Scaling Mount Snowdon would be an achievement for anyone. But for Sarra Wilson it’s even more impressive.
Sarra was paralysed from the chest down in September 2018, when she fell from her horse Lorenzo after he was startled by a pheasant as she rode across the family farm.
Sarra broke the fifth vertebra in her neck – and her life changed in an instant. The accident left Sarra, 39, unable to walk, with minimal movement in her arms, hands and trunk – meaning even sitting around a table to enjoy a normal meal with her husband and three children was impossible.
But now Sarra has regained some movement and sensation after taking part in a UK trial, described as a ‘gamechanger’ for the 110,000 in this country living with paralysis as a result of spinal-cord injury.
Every year, around 4,700 people in the UK suffer a spinal-cord injury, with falls and road traffic accidents the leading causes – around 12 per cent are the result of an injury sustained during horse riding or rugby.
‘Usually when the spinal cord [the nerves and tissue which carry impulses from the brain to the body] is injured, it’s pinched or crushed rather than severed or torn because it’s protected by the bony channel called the spinal canal,’ explains David Baxter, a consultant neurosurgeon at the Whittington Hospital in London and associate professor at University College London, who was not involved in the trial.
‘If you suffer a crush injury, the nerve fibres in the spine, called axons, which transmit electrical signals from the brain to the body and back again are damaged – which causes paralysis.’
This ‘primary’ injury can also lead to bleeding and swelling in the spinal cord, which further reduces blood flow and worsens the extent of paralysis, leading to ‘secondary’ injury, adds Mr Baxter. ‘As a result, a scar forms which makes it difficult to repair the nerve fibres, and there was little hope of improvement in these patients – until now.’
Sarra Wilson with her dog Jess. She is now preparing to scale Snowdon
For the new trial, called Pathfinder 2, ten participants, who had a chronic spinal injury at least a year before, which had left them paralysed, had electrodes attached to the skin on the back of their neck close to their injury site.
These electrodes were then connected to an external device that delivers electrical stimulation set by a programme technician to each participant’s injury and requirements – greater movement in their arms, for instance. At the same time, they carried out targeted rehab activities – such as stacking cups or gym-type exercises, using adapted standing rowing machines, for example.
The idea is that once the nerve fibres had been ‘woken up’ by the stimulation, the exercises help re-train them to send and receive impulses.
‘The electricity isn’t being used to directly move the muscles but instead find and recruit nerve fibres, with some of them responding better than others to different energies,’ says Mr Baxter. Part of the aim of the trial was to find the best level of stimulation to use.
It’s thought doing this over a sustained period – each participant had 120 two-hour sessions over a year – helps to create new pathways in the brain to improve movement, he adds.
‘We know that spinal-cord injuries cause reorganisation between groups of cells in the nervous system which control movement, and so this approach was aiming to remedy that by targeting them more precisely,’ says Mr Baxter. All the participants found their hand grip, dexterity and trunk control improved, meaning they could position themselves better and move in their wheelchair enough to do everyday activities such as eating at a table.
Gains made did not plateau even after a year, which suggests the therapy offers long-term benefits and people might see further improvements if continued. Three participants had their classification of spinal-cord damage changed to reflect their slightly improved function – while another, who was paralysed from the waist down, was able to take her first unsupported steps since 2017. It’s hoped that following these results, due to be published in the journal Neuromodulation, the ONWARD ARC-EX System which delivers this therapy – already approved in the US – will be approved for use in Europe and the UK by the end of the year.
‘Pathfinder is a very positive step for people with spinal-cord injuries where previously they had little hope of restoration of function or walking and using their hands again,’ says Mr Baxter. And, he says, even seemingly small improvements can hugely improve someone’s quality of life, which Sarra would heartily agree with.
After her accident, Sarra, who runs a farm with husband Adam, 40, in Houghton Conquest, Bedfordshire, realised instantly that she couldn’t move.
She was flown by air ambulance helicopter to Addenbrooke’s Hospital in Cambridge, where X-rays revealed she’d broken a bone in her neck so badly it resembled a ‘smashed up digestive biscuit’, she recalls a doctor saying. Sarra underwent an eight-hour operation to take bone from her right hip to replace the broken vertebrae, stabilise her spine and support her head.
She was put into an induced coma for two months before being moved to the National Spinal Injuries Centre in Buckinghamshire in December 2018. Sarra finally went home in March 2020 – after 18 months in hospital – having spent much of her time strapped to a bed unable to move her head. The accident also affected her bowel and bladder function. ‘I went home in a wheelchair,’ she says. ‘I’d been told early on that I would never walk again.’
After being discharged, Sarra attended weekly physiotherapy at the Neurokinex centre, a not-for-profit organisation providing rehabilitation for people with paralysis in Hemel Hempstead. It was through them she was invited to be part of the Pathfinder trial, which began in March 2021.
‘I was keen to try anything,’ says Sarra. ‘When I was connected to the machine and it was switched on, I’d feel a tingling pins and needles-type of sensation.’
At the same time, she did exercises focused on her arms, hands and core. This included ‘using a standing frame that supported me in an upright position, I could use a hand bike – where I’d turn pedals with my hands – or lift light dumbbells, for instance’.
Sarra hoped for ‘little wins’, she says: ‘I wanted to be able to hold and sip a hot drink from a normal cup without using a straw, which I can now do.
‘I can brush my daughter Isla’s hair too – but, annoyingly, I can’t brush my own as I can’t lift my arms high enough. Best of all, I can now sit at the dinner table with my family and feel normal.’
Tara Stewart, chair of trustees at the UK charity Spinal Research, which funded the study, and who was paralysed from the chest down after falling from a horse in 2015, believes it is ‘a gamechanger’.
‘When I had my injury, we were told that a spinal-cord injury was incurable,’ she says. ‘We now have this system that restores some function. It demonstrates that a spinal-cord injury isn’t incurable and at the very least is improvable,’ says Tara, who was also on the trial but did not experience any major changes.
Mr Baxter is now running a trial called ImPRESS at the Royal National Orthopaedic Hospital to see if electrically stimulating the base of the spinal cord after an injury can improve bladder and bowel function – as the majority of patients with spinal-cord injury experience significant loss of control of these.
‘People can develop recurrent urinary or kidney infections that can cause complications and, in some cases, prove fatal,’ he adds.
For the trial, 18 paralysed people with bladder and bowel problems will have an electrode, attached to a small battery, implanted under the skin at the base of their spinal cord, where it will deliver electrical impulses to the spinal nerves that control the bowel and bladder. Participants will then carry out 12 weeks of daily pelvic floor exercises. The results will be published next year.
Later this month Sarra will be pushed and hauled up Snowdon in her wheelchair by her team of 16 helpers, including family and friends, to fundraise for
Back Up, a charity which transforms people’s lives after spinal-cord injury. ‘Going up Snowdon is something I would never have contemplated before the trial,’ she says. ‘But the treatment has given me the ability and the confidence to try more things.’
