Повреждение спинного мозга – не приговор

Повреждение спинного мозга – не приговор

Четыре года назад молодая американка Келли Томас очнулась в одной из больниц Флориды и поняла, что автомобильная авария отняла у нее возможность ходить. Но очень активная до этого момента студентка, принимавшая участие в ежегодных родео, не стала унывать и решила перебраться на год в штат Кентукки, где приняла участие в новом экспериментальном исследовании, которое, она надеялась, заново научит ее поврежденный спинной мозг ходить.

В феврале этого года, нейрофизиолог, проводящий с Томас занятия по физподготовке и помогающий девушке переставлять ноги, в то время как та держится за ходунки-опоры, в какой-то момент просто отступила от своих обязанностей.

«Что вы делаете?», — взволнованно спросила Томас.

«Сама шагай», — ответила тренер Ребека Мортон. – «Я тебе больше не нужна».

Томас на мгновение заколебалась, но затем сделала свой первый самостоятельный шаг, затем еще один, а затем просто замерла в изумлении.

«Я не могла поверить тому, что происходит. Я так усердно работала эти четыре года. Этот момент стал для меня очень эмоциональным», — рассказывает Томас.

Сейчас девушке 23 года. Она, как и несколько других людей, получившие травмы спинного мозга различной степени тяжести, теперь может стоять и делать несколько шагов. При этом в ее случае, она может делать это без какой-либо помощи — все благодаря новой экспериментальной терапевтической методике – комбинации нового нейроимплантата и множественных физиотерапевтических занятий.

В клинических испытаниях новой методики лечения, использованной специалистами Луисвиллского университета, Томас и трем добровольцам врачи имплантировали специальные устройства, стимулирующие работу спинного мозга слабыми электрическими разрядами. В купе с физической терапией, продолжавшейся в течении нескольких месяцев, это дало удивительные результаты.

Журнала New England Journal of Medicine сообщает, что новый экспериментальный метод лечения вернул двум добровольцам возможность стоять и делать ограниченное количество шагов, а еще двум – Томас и другому пациенту, Джеффу Маркису – возможность самостоятельно ходить. Исследование спонсируется местным благотворительным фондом, Больницей университета Луисвилля, а также производителем нейроимплантата, компанией Medtronic.

Об аналогичной методике лечения и результатах также рассказывается в журнале Nature Medicine, где описывается успешный случай ограниченного восстановления моторных функций у пациента с поврежденным спинным мозгом врачами клиники Майо в Рочестере (США).

«История исследований повреждений спинного мозга – это более 50 лет клинических испытаний, различных методик, не показавших никаких существенных положительных результатов», — комментирует нейрохирург Дэвид Дэрроу из Медицинской школы Миннесотского университета, не принимавший участие в описываемых исследованиях, но за свою карьеру уже имплантировавший пациентам с поврежденным спинным мозгом спинномозговые имплантаты-стимуляторы.

«С этих случав начинается новая эра».

Дэрроу поясняет, что к новой методике есть множество научных и медицинских вопросов. Например, в исследовании принимало участие лишь несколько пациентов с травмами разной степени тяжести, поэтому пока сложно сказать, насколько эффективно новая методика будет показывать себя в более массовых случаях. Кроме того, не до конца понятно, как эта технология работает, что в свою очередь должно лишь усилить интерес большего числа специалистов к проведению аналогичных исследований. Но в целом, говорит специалист, метод доказывает состоятельность идеи, разработанной еще несколько лет до начала описываемых клинических испытаний на пациентах-людях.

Электростимулятор, который использовали исследователи, изначально был предназначен для совсем других вещей, в том числе подавления хронической боли. Тем не менее курс реабилитационных процедур, в рамках которых пациентов учат стоять и восстанавливать частичный контроль за движением ног, действительно показывает свою эффективность.

Сьюзан Харкема, научный руководитель Кентуккского исследовательского центра травм спинного мозга при Луисвиллском университете, первой применившая данную методику восстановления моторных функций на людях отмечает, что устройство имплантируется прямо под местом травмы. В этом случае речь не идет о восстановлении поврежденных волокон спинного мозга у пациента. Ученые обратили внимание на то, что даже при самых серьезных повреждениях спинного мозга часть нервных волокон остаются нетронутыми. Эти цепочки нейронов не задействованы в работе двигательной системы организма, однако их можно переключить на выполнение новой задачи. Электростимуляция этих нейронов и особые тренировки в специальном экзоскелете позволили в ранних эксперементах на крысах почти полностью восстановить подвижность лап грызунов после частичного перерезания позвоночника. Позже ученые провели аналогичные опыты на обезьянах.

