The woman sits in her wheelchair at one end of a ping-pong table and focuses intently on the small white ball as it bounces toward her. She readies her paddle, then smacks the ball perfectly, sending a winner back across the net.

Pam Cofer grins, and her eyes twinkle as she smashes ball after ball.

Pam was diagnosed with multiple sclerosis (MS) in 1991. Back then, she worked as an insurance saleswoman and noticed she was having trouble walking in heels. She saw a neurologist who diagnosed her with MS, a progressive condition for which there are treatments to reduce additional attacks, but no cures.

These days, Pam is happily retired at 72 and lives a full life in Fort Collins, where her great grandparents helped settle the community. Her mom is thriving at 92 years old, and Pam has two daughters.

No other family members have MS, and Pam doesn’t know why the challenging illness struck her. But rates of MS are especially high in Colorado. Researchers are trying to determine why MS rates are disproportionately high in Colorado and are investigating an array of potential MS triggers including low Vitamin D levels and prior infections.

Regardless of the causes, MS often robs people of movement over time, and for the last six months, Pam has had to spend most of her days in a wheelchair. When a friend told Pam about a table tennis program called NeuroPong for people with neurodegenerative conditions like MS, Parkinson’s and Alzheimer’s, Pam was uncertain, but figured she’d give it a try.

It turns out that joining the ping-pong group has been a wonderful experience.

“It has encouraged my whole body to wake up again,” Pam said.

When she first started playing several months ago, it was tough to hold the paddle. Now, with a special, lighter-weight paddle, she has become a pro at returning serves. Pam and other NeuroPong participants don’t play competitively. Rather, they meet up twice a week, stretch, socialize, move as well as they can, have fun and hit balls together.

Pam participates in the Fort Collins program where sessions take place at a church gym. There are also NeuroPong gatherings in Boulder, Denver, Colorado Springs, Grand Junction and St. George, Utah, with plans to expand further.

“It’s really awesome to be able to do something that gives you good results and helps you feel very positive,” Pam said.

“With MS, there’s so much in your life that doesn’t work. It’s really nice to have something that does work,” she said.

On top of the in-person NeuroPong sessions, Pam enjoys practicing her shots at home.

“I have a ball on a string hanging from a door,” she said, then cracked a joke about another method to improve her ping-pong skills.

“I’ve been trying to sleep with my paddle, but so far, that hasn’t made me better.”

Playing table tennis has been great for Pam’s eye-hand coordination and helps her keep her arms, wrists and hands loose and strong. Plus, it soothes the soul.

“It’s probably more social than anything. That’s really good for me because I could be happy staying home and being in a little cocoon.”

A table tennis program born, by accident, as a doctor fought his own MS

Dr. Antonio Barbera founded the NeuroPong program after accidentally discovering that table tennis helped him manage some of his most bothersome symptoms after he was diagnosed with MS in 2016.

Barbera used to be a busy obstetrician with practices in Summit County and Fort Collins. Just before the loss of mobility forced the doctor to give up his obstetrical work, Barbera was proud to have assisted a patient with a complex breech delivery of twins.

With Barbera’s help, the woman achieved her goal of avoiding a cesarean delivery. Barbera was relishing the joy of a healthy, complex birth when, just hours later, he lost complete control of his left arm. He couldn’t feel anything or move his arm.

A previous MS episode had robbed him of the use of his right leg.

“I had to re-learn how to walk,” said Barbera. “I had no idea how to fire my muscles.”

With a lot of work, Barbera eventually was able to walk with a cane and was able to work a little while longer. But after losing mobility in his left arm during his second bad MS episode, he could no longer practice medicine.

“I felt worthless at first. I couldn’t do anything for anybody,” he said. “We have no idea why our bodies attack us.”

Barbera’s former wife had given him a ping-pong table as a 40^th birthday gift, and he had played a little table tennis as a teen growing up in Italy. Now 61 with four kids — two of his own, and two with his current partner — Barbera discovered that playing ping-pong was therapeutic and fun.

The most challenging MS symptom Barbera experiences is a severe tightening in his chest. It’s called the “MS hug.” For many people, the tightening sensation lasts a few minutes at a time, but for Barbera it persists 24/7, and the constriction can be so bad that it feels like he’s having a heart attack.

“Back in 2019, during the holidays, I was playing ping-pong, and it was the only time when I got distracted from this darn tightening in my chest,” Barbera said.

“As a physician, I started looking for ways to use ping-pong for people living with MS to see if there were any studies investigating possible benefits of the sport. If it was working for me, I figured it might help others,” he said.

Barbera ended up creating a nonprofit organization called Table Tennis Connections and designed the NeuroPong program in 2021.

