Improving Quality of Life for Multiple Sclerosis Patients: Christopher Patrick (Transcript)

Read the full transcript of Christopher Patrick’s talk titled “Improving Quality of Life for Multiple Sclerosis Patients” at TEDxCSU 2024 conference.

Listen to the audio version here:

TRANSCRIPT:

CHRISTOPHER PATRICK: Thank you. I’d like to get this TED Talk started with a little speaker versus audience showdown. Thank you.

I’d like to challenge you to an epic or TEDx-sized game of Simon Says. That’s right. We’re sticking with the theme of movement. Everybody ready?

Simon says stomp your right foot. Good. Simon says stomp your left foot. Now stomp both feet. Oh, I got some of you there. You can keep playing. You can keep playing. Simon says stand up if you’re able. Now everyone put your hands in the air. Oh, again, all right. Most of you are doing well. Simon says put your arms out in front of you. Now wiggle your fingers. OK, now we’re getting it. Now we’re getting it. Simon says clap your hands three times.

Great. Game over. Simon says game over. You can return to your seats. Now you might be wondering why on Earth I would start a TED Talk with Simon Says. And it’s for two reasons, really. The first is so that when my family calls me later tonight and they say, “Hey, how’d that TED Talk go,” I can tell them with complete honesty that it must have gone great because everybody stood and clapped for me. I know, I know.

But it’s 100% true. The second more important reason is that I hope it demonstrated how quick and seamless movement can be for us. As a movement neuroscientist, what you all just did was amazing, believe it or not. When I said “clap,” your brain took those four little letters C-L-A-P and turned it into a organized symphony of muscle activity.

I mean your shoulders, your biceps, your whole arms had to be coordinated in time and in space so that your hands could meet in front of your body and make that sound.

Much to my pleasure. Thank you very much. And most of you did this without even having to think about it, without having to think about any of those movements. It kind of just happened, right, almost instantaneously.

Importance of Movement

Movement is so important to us. It helps us do daily activities like brushing our teeth or driving to school or to work. They can help define who we are, whether through dance or sport or smaller, finer movements like carefully chopping up an onion to cook with or maybe even moving our fingers to play the piano.

They can help us do the most cherished things in life, like hiking up a mountain to see a beautiful vista or even just doing activities with the ones that we love. We depend on movement so much, which is why neurological conditions that impair movement can be so devastating. When movement goes from effortless to effortful, individuals not only have their daily lives impacted, but they can have their identities reshaped, and they can miss out on those important life moments.

Multiple Sclerosis

One such neurological condition and the focus of my research is known as multiple sclerosis, or MS. MS is a chronic, debilitating, neurodegenerative disease that results from damage to our brain and spinal cord. That damage causes a whole range of different symptoms, but one of the most common among them is mobility impairment or difficulty with movement.

Current estimates indicate that nearly one million people in the United States and millions worldwide have been diagnosed with MS. And there’s two things I really want you to keep in mind in this talk.

The first is that MS is the number one diagnosed neurodegenerative disease in young adults. Typical diagnosis for the most common form of MS is typically around age 30. And I want to pause for a moment, just let that number sink in, 30, in the context of our theme for this conference, Endure. At the age when most people are starting families or getting set in their career is when MS is most typically diagnosed.

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Along with an early life diagnosis, life expectancy for people with MS is just slightly shorter than the general population, meaning that people with MS commonly battle their disease for decades and decades.

The second thing I want you to keep in mind is that MS can look very different from person to person. While mobility impairment is a commonly reported symptom, such that over 90% of individuals with MS report mobility impairment, how those symptoms manifest and progress can be quite varied. So enduring will look different from person to person.

And I’m telling you this because I wanted to highlight the need for individualized care. My graduate research and the focus of our lab, the Sensory Motor Neuroimaging Lab, is to study diseases of the nervous system, ones that particularly impact movement, to understand them better, and design tools and rehabilitation approaches that can help restore or improve mobility, and in turn, improve quality of life.

We know that people with MS will battle their disease for the rest of their lives. So we want to arm them with a sword and a shield to help aid them in that battle, but not any one size fits all sword and shield, one that fits their individual needs.

And I want to emphasize here that this doesn’t necessarily mean extending life, but rather enhancing the quality of that life through movement. In short, we want to help them endure. So how can we do this? How can we help?

Understanding Movement

Well, first we need to understand what happens when we move. To perform movements properly, our brain sends a message to our muscles. An easy way to think about this is as two towns connected by a road, where town A is the brain and town B is the muscle. For us here in Fort Collins, we can think about this road as I-25, where town A is Fort Collins, the brain, and town B is Denver, the muscle.

In the beginning of this talk, when you clapped your hands, a message or a car was sent from town A to town B. That allows you to clap your hands. Now, for most of you, this road is luxurious. Maybe not at all like the real I-25. This road is paved to perfection. And because it’s paved to perfection, that car can travel quickly and undamaged from town A to town B. And thus, you can perform those movements properly. However, for people with MS, this road is no longer paved to perfection.

We can think about it as being covered with potholes and cracks. Now, the car has to travel over this road damage, and so it takes the car much longer to get from town A to town B. In addition, that bumpy road may alter or damage the car so that when it gets to town B, it doesn’t look like the same car as left town A. Both the damage to the car or the altered signal and its late arrival means the muscles can’t contract properly and therefore cannot perform movements properly.

