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An estimated 11,000 spinal cord injuries occur each year in the United States and more than 200,000 Americans suffer from maladies associated with spinal cord injury. This includes paralysis, bowel and bladder dysfunction, sexual dysfunction, respiratory impairment, temperature regulation problems, and chronic pain. During the last two decades, longstanding beliefs about the inability of the adult central nervous system to heal itself have been eroded by the flood of new information from research in the neurosciences and related fields. However, there are still no cures and the challenge of restoring function in the wake of spinal cord injuries remains extremely complex. Spinal Cord Injury examines the future directions for research with the goal to accelerate the development of cures for spinal cord injuries. While many of the recommendations are framed within the context of the specific needs articulated by the New York Spinal Cord Injury Research Board, the Institute of Medicine's panel of experts looked very broadly at research priorities relating to future directions for the field in general and make recommendations to strengthen and coordinate the existing infrastructure. Funders at federal and state agencies, academic organizations, pharmaceutical and device companies, and non-profit organizations will all find this book to be an essential resource as they examine their opportunities.

Sarah D. Phillips examines the struggles of disabled persons in Ukraine and the other former Soviet states to secure their rights during the tumultuous political, economic, and social reforms of the last two decades. Through participant observation and interviews with disabled Ukrainians across the social spectrum -- rights activists, politicians, students, workers, entrepreneurs, athletes, and others -- Phillips documents the creative strategies used by people on the margins of postsocialist societies to assert claims to mobile citizenship. She draws on this rich ethnographic material to argue that public storytelling is a powerful means to expand notions of relatedness, kinship, and social responsibility, and which help shape a more tolerant and inclusive society.

This is the most comprehensive text available, encompassing the breadth and depth of the field of spinal cord medicine, covering topics from acute medical and surgical management to cutting-edge research, rehabilitation, and psychosocial care. This book was developed for all physicians, research scientists, and other health care professionals involved in the management of individuals with SCI, multiple sclerosis, and other spinal cord disorders. This practical clinical guide is the ultimate single source of information on SCM. It will be especially useful for physicians taking the examination for Subspecialty Certification in Spinal Cord Injury Medicine. Spinal Cord Medicine has 74 chapters written by leaders in their fields, and is divided into sections that include: a review of anatomy and physiology, spinal cord imaging, and epidemiology; acute spinal cord injury management, including prehospital management, emergency room evaluation and intensive care, and considerations relating to spine surgery; overall medical management, including management of respiratory and sleep disorders, cardiovascular dysfunction, infection, endocrine and metabolic dysfunction, and bladder, bowel, and sexual dysfunction; the neurologic aspects of spinal cord care, including the neurologic assessment of SCI, electrophysiological evaluation of the spinal tracts, myelopathies, multiple sclerosis, spasticity and pain management, autonomic dysfunction, and concomitant SCI and traumatic brain injury; musculoskeletal care, including the management of overuse injuries, osteoporosis and long bone fractures, and interdisciplinary approaches to upper extremity and pressure ulcer management; wheelchair and seating assessment, orthotics, activity of daily living training, vocational and driving training, and functional electric stimulation; recent advances in spinal cord research, including functional magnetic stimulation, spinal cord regeneration and repair strategies, and body weight supported ambulation; special topics on aging, women?s issues, pediatric care, and SCI prevention; psychosocial issues, cost of care, SCI systems of care, and various supportive environments for SCI and SCD care.

The translation of therapeutic interventions to humans with spinal cord injury with the goal of promoting growth and repair in the central nervous system could, inadvertently, drive mechanisms associated with the development of neuropathic pain. A framework is needed to evaluate the probability that a therapeutic intervention for acute spinal cord injury modifies the progression of neuropathic pain. We analyzed a large, longitudinal dataset from the European Multi-Center Study about Spinal Cord Injury (EMSCI) and compared these observations with a previously published Swedish/Danish cohort. A meta-analysis was performed to produce aggregate estimates for the transition period between 1–6 months and the transition period between 1–12 months after injury. A secondary analysis used logistic regression to explore associations between the progression of neuropathic pain and demographics, pain characteristics, and injury characteristics. For overall neuropathic pain, 72% presenting with pain symptoms at one month reported persisting symptoms at six months, and 23% who did not have neuropathic pain at one month later had it develop. From 1–12 months, there was a similar likelihood of pain persisting (69%) and slightly higher rate of pain developing (36%). Characteristics that were significantly associated with the progression of pain included age and sensory and motor preservation. We provide historical benchmarks for estimating the progression of neuropathic pain during the first year after acute SCI. This information will be useful for comparison and evaluating safety during early phase acute spinal cord injury trials.

