08/20/08

 

BY MITZI BAKER

	Steve Fisch Photography
	Graham Creasey (left) and Gary Steinberg (right) have started a spinal cord injury and repair program helping patients reclaim some abilities.

What could be harder than not being able to walk? Lots of other hardships can be as challenging, said Graham Creasey, MD. Not being able to lift a spoon to your mouth can be difficult, and there are others harder still.

Creasey wants to change that now that he's the medical director of a new program starting at the School of Medicine designed to improve the lives of those with spinal cord injuries.

"If you have broken your neck, most people assume that the most important priority is to walk again," said Creasey, acting professor of neurosurgery. Since he's worked with people paralyzed from spinal cord injuries, he's learned that other things can take precedence over walking: being able to cough to clear your lungs, being able to control when you have to use the bathroom and just being able to use your hands.

"If you can't use your legs, you can still get around in a wheelchair, but if you can't use your hands, it's hard to use anything," said Creasey.

The Spinal Cord Injury and Repair Program was the brainchild of Gary Steinberg, MD, PhD, the Bernard and Ronnie Lacroute-William Randolph Hearst Professor of Neurosurgery and the Neurosciences, who received approval for the program last summer. For the last decade or so, he has been interested in ways to restore the nervous system following injury, particularly after stroke. "But the spinal cord might be the first place we can achieve this goal in patients, since it is so much simpler than the brain," he said.

Steinberg wants the program to do something never done before: restore function to the spinal nerves following paralysis. "The ultimate goal is to achieve as close to a normal lifestyle as possible for people," he said.

Until that dream is realized, Creasey implements the many options that can improve the lives of paralyzed people. In particular, he advocates for the use of electrical stimulation devices that can provide the missing signals from damaged nerves to muscles. Creasey has pioneered the use of such devices, which he called "neural prostheses."

But he wants to do more. "Throughout history, repairing a spinal cord injury hasn't been an option," said Creasey, who arrived at the School of Medicine at the beginning of January. "We hope to capitalize on the wealth of resources at Stanford and the Silicon Valley to consider the word 'cure' as well as 'care' in relation to spinal cord injury," he said.

Steinberg has set out to make the umbrella program a nexus at the intersection of basic scientists, clinicians, industry and the patients themselves. He envisions the program bringing together Stanford's unique combination of strong clinical and basic research components to make the effort a national leader in clinical trials of therapies and devices for people with spinal cord injuries.

The core of the group will be scientists and clinicians from the School of Medicine, Stanford Hospital & Clinics, the Palo Alto Veterans Affairs Health Care System and Santa Clara Valley Medical Center. Steinberg is also actively recruiting a researcher who specializes in rodent research models of spinal cord injury.

An integral part of the program is bringing patients into the loop when setting priorities for research directions. In the first of a series of campus seminars linking patients to the research that applies to them, Creasey invited Amanda Boxtel, a patient from Denver who was paralyzed from the hips down from a skiing accident. Creasey consulted on her case to restore her bladder function with electrical implants.

When Boxtel spoke to an audience in the Clark Center auditorium in April, she presented her case with raw emotion, crying as she described the impact of gaining control over her intimate body functions and sexual function.

That anguish was precisely what Creasey wanted to emphasize. "Part of the intention of inviting her was to introduce the patient to the researchers, to put a human face to the problem and see what her priorities are," he said.

But the other half of the equation was to help patients like Boxtel understand what researchers want to know. In her case, that included her experience traveling to India to get a stem-cell infusion therapy she thinks restored some sensation and function to areas previously paralyzed. Reports of that kind of experimental therapy have generated intense controversy among doctors who question its value.

"We're trying to bridge these communities," said Creasey. "It's a two-way street." Creasey said he hopes to spark creativity and collaboration through these types of seminar series and other campus events that will bring together disparate groups.

He and Steinberg are excited about what the future may hold. "The 'repair' part of the Spinal Cord Injury and Repair Program refers to things like stem cells," Creasey said. "We are not limited to stem cells, though," he added. The program could study the possibility of using cells or drugs or a combination with surgery to create the conditions for some repair, as well as other interventions to improve quality of life here and now. Advances in spinal nerve stimulation techniques and neuroprosthetics, including computer-brain interface devices, will also be developed as therapeutic strategies.

"We will take baby steps," said Steinberg. "Right now we would be happy to improve the current lifestyle of spinal cord injury patients."

Creasey summed up the outlook by saying patients can benefit from technologies available now, but he hoped there would be more options in the future. "We can offer patients bread today and jam tomorrow," he said.