Serum albumin may help predict neurological recovery after SCI
Lay summary by Frank Yeung Edited by Rona Herzog, Crystal Han This is a summary of a research study conducted by Lukas Grassner, Jan Schwab, Gale Whiteneck, Fred Geisler, and ICORD researchers Dr. John Kramer, Anh Vo, and Catherine Jutzeler. Read Read More...
Lay summary by Frank Yeung Edited by Rona Herzog, Crystal Han This is a summary of a research study conducted by Lukas Grassner, Jan Schwab, Gale Whiteneck, Fred Geisler, and ICORD researchers Dr. John Kramer, Anh Vo, and Catherine Jutzeler. Read the original article here. What is albumin? Albumin is the most abundant protein in blood plasma. The function of albumin is to help transport things found in blood, such as hormones, vitamins and drugs. The other major function of albumin is keeping blood from leaking out of blood vessels. There are some situations where we may have low albumin levels: this is called hypoalbuminemia. Hypoalbuminemia refers to abnormally low levels of albumin. This can be caused by reduced production of albumin due to liver dysfunction, increased breakdown of albumin following an infection, or leakage of albumin from the blood vessels. It is also a risk factor associated with faster disease progression and worse outcomes in ALS, Guillain-Barré syndrome, and stroke. How does albumin relate to spinal cord injury? Spinal cord injury (SCI) results in a lot of trauma and is associated with a high rate of infection. As hypoalbuminemia can occur as a result of increased breakdown after infection, it is common to see hypoalbuminemia following an SCI. A previous study has demonstrated that hypoalbuminemia predicted poor neurological recovery. This suggests that serum albumin has the potential to act as a predictive molecule, specifically helping us to predict neurological recovery after SCI. Since this finding was based on older data, the current study was done to confirm the results by using newer data that reflects updated medical practices. What was the purpose of this study? There were two goals in this study: The primary goal: to see if serum albumin levels can help predict neurological recovery after SCI. To use contemporary data that reflects more modern methods of SCI management. How was the research conducted? The researchers used data from the Spinal Cord Injury Rehabilitation study in 2007 to 2009, which enrolled participants aged ≥12 years, whom all have an SCI and were undergoing rehabilitation at six participating rehabilitation centres in the United States. They had collected data about albumin and neurological outcomes from these participants. By using this more recent data, they addressed their second goal of utilizing contemporary data that reflects how an SCI is managed currently. The primary analysis looked at the relationship between serum albumin, injury severity, and long-term outcomes. Injury severity of participants were represented numerically: the lower extremity motor scores (LEMS) and the American Spinal Injury Association Impairment Scale (AIS) grades. Both of these represent how much the SCI has impaired the subject’s ability to function. First, they looked at the relationship between the LEMS and AIS grade and serum albumin concentrations during the subject’s admission into rehabilitation. This helped make sure that injury severity at admission to rehabilitation was associated with serum albumin. For example: if the injury severity is high, low serum albumin levels were expected. To study neurological recovery, they re-evaluated the LEMS and AIS grade at 1-year post-injury to check for changes in the grades. This analysis helped determine if serum albumin can be used to predict neurological recovery after SCI. Given that serum albumin levels were intended to act as a predictive marker of neurological recovery, it was expected that low serum albumin levels upon admission into rehabilitation predicted poor neurological recovery a year later. Thus, it was expected that there would be little changes to the LEMS and AIS scores one year following injury if participants were admitted into rehabilitation with low serum albumin levels. What were the results of the study? The researchers found that lower serum albumin concentrations were associated with more severe injuries at admission to rehabilitation, which matched with previous studies. As a result of an SCI, there would be a high degree of trauma and rates of complications, like infections, in the initial days to weeks. If there is a prolonged infection or severe trauma, hypoalbuminemia could occur, and it would be associated with poor health, which limits the extent of neurological recovery. The researchers’ primary analysis found that serum albumin concentrations were able to predict neurological recovery. However, its predictive ability regarding neurological recovery did not improve beyond what was already predicted from using the baseline LEMS and AIS grades. Thus, although it was found that low serum albumin concentrations are predictive of poor neurological recovery, it does not prove to be a better predictive tool than the LEMS and AIS grades. Why are the findings important? This replicative study has helped confirm the results in previous studies, which have found that albumin concentration is associated with baseline injury characteristics (LEMS and AIS) and long-term neurological recovery after SCI. Since more contemporary data was used, the findings of this paper reflect more modern practices as well. The researchers believe that serum albumin concentrations provide a rough estimate of injury severity and possible future neurological recovery. Thus, it may only be useful for cases where the injury severity can not be assessed by the LEMS and AIS grades. Along these lines, they believe that there is potential for serum albumin to be applied in the clinic as a predictive molecule, and it could lead to more studies.
Exercise capacity and respiratory muscle training in athletes with cervical SCI
Lay Summary by Aleksander Walter Edited by Rona Herzog This lay summary is based on a research study conducted by ICORD researchers Cameron Gee, Alexandra Williams, Dr. William Sheel, Dr. Christopher West, and their colleague Neil Eves. To access the Read More...