Traditional table tennis can be highly competitive as players duke it out for points and games. In NeuroPong, players celebrate every time a participant returns a volley so the player on the other side can try to hit it back.

Since launching the program, Barbera has teamed up with medical experts at UCHealth University of Colorado Hospital and researchers at the University of Colorado Anschutz Medical Campus to study potential benefits of ping-pong for people with neurodegenerative conditions.

“I started learning about what our brains have the capacity to do,” Barbera said. “With MS, it’s like someone has taken a knife and has damaged the lining that protects our nerves.”

Barbera learned that, if challenged, the human brain can generate new cells and new neural connections. He wondered if playing ping-pong could stimulate the brains of people with neurodegenerative conditions.

The sport might be perfect because it’s accessible to people of nearly all ages and all abilities.

“We have people with walkers and canes and in wheel chairs. They all have so much fun,” Barbera said.

Plus, there’s a low bar for trying table tennis. Almost all of us have played at one time or another. It’s affordable, portable and taps into the playfulness of childhood.

It also might be good for the brain.

“We need to challenge our brains. When we play table tennis, our brains say, ‘Oh, this is new for me. I need to produce new cells and create new connections,’” Barbera said. “It doesn’t matter what conditions you have. We are all human. We have brains, and we need to use them.”

Enlisting researchers to study potential health benefits of ping-pong

Dr. Enrique Alvarez is a neurologist who specializes in caring for patients with MS. He and others can help patients with their MS symptoms, but there aren’t good treatments that reverse the damage.

“We don’t have good MS drugs for the progressive form of the disease,” Alavarez said. “So as patients get more advanced cases, trying to fight that progression becomes harder and harder.”

Moving as much as possible clearly helps.

“Simply put, if you don’t move, you just keep getting weaker and worse. None of us does well sitting around,” said Alvarez, who is also vice chair of clinical research and an associate professor of neurology at the University of Colorado School of Medicine.

“It’s very helpful for everybody to stay as active as possible, physically, mentally and in every way that you can,” he said.

Alvarez has joined Barbera in studying the effects of ping-pong on patients with MS. The research is ongoing, so there aren’t results yet.

Dr. Matthew Woodward is a neurologist in a movement disorders fellowship who did a pilot study on the impact of table tennis for patients with Parkinson’s.

“What we have found in prior studies is that exercise is the only thing we have to slow down disease progression,” Woodward said.

Just like MS, there are treatments for the symptoms of Parkinson’s, but increased movement can actually help people regain function.

“So, for every patient with Parkinson’s, we make sure to talk to them about doing some form of aerobic exercise,” said Woodward, who is finishing his fellowship in Colorado and will be heading to a new job in Pittsburgh soon.

“I tell patients to run if they can, or if they don’t like running, do whatever they can to keep moving,” he said. “We need to keep finding things that we enjoy and find entertaining.”

That’s where table tennis comes in. It could be a great fit for a broad swath of people.

Woodward’s study was relatively small, so he didn’t find dramatic results. But both he and Alvarez hope to keep studying the potential benefits of table tennis for people with movement disorders or neurodegenerative coditions.

How does exercise help people with movement disorders?

Alavarez said movement inspires more movement.

“Exercise is one of those things that even if you don’t have any diseases, it helps,” he said.

“There’s a fancy term: neuroplasticity, which refers to the way nerves can reconnect,” Alavarez said. “You can activate nerves with activity and exercise. The nerves may not increase in number, but the connections get more efficient.

“And if you can get stronger, it can help you get around more easily and lose weight. Then you’re not going to be carrying excess weight on weak, unbalanced or tight legs,” he said. “It all depends on how your disease is manifesting, but the benefits of exercise are really multi-faceted.”

Alvarez always encourages patients to pick sports they like. He, for instance, is not a swimmer or a runner.

“But I don’t mind chasing a ball, so I’ll play soccer all day,” he said.

“You have people who like to do individual sports, while others like team sports,” he said.

He said the benefits of ping-pong likely go beyond the boost in physical activity and better coordination.

“It’s social too, so there are a lot of mental health benefits,” Alvarez said. “People get really excited to find these activities and interact with other people. Having fun and being around others with similar conditions has a positive influence on your overall health.”

Woodward said the social benefits can help combat isolation and common symptoms that accompany progressive movement disorders.

“People with Parkinson’s often deal with depression, anxiety and apathy,” Woodward said.

Regular get-togethers with others who face similar health challenges is great.

“There’s some accountability. The community can push you and will ask if you’re going to be here next week,” Woodward said. “We hear this all the time about classes or groups.

“They’re the person’s favorite time of the week. They get to see friends and know they’re going to have fun. So they keep doing the activity.

“As doctors, sometimes we may underemphasize the simple benefits of having fun,” Woodward said.

