The University of Southampton

Author: Thomas Harris

Learning to Walk Again: Orthoses for Spinal Cord Injury

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Spinal cord injury (SCI) can impair an individual’s ability to interact with the physical world. As a nerve pathway to and from the brain, the spinal cord plays a crucial role in muscle control. In 2014, my mum suffered an incomplete SCI following a cycling accident, leaving her partially paralysed from the waist down.

https://www.spinalcord.com/incomplete-spinal-cord-injury

Attending the workshop ‘Practical Prostheses’ opened my eyes to the world of prosthesis and orthosis. We categorised devices as either replacements (prostheses) or modifications (orthoses) of different body parts. At the time, my mind wandered to the devices my mum used during her recovery. I remember being torn how some of her devices would be categorised.

I then realised how I have been quite ignorant to the importance of my mum’s orthotics. I had been viewing them simply as objects, without considering the ingenuity behind their design, or their significance to my mum. I took it upon myself to take a deeper dive into spinal orthoses.

Orthotics for SCI – Examples

Typically, orthotics for SCI are external devices, which support the spinal column during rehabilitation. They also are used to position or enhance the function of a hand, arm, or leg. Below are some examples (click the arrows for more).

Spinal Brace

Generally, a spinal brace immobilises the injured spinal segment, allowing the tissues to heal. My mum’s injury was thoracic (T4-T6 vertebrae), and thus her brace was a Cruciform anterior spinal hyperextension (CASH) brace (right). This brace limits the flexion from T6 to L1, but not lateral bending and rotation.

I feel that this highlights the importance of compromise when it comes to designing orthotics – one should only limit what is necessary, to ensure the best wellbeing for the patient.

https://www.chaneco.co.uk/product/cash-brace/

Ankle-foot Orthosis (AFO)

AFOs are particularly useful for patients who still retain a level of ambulation. They assist the ankle and allow the foot to clear the ground during the swing phase of walking. The particular model my mum uses (TurboMed XTERN) is shown below.

My mum’s AFO…
…in action

Below is a video from TurboMed which puts the importance of this orthotic into perspective:

Spinal Implants

Spinal implants following an SCI promote host tissue regeneration and nerve plasticity and reconnection. These can help to recover some muscle function. Following her accident, my mum had surgically implanted titanium rods to stabilise her vertebrae, allowing the facet joints to heal. Her X-Ray is shown below.

I mentioned earlier that I struggled to categorise some of my mum’s devices, and this one is no exception. I have concluded that her rods are orthotic, since they modify rather than replace the damaged vertebrae (I encourage discussion in the comments if you disagree!).

My mum also had a bone graft from her iliac crest. The lecture on orthopaedic implants highlighted a the INfuse device for lumbar spinal fusion. I was curious as to whether INfuse would be used in this operation today, rather than a bone graft. Researching further revealed that INfuse is not licensed for use in thoracic spinal fusion, due to negative side-effects.

The Effects of Orthotics for SCI

Now understanding the function of these devices, I wanted to explore the psychological effects they have on my mum, and some related ethical issues. She kindly let me chat with her:

Spinal_Orthotics_Interview_Small.mov

Conclusion

I learnt so much by simply sitting down and having a chat with my mum about her orthotics, it seems that they are a constant in her life. Writing this blog has given me a new outlook on SCI orthotics, as well as the importance of learning through hearing other people’s experiences.

Cloning: Simply Science Fiction?

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The idea that an individual could be identically replicated has captivated popular culture for decades. A clone is defined in biology as an organism or cell, produced asexually from one ancestor, to which they are genetically identical. Appearing in the likes of the Star Wars franchise, Oblivion, and more recently Mickey-17 released just this month, clones in science fiction films are often portrayed in a way that challenges this definition. When reproductive cloning and Dolly the sheep were introduced in Nick Evans’ lecture on stem cells, I asked myself the following questions:

  • To what extent does cloning exist?
  • Why haven’t we cloned humans?
  • What are the applications of cloning?
Star Wars: Episode II – Attack of the Clones (2002)
Oblivion (2013)
Mickey 17 (2025)

Animal cloning – Dolly the sheep

On the 5th of July, 1996, the first mammal cloned from an adult somatic cell was born – Dolly the Finn-Dorset sheep. The scientific advancement captured the attention of the media at the time, and continues to do so today (see links on right). The procedure involved somatic cell nuclear transfer, which is a type of reproductive cloning. The diagram below summarises the method.

1997: Science News report on Dolly the sheep
2016: BBC News report on Dolly the sheep
Image from Encyclopædia Britannica, Inc.

Dolly essentially had three mothers, with the DNA from the egg cell of a Scottish Blackface sheep being replaced by the DNA from a Finn-Dorset sheep. The resulting hybrid cells were placed in the uterus of another Scottish Blackface, and astonishingly, Dolly was born with identical genes to the nucleus donor sheep. In theory, the exact same procedure could be completed with humans. It should be noted that it took 227 attempts to produce one sheep clone. Even today, mammalian cloning is highly inefficient.

Ethical Considerations

Following the birth of Dolly, the United Nations Educational, Scientific, and Cultural Organisation (UNESCO) immediately banned cloning. It goes without saying that cloning humans would raise innumerable ethical issues. Below are the most notable (click on the arrows for more information):

Eugenics

An early ethical consideration, following John Lederberg advocating for cloning in 1966. He saw it as an appropriate means to improve the human race – cloning certain individuals for their desirable traits. Many see this is a ‘new form of eugenics’, which is considered immoral by most, due to questions of equality and coercion.

Danger

Utilitarianism focuses on the direct outcome, raising the concern that cloning human beings by nuclear transfer is too dangerous. Too many embryos in animal cloning experiments expire or result in miscarriage.

Individuality

Many believe that cloning violates our dignity, uses people as means, affronts our uniqueness, and threatens our humanity.

Embryonic research

To even research human cloning, a huge amount of human donated eggs would have to be acquired by scientists. The nature of the nuclear transfer method, with implantation would also require the research to surpass the 14-day limit of embryo experimentation, raising questions on identity and the value of human life.

Therapeutic Cloning

Therapeutic cloning is a practical method which in my opinion avoids the ethical issues raised above. It also involves nuclear transfer, but the cells are never implanted. Instead, the embryo is cloned to produce stem cells. Since these would be genetically identical to the donor, these stem cells are less likely to be rejected by the patient.

Image from Mitalipov Lab/OHSU

Conclusion

It seems to me that human cloning is inefficient, immoral, and mostly pointless. The replicas we see in science fiction don’t reflect biology, and with therapeutic cloning, there is no need to clone entire humans for treatment.

“Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.”

Ian Malcolm, Jurassic Park (1993)