Lay Summary by Aleksander Walter Edited by Rona Herzog This lay summary is based on a research study conducted by ICORD researchers Cameron Gee, Alexandra Williams, Dr. William Sheel, Dr. Christopher West, and their colleague Neil Eves. To access the full article click here. The researchers have also created a short video in collaboration with The Physiological Society, click here to access the video. Individuals with cervical spinal cord injuries (SCI) often experience reduced exercise capacity. This is based on a few important physiological factors, including: reduced blood redirection to exercising muscles limited maximum heart rate limited amount of blood the heart can pump with each beat impaired ability to return blood to the heart All of the above factors can result in blood pooling, which occurs when blood fails to return to the heart. When blood begins to pool during exercise, it further decreases the individual’s aerobic ability (i.e. their ability to exercise while oxygen is being utilized). Purpose of the study: The purpose of this study was to measure responses from the circulatory and pulmonary systems, and measure changes to overall exercise capacity in athletes with cervical SCIs following inspiratory and expiratory muscle training (IMT and EMT respectively). How the study was conducted: For this study, 6 wheelchair rugby players were recruited (5 male and 1 female). The participants took part in a 6-week intervention which consisted of RMT 5 days/week, with 2 sessions/day, and 30 breaths per session. During these sessions researchers measured the participants total lung capacity (TLC). TLC is the volume of air measured in the chest after a maximal inspiration (breath in). Researchers also measured: resting pulmonary (lung) function; measured while individuals were in a seated position resting heart function; measured via echocardiogram while participants laid flat on their back at a 45-degree head tilt maximal exercise output; this was tested by athletes cycling until exhaustion on an arm cycle. submaximal exercise output; these tests were conducted in 4 four-minute stages at 20, 40, 60, and 80% field-based exercise performance; this was measured while participants sprinted 20x20m in order to replicate the strain of wheelchair rugby The researchers performed these measurements for each athlete before and after RMT, and then again 6 weeks after RMT had concluded. Findings: Researchers discovered that RMT increased both inspiratory and expiratory muscle strength in athletes with cervical SCI , which was associated with improved exercise capacity. The improvement in exercise capacity may be due to the ability to generate stronger chest pressures that could help blood return to the heart rather than pooling in the abdomen. The study discusses potential theoretical implications of RMT for athletes with cervical SCI. Researchers discuss how often individuals with cervical SCIs recruit specific back and chest muscles for active expiration. These muscles have the potential to be strengthened through EMT, which could lead to improved respiratory function, as well as improvements in wheelchair propulsion (the recruited muscles are actively used for wheelchair movement). Limitations: The applicability of these findings to the general SCI community is somewhat limited as the researchers only observed individuals with cervical SCI, who were highly-trained wheelchair rugby athletes. The decision to include only highly-trained athletes in the study, as opposed to using community-level athletes, was to reduce the chances of any exercise-based limitations that were not related to the cardiovascular system (for example, exercise capacity being limited due to muscle weakness). Therefore, the results of this study may not be replicated in individuals with SCIs that are not highly-trained athletes/do not have an athletic background. Further research must be done regarding non-athletes with cervical SCI and their response to IMT and EMT.
Acute effects of SCI on cardiovascular autonomic function via evaluating changes in low-frequency blood pressure variability
Lay Summary by Daman Dhunna Edited by Rona Herzog This is a summary of a paper by ICORD researchers Vera-Ellen Lucci, Dr. Jessica Inskip, Maureen McGrath, Dr. Brian Kwon, Dr. Victoria Claydon, and their colleagues Dr. Ian Ruiz and Rebekah Read More...
Lay Summary by Daman Dhunna Edited by Rona Herzog This is a summary of a paper by ICORD researchers Vera-Ellen Lucci, Dr. Jessica Inskip, Maureen McGrath, Dr. Brian Kwon, Dr. Victoria Claydon, and their colleagues Dr. Ian Ruiz and Rebekah Lee. To access the original article, click here. <img decoding="async" data-attachment-id="47296" data-permalink="https://icord.org/2021/03/acute-effects-of-sci-on-cardiovascular-autonomic-function-via-low-frequency-blood-pressure-variability/cvd-image-1-page-001/" data-orig-file="https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001.jpg" data-orig-size="1275,1647" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="CVD image (1)-page-001" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001-793x1024.jpg" class="wp-image-47296 alignright" src="https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001.jpg" alt="" width="425" height="549" srcset="https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001.jpg 1275w, https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001-232x300.jpg 232w, https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001-793x1024.jpg 793w, https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001-768x992.jpg 768w, https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001-1189x1536.jpg 1189w, https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001-155x200.jpg 155w, https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001-1080x1395.jpg 1080w, https://icord.org/wp-content/uploads/2021/02/CVD-image-1-page-001-400x516.jpg 400w" sizes="(max-width: 425px) 100vw, 425px" />Our spinal nerves, depicted in the image on the right, innervate various organs/organ systems to modify their function. Autonomic nerves called sympathetic nerves that exit the spinal cord above T6 innervate both the heart, influencing the rate and force of the heartbeat, as well as the blood vessels, which are important in controlling blood pressure. This cardiovascular autonomic modulation of the cardiovascular system is critical for normal control of the circulation, and is important during “fight or flight” situations, known as sympathetic stimulation. Spinal cord injuries (SCI) that affect spinal levels above T6 can severely disrupt the capacity to regulate heart rate and blood pressure, leading to cardiovascular autonomic dysfunction. This can cause problems with adjusting blood pressure and heart rate during position changes, a condition known as orthostatic hypotension (a drop in blood pressure when moving from lying to upright positions), that can lead to fatigue, and dizziness or fainting. Other problems can include an inability to increase heart rate and blood pressure during exercise, creating challenges with activities of daily living, as well as a condition of extremely high blood pressure, known as autonomic dysreflexia, that can be triggered by many different daily activities, such as a full bladder or bowel or conducting personal care routines. Individuals can also experience cardiac arrhythmias, which is defined as abnormal electrical activity in the heart. What was the purpose of this study? We know that individuals with SCI can experience cardiovascular autonomic dysfunction, but