Spinal Cord Injury; Critical Research from PVA

In honor of Veteran’s Day, the Michelson Medical Research Foundation would like to call attention to one of the most debilitating casualties faced by men and women in the armed forces: Spinal Cord Injury.

Over 42,000 current U.S. veterans are disabled by spinal cord injuries (1). The incidence of spinal cord injury has increased significantly among veterans from Afghanistan and Iraq (2). Surprisingly, this increase has been tied to modernized combat and the use of unconventional warfare tactics. In the latter part of the 20th century, spinal cord injuries were relatively rare with a 1% incidence rate, but in the 21st century the incidence of spinal cord injuries has increased to over 5% of all combat-related injuries in the U.S. armed forces (3).

Damage to any part of the spinal cord disrupts movement, sensation, and bodily functions below the site of injury. Injury of the spinal cord can lead to paraplegia (paralysis of the trunk, legs, and pelvic organs) or tetraplegia (paralysis of the arms, hands, trunk, legs, and pelvic organs). It is often associated with loss of bladder control, exaggerated reflex spasms, loss of sexual function, difficulty breathing, and severe chronic pain (4). Disabled veterans with spinal cord injury find that every aspect of their life is affected by the disability. It can be very difficult to independently perform the simplest of everyday tasks, such as eating, getting dressed, and getting to and from their job or community activities.

Spinal Cord - Anatomy

The spinal cord is a soft bundle of nerves that extends from the base of the brain to the lower back. It runs through the spinal canal and is protected by the bones of the spine (vertebrae). Messages between the brain and the nerve roots travel up and down the spinal cord, making it possible for the brain and body to communicate. The discs cushion the vertebrae and provide flexibility to the spine and spinal cord.

Spinal Cord - Description

The spine (backbone) is composed of 33 interlocking bones called vertebrae that are separated by soft, compressible discs and supported by many different ligaments and muscles. It is divided into five segments: cervical (neck), thoracic (upper and middle back), lumbar (lower back), sacrum (pelvis), and coccyx (tailbone). In each segment, the vertebrae are numbered from top to bottom. For example, a C3 is the third vertebra in the neck area, while a T6 is the sixth vertebra in the thoracic area.

The vertebrae in the spine normally form three curves. These curves allow the spine to absorb shock as you move.

Spinal Cord - Areas the nerves control

The nerves in the area of a vertebra control specific parts of the body. For example, the 7th cervical nerve (C7) in the neck area controls the triceps (the muscle in the upper arm), while the thoracic nerves (T2 through T7) control the chest muscles.

In a spinal cord injury, complete or partial paralysis occurs in the areas of the body that are controlled by the nerves associated with the damaged vertebrae and those below the damaged vertebrae. The higher the injury on the spinal cord, the more paralysis there is. For example, damage high on the spinal cord, in the cervical segment, can result in paralysis of the chest, arms, and legs (tetraplegia, also known as quadriplegia). Damage lower down on the spine (thoracic, lumbar, or sacral segments) can result in paralysis of the legs and lower body (paraplegia). Breathing is affected only by injuries high on the spinal cord. But bowel and bladder control can be affected no matter where the spinal cord in injured.

Spinal Cord - Anatomy

The spinal cord is a soft bundle of nerves that extends from the base of the brain to the lower back. It runs through the spinal canal and is protected by the bones of the spine (vertebrae). Messages between the brain and the nerve roots travel up and down the spinal cord, making it possible for the brain and body to communicate. The discs cushion the vertebrae and provide flexibility to the spine and spinal cord.

Spinal Cord - Description

The spine (backbone) is composed of 33 interlocking bones called vertebrae that are separated by soft, compressible discs and supported by many different ligaments and muscles. It is divided into five segments: cervical (neck), thoracic (upper and middle back), lumbar (lower back), sacrum (pelvis), and coccyx (tailbone). In each segment, the vertebrae are numbered from top to bottom. For example, a C3 is the third vertebra in the neck area, while a T6 is the sixth vertebra in the thoracic area.

The vertebrae in the spine normally form three curves. These curves allow the spine to absorb shock as you move.

