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Current status and prospective application of stem cell-based therapies for spinal cord injury

Das AK, Gopurappilly R, Parhar I

Curr Stem Cell Res Ther, 2011 Jun;6(2):93-104.
PMID: 21190537

Spinal cord injuries (SCIs) are a common form of trauma that leaves a huge trail of morbidity and human suffering in its wake. They occur mostly among the young, causing severe physical, psychological, social and economic burdens. The treatment of this condition has rather been disappointing; most of the management strategies being mainly supportive and prophylactic. In recent years there has been an emerging interest in the use of stem cells to regenerate the nervous tissue that has been damaged or lost. Although there has been much hype and unfounded hope, modest successes have been witnessed, and it is possible that these therapeutic strategies may have much more to offer in the future. This paper will review the current strategies of exploring cell-based therapies, mainly different types of stem cells to treat SCI along with the evidence that has been accumulated over the past decade in a rational bench-to-bedside approach. Furthermore, critical aspects such as the mode of delivery and ethical considerations are also discussed along with feasible suggestions for future translational research to provide a contextual picture of the current state of advancements in this field. The impediments to regeneration in the site of injury are briefly explained along with the benefits and drawbacks of different cell types used in the treatment of this condition. We hope that this review will offer a significant insight into this challenging clinical condition.

Matched MeSH terms: Spinal Cord Injuries/therapy*
Fulltext Spinal cord injury without radiological abnormality (SCIWORA)

Izma MKO, Zulkharnain I, Ramli B, Muhamad AR, Harwant S

Med J Malaysia, 2003 Mar;58(1):105-10.
PMID: 14556334

SCIWORA or Spinal Cord Injury Without Radiological Abnormality; is a pre-MRI term that includes injuries to the spinal cord in the absence of radiological (plain radiographs, tomographs and CT scans) evidence of injury to the spinal column or cord. It occurs in skeletally immature spines because of the inherent plasticity of the bony structures in this age group. The prognosis is dependent on the extent of cord damage, and the role of active management is limited. A high index of suspicion is needed to establish a diagnosis. This diagnostic accuracy can be improved with the free availability of MRI scanning for the spines. We describe three cases of SCIWORA with a minimum follow-up of three years and a review of current literature.

Matched MeSH terms: Spinal Cord Injuries/therapy
Fulltext Halovest treatment in traumatic cervical spine injury

Razak M, Basir T, Hyzan Y, Johari Z

Med J Malaysia, 1998 Sep;53 Suppl A:1-5.
PMID: 10968176

This is a cross-sectional study on the use of halovest appliance in the Orthopaedic and Traumatology Department, Kuala Lumpur Hospital from June 1993 to September 1996. Fifty-three patients with cervical spine injuries were treated by halovest stabilization. Majority of cases was caused by motor-vehicle accident; others were fall from height at construction sites, fall at home, hit by falling object and assault. The injuries were Jefferson fracture of C1, odontoid fractures, hangman fractures, open spinous process fracture and fracture body of C2, and fracture, and fracture-dislocation of the lower cervical spines. Majority of patients had hospital stay less than 30 days. The use of the halovest ranges from 4 to 16 weeks and the healing rate was 96%. Two patients of lower cervical spine injury had redislocation and one of them was operated. There was one case of non-union of type II odontoid fracture and treated by posterior fusion. Other complications encountered during halovest treatment were minor. They were pin-site infection, pin-loosening, clamp loosening and neck pain or neck stiffness. This method of treatment enables patient to ambulate early and reduces hospital stay. We found that halovest is easy to apply, safe and tolerable to most of the patients.

Matched MeSH terms: Spinal Cord Injuries/therapy*
Fulltext Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms

Anjum A, Yazid MD, Fauzi Daud M, Idris J, Ng AMH, Selvi Naicker A, et al.

Int J Mol Sci, 2020 Oct 13;21(20).
PMID: 33066029 DOI: 10.3390/ijms21207533

Spinal cord injury (SCI) is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Its pathophysiology comprises acute and chronic phases and incorporates a cascade of destructive events such as ischemia, oxidative stress, inflammatory events, apoptotic pathways and locomotor dysfunctions. Many therapeutic strategies have been proposed to overcome neurodegenerative events and reduce secondary neuronal damage. Efforts have also been devoted in developing neuroprotective and neuro-regenerative therapies that promote neuronal recovery and outcome. Although varying degrees of success have been achieved, curative accomplishment is still elusive probably due to the complex healing and protective mechanisms involved. Thus, current understanding in this area must be assessed to formulate appropriate treatment modalities to improve SCI recovery. This review aims to promote the understanding of SCI pathophysiology, interrelated or interlinked multimolecular interactions and various methods of neuronal recovery i.e., neuroprotective, immunomodulatory and neuro-regenerative pathways and relevant approaches.

Matched MeSH terms: Spinal Cord Injuries/therapy
Exergaming for Individuals with Spinal Cord Injury: A Pilot Study

Mat Rosly M, Halaki M, Mat Rosly H, Cuesta V, Hasnan N, Davis GM, et al.