it isn’t known whether this occurs immediately after injury or takes time to develop, and this has important implications for attempts to prevent or treat cardiovascular autonomic dysfunction. It also isn’t clear how cardiovascular autonomic dysfunction progresses after injury, or how it relates to the cardiovascular symptoms that individuals with SCI experience. Crucially, researchers and clinicians lack simple tools to quantify the severity of cardiovascular autonomic dysfunction after SCI, making it difficult to identify and monitor those at high risk for cardiovascular autonomic dysfunction. This study’s main goal is to: Track the progression of injury to cardiovascular autonomic pathways over the first year (acute phase) after injury using a novel quantitative method based on characterization of blood pressure fluctuations Identify individuals with severe lesions to cardiovascular autonomic pathways Examine the relationships between severity of injury to cardiovascular autonomic nerves and signs and symptoms of cardiovascular dysfunction How was this study conducted? The data in this study was collected upon 5 different visits in the following order: Less than 2 weeks post SCI 2-4 weeks post SCI 3 months post SCI 6-12 months post SCI More than 1 year post SCI Each test visit comprised the following measurements of cardiovascular function, as well as self-reported cardiovascular symptom assessments: Lesion characteristics: level and severity of injury to movement and sensation were determined using the American Spinal Injury Association (ASIA) Impairment Scale (AIS). Symptom Questionnaire: filled out by participants regarding the severity of their cardiovascular symptoms (autonomic dysreflexia (AD), Orthostatic hypertension (OH), fatigue, cardiac arrythmias). Injury to cardiovascular autonomic pathways: with normal fine tuning of heart rate and blood pressure there are continuous fluctuations in these values with every heart beat as they are optimized for the body’s needs. When the fine tuning is lost, for example with injury to cardiovascular autonomic nerves, these values no longer fluctuate. Measures of these low frequency fluctuations in heart rate and blood pressure (low frequency systolic arterial pressure [LF-SAP] oscillations) were calculated from beat-to-beat recordings. This technique enables assessment of the extent of cardiovascular autonomic dysfunction in a simple non-invasive fashion (without poking a needle or requiring a blood sample). Blood pressure control: when blood pressure changes, reflex responses (the baroreflex response) would normally be activated to restore blood pressure to normal levels. From the blood pressure and heart rate readings, the baroreflex response was measured providing information about reflex control of the circulation after SCI. There are also interactions between breathing and cardiovascular control, known as cardiorespiratory interactions and these were also evaluated from the heart rate and blood pressure recordings. Risk for irregular heartbeats: the heart beat is controlled by electrical signals and changes in this electrical activity can be associated with increases in risk for irregular heartbeats. These electrocardiogram parameters were evaluated at each time point. Measurements from this study were compared with previous research on chronic SCI, as well as able-bodied controls in order to gain a comparison and better understanding of the effects of injury to cardiovascular autonomic control in the acute phase of SCI. What are the findings of this study? Individuals with autonomically-complete lesions, meaning those with severe injury to the spinal cardiovascular autonomic pathways, could be readily identified using the new approach of measuring LF-SAP. Those with severe autonomic injuries lost fine tuning of blood pressure and so had low levels of LF SAP that did not improve over time. These analyses were best performed at 1-month after injury and did not reliably detect autonomic impairment before this timepoint. Cardiovascular symptoms were common and worsened with time, particularly in those with severe injuries to cardiovascular autonomic nerves. Baroreflex and cardiorespiratory regulation were also impaired after SCI, and there was an increased risk for irregular heart beats that was present immediately after injury and did not improve over the first year. Overall, the researchers in this study were able to quantitatively measure the extent and impact of autonomic dysfunction in individuals with SCI by performing a simple continuous blood pressure measurement. This is clinically advantageous in many ways as it allows doctors, researchers and clinicians to better classify the presence, symptoms and signs of autonomic dysfunction after SCI without the need for arduous autonomic function tests or relying simply on symptom reports. Why are the findings important for the SCI community? This study provides the research and clinical communities with a distinct tool for assessing cardiovascular autonomic function after SCI, providing quantitative information about injury classification and cardiovascular consequences of injury that are not currently included in the classification of SCI. This information can change the way we understand and treat the cardiovascular autonomic complications of SCI, and fills a gap in the clinical evaluation of SCI. Assessing and measuring cardiovascular autonomic dysfunction will facilitate new research into treating the challenging cardiovascular complications of SCI. This, in turn, can be used to improve quality life for individuals living with SCI.
Time dependent gabapentinoid use for motor recovery after SCI
Lay Summary and Illustrations by Grace Hu Edited by Rona Herzog This is a summary of research conducted by ICORD researchers Dr. Freda Warner, Catherine Jutzeler, Dr. Jacquelyn Cragg, Lukas Grassner, Orpheus Mach, Doris Maier, Benedikt Mach, Jan Schwab, Marcel Read More...
Lay Summary and Illustrations by Grace Hu Edited by Rona Herzog This is a summary of research conducted by ICORD researchers Dr. Freda Warner, Catherine Jutzeler, Dr. Jacquelyn Cragg, Lukas Grassner, Orpheus Mach, Doris Maier, Benedikt Mach, Jan Schwab, Marcel Kopp, and Dr. John Kramer. To access the full article click here. What are gabapentinoids and what are they used for? <img loading="lazy" decoding="async" data-attachment-id="47155" data-permalink="https://icord.org/2021/03/time-dependent-gabapentinoid-use-for-motor-recovery-after-sci/344b67fc-322c-4dfa-a0cb-bb2482a068b8/" data-orig-file="https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8.jpeg" data-orig-size="2409,2047" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}" data-image-title="344B67FC-322C-4DFA-A0CB-BB2482A068B8" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8-1024x870.jpeg" class=" wp-image-47155 alignright" src="https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8.jpeg" alt="" width="435" height="370" srcset="https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8.jpeg 2409w, https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8-300x255.jpeg 300w, https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8-1024x870.jpeg 1024w, https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8-768x653.jpeg 768w, https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8-1536x1305.jpeg 1536w, https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8-2048x1740.jpeg 2048w, https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8-235x200.jpeg 235w, https://icord.org/wp-content/uploads/2021/02/344B67FC-322C-4DFA-A0CB-BB2482A068B8-1080x918.jpeg 