The goal of this study was to assess the therapeutic potential of a 5-hour local spinal cord (SC) hypothermia by 4 °C saline on preservation of SC tissue at the injury epicentre and 3 cranial and caudal 10 mm long SC segments in a porcine experimental model of spinal cord injury (SCI). The SCI was inflicted through L3 laminectomy by a metallic rod moved by a velocity of 30 mm.sec−1, and operated by a computer-controlled apparatus. A group of 15 female minipigs 5‒8-month-old weighing 28‒35 kg was randomly divided into 5 subgroups (each composed of 3 animals): 1) sham controls; 2) SCI by force 8N; 3) SCI by force 8N, 5-hour hypothermia; 4) SCI by force 15N; 5) SCI by force 15N, 5-hour hypothermia. After a 9-week survival period, the minipigs were in deep general anaesthesia transcardially perfused by 5000 ml of saline and fixed by 5000 ml 4 % neutral paraformaldehyde. White and grey SC matter damage was evaluated in specimens cut from the epicentre of injury as well as 3 cranial and 3 caudal 10 mm long SC blocks dyed according to Luxol fast blue (LFB) with cresyl violet (CV) protocol for light microscopic observations. The percentage of preserved SC white and grey matter was assessed in microphotographs and compared with data from sham controls (considered 100 %). The data were statistically evaluated by ANOVA test, the difference P ˂ 0.05 was considered significant. Results of the study suggest that 5-hour local cooling of the epicentre of SCI is well tolerated and facilitates the preservation of SC tissue integrity. Additional experimental and preclinical studies are necessary before introducing the method in practice.

Spinal cord injuries (SCIs) are catastrophic events in humans and animals. They often result in permanent loss of motor, sensory, and autonomic functions caudally from the site of the spinal cord (SC) lesion. The natural history of spontaneous recovery from SC trauma is disappointing and currently available therapeutic interventions fail to operate. Hence further research using bigger experimental animals or primates is necessary. The results of this study performed by the authors in 21 Göttingen-Minnesota-Liběchov female minipigs (3 sham controls, and 18 members of an experimental subgroup) showed that these animals are suitable for SCI research. All mini-pigs survived rather complex experiments carried out in general anaesthesia induced by 5 % thiopental solution administered i.v., maintained by endotracheal inhalation of 1.5 % sevoflurane with O2 as well as a subsequent 9-week monitoring period. The experimental procedures comprised of L3 laminectomy, SCI inflicted by computer-controlled metallic piston crushing the SC with 8N, 15N, or 18N force. After the SCIs there were 9 minipigs left over during the next 5.5 hours in general anaesthesia, without application of hypothermia, then the surgical wounds were sutured, and the animals were allowed to awaken under supervision. Just 30 min following SCIs was in 6 mini-pigs started with the 5-hour application of 4 °C saline via perfusion chambers placed at the epicenter of the SCI, the chambers were removed, surgical wounds sutured, and animals were allowed to awaken. Just 30 minutes following the SCIs, there was in 3 minipigs started with a 5-hour administration of ≈24 °C saline at the epicentre of the SCIs, and then the perfusion chamber was removed, surgical wounds sutured, and the animals were allowed to awaken. The 5.5-hour local hypothermia and protracted general anaesthesia required monitoring of rectal temperature, and external warming of the minipig, if the temperature dropped below 36 °C. The currently available information on the therapeutic capacity of the method, and all technical aspects of its routine employment, needs validation in further experiments and preclinical trials.

Spinal cord injury induces neurological deficits associated with long-term functional impairments. Since the current treatments remain ineffective, novel therapeutic options are needed. Besides its effect on bipolar mood disorder, lithium was reported to have neuroprotective activity in different neurodegenerative conditions, including spinal cord injury. In spinal cord injury, the effects of lithium on long-term neurological recovery and neuroplasticity have not been assessed. We herein investigated the effects of intraperitoneally administered lithium chloride on motor coordination recovery, electromyography (EMG) responses, histopathological injury and remodeling, and axonal plasticity in mice exposed to spinal cord transection. At a dose of 0.2, but not 2.0 mmol/kg, lithium chloride enhanced motor coordination and locomotor activity starting at 28 days post-injury (dpi), as assessed by a set of behavioral tests. Following electrical stimulation proximal to the hemitransection, lithium chloride at 0.2 mmol/kg decreased the latency and increased the amplitude of EMG responses in the denervated hindlimb at 56 dpi. Functional recovery was associated with reduced gray and white matter atrophy rostral and caudal to the hemitransection, increased neuronal survival and reduced astrogliosis in the dorsal and ventral horns caudal to the hemitransection, and increased regeneration of long-distance axons proximal and distal to the lesion site in mice receiving 0.2 mmol/kg, but not 2 mmol/kg lithium chloride, as assessed by histochemical and immunohistochemical studies combined with anterograde tract tracing. Our results indicate that lithium chloride induces long-term neurological recovery and neuroplasticity following spinal cord injury.

