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TCU Magazine "Academe"

Riding it out

There is no sense sitting around waiting for a cure for paralysis, says kinesiology professor Darryn Willoughby. He's helping those with spinal cord injuries to possibly walk again -- and they get a workout in the process.

By Rick Waters '95

6:15 p.m., July 9, 1995. Blaine Manigold vividly remembers that exact minute.

Bailing off the side of a 2,000-pound bull after a successful ride, Manigold felt a shot of pain in his back as a steer hoof ramrodded the hard shell of a protective vest between his shoulder blades. The force snapped his neck backward then forward, dislodging his fifth vertebra.

"No, don't touch me," he cried from the ground as fellow bull riders rushed to help. "Don't even take my boots off."

Manigold had ridden bulls for 15 years and knew the dangers. Instantly, the realization struck -- he was paralyzed.

Until then, his life had been about motion. As a cowboy, he lived it. As an exercise and physiology major, he studied it. He knew more than anyone that motion is what the body craves from one moment to the next, every tenth of a second of the day.

"Your body needs movement for optimum health. The body wants to move whether it is paralyzed or not," Manigold, a TCU kinesiology graduate student, commented almost seven years later.

His stubborn streak remains alive. The self-professed hardhead wakes each morning before the help arrives, sits up, rolls over and struggles to get out of bed alone. It is his routine.

But what he wants is exercise. The problem is finding modified training equipment, which is in short supply. In his search for movement, he also battles conventional medical thinking, which tells him just to sit and wait for a cure.

That cure may be some time off, but Manigold refuses to waste away until scientists achieve a breakthrough. He is finding a way to move as a subject in the groundbreaking exercise research of TCU kinesiology professor Darryn Willoughby and his Tarleton State University colleague Joe Priest.

It started in Stephenville in 1992 when an engineer/inventor named Russell Jennings developed a type of recumbent bicycle for individuals with neuromuscular dysfunction. It allowed them to strap their feet in and have a teammate move the pedals. Some could even push their own legs with their hands.

Jennings saw it as a way to help the disabled, who are at higher risk for cardiovascular and pulmonary disease due to a decrease in physical activity. What Jennings never understood, however, is what effect his invention might have in the muscles.

He showed his bike to scientists at Tarleton's Laboratory for Wellness and Motor Behavior, where Priest thought it would be good to use in exercise experiments that study oxygen intake and electromyography, or electrical activity in the muscles. After a trial run, Priest's initial findings indicated something, indeed, was happening.

To study it further, Priest called on Willoughby, a Tarleton graduate and researcher at the University of Southern Maine at the time. Willoughby took muscle biopsies of the subjects' legs and concluded that some of the muscle fibers, after training, were not only retaining protein but also enlarging.

"At the time, we were saying, ÔHow can this be happening?'" Willoughby said.

Their research was unique in that the subjects were not receiving stimulation. Previous research with the spinal cord injured had involved attaching electrodes to subjects' hamstrings and thighs and applying electrical activity to cause contractions in the muscles to make their legs move. In Willoughby and Priest's study, though, the cyclists were doing all the work themselves by using their torso and arms to assist their legs in pedaling the bike.

Next, Willoughby and Priest added more subjects who pedaled more frequently and for a longer period -- 12 weeks. With that research, they analyzed biochemical factors and discovered accelerated activity within the genes of the muscle, suggesting that disabled persons, if they continued the workout over time, could maintain some muscle mass or significantly slow the rate of muscle wasting and loss of bone density.

Ultimately, this type of exercise may help prepare the disabled to walk again if neurological scientists find a way to regenerate central nervous system cells and repair spinal cord lesions.

"I firmly believe that it is only a matter of time," Willoughby said. "So we are training these people for the future. We are attempting to help the spinal cord injured maintain as much of the muscle mass in their paralyzed legs as possible."

Willoughby admits that some people say he's wasting his time on individuals who can't walk, but there are too many other benefits to stop trying. "Scientists are working aggressively for a cure and that's good," he said, "but why should we write these individuals off now?"

Heart disease, type II diabetes and obesity are major contributing factors to mortality in the spinal cord injured, but by doing preventive maintenance now, they may be able to enjoy a longer and higher quality of life.

In the meantime, Manigold and other subjects reap the benefits of old-fashioned exercise -- a cardiovascular workout, reduction in muscle spasms and increases in pulmonary function.

"I don't take any [antispasticity] medicine at all anymore," he said. "Your muscles get so tired it takes the spasms right out of them."

Anecdotally, some subjects reported their bladder infections and pressure sores from constant sitting went away.

Willoughby has since joined Joel Mitchell in TCU's kinesiology department to build their own bike. They have started a longer-term program with more subjects and tighter controls to take a closer look at what is happening in the muscles and what effect the exercise has on the immune system.

Willoughby is convinced that there is a psychological effect, as well.

"I've watched people come in here and ride these bikes, and after a time the look on their faces speaks volumes," he said. "Their psychological output and their emotional state increase dramatically. Their self-esteem improves."

Willoughby, Mitchell and their research assistants have also found that spinal cord injured people can eclipse projected fitness levels. For example, Manigold said 75 percent of his predicted target heart rate is 136 beats per minute, but he can consistently reach the mid-160s.

Manigold hopes his physical achievements and TCU's continued research can change the thinking among those doctors who see little hope for the disabled to walk again. Instead of taking drastic measures, such as removing leg tendons and surgically grafting them into weakened wrists of disabled patients, Manigold would like the medical profession to wait and assess the cumulative effect of cycling exercise over a number of years.

Then doctors can base future medical procedures and physical therapy on maintaining muscle and bone instead of teaching people how to cope with lost limbs.

"If we can use this as a way -- if nothing else, to improve their quality of life and outlook on life -- that's pretty impactful," Willoughby said.

And maybe the cure is a heartbeat away.

Contact Willoughby at d.willoughby@tcu.edu