1080w" sizes="(max-width: 435px) 100vw, 435px" /> Gabapentinoids are a type of medication primarily used to treat seizures and neuropathic pain. Neuropathic pain is a common side effect of spinal cord injury caused by damage to the central nervous system, which includes the nerves, brain, or spinal cord. Further information on neuropathic pain can be found here. In the context of this research study, gabapentinoids were studied and found to help individuals recover motor function after spinal cord injury. It was found that earlier treatment with these gabapentinoids correlated with greater improved motor scores. The mechanisms underlying this improvement in motor recovery may be due to a subunit found on calcium channels in the central nervous system, and targeted by gabapentinoids. The subunit normally functions to suppress axon regeneration. Suppressing axon regeneration is harmful to motor recovery because axons are like highways that connect and enable communication between cells. Without these highways, information cannot be communicated effectively throughout the body to coordinate motor function. Gabapentinoids target this subunit to prevent the calcium channels from opening and activating the subunit. Once the subunit is inactivated, it may no longer suppress axon regeneration and instead enable axons to grow longer after injury. How was the study conducted? <img loading="lazy" decoding="async" data-attachment-id="47215" data-permalink="https://icord.org/2021/03/time-dependent-gabapentinoid-use-for-motor-recovery-after-sci/screen-shot-2021-03-08-at-9-18-27-am/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/Screen-Shot-2021-03-08-at-9.18.27-AM.png" data-orig-size="641,642" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="Screen Shot 2021-03-08 at 9.18.27 AM" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/Screen-Shot-2021-03-08-at-9.18.27-AM.png" class="wp-image-47215 alignleft" src="https://icord.org/wp-content/uploads/2021/03/Screen-Shot-2021-03-08-at-9.18.27-AM.png" alt="" width="206" height="206" srcset="https://icord.org/wp-content/uploads/2021/03/Screen-Shot-2021-03-08-at-9.18.27-AM.png 641w, https://icord.org/wp-content/uploads/2021/03/Screen-Shot-2021-03-08-at-9.18.27-AM-300x300.png 300w, https://icord.org/wp-content/uploads/2021/03/Screen-Shot-2021-03-08-at-9.18.27-AM-150x150.png 150w, https://icord.org/wp-content/uploads/2021/03/Screen-Shot-2021-03-08-at-9.18.27-AM-200x200.png 200w" sizes="(max-width: 206px) 100vw, 206px" />This observational research study was conducted by examining patient charts of individuals who had sustained a SCI. Information from the charts was extracted to find out the time point at which individuals were administered gabapentinoids following their injury. Chart information was linked to data from the European Multicenter Study about Spinal Cord Injury (EMSCI). For this study, the primary outcome measure were patient motor scores; these scores were measured longitudinally over time for up to one year after injury. <img loading="lazy" decoding="async" data-attachment-id="47156" data-permalink="https://icord.org/2021/03/time-dependent-gabapentinoid-use-for-motor-recovery-after-sci/a35b9404-feec-4a42-938e-979ecc9993c8/" data-orig-file="https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8.jpeg" data-orig-size="1545,1375" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}" data-image-title="A35B9404-FEEC-4A42-938E-979ECC9993C8" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8-1024x911.jpeg" class="wp-image-47156 alignright" src="https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8.jpeg" alt="" width="206" height="183" srcset="https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8.jpeg 1545w, https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8-300x267.jpeg 300w, https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8-1024x911.jpeg 1024w, https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8-768x683.jpeg 768w, https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8-1536x1367.jpeg 1536w, https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8-225x200.jpeg 225w, https://icord.org/wp-content/uploads/2021/02/A35B9404-FEEC-4A42-938E-979ECC9993C8-1080x961.jpeg 1080w" sizes="(max-width: 206px) 100vw, 206px" />The measurement was done using a standard neurological classification of SCI that assessed motor abilities such as elbow flexion and wrist extension. Secondary outcome measures included sensory scores, which involved recording responses to light touch and pin pricks. Results: What happened? Motor scores of individuals who received gabapentinoids earlier after their injury improved significantly. When the drug was administered during the first 30 days after injury, it was associated with better motor recovery than those who did not receive the drugs. In fact, the largest effect on motor recovery happened when the drug was given within the first 5 days of injury. Early administration appeared to impact only some types of sensory function; for example, there was a significantly greater recovery of light touch. However, there was no significant effect on pin prick scores. The conclusion that earlier administration of gabapentinoids correlates with greater motor and some sensory function supports the concept of the “window of opportunity”. The “window of opportunity” refers to the time-sensitive period during which administration of the drug can exert its maximum desired outcome. Consequently, this finding can potentially help physicians figure out the optimal time to administer drug treatment. Why is this important for people with SCI? The improvements in motor recovery related to earlier administration of gabapentinoids for individuals with SCI supports the idea that gabapentinoids are directly affecting neurological recovery. Since the results support a “window of opportunity” of around 5 days for gabapentinoids, physicians can possibly use this knowledge to direct the use of gabapentinoids in future trial design and treatment. This finding is important because often there are ethical concerns with the effects of very early administration, as well as obtaining valid consent so early after injury. However, this 5-day window for gabapentinoid use may be an important consideration for how and when this drug is used to treat individuals with SCI. Limitations Since this was an observational study, individuals were not randomized to drug treatment. As a result, there could be some unknown outside factor that was driving the observed impact of the drug use. In addition, although there was significant improvement in motor and some sensory scores, there was no significant effect on actual functional measures. Functional measures assess the daily life and function of an individual with SCI. This might suggest that the drug’s effect on improving motor and sensory function has not reached a clinically meaningful threshold. In other words, it may not be creating a noticeable effect on the daily life for an individual. This may be due to the fact that most of the patients in the study received the treatment outside of the “window of opportunity”, which this study determined to be less than or equal to 5 days. Or it might point to the idea that multiple therapies, each providing some neurological benefit, should be used together to create a total higher, clinically significant impact on patients.
Script and Art by Yasi Yaghoub This web illustration reviews spinal cord anatomy, and discusses the causes and symptoms of myelopathy.
