Hope is a river
David Estrada lost the use of his legs, but not his will. Now, at Spaulding hospital, he and other paraplegics are learning to row, strengthening body and mind as they wait for a cure.
From his office in the Spaulding Rehabilitation Hospital, Andrew Taylor’s views sweep across the Charles River, where generations of rowers have raced. So maybe it makes sense that the pursuit of science would bring the researcher from his desk to the water’s edge, in what he recently described as “a beautiful convergence.’’
Taylor is amid a grand experiment. In his third-floor laboratory, he is replicating the workouts of avid oarsmen who pound away on indoor rowing machines inside boathouses along the river. But in Taylor’s lab, there’s a key difference: His rowers are paraplegics.
Rowing, Taylor believes, is the perfect exercise for people with spinal cord injuries, and Boston the perfect place to introduce it to them. He is calling on paraplegics from all over the region to join in his study, and begin the grueling training regimen that could rebuild their atrophied bodies. If all goes well, the paraplegics will break free of the Spaulding lab and join in the century-old rite of racing on the Charles.
Dave Estrada comes to Spaulding three days a week and sweats through a 40-minute set with rock songs blaring from a computer speaker. He’s paralyzed from the chest down, but he rows with his whole body, pressing a button to send electrical currents to his legs. It’s called Functional Electrical Stimulation, or FES, and it has helped Estrada pound out 500,000 meters - 300 miles - on an indoor rowing machine over the past year.
When he signed on to be Taylor’s test subject, Estrada’s muscles fatigued in seconds. After all, he’d been sitting for 13 years.
“Imagine what that level of inactivity does to your body,’’ said Taylor. Every part of an unused limb wastes away, including bones, which can become so brittle they snap under light pressure. If researchers suddenly developed a cure for spinal cord injuries, someone like Estrada still couldn’t rise from his chair.
“He’s going to need muscles to walk. He’s going to need strong enough bones,’’ said Taylor. FES-rowing, he says, will “prepare him for the cure.’’ Taylor’s first-in-the-nation program for paraplegics now has three participants, but he’s already working on a home-use model as affordable as a treadmill, so that paraplegics can exercise - or feel guilty about not exercising every day, just like the able-bodied.
“I’m convinced it’s going to have a profound impact,’’ Taylor said. “This is something we have to expand as quickly as we can and move it beyond the laboratory,’’ he added, gesturing to the river that’s steps away from the hospital.
The only rower Dave Estrada ever met was the one he got in a fight with in college after the guy hit on his girlfriend. Estrada had grown up riding dirt bikes. To him, Ivy League crew teams and their stately boathouses were just part of the distant backdrop in Boston.
Back then, Estrada was a 23-year-old cadet in the Boston Police Academy. He lived in a third-floor walk-up in South Boston and he loved weightlifting, which helped him beef up the “chicken legs’’ of his youth.
One night in 1995, Estrada was on his way home from work when a motorist clipped the back tire of his motorcycle, sending him sliding across the concrete, headed straight for the bumper of a parked car. When he woke up next to the curb, Estrada tried to sit up. “I immediately knew I was paralyzed,’’ he says. “At that point, it’s like, life’s over.’’
Instead, Estrada built a life from his chair. Over the next decade, he earned a law degree, married a kindergarten teacher, and won a desk job with the Boston Police. He also began racing in wheelchair marathons. “I’m one of those people who doesn’t feel good if I don’t work out,’’ he said. Eleven marathons later, the upper half of his body was sculpted but the lower half emaciated.
“I didn’t notice it until I looked at a picture of me and was like, ‘Whoa,’ ’’ Estrada said. A biopsy of his thigh turned up almost no remaining muscle, and bone scans revealed severe osteoporosis. His radiologist said areas of his shinbones were “paper-thin.’’
“I would definitely not go out in public in shorts,’’ he admitted.
Then, in 2006, Estrada saw the legs of a paralyzed Englishman named Robin Gibbons and learned that it didn’t have to be that way.
Gibbons was one of the first FES-rowers in the world, trained by British biomechanical engineer Brian Andrews, who developed the idea in the 1990s. He and a small team of paralyzed Britons had come to Boston to row alongside the able-bodied at the CRASH-Bs, an indoor rowing competition. They rowed the 2,000 meter sprint using electrodes to power their legs. When they finished, Gibbons recalls, “There was a roar from the whole place like somebody had just scored the most important goal in a football match.’’ That was the day FES rowing arrived in the United States, and watching from the balcony section was Dave Estrada.
“I was blown away at these guys,’’ says Estrada. Not by the rowing, but by the muscularity of Gibbon’s legs.
After the event, spectators came down for a closer look. “This very thin man came up in a wheelchair,’’ remembers Bari Dreissigacker, whose Vermont company makes the widely used Concept2 rowing machine. “He had this sunken chest and thin, withered legs.’’
Transfixed, Estrada said aloud, to no one in particular: “I want to have legs like that.’’
Two former Olympic rowers slid a long wooden boat into the Charles River from the dock of a Brighton boathouse. Tom Darling, a 1984 silver medalist, kneeled to steady the bow while Gary Piantedosi, who rowed in the 1976 Olympics, steadied the stern.
“Should I just hop in?’’ asked Dave Estrada. Squinting in the spring sun, Estrada wheeled his chair between them and heaved his body into the boat. Spaulding researcher Andrew Taylor hopped in behind him.
