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PubMed1998

Biological interventions for spinal cord injury.

Spinal cord injury is frequently followed by the loss of supraspinal control of sensory, autonomus and motor functions at sublesional level. To enhance recovery in patients with spinal cord injuries, three fundamental strategies have been developed in experimental models. These strategies involve three different time points for postlesional intervention in the spinal cord. Neuroprotection soon after injury uses pharmacological tools to reduce the progressive secondary injury processes that follow during the first week after the initial lesion occurs, in order to limit tissue damage. A second strategy, which is initiated shortly after the lesion occurs, aims at promoting axonal regeneration by acting pharmacologically on inhibitors or barriers of regeneration, or by the application of cell or gene therapy as a source of neurotrophic factors or as a bridge or support to enhance the regeneration of lesioned axons. Finally, a mid-term substitutive strategy is the management of the sublesional spinal cord by sensorimotor stimulation or the supply of missing key afferents, such as monoaminergic systems. These three strategies are reviewed. Only a combination of these different approaches can provide an optimal basis for potential therapeutic interventions aimed at functional recovery after spinal cord injury.

Animals↗
PubMed1992

Clinical management of chronic pain in spinal cord injury.

Spinal cord injury (SCI) can cause paralysis; sensory impairment; autonomic nervous system dysfunction; and bowel, bladder, and sexual dysfunction. These impairments may lead to immobility, physical dependence, and alterations in lifestyle and self-esteem. The addition of chronic, intractable pain to these impairments can be truly devastating. Chronic pain superimposed on spinal cord injury can virtually drain the individual of strength, motivation, and will. For the spinal cord injury survivor who already faces functional loss, severe pain can further restrict even the diversional activities that are available. Thus, it may become impossible for the individual to escape his or her pain even temporarily. The various medical, physical, and surgical treatments considered to be efficacious in treating this pain are reviewed. However, although chronic pain in SCI may be managed by these therapies, a permanent cure may not result.

Chronic Disease↗
PubMed2002

A review of the adaptability and recovery of locomotion after spinal cord injury.

Spinal cord injury (SCI) is associated with multiple motor problems leading to the alteration and limited adaptation in the walking and postural behavior. This review addresses recent findings on locomotor and postural adaptations after spinal cord injury. The adaptation of the locomotor behavior to behavioral goals and external constraints constitute important functional prerequisites in the recovery of locomotion after spinal cord injury. Functional prerequisites in locomotion include coping with changes in speed, slope obstacle, weight support, interaction with walking aids, energy consumption and attentional demands. Various treatment approaches such as locomotor training using body weight support (BWS) and functional electrical stimulation (FES) will be discussed, in the context of functional prerequisites necessary in the recovery of locomotion. Understanding locomotor and postural adaptations will lead to a better appreciation of the normal and dysfunctional mechanisms, and culminate eventually in the development of appropriate rehabilitation assessment and treatment strategies.

Adaptation, Physiological↗
PubMed2006

6-Shogaol, a natural product, reduces cell death and restores motor function in rat spinal cord injury.

Spinal cord injury (SCI) results in progressive waves of secondary injuries, which via the activation of a barrage of noxious pathological mechanisms exacerbate the injury to the spinal cord. Secondary injuries are associated with edema, inflammation, excitotoxicity, excessive cytokine release, caspase activation and cell apoptosis. This study was aimed at investigating the possible neuroprotective effects of 6-shogaol purified from Zingiber officinale by comparing an experimental SCI rat group with SCI control rats. Shogaol attenuated apoptotic cell death, including poly(ADP-ribose) polymerase activity, and reduced astrogliosis and hypomyelination which occurs in areas of active cell death in the spinal cords of SCI rats. The foremost protective effect of shogaol in SCI would therefore be manifested in the suppression of the acute secondary apoptotic cell death. However, it does not attenuate active microglia and macrophage infiltration. This finding is supported by a lack of histopathological changes in the areas of the lesion in the shogaol-treated SCI rats. Moreover, shogaol-mediated neuroprotection has been linked with shogaol's attenuation of p38 mitogen-activated protein kinase, p-SAPK/JNK and signal transducer, and with transcription-3 activation. Our results demonstrate that shogaol administrated immediately after SCI significantly diminishes functional deficits. The shogaol-treated group recovered hindlimb reflexes more rapidly and a higher percentage of these rats regained responses compared with the untreated injured rats. The overall hindlimb functional improvement of hindlimbs, as measured by the Basso, Beattie and Bresnahan scale, was significantly enhanced in the shogaol-treated group relative to the SCI control rats. Our data show that the therapeutic outcome of shogaol probably results from its comprehensive effects of blocking apoptotic cell death, resulting in the protection of white matter, oligodendrocytes and neurons, and inhibiting astrogliosis. Our finding that the administration of shogaol prevents secondary pathological events in traumatic SCIs and promotes recovery of motor functions in an animal model raises the issue of whether shogaol could be used therapeutically in humans after SCI.

