“I thought, ‘He must be so sad! Both of his parents have died. What could I do to make him feel better?  If I cured spinal cord injuries, that would make him feel better, I bet,’” she recalled.

Thus was born her interest in spinal cord injury rehabilitation. After graduating from the University of Louisville School of Medicine this spring, Wilkins will follow that passion as a physical medicine and rehabilitation resident with Case Western Reserve University in Cleveland.

Before embarking on a path to becoming a physician, however, Wilkins earned an undergraduate degree in her other passion, theater and music, and she spent three years working as an actor and a singer in New York City.

“I’m a really people-oriented person, a love-oriented person. In theater you are trying to get people to feel things. You are bringing people into space that they might not feel comfortable or that they had forgotten about or just helping them understand their own experiences about life,” she said. “But when the curtain closes, I don’t actually get to see how they experienced it and ask them, ‘Do you feel better? Is there anything I can do to make you feel better?’ A way to do that would be in medicine.”

So, as she was navigating the bustling world of auditions and theater productions, she also was completing science requirements and applying to medical school.

“I had always loved science. I said, I’ll give it one shot and if I get in, that’s the path I’ll take. If I don’t, I’ll just continue to be an actress and it’ll be fine,” she said.

“I ended up getting in and I chose Louisville because of the work with spinal cord injury.”

Just a week after the wrap of her third New York production, in which she played one of the stepsisters in a production of “Into the Woods,” she moved to Louisville to start classes. But the dramatic life transition caused her to wonder if she was making the right choice.

“I had a big identity crisis,” she said. “Am I abandoning theater because I’m giving up? Am I truly excited and feel like I’m called to go do this other thing?”

The crisis resolved a few months into her first year of medical school when, with encouragement from her instructor, Jennifer Brueckner Collins, she joined a community theater group. The weekly classes with the Commonwealth Theater Company allowed her to stay connected with music and acting.

“I loved doing it! It was a great addition to my life here in Louisville.,” Wilkins said. “It just helped me kind of merge my two personalities. I was able to say, ‘OK, I can be both things. I can still consider myself an actress, too.’”

It also helped that she was able to connect with UofL’s spinal cord injury researchers, starting with Susan Harkema, who leads UofL’s groundbreaking research in epidural stimulation with the Kentucky Spinal Cord Injury Research Center.

“She met with me, she got me plugged in to a research position with Dr. Max Boakye’s lab and I met a bunch of people that way,” Wilkins said.

“I could not have gone to a more supportive place, a better place for what I’m interested in. I cannot say enough great things about the UofL School of Medicine and Frazier Rehab. They’re very inclusive and excited to get students involved.”

In her third year at UofL, however, Wilkins faced another personal challenge. She already was frustrated as the pandemic limited students’ clinical activities when her father was diagnosed with cancer. COVID restrictions meant she was unable to visit him in the hospital and he died just a few months later.

“It was very, very difficult. I was wondering if I should take a leave of absence, if I should go home to Atlanta,” she said.

But she persevered.

“My dad and my mom and all of the faculty and professors here were really integral to me deciding that I could stay, I could finish on time and match on time.”

On Match Day this year, with a photo of her dad in hand, she learned she would be spending her four-year residency at Case Western Reserve University and MetroHealth Medical Center in Cleveland, pursuing specialty training in physical medicine and rehabilitation.

“I’m so excited! I’m in PM&R for life now. I’m over the moon,” she said.

Wilkins plans to continue participating in music and theater, but as she pursues her goal to cure spinal cord injury, she appreciates the ability to have the more personal connections with the people she will treat as a physician.

“I’m still there with people in dark moments, but I actually get to hold their hand and be with them throughout the whole process.”

Despite these significant results, use of epidural stimulation outside a research lab setting to restore function for people with spinal cord injury thus far has been hampered by several limitations, including the use of a technology that was designed for patients with chronic, intractable pain – not those with spinal cord injury.