It was mid-May, the first of many sessions for this unlikely group of oarsmen, whose common goal was to move FES rowing from lab to water. Today would be arms-only rowing in a stable two-man boat under the watchful eyes of the Olympic rowers, who got involved when one of them heard about paraplegics rowing at a hospital downriver, and showed up in Taylor’s lab.
As the veteran rowers gave the boat a gentle push off the dock, Darling asked, “If you feel it tip, what are you going to do?’’ Floating away from the empty wheelchair, Estrada said “Scream?’’ After a year of training, neither he nor Taylor knew how to row on water.
The veteran rowers jumped in a coach boat and motored after them. Estrada had waved off a lifejacket back on the dock, saying he could swim, so they followed closely, shouting tips and “Watch out for that 8!’’ when an 8-man racing shell swept by.
On the water, Estrada looked unremarkable - not like a paraplegic, just another guy in a boat. To kayakers around them, the two men probably appeared to be friends, laughing and struggling to synchronize their oars. More than a rowing lesson, this first session yielded a dockside camaraderie that would grow throughout the spring.
When the men reconvened a week later, Estrada rowed solo, still arms-only, in a sleek shell, stabilized by small floats similar to training wheels. Rich Nici, a Dorchester man paralyzed in a car accident, also joined the expedition. Like Estrada, he tends to make wheelchair jokes. When a lightning storm sent the men running and wheeling for cover, he said, “Hey, if I get struck, do you think I’ll walk again?’’
The next week, it was time to test leg power. Piantedosi, who now designs rowing gear, affixed a sliding seat and oars to an anchored raft. Estrada and Nici stuck electrodes to their legs and took turns on it, simulating full-body rowing. It was an awkward enterprise, but it helped them troubleshoot before the main event that would follow a few weeks later: full-body FES rowing on the Charles.
FES rowing is still in its development phase, but FES itself isn’t new. Used in physical therapy for decades, FES electrodes are commonly applied to patients on special stationary bikes, which are often too costly for all but wealthy patients like the late Christopher Reeve. Most paralyzed people, after their post-injury rehab, have no way to break a sweat, let alone prevent lower-body atrophy.
“It was like, ‘Here’s your wheelchair, go live your life,’ ’’ recalls Nici, who was injured 16 years ago. Now that he and Estrada are seeing their legs grow stronger, they say it’s upsetting that affordable FES therapies haven’t been routinely introduced to the newly injured. The FES device they use costs around $500, looks like a 1960s-era transistor radio, and runs on a 9-volt battery. “It’s not rocket science,’’ says Estrada.
But this simple technology, by making it possible for him to row, has had a profound impact on Estrada’s body. His gains in aerobic capacity are “unheard of,’’ says Taylor, and his legs are visibly thicker. But the most exciting news came when an MGH team showed him his recent bone scan, pointing out a fuzzy, white border of new growth around his shinbone. It represents a 15 percent increase in nine months, a remarkable reversal of his osteoporosis. Taylor and his British collaborators, who supply Spaulding with FES equipment, believe that it’s the heavy weight-load on rowers’ legs that will make the sport revolutionary for paraplegics.
“It’s incredible,’’ says Estrada. “My bones are starting to act like an able-bodied person’s.’’
Dismal skies didn’t seem to bother Dave Estrada or anyone else on the dock. It was a June Sunday, the day a paraplegic aided by FES would, for the first time, row on the Charles.
Estrada wore shorts and a backward baseball cap, singing the refrain from the Monkees’ theme song - “Here we come, walking down the street’’ - as he pulled his body into the boat.
The boat’s high-backed seat, built by former Olympian Gary Piantedosi, required minutes of dockside tinkering in the misty rain before Estrada clapped his hands, announcing, “Lets do it.’’ He stuck eight electrodes to his legs, joking that his wet skin was extra conductive, and the men eased the boat into the water. Estrada began firing the FES button taped to an oar. Snapping photos, the researchers followed him, walked along the dock. He was rowing, but clumsily.
Mid-river, Estrada stopped. “A little play-by-play, Dave?’’ yelled one of the researchers. Paddling back to the dock, he said, “My knees are too high. Stim unit’s in the way.’’ The men huddled around him, discussing how to adjust the angles. Someone suggested duct-taping him into position. Someone else wondered if the FES unit wedged between his legs could be attached to his chest somehow.
When Estrada pushed off a second time, the oars were clearly hitting his knees. “We can fix it!’’ Piantedosi yelled to him. “It’s the hams!’’ Estrada yelled back, visibly frustrated. Despite the voltage hitting his hamstrings, Estrada was stalling out, midstroke. The muscles were still too weak. With the veteran rowers already musing that Estrada and Nici could participate in Boston’s fall racing season, there’s a lot of work left to do this summer.
But Estrada’s real race will take place indoors. “There’s going to be human trials with stem-cell research next year,’’ he explains. “I read through the criteria for this study, and you cannot have severe osteoporosis.’’ If he wants to be among the first to receive experimental treatment, he has a long year of brutal indoor workouts ahead of him.
Spaulding’s researchers have even higher hopes for the regimen. Once Taylor recruits more rowers, a physician team will begin testing them for signs of sensory or function recovery. Scientists around the country suspect that vigorous physical activity could be a key ingredient in a combination of future therapies that could finally provide the breakthroughs 250,000 paralyzed Americans, and millions around the world, are waiting for.
Until that happens, Estrada and Nici don’t sit and wait. They row.
Ann Silvio can be reached at Silvio@globe.com.