Regardless of skill level, everyone is welcome. Ping-pong forces you to ‘move, play and learn’

At six tables spread around a gym, players, volunteers and caregivers all play ping-pong. They can keep score if they wish, but that’s optional.

For Gil Wette, who was diagnosed with Parkinson’s nearly two years ago, the NeuroPong group is a blast.

“There’s a lot of laughter and joking around. It offers so much. Research shows there are a lot of benefits mentally and physically. It’s a fun group,” he said.

Wade Warberg has been dealing with MS for more than 21 years and has had tough impacts like the loss of sight part way up his left eye and reduced mobility in his right leg. For work, Warberg helps design power lines and is still able to do his job he supervises teams and primarily works on computers at a desk. He now needs to walk with a cane and occasionally uses a wheelchair.

He loves NeuroPong.

“You don’t realize all that it’s doing for you. It forces you to move and do things that you probably weren’t comfortable doing on your own. You just play and learn. There’s no whining here. Everyone is positive here. You see people with different issues from Parkinson’s to MS to dementia. It’s all fun,” he said.

As for health benefits, Warberg thinks he’s improving both physically and mentally.

“I’m lucky that my mind is still in pretty good shape, but I think I’ve become sharper mentally,” he said. “I would love to move better, so I keep coming twice a week.

“It’s like riding a bike. You don’t just jump on it and ride the Tour de France,” he said. “You keep practicing, and you get better.”

Until about five years ago, Warberg used to ski regularly. MS robbed him of that joy, which triggered a period of depression.

“I went into a dark hole,” he said.

Now, he knows that staying busy and active — and enjoying time with his wife and two kids — is the key to staying happy and healthy.

At ping-pong sessions, ‘little miracles for everyone’

For Peggy McCauley, coming to NeuroPong gives her the opportunity to see her husband as he once was. Jerry, 73, is dealing with Alzheimer’s.

“He’s always been athletic and thrived on physical activity. He used to ski. Now he gets lost on the slopes,” she said.

The opposite happens at the table tennis gatherings.

“I get to see these little miracles happen for everyone here. You see differences in their demeanor and great social interactions. You see them laughing and moving. It’s wonderful,” Peggy said.

For Joseph Flanigan, now 75, dealing with MS has been a classic hero’s journey. He had served in the Marines and was just 40 and working as a busy engineer for IBM in New York when he received his MS diagnosis.

“I came home from a trip and was really, really tired. I was walking down the steps, fell on my back and lay there unable to get help for 36 hours,” Flanigan said.

Doctors initially thought Flanigan had cancer and nearly did surgery when Flanigan’s team eventually figured out he had MS.

“Until we got MRIs in the 90s, MS was often misdiagnosed,” Flanigan said.

Along with fatigue, he dealt with his left side freezing. There were no good medications.

“When I was first diagnosed, I was really embarrassed. I didn’t want people to open doors for me. I’m a tough guy, an ex-Marine. I started tripping over my feet and thought something was wrong with my shoes,” Flanigan said.

Eventually he started walking with a cane and came to grips with his disease. He loves to solve problems and thinks the ping-pong program is a great way to deal with a tough disease where symptoms can come and go.

“You have to reprogram your brain. You got through a trauma, then you go through a heroes journey — just like Star Wars — to change it.

“I was forced to retire when I was only 50. I had to go through a grief experience,” he said.

Flanigan enjoyed playing ping-pong as a kid and connected with Barbera as soon as he heard about the program. He loves NueroPong because he thinks it helps rewire his brain.

“This is the best experience. I’ve had years and years of physical therapy, and Dr. Barbera developed something that didn’t exist. It helps reconnect the nerves,” said Flanigan, who lives nearby in Loveland and has been participating in the program for about a year.

“People with neurodegenerative diseases have complex life challenges. For some players, just to approach a table and hold a paddle with an expectation of hitting a ball is significant. In NeuroPong, the challenge is to return a single volley so the other player can also hit the ball. Many times, a single return volley is significant,” Flanigan said.

He also loves the group dynamics.

“In sports, team loyalty and esprit de corps are a natural phenomenon. With NeuroPong, Dr. Barbera created new opportunities for people living with neurodegenerative diseases to connect with others and engage in activities that allow everyone to be part of a team,” Flanigan said.

For Pam Cofer, it’s wonderful to have a place where she feels comfortable, regardless of her skill level.

“I’m probably the worst one here, but when I connect with the ball, it feels great,” she said. “We all have struggles. Just because yours aren’t as visible as mine doesn’t mean you’re not dealing with something.”

Rather than having people feel sorry for her, she gets to feel pure as she hits the ball and little white balls plink around tables and the gym floor.

Said Pam: “It’s a universe of positivity.”