Script and Art by Yasi Yaghoub This web illustration reviews spinal cord anatomy, and discusses the causes and symptoms of myelopathy. <img loading="lazy" decoding="async" data-attachment-id="47257" data-permalink="https://icord.org/2021/03/what-is-myelopathy-comic/attachment/1/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/1.jpg" data-orig-size="2048,2048" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="1" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/1-1024x1024.jpg" class="alignnone wp-image-47257" src="https://icord.org/wp-content/uploads/2021/03/1.jpg" alt="" width="337" height="337" srcset="https://icord.org/wp-content/uploads/2021/03/1.jpg 2048w, https://icord.org/wp-content/uploads/2021/03/1-300x300.jpg 300w, https://icord.org/wp-content/uploads/2021/03/1-1024x1024.jpg 1024w, https://icord.org/wp-content/uploads/2021/03/1-150x150.jpg 150w, https://icord.org/wp-content/uploads/2021/03/1-768x768.jpg 768w, https://icord.org/wp-content/uploads/2021/03/1-1536x1536.jpg 1536w, https://icord.org/wp-content/uploads/2021/03/1-200x200.jpg 200w, https://icord.org/wp-content/uploads/2021/03/1-1080x1080.jpg 1080w" sizes="(max-width: 337px) 100vw, 337px" /><img loading="lazy" decoding="async" data-attachment-id="47258" data-permalink="https://icord.org/2021/03/what-is-myelopathy-comic/2-2/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/2-1.jpg" data-orig-size="2048,2048" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="2" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/2-1-1024x1024.jpg" class="alignnone wp-image-47258" src="https://icord.org/wp-content/uploads/2021/03/2-1.jpg" alt="" width="337" height="337" srcset="https://icord.org/wp-content/uploads/2021/03/2-1.jpg 2048w, https://icord.org/wp-content/uploads/2021/03/2-1-300x300.jpg 300w, https://icord.org/wp-content/uploads/2021/03/2-1-1024x1024.jpg 1024w, https://icord.org/wp-content/uploads/2021/03/2-1-150x150.jpg 150w, https://icord.org/wp-content/uploads/2021/03/2-1-768x768.jpg 768w, https://icord.org/wp-content/uploads/2021/03/2-1-1536x1536.jpg 1536w, https://icord.org/wp-content/uploads/2021/03/2-1-200x200.jpg 200w, https://icord.org/wp-content/uploads/2021/03/2-1-1080x1080.jpg 1080w" sizes="(max-width: 337px) 100vw, 337px" /><img loading="lazy" decoding="async" data-attachment-id="47254" data-permalink="https://icord.org/2021/03/what-is-myelopathy-comic/3-2-2/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/3-2-1.jpg" data-orig-size="2048,2048" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="3 2" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/3-2-1-1024x1024.jpg" class="alignnone wp-image-47254" src="https://icord.org/wp-content/uploads/2021/03/3-2-1.jpg" alt="" width="337" height="337" srcset="https://icord.org/wp-content/uploads/2021/03/3-2-1.jpg 2048w, https://icord.org/wp-content/uploads/2021/03/3-2-1-300x300.jpg 300w, https://icord.org/wp-content/uploads/2021/03/3-2-1-1024x1024.jpg 1024w, https://icord.org/wp-content/uploads/2021/03/3-2-1-150x150.jpg 150w, https://icord.org/wp-content/uploads/2021/03/3-2-1-768x768.jpg 768w, https://icord.org/wp-content/uploads/2021/03/3-2-1-1536x1536.jpg 1536w, https://icord.org/wp-content/uploads/2021/03/3-2-1-200x200.jpg 200w, https://icord.org/wp-content/uploads/2021/03/3-2-1-1080x1080.jpg 1080w" sizes="(max-width: 337px) 100vw, 337px" /><img loading="lazy" decoding="async" data-attachment-id="47255" data-permalink="https://icord.org/2021/03/what-is-myelopathy-comic/4-2-2/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/4-2-1.jpg" data-orig-size="2048,2048" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="4 2" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/4-2-1-1024x1024.jpg" class="alignnone wp-image-47255" src="https://icord.org/wp-content/uploads/2021/03/4-2-1.jpg" alt="" width="340" height="340" srcset="https://icord.org/wp-content/uploads/2021/03/4-2-1.jpg 2048w, https://icord.org/wp-content/uploads/2021/03/4-2-1-300x300.jpg 300w, https://icord.org/wp-content/uploads/2021/03/4-2-1-1024x1024.jpg 1024w, https://icord.org/wp-content/uploads/2021/03/4-2-1-150x150.jpg 150w, https://icord.org/wp-content/uploads/2021/03/4-2-1-768x768.jpg 768w, https://icord.org/wp-content/uploads/2021/03/4-2-1-1536x1536.jpg 1536w, https://icord.org/wp-content/uploads/2021/03/4-2-1-200x200.jpg 200w, https://icord.org/wp-content/uploads/2021/03/4-2-1-1080x1080.jpg 1080w" sizes="(max-width: 340px) 100vw, 340px" /><img loading="lazy" decoding="async" data-attachment-id="47256" data-permalink="https://icord.org/2021/03/what-is-myelopathy-comic/5-2/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/5-1.jpg" data-orig-size="2048,2048" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="5" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/5-1-1024x1024.jpg" class="alignnone wp-image-47256" src="https://icord.org/wp-content/uploads/2021/03/5-1.jpg" alt="" width="337" height="337" srcset="https://icord.org/wp-content/uploads/2021/03/5-1.jpg 2048w, https://icord.org/wp-content/uploads/2021/03/5-1-300x300.jpg 300w, https://icord.org/wp-content/uploads/2021/03/5-1-1024x1024.jpg 1024w, https://icord.org/wp-content/uploads/2021/03/5-1-150x150.jpg 150w, https://icord.org/wp-content/uploads/2021/03/5-1-768x768.jpg 768w, https://icord.org/wp-content/uploads/2021/03/5-1-1536x1536.jpg 1536w, https://icord.org/wp-content/uploads/2021/03/5-1-200x200.jpg 200w, https://icord.org/wp-content/uploads/2021/03/5-1-1080x1080.jpg 1080w" sizes="(max-width: 337px) 100vw, 337px" /><img loading="lazy" decoding="async" data-attachment-id="47252" data-permalink="https://icord.org/2021/03/what-is-myelopathy-comic/6-2/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/6-1.jpg" data-orig-size="2048,2048" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="6" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/6-1-1024x1024.jpg" class="alignnone wp-image-47252" src="https://icord.org/wp-content/uploads/2021/03/6-1.jpg" alt="" width="337" height="337" srcset="https://icord.org/wp-content/uploads/2021/03/6-1.jpg 2048w, https://icord.org/wp-content/uploads/2021/03/6-1-300x300.jpg 300w, https://icord.org/wp-content/uploads/2021/03/6-1-1024x1024.jpg 1024w, https://icord.org/wp-content/uploads/2021/03/6-1-150x150.jpg 150w, https://icord.org/wp-content/uploads/2021/03/6-1-768x768.jpg 768w, https://icord.org/wp-content/uploads/2021/03/6-1-1536x1536.jpg 1536w, https://icord.org/wp-content/uploads/2021/03/6-1-200x200.jpg 200w, https://icord.org/wp-content/uploads/2021/03/6-1-1080x1080.jpg 1080w" sizes="(max-width: 337px) 100vw, 337px" /><img