Sarah Service, right, with her mother, Beverly Carter-Service, center, and Susan Harkema, director of rehabilitative research for the Kentucky Spinal Cord Injury Research Center and director of research for the Frazier Rehabilitation Institute, operated by the University of Louisville. For more than a decade, Service has been participating in experimental treatments designed by Harkema and her teams based on scientific breakthroughs in therapies for spinal-cord injuries. Harkema, who also is director of the Christopher and Dana Reeve Foundation’s NeuroRecovery Network, hopes to bring new therapies to the clinical level to improve the quality of life for all people with paralysis. (Staff photo by Phyllis McLaughlin/pmclaughlin@madisoncourier.com)
Sarah Service, right, with her mother, Beverly Carter-Service, center, and Susan Harkema, director of rehabilitative research for the Kentucky Spinal Cord Injury Research Center and director of research for the Frazier Rehabilitation Institute, operated by the University of Louisville. For more than a decade, Service has been participating in experimental treatments designed by Harkema and her teams based on scientific breakthroughs in therapies for spinal-cord injuries. Harkema, who also is director of the Christopher and Dana Reeve Foundation’s NeuroRecovery Network, hopes to bring new therapies to the clinical level to improve the quality of life for all people with paralysis. (Staff photo by Phyllis McLaughlin/pmclaughlin@madisoncourier.com)
If there’s a new research trial in the queue that might help people with spinal cord injuries, Sarah Service is ready to sign up.

The Worthville, Ky. resident suffered spinal cord and brain injuries in a car accident in 2002, which left her confined to a wheelchair at the age of 16. Since 2005, she’s been working at Frazier Rehabilitation in Louisville with Susan Harkema, Ph.D., head of the Kentucky Spinal Cord Research Center.

Service’s personal goal is to walk again, but she has been involved in several experimental trials hoping to help researchers figure out how get her there and, in turn, help others in her situation.

For several months last year, Service was in a grueling program focused on locomotion – standing and walking. For one hour a day, five days a week, she was strapped into a harness that suspended her above a treadmill. Physical therapists helped her maintain her posture and “walk” on the treadmill by moving her legs and feet for her – in the way she would move, were she doing it on her own.

The goal was to reteach her muscles and her spinal cord how to move again.

On Friday, Service was working with physical therapist Erin Nalle and two researchers in another experimental trial involving a neuromuscular electrical stimulation.

During the treatment, electrode pads are secured at several locations on both of Service’s forearms. Therapists on each side help her go through two sets of 90 repetitions, lifting her arms up and stretching them in front of her. They also help open her fingers, which generally are curled in toward her palms because of lack of muscle tone.

During every other repetition, the electrodes are used to stimulate her muscles, Nalle explained.

Nalle, who left the University of Kentucky to join Harkema’s team, was involved with in-patient rehabilitation there for five years, focusing on individuals who had suffered strokes and other brain injuries.

“I was drawn to the research,” she said. “I had seen electronic stimulation work (with her patients at UK) and I believe in what they are doing. ... I’ve not seen anyone not get positive results. Every patient I’ve worked with has seen huge gains in their strength.”

The treatment has clearly strengthened Service’s forearms and her hand muscles, Nalle said, adding that at the beginning Service had only been able to do 15 to 20 reps at a time.

Indeed, Service, who had learned to crochet before the accident, has been able to take up the hobby again. And as soon as she started, Service said, her brain kicked in and she could remember what she had learned all those years ago.

“Once she started doing it, it didn’t take long to refresh her memory,” said her mother, Beverly Carter-Service. “She’s just so determined.”

“It’s not walking, so I don’t really give myself any credit,” Service said with a frown.

Still, her mother and her therapists are very pleased with her progress.

“It just continues to get better, little by little. When she was first hurt in 2002, she couldn’t pick up a potato chip. Now she can pick up her nephews,” Carter-Service said. “It’s like a snail going (from Carrollton) to Louisville. It goes very, very slowly, but she keeps getting better and better.”

When asked if she’d reached the Gene Snyder Parkway or the Watterson Expressway, Service balked. “I’m at Zorn.”

“The snail is almost there,” her mom agreed.

Goal is to make new therapies routine

Harkema, who was recruited 10 years ago from UCLA to the University of Louisville and Frazier Rehab, also is director of the Christopher and Dana Reeve Foundation’s Neurorecovery Network, overseeing about eight other research locations nationwide that are working toward understanding the fundamental mechanisms of human locomotion.

Harkema had worked with Christopher Reeve, the actor who was a staunch advocate for spinal cord-injury research until his death in 2004. Known for his role in “Superman,” Reeve became a quadrapelegic after he was thrown from a horse in 1995. He required a wheelchair and a portable ventilator for the rest of his life, but he was committed to speed up research and get it to more ordinary folks who also suffered spinal cord injuries.

During the past 10 years, each of the clinics involved in the Neurorecovery Network tests out the same clinical interventions, or therapies, designed to help improve nerve function, Harkema explained. “We took very quantitative measurements to see how the intervention improves function or health in people, so we can learn what types of patients (to target), how much they recover, how many sessions (are needed).”

While she’s still not standing or walking on her own, the work done by Service and other participants is invaluable.

“Sarah has made big gains, in my perspective,” Harkema said. “She went from not being able to sit up independently or (maneuver) her own wheelchair and can do both those things now. She was able to stand a little bit; she got a lot stronger, overall. I remember in the beginning, she wasn’t using her arms very much.

“She’s a great example of how our program is working. As we learn more, we can bring people back (to Frazier) and try the new discoveries we have found.”

The neuromuscular electrical stimulation therapy is one example. “We reached a point where we thought we had a good standardized therapy that we could move into the clinic, and that’s what we’ve been doing with Sarah most recently. And word on the street is that she’s been able to do things that she hasn’t been able to do in about a decade.”

Those things include crocheting, drawing and tying her own shoes.

“It took me awhile to remember how to tie my shoes and crochet, but once I started, it’s like my brain remembered how to do it,” Service said. “So my brain is close to remembering how to walk again, so I just need to practice more.”

“That’s the whole idea,” Harkema said. “Our theory is that the neurosystem is plastic, a lot of moving is really controlled at the spinal cord level (rather than the brain) and a lot of that is driven by the information coming from the environment. So, the cord is interpreting that, plus signals from the brain. At some point, there’s a decision by the spinal cord to do something, and the more often you do it, you memorize it not just in your brain but your spinal cord.”

She likens it to a chicken that continues to run after being decapitated. “They don’t have a brain, but they can still run,” Harkema said. “The same thing happens in humans. ... If we can understand (those control mechanisms,) we can drive them to become more functional.

“One of the things that’s most powerful about what we see with Sarah is ... here she is 14 years (after the injury) and a new intervention can still help her recover her nervous system even today.”

What’s most important for people to know “is that there’s new knowledge that can help people with paralysis ... and it should reshape our thinking about what therapies are available to people, especially those who have been injured for many years, and what should be reimbursed by healthcare providers,” Harkema said. “If individuals can become more independent and be able to even stand, then their health issues are going to be much less, which overall will be less healthcare costs” and costs associated with day-to-day personal care, as well as improving their quality of life.

While she is thrilled by the progress being made through all the research being done on spinal cord injury, she said she misses the program’s biggest cheerleader – Reeve.

“He did make a big difference about awareness,” she said. “It is with great disappointment that he is not here to see how we’ve progressed. Because where we are today is, in great part, because of him and Dana.”