6 Jefferson REVIEW
For MJ (Mary Jane) Mulcahey, MSOT ’91, PhD, professor of occupational therapy in the Jefferson School of Health Professions, there’s a practical beauty in the scans. With a $1.7 million grant from the National Institutes of Health, she’s testing whether diffusion tensor imaging (DTI) can improve the diagnosis of spinal cord injuries (SCI) in children and teens. “Kids with SCI and their families deserve a more accurate diagnosis,” she explains. “It would be phenomenal to be able to quickly visualize the extent of injury and where it is located along the spinal cord.” Rehabilitation plans, school placements and a child’s prognosis all depend on an accurate diagnosis after SCI. Because DTI shows the integrity of nerve bundles, called tracts, in the spinal cord, it may be used in the future to study new SCI treatments, including rehabilitation programs, she notes. “Right now, the nerves can only be seen during surgery, and with magnification,” she says. “This could also pave the way for the inclusion of children and teens in phase II and III clinical trials — something that’s extremely rare now, but that almost every family I’ve ever worked with asks about.” In a five-year study that will ultimately scan 75 kids and teens with SCI as well
as 25 with healthy spines as a comparison group, Mulcahey and co-investigator Feroze B. Mohamed, PhD, professor of radiology at the Temple University School of Medicine, are probing DTI’s ability to consistently pinpoint severed, contused (bruised) and crushed fibers in the spinal cord — as well as still-intact ones. The team has already found that DTI can be more accurate than magnetic resonance imaging at spotting pediatric SCI. The project is part of Mulcahey’s mission to put a scientific foundation under the tests widely used to assess pediatric SCI. And it fits into a bigger goal: pushing the age continuum of spinal cord injury research and care in both directions. (Also among her current research projects is an innovative fallprevention program for older adults.) “On the inside, I am very excited. On the outside, I’m very cautious,” says Mulcahey, one of the first researchers in the world to study DTI in children. “DTI shows promise. Now we need to build strong evidence.”
Valid, Reliable, Accurate Every year, about 2,400 babies, kids and teenagers in the United States sustain a spinal cord injury. Car accidents (especially
when car seats and seat belts aren’t used), falls, violence and sports injuries are leading causes. It’s a fraction of the 12,000 SCIs that happen in the U.S. each year, but in many ways the stakes for young people are higher. More than half of all pediatric SCIs occur in the spine’s top-most, cervical region, raising risk for paralysis of arms, legs and even lungs. If the injury happens before a child’s adolescent growth spurt, the risk for scoliosis — curving and twisting of the spine that can affect posture and even interfere with breathing — is extremely high, too. Knowing the location and extent of a child’s injury is crucial for developing an effective rehabilitation plan and predicting future progress, mobility and independence. “But children aren’t small adults,” Mulcahey says. “They can’t always tell you what’s going on.” That’s a challenge. The primary SCI assessment for kids and adults, called the International Standards for Neurological Classification of Spinal Cord Injury, uses muscle strength in the arms and legs and sensation at 56 locations on the body to classify injuries. (Numbness or muscle weakness in specific spots correlates with cord damage.) In a 2007 study published
Diffusion tensor imaging is a type of non-invasive functional magnetic resonance imaging that measures the diffusive transport of water in tissues, which allows for the visualization of microscopic tissue structure. Jefferson occupational therapist MJ Mulcahey, MSOT ’91, PhD, OTR/L, is working to refine this technology to improve pediatric spinal cord injury diagnosis.