Applying this therapy for spinal cord injury is a big step closer to use outside the research lab thanks to a $7.8 million grant from the National Institute of Neurological Disorders and Stroke, one of the National Institutes of Health. The grant will fund work at UofL’s  in collaboration with medical device manufacturer Medtronic to develop and test software applications specifically designed for spinal cord injury that work in concert with Medtronic’s commercially-available device, Intellis, which is indicated as a spinal cord stimulator for chronic pain. The five-year project, funded through the , is focused on incorporating technology to improve control of locomotor and bladder function using epidural stimulation.

“We have seen excellent results with epidural stimulation in the lab, but these enhancements to the technology system will make it much easier to implement this therapy out in the community. Integrating multiple systems will allow people with chronic spinal cord injuries to benefit from stimulation on a daily basis by reducing the need to monitor and manually revise stimulation settings,” said Claudia Angeli, assistant professor of bioengineering in the UofL and director of the Epidural Stimulation Program at KSCIRC. Angeli and Maxwell Boakye, neurosurgeon and clinical director of KSCIRC, will lead the project.

Medtronic epidural stimulators first were used for spinal cord injury in 2009 under an Investigational Device Exemption with the FDA during research at UofL led by Susan Harkema, professor of neurological surgery and associate scientific director for KSCIRC. The epidural stimulation therapy involves implanting a neurostimulator under the patients’ skin and implanting electrodes in the epidural space of the lower spinal cord, which together deliver mild electrical impulses to the spine. 

While epidural stimulation has been proven to provide effective relief for chronic pain, there are limitations in functionality when treating individuals with spinal cord injury. For example, the stimulation settings that allow individuals with spinal cord injury to stand are different from settings that allow them to walk, while a third configuration is required to help with bladder function and so forth. The devices that researchers use today must be programmed manually for each individual function.

The goal of the new project is to develop integrated, closed-loop programming for multiple systems, specifically locomotion and bladder function, using wireless sensors to monitor the user’s condition and adjust stimulator settings as needed. Working with Medtronic, the UofL researchers will develop learning programs for the closed-loop system and integrate the programming with commercially available epidural stimulators, as an investigational use.

“This device will be customized for the needs of individuals with spinal cord injury, which will require less manual interaction and lead to more positive outcomes in both locomotion and bladder function, dramatically improving the future of neuromodulation for spinal cord injury,” said Boakye, chief of spinal neurosurgery at the , neurosurgeon with and lead neurosurgeon for implantation of the device.

During the first phase of the study, the researchers will develop learning algorithms and the closed-loop system, working with the Medtronic’s Intellis Spinal Cord Stimulation platform. This phase calls for eight individuals to receive implanted stimulators and either locomotor or bladder interventions to develop learning algorithms, which later will be integrated in closed-loop controls. Those data and technical tools then will be applied to a second group of eight individuals who have not received prior training.

“By monitoring multiple systems and enabling the controller to adjust stimulation without direct input from the user, these improvements will make this device a powerful tool for improving the lives of people with spinal cord injury,” said April Herrity, an investigator on the project.

The 2018 breakthrough was the result of years of research by the UofL team, which found that applying electrical stimulation to the lower spinal cord, combined with physical therapy, allows unexpected degrees of recovery in people with complete spinal cord injury. Research participants are able to move voluntarily, stand and take steps, in addition to experiencing improvements in blood pressure regulation, bowel and bladder function and other common health issues associated with spinal cord injury.

“One of the main obstacles to making this therapy available to patients has been the need for programming specific for spinal cord injury,” said Harkema, also an investigator on this project. “This new work will promote the safe, long-term use of the therapy in the home and community, allowing people with spinal cord injury to benefit from the discoveries we have made over the past two decades.”

“Medtronic is excited to be collaborating with the University of Louisville on research related to the use of spinal cord stimulation to improve function for individuals with spinal cord injury,” said Charlie Covert, vice president and general manager of Pain Therapies, part of the Neuromodulation Operating Unit at Medtronic. “Collaboration is vital to innovation in this space in order to meet the needs of this important patient population.”