization of a mechanical exoskeleton to simulate walking and evoke muscle memory. To enhance the effectiveness and enjoyment of the rehabilitation process, the team incorporates therapies such as virtual reality games and assisted walking exercises.

Three patients, all of whom were paralyzed from the chest down due to spinal cord damage, were recruited for the study. Two participants, Sam Subian (49 years old) and Asyraf Ghazali (28 years old), completed the treatment study, while the third patient is scheduled to begin treatment early next year, with an expected completion in the third quarter.

Sam Subian, a former competitive jockey, suffered a spinal fracture in June 2017 when his horse stumbled during training. Recalling the incident, he told The Straits Times, “Silver Spoon died and I fractured my spine. I could not sense anything below my chest. I was told I would never stand or walk again.”

Asyraf Ghazali, a financial adviser, experienced a road accident in 2018 that left him paralyzed from the chest down. He expressed his disbelief at being half paralyzed, especially considering his youth and strength.

After completing the initial month of rehabilitation training, both patients could independently transition from a sitting to a standing position. Following the seven-month rehabilitation course, they were capable of walking under supervision.

Sam’s future objective is to stand independently without the aid of a brace, hoping to inspire others through his experience. Asyraf mentioned that apart from improvements in mobility, his urinary incontinence has also significantly improved, leading to an enhanced quality of life.

Despite the improvement in motor skills, neither patient has regained sensation in their lower bodies. Dr Wan noted that the research team is collaborating with industry partners to explore avenues for restoring sensation to patients.

She highlighted the next phase of the study, which aims to recruit approximately 15 patients, including those with higher levels of spinal cord damage and paralysis from the neck down. The objective is to restore hand movement abilities and further enhance their quality of life.

Dr Wan emphasized that the results of the study have exceeded those of similar programs. She cited one program in Texas that required 1½ to 2½ years of conventional rehabilitation to achieve the same progress made in just six months. Another program in Minnesota focused solely on spinal cord stimulation without follow-up rehabilitation, resulting in patients being able to move their toes and knees but not stand or walk. A recent study in Switzerland developed its own implants, which limited scalability and accessibility.

The research team utilizes readily available implants and has devised an efficient rehabilitation program and programming recommendations to facilitate optimal improvement. The team considers this breakthrough a significant stride toward improving the quality of life for individuals with spinal cord injuries.