As you’ll probably know, Miami is a vibrant city situated in America’s “sunshine state”, Florida. With miles of beaches and numerous restaurants and shops, it’s a place where the rich and famous frequent and often mingle amongst visitors from all over the world. The city is also home to The Miami Jewish Home and Hospital (The MJHH) and although not top of most peoples list of places to visit whilst in Miami, for Marrianne it was the sole reason to make the 9 hour flight from London. The MJHH is where the laboratories of The ‘Brucker Biofeedback team are housed. Devised after a life time of study by the late Professor Bernard Brucker, in short - Bio-feedback is a sophisticated machine designed to measure the neurological connection between the brain and muscle. In 2007 we paid our first visit to Miami.
The Bio-feedback programme isn’t exclusive to Miami, but Profersor Brucker’s knowledge of spinal injury is renowned and his years of scientific study mean the evidence of how the body continues to repair itself long after a spinal injury has occurred is leading the way forward. This knowledge means he comes highly recommended by many patients.
You can’t argue with scientific proof!
The Brucker Clinic is actively canvassing for the clinical world to stop giving people with spinal injury the prognoses that they will never improve beyond the first year or so of their recovery. Science has proved that the brain will continue to try and connect with muscles for years after an injury, but because the ‘new’ signal to the muscle often begins too weak for actual movement – people/doctors can’t gage how much recovery their body has made and therefore presume it’s zero. Of course, everybody is different and some will recover more than others, but many with SCI give up trying because they aren’t aware of any recovery to try and build on. This is why many who are told by the clinical world “you will never move x and y again” prove their doctor right! Had they known that their brain had reconnected with certain muscles groups – things might have been very different.
Knowledge is key
We were lucky enough to meet Professor Brucker in the summer of 2007. His knowledge of spinal injury and the body was immediately apparent and way beyond that of us “mere mortals” to understand. However, he did break things down and explain things impeccably. He began by explaining that bio-feedback is by no means any kind of miracle cure and isn’t a replacement for any kind of therapy you currently do. In its simplest form, it is a way of gauging the body’s natural recovery. The physio team at the MJHH work with any neurological signals that particular muscles might have, to try and increase the signal as much as possible towards a full 100%. Once 100% is reached for that muscle – their work is done. The patient then has to go away and strengthen that muscle to match its neurological connection.
Ie; if you have 100% neurological connection to your bicep but no movement, this is because of poor muscle strength. You then have to physically work at strengthening the muscle to match the 100% connection. Then, the bicep will be as before the injury.
Any muscles found with less than 100% neurological connection are worked on for a couple of days to try and increase the percentage registered. After this time the connection would have peaked and if it hasn’t reached 100%, is unlikely to get any higher than its current reading until more repair has occurred in your body. These muscles will therefore be measured again in 12 months, during which time you must exercise to ensure muscle strength percentage matches any neurological connection found.
Professor Brucker also concurred with our view – a view that all tetraplegic people will identify with - that it isn’t a case of either being able to walk or not; any new muscle movement that you can regain can make a world of difference to your quality of life. Whilst walking is the ultimate goal, there’s a lot to achieve along the way. He also stressed that any muscle groups that measures zero now, will not necessarily stay at zero forever…….it’s simply impossible to predict.
Once fully briefed on bio-feedback, the hard work begins for Marrianne. A 3 week programme is set out and during each day of the programme, the physios work on a different muscle group/re-visit previously tested groups to see if they can improve on the initial connection made.
- Starting at the top, the team work their way down the body.
- Pads are fitted to the particular muscle group being tested and wired up to the computer. Marrianne is then encouraged to try and move that particular muscle group.
- On the screen there is a line and a scale, the more connection you have – the higher the line goes. The line can move without your actual muscle feeling as though it has moved as it’s the neurological connection being measured, not movement.
- Because the pads are placed to isolate specific muscles, there is no way of cheating. (i.e using other muscles that do work, instead of the ones that don’t!)
- The areas worked on fatigue very quickly, so attempts per day are limited.
- Recovery starts at the top and works its way down. It is therefore not uncommon to have greater reading on the upper extremities and zero on the lower extremities during your first visit.
- Once a neurological connection has been made to a muscle, you don’t lose it.
Of course, we all hoped that Marrianne would get good results but we were also prepared for a few zeros, which many people receive (although they may not always be zero) Thankfully, Marrianne had a neurological connection to all of her muscles. Some on the lower extremities were very low (2 – 3 %), whilst parts of the upper extremities started at 8% and went back to a normal 100%. (To have normal function again, Marrianne now has to physically work on muscle growth for these areas) The team, like us, were over the moon with Marrianne’s readings. Professor Brucker informed us that there are only a very few percentage of people with Marrianne’s level of injury who have readings all over their body. (He even took a few pictures of Marrianne because he was excited about the future… and as we all know, Marrianne loves the camera!)
The whole Miami trip was a very positive experience for us and the bio-feedback helped to reiterate our positive thoughts for the future.
We have since returned on three occasions and March 2011 will see us make our forth trip. The progress can been seen on the second Miami link. Everyone on the bio-feedback team is great and very encouraging and we look forward to seeing you soon.
This clip gives an example of how the process works.