«В основе этой работы лежат эксперименты, которые показывают, что позвоночная схема очень сложна и в некоторых случаях, в контексте данного исследования, имеет аналогичные свойства, присущие мозгу, показывая возможность при подходящих условиях переобучаться на выполнение новы задач», — комментирует Харкема.

Но это далеко не так просто, как может показаться на первый взгляд. Добровольцам, принимающим участие в исследовании, до начала эксперимента дали два месяца на самостоятельные интенсивные сеансы физиотерапии и тренировки. Таким образом ученые убедились, что обычным способом моторные функции восстановить не получится. После этого людям в ходе хирургической операции имплантировали электростримуляторы, а затем снова возобновили ежедневные физические тренировки, с помощью которых, мозг пациентов буквально заново учили ходить, шаг за шагом.

По словам Томас, поначалу это было очень неинтуитивно: девушка мысленно давала мозгу такие команды, как «подняться», «переместить вес», «поднять колено». Тем не менее правой ногой двигать она начала самостоятельно уже на третий день после проведенной операции. Для левой ноги процесс обучения занял более продолжительное время.

«Сначала это было очень сложно. Я не могла ни с кем говорить, не могла ни на кого смотреть. Я должна была полностью концентрироваться только на своем теле. Теперь же я могу и ходить, и говорить. Теперь это требует не таких чудовищных усилий, как было изначально. Это по-прежнему нелегко и не совсем естественно, но уже гораздо проще», — отмечает пациент.

Выписавшись из больницы Томас продолжает ежедневные тренировки уже самостоятельно. Она постоянно возит с собой опору-ходунок, пульт, позволяющий управлять электростимулятором и часто ходит, заставляя спинной мозг привыкнуть к новой для него функции.

Повреждение спинного мозга – не приговор

Специалисты клиники Майо в Ротчестере получили аналогичные результаты при использовании данного метода в эксперименте с участием 29-летнего добровольца, парализованного в результате падения с горного велосипеда в 2013 году. В результате перелома позвоночника он утратил возможность ходить, при этом контроль над руками и другими частями тела сохранился.

Два года назад, отмечает глава исследования Кендалл Ли, хирурги имплантировали набор электродов в поврежденную часть спинного мозга. Когда они прижились, ученые начали проводить с молодым человеком ту же серию физических упражнений, что и с Томас, заново обучая его мозг управлять движением ног.

Всего через две недели доброволец научился самостоятельно стоять и совершать произвольные движения ногами, находясь внутри экзоскелета. Более полная реабилитация, после которой мужчина научился самостоятельно ходить без помощи этого устройства и физиотерапевтов, потребовала еще 44 недели тренировок и упражнений.

Повреждение спинного мозга – не приговор

Сейчас, по словам Ли, их подопечный может самостоятельно стоять на месте, ходить по беговой дорожке, опираясь на поручни, и передвигаться на сотни метров без помощи медперсонала, используя ходунки. Новые стимулирующие программы и методики реабилитации, как надеются ученые, помогут пациенту ходить быстрее и перемещаться на более дальние расстояния.

«Важная особенность данной технологии заключается в том, что она способна вернуть функциональный контроль над конечностями, возвратить возможность стоять и ходить без какой-либо помощи. Эта технология действительно способна дать паралитикам надежду на возвращение моторных функций», — комментирует Ли.

Исследователи отмечают важность проведения более массовых испытаний методики на большем количестве пациентов, а также указывают на необходимость разработки отдельного специализированного устройства, а не использование стимулятора, который изначально был разработан совершенно для других целей. Кроме того, специалисты отмечают необходимость расширения возрастной выборки. Возраст всех участников нынешних экспериментов составлял от 20 до 30 лет. В большинстве же случаев, говорят специалисты, повреждение спинного мозга наблюдаются у людей более старшего возраста, поэтому неизвестно, как эта методика подействует на них.

Обсудить достижение нейрофизиологов можно в нашем Telegram-чате.

Источник: news-ria.ru
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