BackgroundTraumatic spinal cord injury (SCI) leads to disruption of axonal architecture and macroscopic tissue loss with impaired information flow between the brain and spinal cord—the presumed basis of ensuing clinical impairment.ObjectiveThe authors used a clinically viable, multimodal MRI protocol to quantify the axonal integrity of the cranial corticospinal tract (CST) and to establish how microstructural white matter changes in the CST are related to cross-sectional spinal cord area and cortical reorganisation of the sensorimotor system in subjects with traumatic SCI.MethodsNine volunteers with cervical injuries resulting in bilateral motor impairment and 14 control subjects were studied. The authors used diffusion tensor imaging to assess white matter integrity in the CST, T1-weighted imaging to measure cross-sectional spinal cord area and functional MRI to compare motor task-related brain activations. The relationships among microstructural, macrostructural and functional measures were assessed using regression analyses.ResultsDiffusion tensor imaging revealed significant differences in the CST of SCI subjects—compared with controls—in the pyramids, the internal capsule, the cerebral peduncle and the hand area. The microstructural white matter changes observed in the left pyramid predicted increased task-related responses in the left M1 leg area, while changes in the cerebral peduncle were predicted by reduced cord area.ConclusionThe observed microstructural changes suggest trauma-related axonal degeneration and demyelination, which are related to cortical motor reorganisation and macrostructure. The extent of these changes may reflect the plasticity of motor pathways associated with cortical reorganisation. This clinically viable multimodal imaging approach is therefore appropriate for monitoring degeneration of central pathways and the evaluation of treatments targeting axonal repair in SCI.

A young stray entire female domestic shorthair cat was presented with symmetrical forelimb extensor rigidity, neck hyperextension and hindlimb paraplegia, characteristic of Schiff–Sherrington phenomenon (SSP), within 30 min of a motor vehicle accident. Radiographic and post‐mortem studies disclosed complete transection of the spinal cord from traumatic dorsocranial luxation of the second lumbar vertebra, displacement of the sacrum from the ilium, seventh lumbar and first caudal vertebrae and multiple pelvic fractures. Other causes of forelimb extensor rigidity and neck hyperextension such as decerebrate and decerebellate rigidity were excluded by a lack of neurological signs consistent with these entities and unremarkable findings on post‐mortem examination of the cranial cavity and brain and histological examination of the cerebrum, brainstem and cerebellum. To the best of the author's knowledge, this is the first report of SSP in the cat outside the experimental arena of decerebrate or non‐decerebrate preparations following post‐brachial spinal cord transection/cold block.

Background Restoring community walking remains a highly valued goal for persons recovering from traumatic incomplete spinal cord injury (SCI). Recently, studies report that brief episodes of low-oxygen breathing (acute intermittent hypoxia, AIH) may serve as an effective plasticity-inducing primer that enhances the effects of walking therapy in persons with chronic (> 1 year) SCI. More persistent walking recovery may occur following repetitive (weeks) AIH treatment involving persons with more acute SCI, but this possibility remains unknown. Here we present our clinical trial protocol, designed to examine the distinct influences of repetitive AIH, with and without walking practice, on walking recovery in persons with sub-acute SCI (< 12 months) SCI. Our overarching hypothesis is that daily exposure (10 sessions, 2 weeks) to AIH will enhance walking recovery in ambulatory and non-ambulatory persons with subacute (< 12 months) SCI, presumably by harnessing endogenous mechanisms of plasticity that occur soon after injury. Methods To test our hypothesis, we are conducting a randomized, placebo-controlled clinical trial on 85 study participants who we stratify into two groups according to walking ability; those unable to walk (non-ambulatory group) and those able to walk (ambulatory group). The non-ambulatory group receives either daily AIH (15, 90s episodes at 10.0% O 2 with 60s intervals at 20.9% O 2 ) or daily SHAM (15, 90s episodes at 20.9% O 2 with 60s intervals at 20.9% O 2 ) intervention. The ambulatory group receives either 60-min walking practice (WALK), daily AIH + WALK, or daily SHAM+WALK intervention. Our primary outcome measures assess overground walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up & Go Test). For safety, we also measure levels of pain, spasticity, systemic hypertension, and autonomic dysreflexia. We record outcome measures at baseline, days 5 and 10, and follow-ups at 1 week, 1 month, 6 months, and 12 months post-treatment. Discussion The goal of this clinical trial is to reveal the extent to which daily AIH, alone or in combination with task-specific walking practice, safely promotes persistent recovery of walking in persons with traumatic, subacute SCI. Outcomes from this study may provide new insight into ways to enhance walking recovery in persons with SCI. Trial registration ClinicalTrials.gov, NCT02632422 . Registered 16 December 2015,