www.nrrfr.com . or write: Dr. Hongyun Huang, Department of Neurosurgery of Beijing, Xi Shan Hospital, Shi Jing Shan District, Beijing 100041, P.R. China.

A Portuguese physician who shares the dream of paralyzed patients that they'll walk someday came to the United States last week to find out how they are faring after experimental spinal cord surgery.

And while none yet walks unassisted, more than a dozen who met with Dr. Carlos Lima at the Rehabilitation Institute of Michigan in Detroit report gains. From lives largely spent in wheelchairs before surgery, some of the patients walk with equipment, stand alone and perform more tasks by themselves.

Each one follows a rigorous workout schedule, often five days a week, to maximize gains from surgery that uses stem cells and other cellular therapies to repair damaged spinal cords. No U.S. hospital yet offers the procedures. But the Rehabilitation Institute has formed a network of international centers that hope to conduct the surgery if they gain approval from the federal Food and Drug Administration.

"I think for the most part, those of us that do go through with these surgeries understand it's not a silver bullet," said Erica Nader, 27, of West Bloomfield, who exercises five days a week, several hours at a time to built stamina and the strength she needs to walk. .

"It does take a definite amount of commitment to therapy before and afterwards," she said. "If even one thing is better, that's an improvement and I'm happy with that. I don't know how you can put a number or price on it."

were among the first Americans to go to Portugal and China for the spinal cord repair surgeries, attracting worldwide attention. Michigan also is a focus of attention because of the role of the Rehabilitation Institute.

It is the only U.S. site that evaluates patients for surgery at Lisbon's Hospital de Egas Moniz. . And it is one of a handful of U.S. rehabilitation centers with strong intensive therapy programs for recovery from spinal cord injury. Patients come from all over the world to Detroit to be evaluated for the surgery program or to participate in the rehabilitation program. Many were here last week to hear Lima, spokesman for the Lisbon team.

At a time of job loss and retrenchment in the state, the institute's Center for Spinal Cord Injury Recovery is growing in size and stature. Since it opened in May 2004, its space has more than tripled, its staff has grown from two to 18 people and it has added an outpatient center in Novi.

In the past year, the institute has sent 31 Americans to Portugal for the surgery and screened dozens of others. Hundreds of others have gone on their own to Beijing, another major city where the surgery is performed.www.carecure.org . The Rehabilitation Institute, which is part of the Detroit Medical Center and the Wayne State University School of Medicine, is collaborating with the Lisbon team in hopes of doing the surgery in Detroit someday. It has begun preliminary talks with the FDA.

The institute is working with doctors in Colombia, Greece, Saudi Arabia, Italy, Japan, New Zealand and Mexico to set up a clinical trials network to study the surgery once the FDA allows the research to continue, said Lima in an interview during his Detroit visit.

Lima stressed that the operation remains experimental, but he is pleased with the results of the first 74 procedures. There have been no deaths and the only troublesome complication has been the development of a viral infection in three patients, all of whom responded to antibiotics, he said.

Now, applicants for the surgery will be tested for the virus, which is common in people who have spent months in hospitals, and excluded from surgery if they have the infection.

All the patients who had the surgery in Portugal are walking with assistance; crawling, an activity that builds muscle needed to walk, or have had other motor and sensory gains, he said. Some 10-15% have significant improvements in bladder and bowel function.

"Every week, I feel stronger," said Eric Chase, 19, of Hastings, who had surgery in Lisbon on July 29. "I have more energy; I can crawl backwards now, and I'm balancing myself better. It's good enough, I guess, but it's still a beginning. But nothing gives you 100% of what you want."

Chase was paralyzed from the mid-chest down in an Aug. 9, 2003, dirt bike accident. He is pursing a degree in agriculture at Kellogg Community College in Battle Creek.

Sam Wassink, 14, an eighth-grader from Ada, also has seen small gains since his July 30 surgery in Lisbon, where he met Chase. "It's pretty much the same as before, only I can do things a little better," said Sam, who was paralyzed from his abdomen to his feet in a June 11, 2004, dirt bike accident.

Also among those who went to Portugal was Cortney Hoffman, 21, of Temperance. Her surgery was Jan. 8. She was paralyzed from the chest down in a July 30, 2002, auto accident.

This month, she stood by herself three times. The first time she moved her leg by herself, she cried. Now, she uses braces and a walker and moves her feet slowly by herself, though two therapists stand by in case she needs them.

Nader is taking steps around a track with an overhead harness device to assist her. She recently moved out of her parents' home to live on her own. She plans to start her own disability consulting business next year, and recently hosted her second event to raise money for intensive therapy for people injured in gun accidents and whose insurance does not pay for the more extensive rehabilitation she pursues.

does not cover surgery and often does not pay for rehabilitation, unless a person is injured in an auto accident. Even those patients have to continue to apply for coverage and show gains.

Patients and their families often hold fund-raisers to help pay for the $50,000 surgery in Portugal or $20,000 in China, in addition to transportation and rehabilitation costs later. Rehabilitation costs $3,228 at the institute for a month of therapy, three days a week, three hours a session.

In Lisbon, doctors use the adult stem cells in a patient's own mucosal tissue, extracted from a region high in the nose. They are placed over the spinal injury site after surgeons clear out scar tissue.

The spinal cord is so complex that the insertion of stem cells and other cellular therapies may cause long-term problems, such as nerve pain or a worsening of paralysis, said Dr. David Gater Jr., director of spinal cord injury medicine at the University of Michigan.

"If we don't hook everything back up appropriately, the person may be worse off," he said. "It's like trying to replace a fuse in a fuse box and just shoving in a bunch of new fuses and closing the door. That's why I am appropriately skeptical."

Published reports on surgery patients also have lacked precise medical measurements to determine if motor, sensory and bladder functions indeed have improved, he added.

Dr. Lisa-Ann Wuermser, medical director of acute spinal cord injury at the Rehabilitation Institute of Chicago, said her "comfort level has grown" with the experimental surgeries because of the involvement of the Rehabilitation Institute and the respected physician, Dr. Steven Hinderer, who oversees the program.

She tells patients many therapies will be available eventually in the United States. She refers those who don't want to wait to Hinderer. "At least they are collecting data there in a rigorous way," she said.

Dan Young, 27, of Ann Arbor, was one of the three patients who developed a viral infection. He subsequently lost some sensation in one of his legs. But he doesn't regret the surgery. Young, a Southfield Lathrup High School teacher before a Jan. 18, 2004, sledding accident, is quadriplegic, with paralysis from the chest down.

"It's only been six months," said Young, before beginning one of his three-hour therapy sessions at the Recovery Project in Livonia, which also has an intensive therapy program. "I knew it would be slow. I think people should know it's not a quick fix."

Gains are coming as much as two years later for Bob Smith, 48, of Harrison Township. He was injured diving from his boat on Lake St. Clair on July 4, 1999, and was the first American to travel to China for surgery in September 2003.

drives around in his van; plays cards and feeds himself, all skills reacquired since his injury. He sometimes bumps into Hoffman, Nader and dozens of other surgery patients at the Rehabilitation Institute. As a trailblazer, and a friendly man willing to share personal details, including improved bladder and sexual function, the community looks to him as an unofficial leader.

Still he is happy with his progress. Small things delight him: His wife waking him up by rubbing his belly. The feel of a blanket on his body. And his dog licking his feet.

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