Now, this may not seem like a really big deal if your goal is to just clap for somebody on stage, maybe especially if they forced you to kind of do it, right? But I want you to think about what if that car has to get to the muscles of your legs during walking or weight shifting movement. The inability for that car to arrive on time and undamaged means that the muscles of the legs can’t contract properly, and this will lead to falls and other adverse events. Our mission.

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Mapping Neural Pathways

So for us as researchers, the condition of this road is really important. If we can better understand the condition of this road and how it impacts mobility, we can better predict, monitor, and address mobility impairment. Now, this isn’t the only road that we have in our brain and spinal cord. In fact, we have tons of roads in our brain.

If we were to map out every road in our brain, it might look something like this. Pretty wicked, right? You can think of each one of those little spaghetti strands as a lane leading to a superhighway in the brain. And those superhighways allow for cars to zip back and forth across the brain, letting us do all kinds of different functions.

By tracking each one of these spaghetti strands, we can identify and analyze these superhighways. From there, we can assess which of these roads or which of these highways sustains the most road damage and therefore may contribute to mobility impairment. Now, the road that I’m showing you right now is just a piece of the largest highway that exists. And it’s a very small highway.

The road that I’m showing you right now is just a piece of the largest highway that we have in the brain, known as the corpus callosum. And it helps connect the brain’s two hemispheres or both sides of the brain.

Studies from our lab have found a correlation between the amount of road damage in this particular road and the ability for people with MS to coordinate their two legs during walking and turning movements. Specifically, what we see is a negative correlation, such that the more road damage that we see on the road, the harder it is to coordinate those two legs. And the less amount of road damage, we see more typical coordination in the lower limbs. What this means is that communication between the two sides of the brain during movement might be impaired in people with MS, thus leading to mobility impairment.

These findings not only highlight this particular road as an area for intervention, but could also be used as a key biomarker or indicator that impairment exists before we can even visually detect that somebody has coordination deficits. This would lead to faster implementation of individualized neurorehabilitation, and hopefully, in turn, slow down or prevent the progression of mobility impairment.

Rehabilitation Approaches

With rehab in mind and sticking to our road theme, I’m gonna quickly switch gears to talk about some of the rehabilitation approaches we’ve been testing in our lab. I’ve told you that people with MS struggle to coordinate their lower limbs during walking.

This usually manifests because one leg takes a shorter step and the other leg takes a longer step, making a very asymmetric walking pattern. So our lab had the question, is it possible to retrain the brain to walk more symmetrically? To test this, we used a specialized piece of equipment known as a split-belt treadmill. A split-belt treadmill looks exactly like a regular treadmill, except where a regular treadmill has one belt or one walking surface, a split-belt is cut into two.

Very well-named. So there’s two walking surfaces or two belts, one for each leg, and having two belts allows us to manipulate the speed of each belt so we can make one go slow and one go fast. Using the split-belts, we placed people with MS on the treadmill so that their leg that initially had the shorter step was placed on the faster belt, encouraging the brain to move that leg faster and further so that over time, they might adapt a new walking pattern. What we found is that individuals who had an asymmetric walking pattern before training on the split-belt treadmill actually adapted and became more symmetrical for a period of time after split-belt treadmill training, which is great.

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And what’s really interesting is the way that these individuals adapted was different. Some took a longer step on the faster belt just as we predicted. Others maybe just sped up that leg or even took a shorter step on the slower belt. Now, I want to emphasize that all of these solutions led to more symmetrical walking, which is great.

We think this will help reduce falls. But how to predict who will adapt and in what way is still the subject of ongoing research in our lab. Lastly, in conjunction with our walking adaptation research, we’re also exploring whether we can use auxiliary roads to help with mobility. In the beginning of this talk, we saw that road damage impacted how cars got to their destination.

And like any parent who has been stuck in traffic during a family vacation, we naturally thought, what about the side roads? Right, for us here in Fort Collins, sorry, for us here in Fort Collins, we know that if I-25 is jammed up, we always have the option of taking 85 or 287 down to Denver. So we thought, is this true in MS as well? And our preliminary evidence suggests that while these side roads may have potholes as well, it could be that by training the brain to use the main road and the side road more effectively, we could get more cars through to the muscle.

Did my cars already go? No? Come on, cars. There they are. So that’s the goal. Can we get more cars through to the muscle?

Conclusion

To wrap up, I’m thrilled that I’ve been able to share some of our promising research projects with you. And hopefully I’ve planted enough teasers that maybe you’ll wanna keep up with our progress in the future.

But I wanna get us back to the mission of our lab and the call to action I hope this TED Talk serves as. People with MS are typically diagnosed young. And because of that, they commonly battle or endure their disease for decades. And while strong efforts have and continue to be made to identify pharmaceuticals that can cure or prevent MS from ever being a human disease ever again, equally strong efforts need to be made to improve the quality of life for those with MS who battle day to day and battle for the rest of their lives, those who may not see the benefits of that pill by the time we find it.

We believe that through better understanding of neural pathways and improved individualized rehabilitation approaches, we can help those with MS regain their independence, recapture their identities, and ensure they never miss out on those important life moments. Enduring is about support. Enduring is about community. Enduring is about resilience.

But it’s also about innovation. It’s about breaking through that cloud of unknown to find answers to unsolved questions. It’s about discovering tools that not only help people endure, but one day help them thrive. Our lab looks to answer these questions and uncover these tools to pave the way for a better tomorrow for people with MS.

Thank you.