Spinal Cord - Areas the nerves control

The nerves in the area of a vertebra control specific parts of the body. For example, the 7th cervical nerve (C7) in the neck area controls the triceps (the muscle in the upper arm), while the thoracic nerves (T2 through T7) control the chest muscles.

In a spinal cord injury, complete or partial paralysis occurs in the areas of the body that are controlled by the nerves associated with the damaged vertebrae and those below the damaged vertebrae. The higher the injury on the spinal cord, the more paralysis there is. For example, damage high on the spinal cord, in the cervical segment, can result in paralysis of the chest, arms, and legs (tetraplegia, also known as quadriplegia). Damage lower down on the spine (thoracic, lumbar, or sacral segments) can result in paralysis of the legs and lower body (paraplegia). Breathing is affected only by injuries high on the spinal cord. But bowel and bladder control can be affected no matter where the spinal cord in injured.

Spinal Cord - Anatomy

The spinal cord is a soft bundle of nerves that extends from the base of the brain to the lower back. It runs through the spinal canal and is protected by the bones of the spine (vertebrae). Messages between the brain and the nerve roots travel up and down the spinal cord, making it possible for the brain and body to communicate. The discs cushion the vertebrae and provide flexibility to the spine and spinal cord.

Spinal Cord - Description

The spine (backbone) is composed of 33 interlocking bones called vertebrae that are separated by soft, compressible discs and supported by many different ligaments and muscles. It is divided into five segments: cervical (neck), thoracic (upper and middle back), lumbar (lower back), sacrum (pelvis), and coccyx (tailbone). In each segment, the vertebrae are numbered from top to bottom. For example, a C3 is the third vertebra in the neck area, while a T6 is the sixth vertebra in the thoracic area.

The vertebrae in the spine normally form three curves. These curves allow the spine to absorb shock as you move.

Spinal Cord - Areas the nerves control

The nerves in the area of a vertebra control specific parts of the body. For example, the 7th cervical nerve (C7) in the neck area controls the triceps (the muscle in the upper arm), while the thoracic nerves (T2 through T7) control the chest muscles.

In a spinal cord injury, complete or partial paralysis occurs in the areas of the body that are controlled by the nerves associated with the damaged vertebrae and those below the damaged vertebrae. The higher the injury on the spinal cord, the more paralysis there is. For example, damage high on the spinal cord, in the cervical segment, can result in paralysis of the chest, arms, and legs (tetraplegia, also known as quadriplegia). Damage lower down on the spine (thoracic, lumbar, or sacral segments) can result in paralysis of the legs and lower body (paraplegia). Breathing is affected only by injuries high on the spinal cord. But bowel and bladder control can be affected no matter where the spinal cord in injured.

Spinal Cord - Anatomy

The spinal cord is a soft bundle of nerves that extends from the base of the brain to the lower back. It runs through the spinal canal and is protected by the bones of the spine (vertebrae). Messages between the brain and the nerve roots travel up and down the spinal cord, making it possible for the brain and body to communicate. The discs cushion the vertebrae and provide flexibility to the spine and spinal cord.

Spinal Cord - Description

The spine (backbone) is composed of 33 interlocking bones called vertebrae that are separated by soft, compressible discs and supported by many different ligaments and muscles. It is divided into five segments: cervical (neck), thoracic (upper and middle back), lumbar (lower back), sacrum (pelvis), and coccyx (tailbone). In each segment, the vertebrae are numbered from top to bottom. For example, a C3 is the third vertebra in the neck area, while a T6 is the sixth vertebra in the thoracic area.

The vertebrae in the spine normally form three curves. These curves allow the spine to absorb shock as you move.

Spinal Cord - Areas the nerves control

The nerves in the area of a vertebra control specific parts of the body. For example, the 7th cervical nerve (C7) in the neck area controls the triceps (the muscle in the upper arm), while the thoracic nerves (T2 through T7) control the chest muscles.

In a spinal cord injury, complete or partial paralysis occurs in the areas of the body that are controlled by the nerves associated with the damaged vertebrae and those below the damaged vertebrae. The higher the injury on the spinal cord, the more paralysis there is. For example, damage high on the spinal cord, in the cervical segment, can result in paralysis of the chest, arms, and legs (tetraplegia, also known as quadriplegia). Damage lower down on the spine (thoracic, lumbar, or sacral segments) can result in paralysis of the legs and lower body (paraplegia). Breathing is affected only by injuries high on the spinal cord. But bowel and bladder control can be affected no matter where the spinal cord in injured.