Animals↗
PubMedDate not supplied

Long-term psychosocial effects of spinal cord injury.

Spinal cord injury typically occurs in males during late adolescence or young adulthood. These individuals face the developmental challenges of adulthood with significant restrictions in mobility and position. The purposes of this study were to examine how spinal cord injured male experience these limitations and to identify how they fulfill adult developmental tasks/expectations. Interviews on this topic were conducted with a convenience sample of 5 spinal cord injured men between the ages of 30 and 45 who had been injured at least 10 years. The findings of this study indicated that the impairment of mobility and position that resulted from the spinal cord injury did have a significant impact upon the developmental tasks/expectations of adulthood. Mobility and position restrictions delayed and/or interfered with the establishment of close personal relationships and the development of a satisfying career. Information also was obtained about the process of coping with the paralysis of a spinal cord injury over time.

Activities of Daily Living↗
PubMedDate not supplied

Acute management of the patient with spinal cord injury.

Spinal cord injuries are not as common as many other types of injuries. The victims are often young, the injury debilitating, and the effects devastating and incalculable. The acute management of patients with spinal cord injury can significantly affect the patient's eventual neurologic and functional outcome and ultimately their quality of life. Early interventions are aimed at reestablishing physiologic homeostasis, lessening the amount of secondary injury, and preserving neurologic function.

Autonomic Dysreflexia↗
PubMed2004

Experimental bypass surgery between the spinal cord and caudal nerve roots for spinal cord injuries.

Spinal cord injuries often cause permanent neurological deficits and are still considered as inaccessible to efficient therapy. Injured spinal cord axons are unable to spontaneously regenerate in adult mammalians. Re-establishing functional activity especially in the lower limbs by reinnervating the caudal infra-lesional territories could represent an attractive therapeutic strategy. For several years, we have studied and developed surgical bypasses using peripheral nerve grafts bridging the supra-lesional rostral spinal cord to the caudal infra-lesional lumbar roots. Main objectives were: 1- to overcome the spinal cord lesion and the consecutive glial barrier blocking the axonal regeneration; 2- to find and bring an alternative source of regenerating axons; 3- to guide those axons toward precisely definite targets (for example, lower limb muscles). We report here the results of our experimental research, which led us from animal experimental models (rodents, primates) to the first human experimentation. Limitations of the method (especially technical pitfalls) are numerous. However, we have obtained encouraging results in our attempts to "repair" the motor pathway. Functional recovery with strong evidence of centrifugal axonal regeneration from the spinal cord to the periphery has been observed. Regarding the sensory pathway, we have found evidence of centripetal axonal regeneration from the periphery toward the spinal cord. Further studies are obviously advocated, but our experimental model of spinal cord - nerve roots bypasses may be integrated in future "repair" strategies of both motor and sensory pathways following spinal cord injury.

Animals↗
PubMed1992

GM-1 ganglioside in human spinal cord injury.

Spinal cord injury is typically a devastating injury with no or only limited neurologic recovery. Recent papers have reported enhancement of neurologic recovery following spinal cord injury with both methylprednisolone and GM-1 ganglioside. This paper provides additional details of the GM-1 study and a further analysis of recovery of motor function for each of the ten neurologic levels assessed in the study. This additional analysis provides further evidence that the largest enhanced recovery of motor function in the GM-1 treatment group occurred in the muscles of the lower extremities and is consistent with the enhanced recovery occurring in the white matter tracts passing through the level of injury.

Adult↗
PubMed1992

GM-1 ganglioside in human spinal cord injury.

