Rehabilitation outcomes following autologous human stem cell transplantation in a chronic complete C4 tetraplegic - the first 12 months: A case report

Abstract

Autologous Human Stem Cell Transplantation (AHESC) is emerging as one of several promising new cell-based treatments for chronic spinal cord injury (SCI). Since chronic SCI is generally deemed irreversible, treatment paradigms for post-intervention rehabilitation after many years of disability are limited, and a description of the impact of such intervention on the patients is hard to find. Here we describe, for the first time, the multi-disciplinary post-operative rehabilitation and outcome of a patient with chronic cervical SCI after autologous human embryonic stem cell transplant. We include the anatomical, physiological, functional and quality of life outcomes. METHODS: A 33 year old male, American Spinal cord Injury Association (ASIA) Grade A, C4 chronic SCI patient received glial scar resection and Autologous Human Embryonic Stem Cell (AHESC) transplant, 6 years after injury, and thereafter had intensive interdisciplinary rehabilitation comprising occupational, biokinetic and physiotherapy, for an average of 17 hours per week over the course of 12 months. Outcomes were measured with standardised outcome measures of physiological improvement, increased independence, and a questionnaire was designed to gain understanding of the changes in quality of life and well-being of the patient, from his perspective RESULTS: The patient progressed from ASIA Grade A to ASIA Grade C, over the first 12 post-operative months. Sensory recovery comprised awareness of deep pressure and light touch in all dermatomes, with accurate localisation to L1. Motor activation was restored to all major muscle groups of the right upper limb, and to a lesser extent in the left upper limb, with some recovery in thoracic, abdominal and spinal muscles. Gains have been made in areas of motor, sensory and vascular function, self-care, wheelchair use and safety, and leisure participation. The patient has found these changes meaningful in terms of quality of life CONCLUSION: Regenerative medicine approaches may create rehabilitation potential where none formerly existed, presenting unprecedented challenges to rehabilitation therapists. Our experience demonstrates the value of intensive multi-disciplinary rehabilitation programmes in this setting, and provides a template for functional restoration and retraining after many years of chronic disability. It also emphasises the need to debate the ethical questions surrounding the application of such interventions and highlights the impact that participation in rehabilitation can have on a patient's perception of quality of life and health status. Key words: Human therapeutic cloning, autologous human embryonic stem cells, spinal cord, spinal cord injury, quadriplegia, motor rehabilitation, motor retraining, mirror therapy, quality of life

Review of the Current Knowledge on the Role of Stem Cell Transplantation in Neurorehabilitation

“…For the vast number of diseases and injuries that affect the nervous system, currently the most effectively used rehabilitation methods are the PNF concept, the Bobath method, and biofeedback. For spinal injuries, the patient's rehabilitative status could also be improved by restorative neurology and regenerative medicine (stem cell transplantation) [ 62 ]. These rely on improving residual functions through selective structural or functional modifications of insufficient neurocontrol according to the underlying mechanisms and clinically yet unrecognized residual functions [ 63 ].…”

“…In humans, there is one leading report concerning a complete rehabilitation program (initial, postinjury/adaptation, and posttransplantation) in a chronic complete C4 tetraplegic [ 62 ]. The patient received postinjury treatment, which was provided over a period of three months, consisting of 60-minute sessions with a student biokineticist twice weekly.…”

“…These sessions included training on an active-passive upper limb trainer and passive-assisted weight training using a pulley system. The detailed rehabilitation schedule for the first 56 weeks following autologous human stem cell transplantation (AHESC) has been described [Table II in [ 62 ]].…”