Breakthroughs in Spinal Cord Injury Research - Supplemental Update - Winter 2014

Breakthroughs in Spinal Cord Injury Research: The Role of Activity-based Therapies in Conjunction with Surgical Interventions

By Cristina Sadowsky, MD January 22, 2015 (updated February 5, 2015)

THE pace of clinical research into spinal cord injury (SCI) is progressing rapidly. Researchers are now close to trialing promising interventions in humans—an advance that has clinicians and those impacted by SCI very excited. Recently, two very interesting cases have made waves in the mainstream media.

In the first, five men with chronic, complete spinal cord injury who received implanted epidural stimulation reported significant neurologic gains. In this procedure, the implanted stimulator delivers a continuous electrical current to the participant’s lower spinal cord to recreate the brain’s normal signal for movement. To build on this research, the Christopher and Dana Reeve Foundation has started “The Big Idea” campaign to fund a project that would implant epidural stimulators in 36 individuals with SCI. Commercial interests like NeuroRecovery Technologies and prominent, independent neuroscientists are also involved in this effort.

The second promising report comes out of Poland, where an individual with chronic SCI demonstrated improvement in neurologic deficit after a surgery that combined two previously practiced and studied procedures. Medical teams from the UK and Poland collaborated on the transplant of olfactory ensheathing cells into the patient’s spinal cord.

A peripheral nerve graft was then used to bridge a small gap in the spinal cord. The results are promising and have recently been published in a peer reviewed scientific journal.

In addition to these exciting developments, there are upcoming and ongoing clinical trials that target both acute and chronic spinal cord injuries to examine the efficacy of diverse interventions.

One factor these case studies and trials have in common is the inclusion of a significant amount of daily activitybased therapies. These therapies closely match the activity-based restorative therapies (ABRT) model advocated and practiced at the International Center for Spinal Cord Injury (ICSCI) for the past 10 years. ICSCI has been a pioneer in the development of functional electrical stimulation and has greatly expanded the application of therapies including:    

Locomotor gait training Weight loading/standing Task-specific training Massed practice (multiple repetitions of same motor pattern)

Since its founding in 2005, ICSCI’s innovative rehabilitation program has helped individuals with paralysis gain improved health and quality of life through activity-based therapies. As clinical research continues to gain ground with promising breakthroughs, maintaining adequate levels of activity above and below the injury level remains a mainstay in neurologic and day-to-day functional restoration in individuals with chronic paralysis. It will continue to be an important adjunct to most (if not all) surgical transplantation studies.