Games Health J, 2017 Oct;6(5):279-289.
PMID: 28968153 DOI: 10.1089/g4h.2017.0028

OBJECTIVE: Commercially available exergames that are for wheelchair-bound individuals with spinal cord injury (SCI) are scarce. This study sought to identify exergames for individuals with SCI that are "dose-potent" for health benefits.
MATERIALS AND METHODS: Six participants with SCI were recruited for a pilot study to investigate the exercise intensity of selected exergames (Move Tennis, Move Boxing, and Move Gladiator Duel) for the potential to improve health. Issues relating to exergaming for individuals with SCI were identified, and a Move Kayaking exergame was conceived using relevant design processes in an iterative manner. These processes included the following: participant needs and requirements, system requirements (hardware), system architecture (physical and operational views), and integration and verification of the finished system. Emphasis was given to operational and physical designs of the Move Kayaking exergame.
RESULTS: Move Boxing, Move Gladiator Duel, and Move Kayaking achieved moderate intensity exercise, while Move Tennis only achieved exercise of low intensity based on participants' metabolic equivalent. However, all four exergames achieved at least moderate intensity based on individuals' ratings of perceived exertion (RPE).
CONCLUSION: The intensity classification while playing Move Boxing, Move Tennis, Move Gladiator Duel, and Move Kayaking, using RPE, reported adequate exercise intensities prescribed by exercise guidelines.

Matched MeSH terms: Spinal Cord Injuries/therapy*
A novel motion sensor-driven control system for FES-assisted walking after spinal cord injury: A pilot study

Braz GP, Russold MF, Fornusek C, Hamzaid NA, Smith RM, Davis GM

Med Eng Phys, 2016 11;38(11):1223-1231.
PMID: 27346492 DOI: 10.1016/j.medengphy.2016.06.007

This pilot study reports the development of a novel closed-loop (CL) FES-gait control system, which employed a finite-state controller that processed kinematic feedback from four miniaturized motion sensors. This strategy automated the control of knee extension via quadriceps and gluteus stimulation during the stance phase of gait on the supporting leg, and managed the stimulation delivered to the common peroneal nerve (CPN) during swing-phase on the contra-lateral limb. The control system was assessed against a traditional open-loop (OL) system on two sensorimotor 'complete' paraplegic subjects. A biomechanical analysis revealed that the closed-loop control of leg swing was efficient, but without major advantages compared to OL. CL automated the control of knee extension during the stance phase of gait and for this reason was the method of preference by the subjects. For the first time, a feedback control system with a simplified configuration of four miniaturized sensors allowed the addition of instruments to collect the data of multiple physiological and biomechanical variables during FES-evoked gait. In this pilot study of two sensorimotor complete paraplegic individuals, CL ameliorated certain drawbacks of current OL systems - it required less user intervention and accounted for the inter-subject differences in their stimulation requirements.

Matched MeSH terms: Spinal Cord Injuries/therapy*
Fulltext Botulinum toxin type A for rehabilitation after a spinal cord injury: a case report

Naicker AS, Roohi SA, Chan JL

J Orthop Surg (Hong Kong), 2009 Apr;17(1):96-9.
PMID: 19398803 DOI: 10.1177/230949900901700121

A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.

Matched MeSH terms: Spinal Cord Injuries/therapy*
Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics

Shuhart CR, Yeap SS, Anderson PA, Jankowski LG, Lewiecki EM, Morse LR, et al.

J Clin Densitom, 2019 07 05;22(4):453-471.
PMID: 31400968 DOI: 10.1016/j.jocd.2019.07.001

To answer important questions in the fields of monitoring with densitometry, dual-energy X-ray absorptiometry machine cross-calibration, monitoring, spinal cord injury, periprosthetic and orthopedic bone health, transgender medicine, and pediatric bone health, the International Society for Clinical Densitometry (ISCD) held a Position Development Conference from March 20 to 23, 2019. Potential topics requiring guidance were solicited from ISCD members in 2017. Following that, a steering committee selected, prioritized, and grouped topics into Task Forces. Chairs for each Task Force were appointed and the members were co-opted from suggestions by the Steering Committee and Task Force Chairs. The Task Forces developed key questions, performed literature searches, and came up with proposed initial positions with substantiating draft publications, with support from the Steering Committee. An invited Panel of Experts first performed a review of draft positions using a modified RAND Appropriateness Method with voting for appropriateness. Draft positions deemed appropriate were further edited and presented at the Position Development Conference meeting in an open forum. A second round of voting occurred after discussions to approve or reject the positions. Finally, a face-to-face closed session with experts and Task Force Chairs, and subsequent electronic follow-up resulted in 34 Official Positions of the ISCD approved by the ISCD Board on May 28, 2019. The Official Positions and the supporting evidence were submitted for publication on July 1, 2019. This paper provides a summary of the all the ISCD Adult and Pediatric Official Positions, with the new 2019 positions highlighted in bold.

Matched MeSH terms: Spinal Cord Injuries/therapy