Researchers at Northwestern University’s Institute for Cell Engineering are concentrating on progress with Bone Morphogenetic Proteins as a means of making a major breakthrough in recovery for victims of spinal cord injuries. As Northwestern’s research experts continue to learn about these complex proteins, they are discovering more and more ways in which they are beneficial in repairing spinal cords after traumatic accidents and injuries.

Drug studied as possible treatment for spinal injuries might also treat Multiple Sclerosis

Researchers have shown how an experimental drug might restore the function of nerves damaged in spinal cord injuries by preventing short circuits caused when tiny "potassium channels" in the fibers are exposed. The chemical compound also might be developed as a treatment for multiple sclerosis.

Because nerves usually are not severed in a common type of spinal cord trauma, called "compression" injuries, the drug offers hope as a possible treatment, said Riyi Shi, a professor in Purdue University's Department of Basic Medical Sciences, School of Veterinary Medicine, Center for Paralysis Research and Weldon School of Biomedical Engineering.

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"Compression is responsible for most spinal cord injuries, including many resulting in paralysis," Shi said. "Since the nerves are not severed, this type of drug represents a potential golden opportunity to treat spinal cord injuries." The experimental compound, 4-aminopyridine-3-methyl hydroxide, has been shown to restore function to damaged axons, slender fibers that extend from nerve cells and transmit electrical impulses in the spinal cord.

Findings, based on experiments with guinea pig spinal cord tissue, appeared online in the Journal of Neurophysiology. The work was led by Department of Basic Medical Sciences doctoral student Wenjing Sun. Shi said the findings were made possible by the interdisciplinary nature of the work, which also involves researchers Richard Borgens, director of Purdue's Center for Paralysis Research and the Mari Hulman George Professor of Neurology in the School of Veterinary Medicine; Stephen Byrn, the Charles B. Jordan Professor of Medicinal Chemistry, and Daniel Smith, a research assistant professor, both in the Department of Industrial and Physical Pharmacy; and Ji-Xin Cheng, an associate professor in the Weldon School of Biomedical Engineering and Department of Chemistry.

Researchers have shown how an experimental drug might restore the function of nerves damaged in spinal cord injuries by preventing short circuits caused when tiny "potassium channels" in the fibers are exposed by trauma. The compound also might be developed as a treatment for multiple sclerosis. This diagram illustrates how the drug functions as a "channel blocker," meaning it permits the conduction of signals even though the protective myelin insulation has been damaged.

The researchers subjected spinal cord tissue to stresses that mimic what happens in a compression injury, which stretches nerves. Then they treated the damaged axons with 4-aminopyridine-3-methyl hydroxide. The compound is a derivative of the drug 4-aminopyridine, used primarily as a research tool and also to manage symptoms of multiple sclerosis. The axons of each nerve are sheathed in a thick insulating lipid layer, called myelin, which enables the transmission of signals without short circuiting, much like the insulation surrounding electrical wires.

Spinal cord trauma damages the myelin sheath, exposing "fast potassium channels" that are embedded in the axons and are critical for transmitting nerve impulses. The researchers confirmed previous circumstantial evidence suggesting injury causes the myelin insulation to recede, exposing the channels and impairing signal transmission. Laboratory and imaging techniques revealed the exposed channels in damaged axons. The researchers also discovered that 4-aminopyridine-3-methyl hydroxide is a "potassium channel blocker," using a sophistic laboratory technique called "patch clamp" to measure signal conduction.

Findings confirmed that the compound prevents the exposed channels from leaking electrical current and enhances nerve conduction in segments of the damaged spinal cord. The compound could make it possible to sidestep spinal cord damage by enabling axons to transmit signals as though they were still sheathed in myelin, Shi said. Nerves transmit signals through a series of rapid electrical pulses, or "action potentials." For proper nerve function, the time gap between pulses must be as brief as possible. However, 4-aminopyridine has been shown to lengthen the gap, or "refractory period," between pulses.

The researchers found that 4-aminopyridine-3-methyl hydroxide restores function without affecting the refractory period. As a result, the damaged nerves perform more like healthy nerves than those treated with other drugs, he said. Another key advantage of the new compound is that it's about 10 times more potent than 4-aminopyridine, meaning lower doses can be used to reduce the likelihood of serious side effects.

