New intervention shows promise for relief of shoulder pain in wheelchair users with spinal cord injury

A New Jersey team of researchers has reported the successful, long-term relief of chronic refractory shoulder pain in a wheelchair user with spinal cord injury (SCI) following a single injection of autologous, micro-fragmented adipose tissue into the affected shoulder joint. The article, “Autologous micro-fragmented adipose tissue as a treatment for chronic shoulder pain in a wheelchair using individual with spinal cord injury: a case report” (doi: 10.1038/s41394-019-0186-8) was epublished ahead of print on May 13, 2019 by Spinal Cord Series and Cases. This is the first reported use of this intervention for shoulder pain in an individual with spinal cord injury who has failed to improve with conservative care, such as physical therapy and pharmacological agents.

The authors are Chris Cherian, MD, of Rutgers New Jersey Medical School, Gerard Malanga, MD, of the New Jersey Regenerative Institute and Kessler Institute for Rehabilitation, Trevor Dyson-Hudson, MD, and Nathan Hogaboom, PhD, of Kessler Foundation, and Michael A. Pollack, MD, of Montclair Radiology.

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Active lifestyles may help nerves to heal after spinal injuries

Leading an active lifestyle may increase the likelihood of damaged nerves regenerating after a spinal cord injury.

The early-stage findings, published in the journal Science Translational Medicine, come from studies in mice and rats with spinal cord injuries, in which scientists uncovered a mechanism for nerve fibres repairing after they had been damaged.

An international team, led by researchers from Imperial College London, found that providing rodents with more space, an exercise wheel, toys and company before an injury helped to ‘prime’ their cells, making it more likely their damaged nerves would regenerate following spinal injury.

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Spinal cord is ‘smarter’ than previously thought

We often think of our brains as being at the centre of complex motor function and control, but how ‘smart’ is your spinal cord?

Turns out it is smarter than we think.

It is well known that the circuits in this part of our nervous system, which travel down the length of our spine, control seemingly simple things like the pain reflex in humans, and some motor control functions in animals.

Now, new research from Western University has shown that the spinal cord is also able to process and control more complex functions, like the positioning of your hand in external space.

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The study opens up a new path for identifying pro-regenerative molecules and potential therapeutic targets for human spinal cord injury.

Spontaneous recovery from spinal cord injury is almost unheard of in humans and other mammals, but many vertebrates fare better. The eel-like lamprey, for instance, can fully regenerate its spinal cord even after being severed—within three months the lamprey is swimming, burrowing, and flipping around again, as if nothing had happened.

“We’ve determined that central nervous system regeneration in lampreys is resilient and robust after multiple injuries. The regeneration is nearly identical to the first time, both anatomically and functionally,” says senior author Jennifer Morgan, director of the University of Chicago-affiliated Marine Biological Laboratory’s Eugene Bell Center for Regenerative Biology and Tissue Engineering.

Morgan’s lab has been focusing on the descending neurons, which originate in the brain and send motor signals down to the spinal cord. Some of these descending neurons regenerate after central nervous system injury in lamprey, while others die.

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A recipe for regenerating nerve fibers across complete spinal cord injury

Neuroscientists at UCLA, Harvard University and the Swiss Federal Institute of Technology have identified a three-pronged treatment that triggers axons—the tiny fibers that link our nerve cells and enable them to communicate—to regrow after complete spinal cord injury in rodents. Not only did the axons grow through scars, they could also transmit signals across the damaged tissue.

If researchers can produce similar results in human studies, the findings could lead to a therapy to restore axon connections in people living with spinal cord injury. Nature publishes the research in its Aug. 29 online edition.

“The idea was to deliver a sequence of three very different treatments and test whether the combination could stimulate disconnected axons to regrow across the scar in the injured spinal cord,” said lead author Michael Sofroniew, a professor of neurobiology at the David Geffen School of Medicine at UCLA. “Previous studies had tested each of the three treatments separately, but never together. The combination proved to be the key.”

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Scientists discover new way to help nerve regeneration in spinal cord injury

There is currently no cure for spinal cord injury or treatment to help nerve regeneration so therapies offering intervention are limited. People with severe spinal cord injuries can remain paralysed for life and this is often accompanied by incontinence.

