Although the auditorium was only half full, perhaps because of the good weather, the personal interest of those present at the event “Rehabilitation after Paraplegia”, was clearly evident. Many who were directly affected, their relatives or those professionally involved with paraplegia, made their way to Zurich university. The audience was given a most comprehensive insight into the research and possible therapies after a spinal cord injury. At the same time, however, the presentations never lost sight of the experience of those affected. After giving brief individual presentations, a group of experts comprising a researcher, two rehabilitation specialists and a directly affected paraplegic was available to the public for questions and discussions.

Regrowing nerves for paralysis patients

The series of presentations was opened by Professor Martin Schwab, Neurobiologist at ETH Zurich and Zurich university. He again described the research studies showing that although the nerve fibres of rats attempt to create new connections after injury to the spinal cord, they were prevented from growing by the inhibitor Nogo-A. When the researchers blocked the action of Nogo-A with an antibody, the nerves grew again and formed new connections. Paralysed rats were able to move better as a result. When Schwab mentioned that the antibody had now also been tested on 20 paraplegic persons in initial clinical studies, this aroused great interest and raised many questions from the public.

What aroused most interest was whether there were any initial successes to report with the new antibody therapy. The neurobiologist’s comment in this respect was rather reticent. He expressed the view that the main purpose of the experiments was to show how well the antibody was tolerated by patients. He said it was still much too soon to make predictions about the growth of human nerves. However, according to Schwab, since no side-effects of the new therapy had occurred up to now, he was confident that initial results would be obtained in the next few years. If it turned out to be possible to rebuild some nerve connections by using this antibody therapy, it might be possible to recover a large degree of movement.

Rehabilitation in the clinic and at home

Martin Schubert, consultant neurologist at the Balgrist Paraplegics Centre, showed the rehabilitation methods that already exist today to train the potential of a few such nerve connections. Such training allows patients with an incompletely severed spinal cord to regain part of their ability to walk. However, this involves a very expensive and lengthy process in which walking has to be relearned with the help of numerous therapists and exercise machines.

Martin Schwab, ETH Zurich Professor for neurobiology, described initial clinical experiments in which promising antibodies to treat paraplegics were tested. large

However, merely regaining physical functions is not always what is uppermost in the minds of paraplegics during a rehabilitation course. Claudia Rudhe-Link, ergotherapist at the Balgrist Paraplegics Centre, explained that successful rehabilitation should also include the mental well-being and environment of the patients. Thus one cannot say that rehabilitation has been successful until the paraplegic sees a meaning or purpose in life again and is integrated into an intact social environment. Rudhe-Link expressed her regret that these emotional and social factors are very often ignored by outsiders and funding providers.

The fight back to a normal life

Christian Wenk, a doctor at the Bülach hospital and himself a paraplegic, stressed that rehabilitation involves more than just bodily functions. For him the real rehabilitation starts at home, when one must be self-reliant and constantly find ingenious new ways to cope with simple everyday problems. Wenk’s presentation gave an impressive report of his personal experience in dealing with paraplegia. He also described the hopelessness that engulfed him immediately after the accident. This was despite the fact that at the time of his accident he was already extremely knowledgeable about the numerous therapies for paralysis patients, having gained his doctorate degree in neurobiology with Martin Schwab.

He says the best way to climb back out of the abyss after paralysis is to concentrate on one’s remaining strengths and capabilities, and to set realistic aims. Wenk explains that “It means learning to be happy even at small things like being able to put on a T-shirt or tie one’s shoelaces.” However, since Christian Wenk’s spirited talk about rehabilitation scarcely left any room for bad days and disappointments, listening to it occasionally made one ask oneself what could be achieved by those patients who do allow themselves to be discouraged by a set-back, because not every paraplegic is a born fighter like Wenk.