Megan Gill

Matt introduces her: Our next speaker is Dr. Megan Gill from the Mayo Clinic. A couple of weeks ago there was an explosion of press about her work, along with that of researchers from the Louisville lab. This is the epidural stimulation all your friends have been talking about.

Matt’s reminder: If it’s not clear from the program, right after this there will be a moderated panel discussion to revisit all three of the scientific presentations from this morning. And after that, some time for your individual tables to discuss, followed by one more moderated panel.)

Megan: I don’t have a computer! (some sort of technical glitch) I’ve been a physical therapist for the last 15 years, and I’m here to talk about the PT element of epidural stimulation studies. (Boy, is she game! Full of energy, in a really good way.)

If you’ve been living in a hole you might have missed the media frenzy that’s been occurring. She’s showing a bunch screenshots from the press.

What I’m not going to do is tell you what the press is saying. I’m going to tell you what people have been experiencing.

First, what is epistim? It’s a set of electrodes that sit outside the cord and send very small signals into the cord itself.

What’s motor activation? single joint activation, which can lead to synergistic movement, where individual motor units synchronize.

This is about mobility .. standing, stepping, walking.

Back in 2011 the Louisville team published a paper in Lancet that showed how epistim created voluntary movement in a patient’s legs while he was supine. Shows a video of a pair of naked feet. The patient is isolating his right big toe, rhythmically. New video, same process with his right ankle.

The idea is that you can have motor activation (single muscles) that leads to synergy, where whole groups work together to get you somewhere. So, they’ve been mapping the motor recruitment process to show exactly what gets activated when exactly what is stimulated.

(Reminder: this is not stimulation of muscles. That would be easy. This is activation of neurons themselves, inside the cord.)

Frequency of stimulation is one of the parameters. She’s showing exactly how this works … from the therapist standpoint. You go from lying down to standing to stepping. Low frequencies are needed for stationary standing and higher ones for stepping.

Shows a video that was part of their Louisville replication study — which took them a week. Unheard of. One week!

The video is of a patient lying on his side with his right leg suspended in a red sling. He’s voluntarily making a stepping motion. When they turn up the intensity of the stimulator, he can make it go faster. He can also stop when asked to.

Now showing data from a 2015 Louisville paper about how sit to stand works in two different patients. Their data showed that patients had trouble doing both.

Back to their own patient. It was time to see if his ability to make stepping motions was intact when he was upright and not lying down.

Her question as a PT was the one we all want to know: What’s a PT supposed to do with a patient who has a stimuliator?

They created what they call Multi modal rehab. It includes treadmill, horizontal, overground, everything they could think of. They focused on task-specific training. They saw a progression on treadmills. Shows a series of videos, ASIA A/B injury.

Starts with a body-weight supported person and two therapists doing all the work. A year later, no therapists. Followed by overground walking … the gist of all this is that the Louisville data showed that stand training interfered with step training and vice versa. They didn’t know that, so they went forward as if it hadn’t worked that way — and didn’t see that effect.

Great talk, lotsa intensity.

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