A team led by Drs Liang-Fong Wong and Nicolas Granger from Bristol’s Faculty of Health Sciences has successfully transplanted genetically modified cells that secrete a treatment molecule shown to be effective at removing the scar following spinal cord damage. The scar in the damaged spinal cord typically limits recovery by blocking nerve regrowth.

Previous work by the team proved olfactory ensheathing cells – which are taken from the ‘smell system’ where they regenerate and repair throughout life to maintain sense of smell, could be genetically modified to secrete a treatment enzyme known as chondroitinase ABC (ChABC). This treatment enzyme is key in breaking down the glial scar at the injury point of the spinal cord and helping to promote nerve regrowth.

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From PTJ: High-Intensity Locomotor Exercise Improves Ability to Walk After Incomplete SCI

The conventional approach to rehabilitation for patients with incomplete spinal cord injury (iSCI) is being turned on its head: according to researchers, high-intensity locomotor exercise does not “degrade gait performance” but actually improves an individual’s locomotor function and quality.

It wasn’t exactly what the researchers were expecting. They had a 2-part hypothesis: first they hypothesized that short-term exposure to higher walking speeds and higher-intensity stepping would cause a decline in gait quality in people with iSCI. The second part of their hypothesis was that once achieved, repeated high-intensity walking would then improve gait quality. Findings were published in Physical Therapy (PTJ), the scientific journal of APTA.

Full story of high-intensity locomotor exercise after SCI at APTA

From PTJ: Selecting the Right SCI Outcome Measure Sometimes a Matter of Clinical Judgment

A new report on outcome measure (OM) recommendations for treatment of people with spinal cord injury (SCI) finds that, yes, there are strong tests and measures for this population, but physical therapists (PTs) still need to rely on their clinical judgment when the measures are weak on evidence.

Appearing in the November 2016 issue of Physical Therapy (PTJ), APTA’s scientific journal, the report comes from the Spinal Cord Injury EDGE (Evaluation Database to Guide Effectiveness) Task Force led by the APTA Academy of Neurologic Physical Therapy. In addition to the recommendations, the task force’s efforts illuminated areas of strength and weakness in outcomes tools for specific areas.

Full story of the right outcome measure for treatment with SCI at APTA

Many IRF Patients Experience Interruptions in Care – About 10% Due to Preventable Conditions

New research into Medicare data has found that potentially costly interruptions in inpatient rehabilitation for neurological conditions may be occurring for as many as 1 in 3 patients, depending on the condition—and about 10% of all interruptions are related to complications that are considered preventable.

In an article e-published ahead of print in The American Journal of Physical Medicine and Rehabilitation, researchers analyzed data from nearly 80,000 Medicare beneficiaries admitted to an inpatient rehabilitation facility (IRF) for services related to stroke (71,769), traumatic brain injury (TBI; 7,109), and spinal cord injury (SCI; 659) between 2012 and 2013. Their analysis was focused on the prevalence and causes of 2 types of interruptions in care: “program interruptions,” wherein patients are transferred to another facility and returned to the IRF within 3 days; and “short-stay transfers,” in which patients are transferred to a hospital, skilled nursing facility (SNF), or other facility before their expected IRF length-of-stay ends.

Full story of IRF patients and interruptions in care at APTA

Researchers Say Brain-Controlled Exoskeleton Training Sparked Neurological Improvement in Individuals With Paraplegia

While pursuing a brain-controlled exoskeleton technology for individuals with paraplegia, researchers at Duke University uncovered something unexpected: in what they call “unprecedented neurological recovery,” researchers found that patients actually experienced neurological improvements in sensation and voluntary muscle control during the brain-machine interface (BMI) training period. A few patients were even upgraded from complete to incomplete paraplegia classification after 12 months of work with the BMI.

The findings, presented in the journal Scientific Reports, were uncovered after researchers monitored progress in 8 patients with spinal cord injury (SCI) as they participated in the Walk Again program. The program employs noninvasive electrode monitoring that allows the patient to control movements—first in a virtual reality setting, but, ultimately, by way of a brain-controlled exoskeleton capable of providing tactile information delivered to the patients’ forearms. The exoskeleton was featured at the 2014 World Cup soccer tournament, when 29-year-old Juliano Pinto, who has complete paralysis of his lower trunk, completed the ceremonial kickoff at the event.

Full story of brain control for individuals with paraplegia at APTA