Because myelin also is damaged in multiple sclerosis, the same drug might be used to restore nerve function in people stricken with the disease, Shi said. Since the newer drug can be used in lower doses, it might be more effective than 4-aminopyridine in treating multiple sclerosis, which affects more than 350,000 people in the United States and 2.5 million worldwide, he said.

Source: Science Codex (20/11/09)

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Breakthrough spine treatment could prevent nerve damage

In a study that appears in the medical journal Nature Nanomedicine, Purdue University researcher Ji-Xin Cheng has released a study that profiles a new treatment that could stop the secondary nerve damage caused by spinal injuries, as well as help restore movement in injury victims. By injecting tiny spheres known as copolymer micelles, rats that had suffered new spinal injuries immediately showed signs of recovery with no additional nerve damage.

The experimental surgery involves the injection of the tiny spheres, which then fuse to the initial injured nerves. This combination eliminates the possibility of inflammation and swelling in the surrounding nerves and tissues, thus decreasing the ultimate damage of the injury. Long used in surgeries and research as drug-carrying agents, the copolymer micelles are now used as a repair mechanism, something that is entirely new for these infinitesimally small spheres.

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Because of the micelles’ makeup, the tiny bodies are perfectly suited to travel through the bloodstream and not face any decomposition or rejection from the body’s immune system, nor are they affected by bodily fluids, as they thrive in fluids. By using dyed micelles, the researchers were able to prove that the spheres traveled directly to the injured area and immediately fused to the membranes to being a reparation process.

So far, in the cases of testing rats, the toxicity tests show that this process is ultimately safe. Rats that were treated immediately after their injuries showed recovery signs in all four limbs. Some of the test subjects, however, did not fare as well. The next step for this Purdue team is to test the micelles on rats that have suffered a spine injury three hours before treatment. The research team believes that if they can make progress on animals that were not treated immediately after injury, then they might be able to use this treatment process in emergency rooms for humans after accidents that led to spinal injuries.

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Spinal cord injury patients around the world may draw new hope for the future from the story of a paralyzed little dog who was able to walk again after receiving an experimental spinal cord treatment. Cambridge University scientists pioneered the new treatment that made it possible for Henry the dachshund to walk after he was paralyzed by a severe spinal cord injury.

Veterinarians at the Cambridge Veterinary School took cells from the dog’s nose and injected them into his ailing spinal cord. The New York Daily News reported that nose cells were used because they encourage the growth of new nerve fibers in the spinal cord. Henry had lost the ability to walk at the end of last year when discs between the vertebrae in his spine ruptured. It was also reported that certain species of canines have an increased risk of spinal cord injuries, so they make good candidates for exploration of experimental treatments.

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Scientists had previously reported success with the nose cell technique in experiments with rats, which inspire professors Nick Jeffrey and Robin Franklin to attempt the experimental procedure on the dachshund. The scientists hope to eventually use the procedure to treat human patients with severe spinal cord injuries.

In addition to the medical treatment, Henry received physiotherapy and rehabilitation on a treadmill. Only a month after getting the nose cell treatment, Henry was able to walk again. The poor little puppy was reportedly downtrodden and depressed before he received the procedure. Afterward, his owner reported signs of the dog’s returning happiness.

Sarah Beech, the owner of the lucky dachshund, was amazed by the miraculous results of the veterinary treatment. She was quoted in the New York Daily News article saying, “It’s incredible,” Henry’s owner, Sarah Beech, told the Daily Mail. “I didn’t think Henry would ever be able to walk again, but over the last few months, he has been wagging his tail and taking small steps.”

The news of such rapid success in reversing Henry’s paralysis should bring hopeful expectation to the many spinal cord injury patients waiting for such amazing treatments to be made available to humans. With all the recent advances in spinal cord injury treatments, it seems only a matter of time before paralysis is seen as a temporary, instead of irreversible, condition.
 

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Step Up Recovery Center Offers Hope for Those with Spinal Cord Injuries

Upwards of 250,000 people suffer from severe spinal cord injuries, and many of those patients have lost the ability to use their arms, legs, or even most of their bodies. There are very few treatment options available for paralysis and spinal cord injury victims, but a recent article in Health Scout from the Ivanhoe Broadcast News reported on a controversial camp that is providing new hope for many patients. The camp in question is in Sanford, Florida, and patients at the camp are encouraged to get out of their wheelchairs and “stand on their own,” the article reported.