loading="lazy" decoding="async" data-attachment-id="47251" data-permalink="https://icord.org/2021/03/what-is-myelopathy-comic/7-2/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/7.jpg" data-orig-size="2048,2048" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="7" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/7-1024x1024.jpg" class="alignnone wp-image-47251" src="https://icord.org/wp-content/uploads/2021/03/7.jpg" alt="" width="337" height="337" srcset="https://icord.org/wp-content/uploads/2021/03/7.jpg 2048w, https://icord.org/wp-content/uploads/2021/03/7-300x300.jpg 300w, https://icord.org/wp-content/uploads/2021/03/7-1024x1024.jpg 1024w, https://icord.org/wp-content/uploads/2021/03/7-150x150.jpg 150w, https://icord.org/wp-content/uploads/2021/03/7-768x768.jpg 768w, https://icord.org/wp-content/uploads/2021/03/7-1536x1536.jpg 1536w, https://icord.org/wp-content/uploads/2021/03/7-200x200.jpg 200w, https://icord.org/wp-content/uploads/2021/03/7-1080x1080.jpg 1080w" sizes="(max-width: 337px) 100vw, 337px" /> <img loading="lazy" decoding="async" data-attachment-id="47253" data-permalink="https://icord.org/2021/03/what-is-myelopathy-comic/attachment/8/" data-orig-file="https://icord.org/wp-content/uploads/2021/03/8.jpg" data-orig-size="2048,2048" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="8" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2021/03/8-1024x1024.jpg" class="alignnone wp-image-47253" src="https://icord.org/wp-content/uploads/2021/03/8.jpg" alt="" width="337" height="337" srcset="https://icord.org/wp-content/uploads/2021/03/8.jpg 2048w, https://icord.org/wp-content/uploads/2021/03/8-300x300.jpg 300w, https://icord.org/wp-content/uploads/2021/03/8-1024x1024.jpg 1024w, https://icord.org/wp-content/uploads/2021/03/8-150x150.jpg 150w, https://icord.org/wp-content/uploads/2021/03/8-768x768.jpg 768w, https://icord.org/wp-content/uploads/2021/03/8-1536x1536.jpg 1536w, https://icord.org/wp-content/uploads/2021/03/8-200x200.jpg 200w, https://icord.org/wp-content/uploads/2021/03/8-1080x1080.jpg 1080w" sizes="(max-width: 337px) 100vw, 337px" />
Factors influencing the size of activity spaces for people who use mobility devices
Lay Summary by Michael Limmena Edited by Rona Herzog This is a summary of research conducted by ICORD PIs Dr. Ben Mortenson and Dr. William Miller, and their colleagues Dr. Mike Prescott and Dr. François Routhier. Click here to access Read More...
Lay Summary by Michael Limmena Edited by Rona Herzog This is a summary of research conducted by ICORD PIs Dr. Ben Mortenson and Dr. William Miller, and their colleagues Dr. Mike Prescott and Dr. François Routhier. Click here to access the original research paper. People who use mobility devices such as wheelchairs, scooters, walkers, and canes, may find that travelling within their neighbourhood and city can be challenging. This is due to both physical barriers, including missing curb ramps, stairs, unsafe street crossings, etc.; and social barriers, such as fear of crime and feelings of stigma. As a result, these barriers have the potential to reduce the area of the activity spaces that people who use mobility devices utilize. Activity spaces are defined as the areas where people typically go in their daily lives, including grocery stores, restaurants, schools, and workplaces. Along with the barriers listed above, there are also many personal and environmental factors that have the potential to affect the area of activity spaces. There is currently very little research about how personal and environmental factors may influence one another and affect the area of the activity spaces of people who use mobility devices. Factors considered for people who use mobility devices include: age, type of physical disability, mobility independence, characteristics of where they live (e.g. urban/rural), walkability, and personal perception of the accessibility of their neighbourhood. With this information, city planners can make communities and cities more accessible for people who use mobility devices. What was the purpose of this study? The three purposes of this study were: to determine how personal and environmental factors affect the area of activity spaces for individuals using mobility devices to estimate how these factors might affect the activity space sizes of mobility device users to determine whether there are differences based on type of mobility device used How was the research conducted? The researchers surveyed participants living in Vancouver and Québec City to collect personal and environmental information and provided them with wearable GPS devices that tracked their movements. Using the tracking data from the GPS devices, the researchers could estimate the participants’ daily path area and the area of their activity spaces. What were the results? The researchers found: 43% of the differences in the area of a person’s activity space could be attributed to environmental and personal factors. People who use mobility devices and volunteer, go to school, or work, are typically younger and have larger activity spaces than those not involved in similar activities. Neighbourhoods with greater walkability were associated with smaller activity spaces of people who use mobility devices. This could be related to the importance of being able to access transportation – whether private or public – for people who use mobility devices in their daily lives. With access to transportation, people who use mobility devices can travel farther from their neighbourhoods to visit their family, friends, doctors, etc. People who had their own car had activity spaces two times larger than those who did not. Activity spaces were larger in the winter than during summer. This could be attributable to relying on cars because walking or wheeling in the neighbourhood was too difficult.. Researchers did not find a significant relationship between the type of mobility device used and the area of activity space of people who use mobility devices. Why is this study important? The importance of this study relates to a greater understanding of how factors* can affect people who use mobility devices ability to travel, which in turn affects the area of their activity space. The researchers findings suggest that city and neighbourhood planners need to consider the difference between walkability and accessibility in their environmental design processes. Definition of Study-Specific Terms: Daily Path Area – A technique used to calculate the area of a person’s activity space. Using the person’s actual travel data, the researchers can estimate the area of a person’s activity space Walkability – A score between 0 (not walkable) and 100 (walking paradise) that describes how walkable a specific neighbourhood or city is. This score was calculated using this website.