Spinal cord injury is typically a devastating injury with no or only limited neurologic recovery. Recent papers have reported enhancement of neurologic recovery following spinal cord injury with both methylprednisolone and GM-1 ganglioside. This paper provides additional details of the GM-1 study and a further analysis of recovery of motor function for each of the ten neurologic levels assessed in the study. This additional analysis provides further evidence that the largest enhanced recovery of motor function in the GM-1 treatment group occurred in the muscles of the lower extremities and is consistent with the enhanced recovery occurring in the white matter tracts passing through the level of injury.

Adult↗
PubMed2002

Motor unit firing during and after voluntary contractions of human thenar muscles weakened by spinal cord injury.

Spinal cord injury may change both the distribution and the strength of the synaptic input within a motoneuron pool and therefore alter force gradation. Here, we have studied the relative contributions of motor unit recruitment and rate modulation to force gradation during voluntary contractions of thenar muscles performed by five individuals with chronic (>1 yr) cervical spinal cord injury. Mean +/- SD thenar unit firing rates were low during both steady-level 25% (8.3 +/- 2.2 Hz, n = 27 units) and 100% maximal voluntary contractions (MVCs, 9.2 +/- 3.1 Hz, n = 23 units). Thus modest rate modulation, or a lack of it in some units, was seen despite an average fourfold increase in integrated surface electromyographic activity and force. During ramp contractions, units were recruited at 5.7 +/- 2.5 Hz, but still only reached maximal firing rates of 12.8 +/- 4.9 Hz. Motor units were recruited up to 85% of the maximal force achieved (14.6 +/- 5.6 N). In contrast, unit recruitment in control hand muscles is largely complete by 30% MVC. Thus, during voluntary contractions of thenar muscles weakened by cervical spinal cord injury, motor unit rate modulation was limited and recruitment occurred over a wider than usual force range. Those motor units that were stopped voluntarily had significantly lower derecruitment versus recruitment thresholds. However, 8 units (24%) continued to fire long after the signal to end the voluntary contraction at a mean frequency of 5.9 +/- 0.8 Hz. The forces generated by this prolonged unit activity ranged from 0.3 to 7.2% maximum. Subjects were unable to stop this involuntary unit activity even with the help of feedback. The mechanisms that underlie this prolonged motor unit firing need to be explored further.

Adult↗
PubMed2002

Muscular, skeletal, and neural adaptations following spinal cord injury.

Spinal cord injury is associated with adaptations to the muscular, skeletal, and spinal systems. Experimental data are lacking regarding the extent to which rehabilitative methods may influence these adaptations. An understanding of the plasticity of the muscular, skeletal, and spinal systems after paralysis may be important as new rehabilitative technologies emerge in the 21st century. Moreover, individuals injured today may become poor candidates for future scientific advancements (cure) if their neuromusculoskeletal systems are irreversibly impaired. The primary purpose of this paper is to explore the physiological properties of skeletal muscle as a result of spinal cord injury; secondarily, to consider associated changes at the skeletal and spinal levels. Muscular adaptations include a transformation to faster myosin, increased contractile speeds, shift to the right on the torque-frequency curve, increased fatigue, and enhanced doublet potentiation. These muscular adaptations may be prevented in individuals with acute paralysis and partially reversed in individuals with chronic paralysis. Moreover, the muscular changes may be coordinated with motor unit and spinal circuitry adaptations. Concurrently, skeletal adaptations, as measured by bone mineral density, show extensive loss within the first six months after paralysis. The underlying science governing neuromusculoskeletal adaptations after paralysis will help guide professionals as new rehabilitation strategies evolve in the future.

Adaptation, Physiological↗
PubMed2003

Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury.

Spinal cord injury has been recognized as a complication of cervical transforaminal injections, but the mechanism of injury is uncertain. In the course of a transforaminal injection, an observation was made after the initial injection of contrast medium. The contrast medium filled a radicular artery that passed to the spinal cord. The procedure was summarily abandoned, and the patient suffered no ill effects. This case demonstrates that despite using careful and accurate technique, it is possible for material to be injected into a radicular artery. Consequently, inadvertent injection of corticosteroids into a radicular artery may be the mechanism for spinal cord injury following transforaminal injections. This observation warns operators to always perform a test injection of contrast medium, and carefully check for arterial filling using real-time fluoroscopy with digital subtraction.