One patient, 20-year-old quadriplegic Amanda Perla, was mentioned in the article as being able to stand by herself with the help of a metal bar. Two years ago, Amanda was paralyzed in a tragic car accident on her prom night. She was told by doctors she would never walk again and would be bound to a powered wheelchair for the rest of her life, but six months later, with the help of the Step Up Recovery Center, she has transitioned to a manually powered wheelchair.

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The owner and founder of the Step Up Recovery Center, Amanda Perla’s mother Liza Reidel, opened up the center as her response to the hopelessness and lack of available treatment options presented to her daughter by doctors. At the center, spinal cord injury recovery specialists prompt patients to get up out of their wheelchairs and perform “aggressive exercise and repetitive motions” in an attempt to “reorganize the nervous system,” the article read.

While some doctors have criticized the recovery center for providing false hope to its patients, the goals of the center are to “help patients regain function,” and to “possibly even walk again.” Although Amanda Perla is still bound to a wheelchair, she noted that she has already recovered beyond the expectations of her doctors, and she believes that with further treatment and rehabilitation she will walk again some day.

Clients at the recovery center undergo three-hour therapy sessions three or four times a week. While critics worry about giving patients false hope, the center advocates progressive action in the face of an otherwise dreary prognosis. It is a progressive advance to offer movement therapy and physical rehabilitation attempts to patients who would otherwise have resigned themselves to life in wheelchairs with no hope.

Although patients at the center have yet to walk again after paralysis, the increased movement and deliberate exercise is something the patients would not otherwise be exposed to, and in that sense, it provides a positive option where one did not previously exist.

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Janneke J. P. Schimmel, MSc, a scientist at Sint Maartenskliniek in Nijmegen, The Netherlands, recently spoke about the findings of a study on the occurrence of infections in lumbar fusion surgery sites. The study performed by Schimmel and a team of Dutch researchers showed that there is a link between lumbar spinal fusion surgery and surgical site infections on surgeries done in the same location.

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Orthopedics Today quoted Schimmel who said, “Our main finding is that previous surgery was associated with the higher risk for the appearance of an infection. More complex surgery resulted in an increase for the infection rates.” She also noted that the longer it took to perform a spinal surgery, the higher the chance of infection at the surgery site. Schimmel reported on the findings of the 9-year-long study in Miami, Florida at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine.
The investigators gathered and analyzed data on more than 1400 patients who had received lumbar fusion surgery in The Netherlands between 1999 and 2007. The study identified many factors concurrent with the appearance of deep infections at the site of the operations. In addition to factors already mentioned, patients who smoke cigarettes, and patients with diabetes mellitus were also found to be at greater risk of deep infections after lumbar spinal fusion surgery. The data for the study was collected from hospital databases and patient charts.

The intensive study showed that out of 1454 patients, 31 of them tested positive for bacterial infections. Nearly all of the infections found were caused by Staphylococcus basteria.
The increased costs of treatment for postoperative infections are staggering. Over 1000 extra hospital days were required for further treatment of patients with deep infections in their spines. The Orthopedics Today article reported that it is extremely costly to treat and care for deep infections due to longer hospital stays and expensive pharmaceuticals, lab tests, and other necessary procedures.

Some implications of the study suggest that shortening the length of time it takes to perform lumbar fusion surgery could lessen the chance of infection. This may inspire innovative surgeons and researchers to develop faster, more efficient, and less invasive procedures for lumbar surgery in the future.

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Spinal Cord injury and spinal cord dysfunction patients have new cause to celebrate. Last week marked the official launch of the Academy of Spinal Cord Injury Professionals. With support form the Paralyzed Veterans of America, the new interdisciplinary academy aims at improving the quality of care and quality of life for spinal cord injury patients.

Nurses, doctors, social workers, rehabilitation therapists, and psychologists will be able to work together more closely as part of the new academy to share data and pool their knowledge and experience to work toward developing more effective treatment plans and improving the quality of life-long care for those suffering with spinal cord injuries.

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The Academy of Spinal Cord Injury Professionals arose as a merger between the American Association of Spinal Cord Injury Nurses, the American Paraplegia Society, the American Association of Spinal Cord Injury Psychologists and Social Workers, and the Therapy Leadership Council in Spinal Cord Injury.

The professionals who make up the academy hope to achieve their goals by way of: raising public, lawmaker, and charitable organization awareness of the challenges of life with spinal cord injury; encouraging community development in support of spinal cord injury patients; and providing advanced networking opportunities for spinal cord injury professionals.