Proprioception training protocol for people with incomplete SCI
Lay Summary by Frank Yeung Edited by Rona Herzog This is a summary of a paper by ICORD researchers Taha Qaiser, Gevorg Eginyan, Franco Chan, and Dr. Tania Lam. To access the full article click here. In 2019, researchers from Read More...
Lay Summary by Frank Yeung Edited by Rona Herzog This is a summary of a paper by ICORD researchers Taha Qaiser, Gevorg Eginyan, Franco Chan, and Dr. Tania Lam. To access the full article click here. In 2019, researchers from ICORD studied a new passive training protocol that used the Lokomat robotic gait device. As opposed to many neurorehabilitation strategies that focus on active interventions, including inducing and strengthening motor function, the training protocol used in this study was passive. The passive intervention focused on the recovery of sensory function in individuals with spinal cord injury (SCI). Specifically, this training protocol was designed to recover proprioception. Proprioception refers to our ability to recognize the position and movement of our body, and it plays a critical role in human movement control. What were the objectives of this study? The study had two objectives: The main objective was to test the effects of the researchers’ proprioception training protocol on lower limb proprioceptive sense in people with incomplete SCI. The secondary objective was to assess whether the benefits from training transferred to a precision stepping task for people with incomplete SCI. The Training Protocol: The training protocol used in this study focused on improving two aspects of proprioception, which were end-point discrimination and knee joint position sense. For the end-point discrimination task, the Lokomat moved one of the participant’s entire lower limb twice, resulting in a change in the participant’s heel position; the participant reported if the final position was either higher or lower relative to the starting position. For the knee joint position sense task, the Lokomat flexed or extended the knee, and the participant had to position the knee back to the starting position using a joystick to control the Lokomat. Visual feedback was provided for learning after each response in the proprioception training. After the proprioception training, the participants performed a precision stepping task, where they walked on a treadmill and trained their ability to raise their foot to a target height during the swing phase. How was the research conducted? The researchers recruited 15 participants with incomplete SCI and 10 able-bodied participants. Participants with incomplete SCI were asked to determine the leg for which they had greater difficulty sensing position; this leg was then used in the training protocol. For able-bodied participants, their non-dominant leg was used. Before the training protocol, all participants assessed their baseline ability to sense their knee joint position and heel position. For the participants who were able to walk safely to some degree, researchers also assessed their ability to carry out the precision stepping task on the treadmill. The participants used the training protocol over two consecutive days to improve in the three tasks. Researchers tested if the participants improved their scores after the training protocol was completed. What did the researchers find? Researchers found that both end-point discrimination and knee joint position sense could be improved after a small amount of proprioceptive training. The extent of an individual’s improvement was related to their proprioceptive sense prior to the training protocol, where individuals who had larger deficits in proprioceptive sense showed larger improvements following training. The results also demonstrated that improvements in proprioceptive sense transferred from the end-point discrimination task to the joint position sense task, and also the precision stepping task. Why are these findings important? The findings of this study indicated that passive training was beneficial and had potential to become a rehabilitation intervention alongside the other protocols focused on improving limb strength, walking speed and endurance. This matched results from previous studies that also demonstrated the possibility of training an individual’s ability to sense the position of their limbs; an ability that has importance in precisely controlling the path of their feet while walking. Researchers note the importance of further studies in order to determine the long-lasting effects of such training, interactions with other therapies, and effects on rehabilitation outcomes. Definitions: Motor function: The ability to learn or demonstrate control over one’s movements and posture. Sensory function: The ability to perceive and interpret the world around us.
Infographic by Crystal Han, inspired by SCIRE community page. Edited by Rona Herzog If you are interested in learning more, take a look at SCIRE Community’s page on Osteoporosis after SCI. Osteoporosis commonly affects individuals with SCI, primarily occurring below Read More...
