From patient to researcher
Mathew Szymanowski was one of the first Sunnybrook patients to receive an innovative nerve transfer surgery for his spinal cord injury. Now he’s studying to help others.
Mathew Szymanowski raises his left arm toward the sky and then bends his elbow like he’s preparing to scratch his back.
“They took nerves from a muscle that was working and connected them to another muscle that wasn’t so I can do this,” he says, his face breaking into a wide smile. “It means I’m able to be more independent and I’m grateful for that.”
Mathew was one of the first Sunnybrook patients to receive nerve transfer surgery to help restore hand and arm function following a spinal cord injury. Nerve transfer surgery is fast becoming the gold standard treatment for proximal peripheral nerve injuries – damage to the nerve tissue caused by a cut or tear, for example. Only recently has it been adapted for people with cervical spinal cord injuries.
Applying a world-first technique
Sunnybrook plastic and reconstructive surgeon Dr. Jana Dengler learned the specialized technique from a former Sunnybrook surgeon, who was also the first in the world to apply it in a spinal cord case with positive results.
Dr. Dengler is currently the only Toronto surgeon to offer the treatment for patients with paralysis following a spinal cord injury – and one of just a few in Canada with this expertise. She is sharing her learnings and actively training more people.
“There’s a lot of research underway involving stem cells and electrical stimulation for people with cervical spinal cord injuries, but this intervention has shown the most promising result – by far,” says Dr. Dengler, who operated on Mathew in two separate surgeries in February and March 2020, six months after his injury in a cycling accident.
Over the course of each six-hour-long operation, she redirected nerves to allow the now 27-year-old to open and close his fingers and activate the triceps muscle required to lift his arms.
Flicker of hope
Within six months, about the time it takes for the nerves to grow and start to form new connections to muscle, Mathew started to notice “flickers” of movement in his hand.
“To start to see progress again was very motivating,” he says.
Today, Mathew is not only able to lift his arms, he can also open doors, grasp items and even operate a manual wheelchair – something he says has changed his life. “I can transfer into a car and just put the wheelchair in the back, so I can travel with family and friends. That’s really big.”
Finding his purpose
Mathew is also using his newly acquired mobility to return to school. A University of Victoria engineering student prior to his injury, Mathew is now studying biomedical engineering at Toronto Metropolitan University. He hopes to become a spinal cord researcher, seeking out solutions to challenges like the ones Dr. Dengler helped resolve for him.
“A big goal after being injured is finding purpose and seeing how you might contribute to society,” says Mathew. “Having this procedure at Sunnybrook helped me to find my purpose. It’s making school and a whole lot more possible.”
Since operating on Mathew, Dr. Dengler has completed upper-extremity nerve transfers involving more than a dozen patients with spinal cord injuries. Her quickly growing practice has now spawned two Sunnybrook clinics: a peripheral nerve clinic in partnership with Sunnybrook’s Plastic Surgery team, and a clinic specifically for patients with spinal cord injuries.
The Complex Spinal Cord Injury Clinic is offered monthly through Sunnybrook’s Jennifer Tory Trauma Recovery Clinic, an innovative, donor-funded model of care focused on improving functional and psychological outcomes after traumatic injury. Co-led by Dr. Dengler and Dr. Larry Robinson, chief of Sunnybrook’s St. John’s Rehab and the John and Sally Eaton Chair in Rehabilitation Sciences, the Complex Spinal Cord Injury Clinic partners with a multidisciplinary team of experts including Toronto Rehab-Lyndhurst Centre to identify and assess individuals with spinal cord injury to determine who might benefit from surgical intervention.
“Time equals muscle,” says Dr. Robinson, who has performed the electrodiagnostic testing on almost 60 patients since 2020. The testing of nerves and muscles is a critical component of finding appropriate nerve donors and recipients, and planning surgical procedures. “We like to operate around the six-month mark. Wait too long and the window to reanimate the muscles will close.”
The team recently launched a pilot program to ensure every Sunnybrook trauma patient with a cervical spinal cord injury has the opportunity to undergo nerve transfer assessment. Dr. Dengler is also training other plastic surgeons in the nerve transfer technique and conducting ongoing research so even more patients like Mathew can benefit from the life-changing procedure.
The Jennifer Tory Trauma Recovery Clinic is the first clinic of its kind in Canada for patients navigating a new reality following trauma and injury. Launched in 2021, it brings care providers to the patient, in a purpose-built space consisting of five exam rooms, a dedicated registration and waiting area, staff workstations and equipment areas and a meeting room to support virtual appointments. It was made possible thanks to a leadership gift from Jennifer Tory, which has since inspired other donors to provide support.
James Mann is happy at home on his Port Perry farm, thanks to Sunnybrook’s life-saving trauma and critical care