In acknowledgement of the challenges faced by those with spinal cord injury and the urgent need for new treatment options, on July 31st of this year Congress passed U.S. Senate Resolution 533 designating September 2014 as National Spinal Cord Injury Awareness Month (5). A number of private foundations are dedicated to funding regenerative treatments for spinal cord injury, and this Bill aimed to raise support for new research and clinical trials.

As is often the case, the majority of foundations offering funding were established by someone who was personally affected by spinal cord injury. Paralyzed Veterans of America (PVA) is a Washington-based non-profit organization founded by veterans returning from World War II with spinal cord injury. Its mission is to fund cutting-edge research and advocate for comprehensive civil rights for veterans and civilians with spinal cord injury.

Every year Paralyzed Veterans of America selects a number of academics and clinicians who are performing critical research to improve treatment options for spinal cord injuries. The 2014 Paralyzed Veterans of America Research Foundation grant recipients were funded to push the boundaries of current treatments. Current treatments for spinal cord injury are focused on rehabilitation using physical therapy, assistive devices, and pain management. The 2014 grant recipients are working to expand the range of effective therapies and our basic understanding of the mechanisms of repair.

Paralyzed Veterans of America: 2014 Research Foundation Grant Recipients

Spinal Cord Injury and Disease (SCI/D)
2014 Research Foundation Grant Recipients [PVA]

John Cirillo, PhD
University of Pittsburgh

Fellowship – 2014 Fritz Krauth Memorial Fellow

Synchronization of Corticospinal Volleys after Tetraplegia

The control of hand movements is largely disrupted in individuals with cervical spinal cord injury (SCI). During voluntary movement multiple descending volleys are generated in the corticospinal tract, which travel from the motor cortex down to the spinal cord. An efficient synchronization of these descending corticospinal volleys is fundamental for proper generation of movement. Partial loss and demyelination of corticospinal axons after SCI is likely to impair synchronization of descending volleys.

At present, it is possible to investigate noninvasively synchronization of descending volleys in humans by using paired-pulse transcranial magnetic stimulation (TMS) protocols. Using these protocols, we will first examine time-dependent intervals of descending volleys targeting finger muscles at rest and during voluntary activity after SCI. Second, we propose to promote hand motor function recovery after SCI by enhancing the synchronization of descending volleys.

The proposed research will increase our understanding on the mechanisms contributing to the generation of voluntary movement and may support the development of novel and more effective therapeutic interventions in individuals with SCI.

Rosalyn Adam, PhD
Boston Children’s Hospital

Basic Science

Inosine: A New Treatment for Urinary Tract Complications following SCI

Spinal cord injury (SCI) has devastating and often life-long effects on its victims and their caregivers. Due to the risks associated with military training and service, military personnel are at greater risk of SCI than others. A major complication resulting from SCI is the loss of bladder control, which is associated with physical, economic and psychological distress.

In recent studies, we have identified significant improvements in bladder function in spinal cord injured rats that are given a substance called inosine. A daily dose of inosine was able to significantly reduce the abnormal overactivity of the bladder that results from SCI.

The goal of our studies is to investigate how inosine improves bladder control and to determine the treatment regimen that best improves bladder function. Successful completion of the study would provide the basis for translating this approach to human patients with SCI.

David Stirling, PhD
University of Louisville Research Foundation

Basic Science

Microglia Polarization Protects White Matter and Promotes Regeneration

Spinal cord injury (SCI) often destroys axons, a vital component of the body’s wiring that allows us to sense and move within our environment. Once axons are severed they are unable to regenerate due in part to inhibitory cellular debris and scar formation.

Through this proposal we will investigate whether promoting an alternative activation state of microglia — the immune cells of the central nervous system —will provide a more permissive environment so axons can regenerate. We will accomplish this by using state-of-the-art microscopy that allows us to track microglia, other immune cells, and axon growth after injury, as these dynamic changes occur after spinal cord injury. The information obtained may identify novel targets that stimulate microglial-mediated spinal cord repair.