Infographic by Crystal Han, inspired by SCIRE community page. Edited by Rona Herzog If you are interested in learning more, take a look at SCIRE Community’s page on Osteoporosis after SCI. Osteoporosis commonly affects individuals with SCI, primarily occurring below the level of injury. This is termed sublesional (below the lesion) osteoporosis. As shown below, osteoblasts are cells that work to build bone, while osteoclasts are cells that break down bone. After SCI, osteoblasts are not able to build bone at the same rate as osteoclasts are breaking it down. High levels of bone breakdown, decreased bone mineral density (linked to strength of the bone) in the hip and/or knee area, and an increased likelihood of fracture can be associated with sublesional osteoporosis. Potential factors contributing to SCI and osteoporosis include: overall changes to the body after injury, e.g. changes to the immune, hormonal, circulatory and nervous systems decreased weight-bearing activities decreased muscle activity lifestyle changes after injury, e.g. amount of physical activity The infographic below examines bone formation, bone regulation and osteoporosis after SCI. <img loading="lazy" decoding="async" data-attachment-id="46437" data-permalink="https://icord.org/2020/10/osteoporosis-after-spinal-cord-injury/osteoporosis-update/" data-orig-file="https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update.png" data-orig-size="1620,2160" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="Osteoporosis update" data-image-description="" data-image-caption="" data-large-file="https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-768x1024.png" class="alignnone size-large wp-image-46437" src="https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-768x1024.png" alt="" width="768" height="1024" srcset="https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-768x1024.png 768w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-225x300.png 225w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-1152x1536.png 1152w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-1536x2048.png 1536w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-150x200.png 150w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-200x266.png 200w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update-1080x1440.png 1080w, https://icord.org/wp-content/uploads/2020/10/Osteoporosis-update.png 1620w" sizes="(max-width: 768px) 100vw, 768px" />
Cardiovascular health during rehabilitation
Cardiovascular disease is more prevalent within the SCI community than in the general population.The reason for this is because of the extensive amount of bed rest following traumatic spinal cord injury, which results in a low level of physical activity and cardiovascular fitness. Continue reading →
Sonya Kung Edited by Ana-Maria Oproescu This is a summary of a research study conducted by Drs. Andrei Krassioukov and Janice Eng at ICORD. To read the original article, please click here. Why is cardiovascular disease prevalent among individuals with SCI? Cardiovascular disease is more prevalent within the SCI community than in the general population. The reason for this is the extensive bed rest following traumatic spinal cord injury, which results in a low level of physical activity and cardiovascular fitness. However, physical training in individuals with spinal cord injuries has the potential to improve their cardiovascular health and to reduce the medical complications associated with being physically inactive. These potential benefits underscore the importance of participating in an exercise program after SCI. The objective of this observational study was to determine if vigorous exercise could help individuals recovering from a recent SCI reach their full potential during physical therapy. The researchers measured the amount of cardiovascular stress experienced by individuals with SCI during recovery. Researchers looked at how much activity was spent at 40% heart rate reserve which is considered moderate activity and the minimum level to improve cardiovascular fitness. How was data collected for this observational study? Participants were recruited as part of a larger study examining spinal cord injury admissions to inpatient care at two rehabilitation centres. Data for the present study were collected over two weekdays near the end of a patient’s rehabilitation stay. It was expected that at this point in time participants would be near their peak of inpatient recovery and would be able to maximally participate in rehabilitation activities. Participants took part in their regular physical therapy activities. Heart rate was then recorded and their level of physical activity was collected by self-reported spinal cord injury questionnaire. What did researchers discover? Researchers found that the time spent at a heart rate within a physical therapy (≥40% heart rate reserve) was low and did not exceed a median of 5 minutes. Only 13% of individuals undertook any activity that exceeded 20 minutes of moderate activity. This indicates that individuals in recovery are spending very little time at an intensity that could improve cardiovascular fitness, despite it being known that these individuals have low endurance. Thus, participants may not be obtaining the sufficient amount cardiovascular training effect needed to enhance their neurological, cardiovascular or musculo-skeletal health. What do these results mean? Their findings on heart rate indicate that individuals with SCI spend a short amount of time during physical therapy sessions at the moderate to vigorous intensities. This indicates the lost opportunity to maximize rehabilitation. In the future, we should explore strategies to incorporate more physical activities with a cardiovascular component to maximize recovery. *heart rate reserve: This is the difference between resting heart rate and maximum heart rate.
Experimental treatment of SCI using transplantation of olfactory ensheathing cells with nerve bridging.
By: Dominik Zbogar This is a summary of a paper by researchers in Poland. Original article: Pawel Tabakow et al. (2014). Functional regeneration of supraspinal connections in a patient with transected spinal cord following transplantation of bulbar olfactory ensheathing cells Read More...
By: Dominik Zbogar This is a summary of a paper by researchers in Poland. Original article: Pawel Tabakow et al. (2014). Functional regeneration of supraspinal connections in a patient with transected spinal cord following transplantation of bulbar olfactory ensheathing cells with peripheral nerve bridging. Cell Transplantation. 23(12):1631-55. Find the original article here. Summary: Olfactory ensheathing cells (OECs) are found deep in the nose as well as in the olfactory bulb that is part of the brain inside the skull just above the nose. In animal experiments, these cells have been transplanted into the damaged spinal cord and have been claimed to promote the regrowth of severed axons (the ‘wires’ that transmit information from one cell to another) by an English group headed by Dr. G. Raisman. This paper describes the results of OEC transplantation into the spine of one patient with an AIS A injury (this is known as a complete injury where the patient has no measurable sensation or motor function at the lowest part of the spine). The patient was a 38 year-old man named Darek who was stabbed thirteen months earlier. His spinal cord was incompletely severed at the ninth thoracic level with a 2mm rim of spared tissue, i.e. it was anatomically incomplete. Despite spared tissue, functional testing indicated a “complete” injury by the AIS scoring system. Before the spinal surgery for OEC transplantation, Darek underwent 8 months of intense (5 hours per day, 5 days per week) physiotherapy consisting mostly of locomotor training. Two weeks before the surgery, one of Darek’s olfactory bulbs was removed from the brain and placed in a cell culture to produce OECs for insertion into the spinal cord. On the day of the spinal surgery, scar tissue was removed, the cells were injected above and below the injury site, and strips of nerve tissue obtained from the ankle were placed in the injury gap to provide a bridge for the OECs to grow over. There were no complications from the surgery and physiotherapy continued for 21 months. After 4 months, Darek experienced the return of some sensation. At the same time as sensation increased, so too did some voluntary motor function. This occurred mostly in the left leg, the thigh of which also increased in muscle mass. Additionally, Darek experienced increased trunk stability and improved visceral sensation. In all, he improved from An AIS A to an AIS C injury, which means there was sensation and some muscle control below the level of the injury. Along with these signs of improvement, Darek began to walk with assistance. First, at 6 months with assistance from a physiotherapist, leg braces, and parallel bars, and then at the end of the study, with short leg braces and a walker. Things to consider: Interestingly, MRI of the spine performed 19 months following treatment did not show new nerve fibres at the site of the lesion, which indicates that regeneration of tissue was not responsible for Darek’s recovery. At this point it is difficult to state what factors were responsible for Darek’s recovery as the surgery, consisting of spinal cord untethering, resection of scar tissue, injection of OECs into the stumps, and transplantation of peripheral nerve segments into the lesion cavity, as well as intensive physiotherapy, may have played a role in recovery. What does this mean for people living with SCI? While this study sounds exciting, it is very important to remember that it involved only one patient. It’s not clear whether his improvement was due to the cell transplantation or other major aspects of the study. Much more research must be done with more patients, and the experimental treatment needs to be validated in a clinical trial before it can be considered a viable clinical treatment.