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As in many areas of science, an interdisciplinary collaboration can result in revelations and rapid advances in applicable knowledge due to the sharing of experience and information facilitated by such partnerships. For example, a spinal cord injury psychologist may be able to assist as a liaison between patient and family and between patient and doctor, making communication and understanding more easily achieved for all parties involved.

The Academy of Spinal Cord Injury Professionals uses “Many Minds, One Vision,” as their tagline. The vision statement on their site reads, “The Academy of Spinal Cord Injury Professionals aims to be the world’s premier, interdisciplinary organization dedicated to advancing the care of people with spinal cord injury/dysfunction. We have one vision: it is a world where people with disabilities are healthier, more independent, and more empowered through a comprehensive lifetime of care and full community participation to take on all the challenges that life presents.”

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The Ohio State Medical Center (OSMC) recently published a study online in the Journal of Clinical Investigation. The study explored the effects of the body’s immune response after a spinal cord injury. It was already widely known that immune cells gather and release large amounts of antibodies in spinal fluid around a fresh injury site. Up until the OSMC study was published, no one knew exactly how those antibodies affected the injury. The study revealed that antibodies can actually damage and worsen the spinal cord injury by confusing the immune system into attacking the cells near the injury site as a response.

The study leader, Phillip G. Popovich, discerned a possible solution to the problem they identified. By inhibiting certain antibody-producing cells, the scientists asserted, a spinal cord injury patient might benefit from faster healing and reduced risk of more severe long-term damage. Popovich said, “[The antibodies] may also help explain why the central nervous system does not repair itself efficiently and why other impairments often follow spinal cord injury.”

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The study was conducted using anaesthetized mice that had been given moderate spinal injuries. Half of the mice had normal immune systems and the other half had immune systems that did not produce antibodies. The group with the inhibited immune systems showed about 30% smaller areas of injury than the mice with normal functioning immune systems.

To determine whether or not it the accumulation of antibodies around the spinal cord injury site was to blame for the larger and more severe injuries, the researchers injected antibodies from injured mice into the spinal cords of healthy mice. They became partially paralyzed and showed signs of damage to their spinal cords only 48 hours after the injections.

Another researcher in the study, Daniel P. Ankeny, said, “These experiments essentially prove that the antibodies have the potential by themselves to make spinal lesions worse.” The researchers also suggested that other health issues that arise in concert with spinal cord injuries might be related to and even caused by the heightened presence of antibodies in the bloodstream. Further research may reveal a host of problems associated with the antibodies in the system.

Better treatments designed to slow down the body’s immune response to spinal cord injuries may result from the findings of this study and further research to determine whether or not the results translate into human patients.

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Lauren Barkwick, a former worker at an elite horse ranch known for providing horses for movies and television in Canada, learned an extremely tough lesson about the value of life and freedom of movement. Barwick had competed with and defeated other applicants to land an internship at the Mission, British Columbia studio ranch. She was only a week into her new job when she had a catastrophic accident that left her irreversibly paralyzed.

Work at the studio ranch required difficult physical labor, and Barwick eagerly sought out the position. Part of her duties at the ranch included feeding the horses with bales of hay at 7:00 a.m. On the fateful morning of her accident, Barwick climbed up a poorly stacked pile of hay bales to knock a bale down to feed the horses.

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Once Barwick had climbed to the top of the hay bales, she realized it was unsafe. She jumped back down to the ground immediately. A bale of hay came with her and smashed her to the ground. It broke her back and left her paralyzed from the waist down. The accident had smashed two bones in her spine and severed her spinal cord.

Barwick must now continue living with the horrifying knowledge that her injury could have been prevented. Although she faces daily challenges of living with paralysis, she has still managed to triumph. Barwick took a gold and a silver medal in equestrian events in the 2008 paralympics in China.

Looking back in hindsight on her unfortunate accident, the Vancouver Sun reports that Barwick “recognizes she should have asked for help.” She feels convinced that by putting aside her fears, recognizing the inherent dangers of her job, and asking for help not matter what the consequences, she could have perhaps been able to avoid losing the feeling and use of her legs.