Peter Hunt, PhD, MPH
Southern California Institute for Research and Education

Clinical

Conflict Resolution Training for Reducing Caregiver Burden and Stress

Caregivers for eterans with spinal cord injury (SCI) face insurmountable challenges every day. This can result in high level of caregiving burden and stress and lead to potential emotional conflicts between caregivers and care recipients.

Conflict resolution is a skill set that can be used to promote effective solutions among conflicting parties. Providing caregivers with appropriate conflict resolution training may have the potential to lessen caregiving burden and stress.

This project has two main objectives: 1) To determine the root causes of conflict arise in caregiving settings by conducting focus group discussions with caregivers and Veterans with SCI; and 2) To develop a conflict resolution training program tailored specifically for caregivers for Veterans with SCI. Caregivers and Veterans with SCI will be involved in the design and development of this training program.

Robert Kriel, MD
University of Minnesota – Twin Cities

Clinical

Dose Escalation Study of Intravenous Baclofen in Healthy Adult Volunteers

The purpose of this study is to reduce some of the problems which sometimes happen in people who are taking baclofen. Baclofen is the most effective and commonly used medicine to reduce spasticity or abnormal tightness of muscles that commonly occurs in people with spinal cord injuries, traumatic brain injuries, and cerebral palsy.

The body develops a reliance on baclofen and, if it is stopped suddenly for any reason, a potentially severe withdrawal syndrome can develop. Currently, baclofen can only be given by mouth or by an infusion pump into the spinal canal.

The goal of this study is to test an intravenous formulation of baclofen. The results of our study be helpful for planning studies to design intravenous baclofen therapy to prevent baclofen withdrawal in people who may need to temporarily stop taking the medicine, and to manage people who are having baclofen withdrawal symptoms.

Toshiki Tazoe, PhD
University of Pittsburgh

Clinical

Targeting the Ipsilateral M1 to Improve Hand Opening-Closing after Spinal Cord Injury (SCI)

The ability to open and close the hand is largely impaired in individuals with cervical spinal cord injury. These movements are fundamental motor skills in daily-life activities such as eating, writing, and many other object manipulations. Hand movements are mainly controlled by the motor cortex contralateral to the moving hand, but some involvement of the ipsilateral motor cortex has been demonstrated.

The goals of this proposal are to investigate the physiological contribution of the ipsilateral motor cortex to hand opening-closing movements in individuals with chronic incomplete cervical spinal cord injury and study strategies to elicit neural plasticity in the ipsilateral motor cortex to promote the recovery of hand function.

To achieve these research goals, we will conduct neurophysiological experiments using transcranial magnetic stimulation and peripheral nerve electrical stimulation techniques on individuals with and without spinal cord injury. The proposed experiments will provide new knowledge on the neural substrates contributing to hand motor function and might contribute to develop novel interventional approaches to enhance the recovery of hand motor function after spinal cord injury.

Brian Kwon, MD, PhD, CSC
University of British Columbia

Design and Development

Characterization of Intraparenchymal Pressures after Spinal Cord Injury

This research proposal is focused on this severe swelling of the human spinal cord that is typically observed after traumatic injury, which is poorly understood. Characterizing the physiologic and biologic effects of this phenomenon and determining how they can be mitigated to reduce secondary injury will guide the optimal clinical management for these acute spinal cord injury (SCI) patients.

To interrogate this phenomenon, we will utilize our recently developed large animal (porcine) model of SCI which shares similar size and anatomic characteristics to the human spinal cord, thus allowing us to model the swelling and filling of the intrathecal space that is observed after human injury.

Fan Ye, PhD
University of Florida

Fellowship

Therapeutic Strategies to Promote Musculoskeletal Recover After SCI

Spinal cord injuries (SCIs) occur mainly among males, with a high prevalence in young adults. SCI was once deemed irreversible and untreatable but recent approaches have shown great promise in facilitating functional recovery. One promising strategy is to provide specific hormonal factors that improve muscle and bone recovery following SCI either alone or in combination with locomotor training in order to improve functional recovery.