Adrenal Cortex Hormones↗
PubMed1999

Association of head trauma with cervical spine injury, spinal cord injury, or both.

BACKGROUND: Links between cervical spine and/or spinal cord injuries and head trauma have not been reported in detail. METHODS: 188 patients with cervical spine and/or spinal cord injury were divided into two groups, i.e., with upper cervical and mid-lower cervical injury, and compared for head injury. RESULTS: Associated head trauma was investigated in 188 patients with cervical spine and/or spinal cord injuries; 35% had moderate or severe injuries. Brain damage was more frequently observed in patients with upper cervical injury than in those with mid to lower cervical injury. Those patients with upper cervical injury appeared to have an elevated risk of suffering skull base fractures, traumatic subarachnoid hemorrhage, and contusional hemotoma. CONCLUSIONS: Approximately one third of patients with cervical spine and/or spinal cord injuries had moderate or severe head injuries. Brain damage was more frequently associated with upper cervical injury. Those patients with upper cervical injury are at greater risk of suffering from skull base fractures and severe intracranial hematomas than those with mid to lower cervical injury.

Adolescent↗
PubMed1988

Sexuality and spinal cord injury.

Spinal cord injury may have a profound effect on the patient's sexuality. In order to maximize the patient's potential, concern and support from health care professionals is needed. This article reviews normal sexual function and changes occurring following spinal cord injury. The PLISSIT model is described and is used to describe nursing interventions designed to deal with the sexual concerns of spinal cord-injured patients.

Humans↗
PubMed1991

A functional classification of respiratory compromise in spinal cord injury.

Spinal cord injury (SCI) patients have unique care needs, particularly related to the respiratory system. Respiratory problems now comprise a major cause of death in the acute and chronic phases of SCI, especially among quadriplegics. Previous literature has analyzed respiratory muscle dysfunction in SCI according to neurologic levels of injury (Alvarez, Peterson & Lunsford, 1981; McMichan, Michel & Westbrook, 1980). In general, the higher the level of injury, the greater the respiratory compromise and need for ventilatory assistance. Although level of injury is significant, it cannot be used as the sole determinant of respiratory compromise. For example, a 25 year old C4 quadriplegic with an intact diaphragm might have less respiratory impairment than a 60 year old C6 quadriplegic with CHF and a history of COPD. A new classification of SCI patients according to amount of respiratory compromise was developed by our team at the Spinal Cord Injury Unit at the Palo Alto VA Medical Center. The patient is scored in three categories: 1) level of injury; 2) completeness of injury; and 3) associating factors, i.e. age, preinjury chronic lung disease. The purpose of this grouping is to better predict the amount of ventilatory impairment in SCI patients. Used during the initial assessment, patients at high risk for impairment could be determined and optimal respiratory care initiated. This classification can also be used as a clinical nursing tool. Using this scoring system, the nurse could anticipate the patient's respiratory needs, i.e. suctioning, chest physiotherapy, oxygen, hydration, nutritional support and teaching of patient and family in order to comprehensively plan and implement care.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Theoretical aspects of sensory substitution and of neurotransmission-related reorganization in spinal cord injury.

Spinal cord rehabilitation has progressed enormously since World War II, and persons with spinal cord injuries now have long life expectancies. Research has recently concentrated on improvement of the quality of life, and on neural mechanisms of recovery. This article will explore some aspects of both of these areas. In the first section, the potential applications of sensory substitution systems for such functions as sex sensation and sensation from feet and from robotic hands will be examined. In the second section, the potential role of nonsynaptic diffusion neurotransmission (NDN) in neural reorganization after spinal cord injury will be considered. This article includes portions of previous publications and reports.

Animals↗
PubMed1998

Clinical trials of pharmacotherapy for spinal cord injury.

Spinal cord injury remains with limited natural recovery and only a few general ineffective treatment options. Recent publications have reported enhanced neurologic recovery with the use of methylprednisolone and GM-1 ganglioside. The results of the Maryland GM-1 Ganglioside Study reported a significant drug effect with respect to the fraction of patients that had a change of two or more Frankel grades from entrance into the study to 1-year follow-up. This study formed the basis for the currently ongoing larger placebo-controlled multicentered study using Sygen GM-1 following acute spinal cord injury. This study has entered 797 patients and is expected to present results in early 1998.

Adult↗