It was a tough lesson to learn. Barwick concluded by telling the Sun that, “No amount of money is worth your health or life. We have careers to better our lives. You look at me in my wheelchair. Have I bettered my life?” Hopefully, Barwick can be an inspiration to others to have gratitude for the ability to use legs, to remain aware and attentive to surroundings, and to take actions to avoid preventable injuries.

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What is Physical Rehabilitation?

Physical rehabilitation medicine is the treatment of disorders that have caused either temporary or permanent disability. Rehabilitation usually involves the neurological, muscuoskelatal, cardiovascular and pulmonary systems with the goal being restoring function of the affected physical systems.

Who may Need Physical Rehabilitation?
People recommended for physical rehabilitation treatment include all ages, all socioeconomic strata and all races and ethnic groups.

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Physical rehabilitation is effective for:
- Spinal cord injury victims
- Professional athletes
- Weekend warrior (occasional athletes)
- Employees with work-related injuries
- Infants with birth defects
- Arthritis patients
- Auto-accident victims
- Osteoporosis patients
- Amputees
- Incontinence patients
- Stroke victims
- Cancer survivors
- Scoliosis patients
- Drug overdose survivors
- Elderly adults with a broken hip
- Agricultural accident victims
- Multiple Sclerosis patients
- ALS patients
- Patients recovering from surgery
- Brain injury patients
- Gun shot victims
- Heart attack patients
- Accidental poisoning victims
- Teens with sprained ankles
- Suffers of chronic back pain
- Cerebral palsy patients
- Workers with carpel tunnel syndrome

Why is Physical Rehabilitation Important?
Costs for on-the-job muscuoskelatal injuries continue to rise, despite improving safety statistics. The average cost for an injury claim has surpassed $25,000 while a few claims cost 10-100 times the average. Companies look to rehabilitation team experts for cost-effect methods of returning good workers back to productive jobs.

Rehabilitation professionals take a moderately-to-severely impaired patient and through specific therapies, return the individual to the highest level of function and independence. Many individuals return to lives that are essentially unchanged from before the injury or disorder. Some patients, although they never return to pre-injury or pre-disease/disorder status, are able to live independently, hold down responsible jobs and have an excellent quality of life. Without rehabilitation, these individuals would need to be cared for the rest of their lives. The cost of rehabilitation is small compared to the costs of lifelong care.

More than two million people in the U. S. suffer strokes every year costing nearly $30 Billion in direct and indirect costs. The 67 percent who survive undergo rehabilitation to help them regain functionality and independence. Although rehabilitation cannot reverse brain damage, rehabilitation helps stroke survivors relearn skills such as speech, motor control and urinary or bowel continence. To help stroke survivors make the greatest amount of progress, rehabilitation usually begins 24-48 hours following the stroke.

With as many as 8.9 Americans have a history of cancer, 2 million brain injuries, 15,000 spinal cord injuries, 4 million on-the-job injuries and 100,000 automobile injuries annually, rehabilitation will become even more important.

Who Directs or Coordinates Physical Rehabilitation?

An interdisciplinary rehabilitation team usually has the responsibility of assessing the injury or disorder, designing a rehabilitation plan and working one-on-one with each patient. The rehabilitation team may consist of a physician specializing in physical medicine and physical rehabilitation (a physiatrist), a chiropractor, rehabilitation nurses, a physical therapist, a massage therapist, an occupational therapist, a vocational rehabilitation therapist and a speech pathologist. The rehabilitation team members work with patients until maximum function is attained. They may also periodically evaluate patients after rehabilitation is complete and recommend additional therapy.

How does the Physical Rehabilitation Process Work?
Physical rehabilitation methods differ widely with the specific injury or disorder. Rehabilitation may require prescription medications, specially prescribed mobility equipment, such as wheelchairs or walkers, leg braces or even a prosthetic limb. Rehabilitation may also require techniques including massage, heat or cold therapy, biofeedback, electrotherapy, traction and rehabilitation exercises.

For spinal cord injury, head trauma and stroke, patients may also need mental as well as physical rehabilitation. Psychological, neurological, social and behavioral therapy may be added to the regimen of rehabilitation.
Is Physical Rehabilitation Merely Exercises?

Physical rehabilitation is a multi-pronged approach to guiding patients to as high a functioning as possible. Physical exercise is only one part of a rehabilitation treatment plan.

It is always advisable to seek advice of a doctor, a chiropractor or a certified medical professional specializing in the field of physical rehabilitative therapy prior to starting any physical regiment.

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