When he was flung off his
horse during training,
competitive jockey
Mr Sam Subian fractured
his spine and was told
he would never stand
or walk again. He was devastated. That was
six years ago. Now, thanks to an implant and
a whole lot of hard work and determination,
Mr Sam is starting to walk again.
The implant and intensive rehabilitation
programme he underwent were part of
RESTORES (restoration of rehabilitative
function with epidural spinal stimulation),
a clinical trial conducted by the National
Neuroscience Institute (NNI), Tan Tock Seng
Hospital (TTSH), and the Agency for Science,
Technology and Research (A*STAR). It is the
first of its kind in the region.
“It took me a while to accept my situation.
Just as I was coming out of a low point, I
was told about the trial. I didn’t hesitate at
all to sign up,” said Mr Sam, who is the first
of three participants in the trial. All three
suffered complete spinal cord injuries.
When the spinal cord is damaged,
transmission of electrical signals to and from
the brain is disrupted. “Depending on which
part of the spinal cord is severed, patients
will not be able to move their arms and legs,
or have any sensation below the level of the
injury,” said Dr Wan Kai Rui, Consultant,
Department of Neurosurgery, NNI.
Together, NNI and TTSH treat about
100 new cases of spinal cord injury a year,
and about 95 per cent of them with severe
injuries show no neurological improvement
five years after their injury. But having an
implant — an electrode placed on the surface
of the spinal cord near the damaged area —
can help patients overcome this.
“The spinal cord stimulator helps bridge
the damaged part of the spinal cord and
boost signals from the brain to the muscles
by tapping residual pathways that are
still viable,” said Dr Wan, who is also the
principal investigator of the trial.
However, the implant alone is not
enough; rehabilitation is also vital.
Prior to the implant operation, Mr Sam
underwent one month of twice-weekly
rehabilitation to strengthen his limbs and
core. After recuperating for a month postsurgery,
he was back again for rehabilitation
five times a week for seven months.
In the past, patients with spinal cord
injuries also underwent rehabilitation,
but it was mostly to help them cope with
their disability. “What we are doing now is restorative rehabilitation, where we are
actually working on restoring function,”
said Dr Valerie Ng, Consultant, Department
of Rehabilitation Medicine, TTSH, and
co-principal investigator of the study.
Various techniques of rehabilitation
were used in this trial. These included
motor imagery, where patients imagine a
movement although they cannot actually
perform the physical movement; truncal
rehabilitation and an advanced robotic
exoskeleton, where patients use a suit to
hold them upright and ‘walk’ the legs so that
their dormant muscles can be reactivated.
By recording and analysing signals from
the muscles, researchers noted a significant
improvement in nerve function and muscle
activity in these patients.
The second participant, financial adviser
Mr Asyraf Ghazali, was in a road accident five
years ago. Just like Mr Sam, he was paralysed
from the chest down. “I was not ready to
accept it and was continuously looking for
treatments to help me walk again,” he said.
Although Mr Asyraf found one in
Thailand, they were not accepting patients
with complete impairment of the spinal cord.
“So the moment I was offered the opportunity
to be on the clinical trial, I jumped on it,”
he stated. Mr Asyraf received his implant in
Standing and walking on
their own two feet again
March 2023, a month after Mr Sam.
The third participant, a woman, had an
electrode implanted in January 2024.
Both men were up and taking their
first steps and walking within a month of
starting rehabilitation. “But because they
have not walked for so long, we had to work
on strengthening their muscles during the
remaining five to six months so that they
can support their own weight and be off the
safety harness,” added Dr Wan.
While they are able to move, they cannot
feel themselves moving and were therefore
initially sceptical. “I just put the movements
down to spasms. But as the rehab progressed,
the greatest thing was to see movements I
didn’t think were possible,” said Mr Asyraf.
With the success stories so far, the
multidisciplinary team intends to move into
the next phase of the trial with about 15
patients. “We will be looking at those with
paralysis from the neck down. We hope that
the electrode stimulation can also help with
functional improvement of their arms,”
shared Dr Wan.
For Mr Sam, his experience has
shown him that what appears to be
an irreparable situation can still
turn around. “Hopefully, this will
inspire others to not lose hope.”
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