Our proposed studies combine the high-dose testosterone (a male hormone) treatment with body weight supported treadmill or motor driven bicycle locomotor training to promote muscle, bone, and neural recovery following severe chronic spinal cord contusion in adult male rats. In addition, we will co-administer MK-434 (a drug that limits the conversion of testosterone to dihydrotestosterone) with testosterone in order to prevent prostate enlargement, a primary side effect associated with testosterone treatment.

Joseph O’Doherty, PhD
University of California, San Francisco

Fellowship

Restoring Somatosensory Function through Intracortical Microstimulation

Individuals with spinal cord injury (SCI) typically lose the ability to move their limbs, but they often lose limb sensations as well. One key component of this lost sensation is proprioception, the feeling of where the body is in space. Even if there were therapies that could restore movement after SCI, without proprioception those movements would be slow and uncoordinated. The goal of this work is to develop strategies for restoring proprioception.

We focus on restoring proprioception in the context of brain machine interfaces (BMIs), devices that harness brain activity to control assistive devices. We will develop and test “bidirectional” BMIs, which additionally create patterns of activity in the brain that are interpreted as proprioception. Since these precise neural patterns are not known in advance, we will focus on the brain’s ability to learn to interpret new signals. If successful, this project will move us closer to restoring movement and sensation for persons with paralysis.

Paralyzed Veterans of America: 2014 Research Foundation Grant Recipients

Spinal Cord Injury and Disease (SCI/D)
2014 Research Foundation Grant Recipients [PVA]

John Cirillo, PhD
University of Pittsburgh

Fellowship – 2014 Fritz Krauth Memorial Fellow

Synchronization of Corticospinal Volleys after Tetraplegia

The control of hand movements is largely disrupted in individuals with cervical spinal cord injury (SCI). During voluntary movement multiple descending volleys are generated in the corticospinal tract, which travel from the motor cortex down to the spinal cord. An efficient synchronization of these descending corticospinal volleys is fundamental for proper generation of movement. Partial loss and demyelination of corticospinal axons after SCI is likely to impair synchronization of descending volleys.

At present, it is possible to investigate noninvasively synchronization of descending volleys in humans by using paired-pulse transcranial magnetic stimulation (TMS) protocols. Using these protocols, we will first examine time-dependent intervals of descending volleys targeting finger muscles at rest and during voluntary activity after SCI. Second, we propose to promote hand motor function recovery after SCI by enhancing the synchronization of descending volleys.

The proposed research will increase our understanding on the mechanisms contributing to the generation of voluntary movement and may support the development of novel and more effective therapeutic interventions in individuals with SCI.

Rosalyn Adam, PhD
Boston Children’s Hospital

Basic Science

Inosine: A New Treatment for Urinary Tract Complications following SCI

Spinal cord injury (SCI) has devastating and often life-long effects on its victims and their caregivers. Due to the risks associated with military training and service, military personnel are at greater risk of SCI than others. A major complication resulting from SCI is the loss of bladder control, which is associated with physical, economic and psychological distress.

In recent studies, we have identified significant improvements in bladder function in spinal cord injured rats that are given a substance called inosine. A daily dose of inosine was able to significantly reduce the abnormal overactivity of the bladder that results from SCI.

The goal of our studies is to investigate how inosine improves bladder control and to determine the treatment regimen that best improves bladder function. Successful completion of the study would provide the basis for translating this approach to human patients with SCI.

David Stirling, PhD
University of Louisville Research Foundation

Basic Science

Microglia Polarization Protects White Matter and Promotes Regeneration

Spinal cord injury (SCI) often destroys axons, a vital component of the body’s wiring that allows us to sense and move within our environment. Once axons are severed they are unable to regenerate due in part to inhibitory cellular debris and scar formation.

Through this proposal we will investigate whether promoting an alternative activation state of microglia — the immune cells of the central nervous system —will provide a more permissive environment so axons can regenerate. We will accomplish this by using state-of-the-art microscopy that allows us to track microglia, other immune cells, and axon growth after injury, as these dynamic changes occur after spinal cord injury. The information obtained may identify novel targets that stimulate microglial-mediated spinal cord repair.

Peter Hunt, PhD, MPH
Southern California Institute for Research and Education

Clinical

Conflict Resolution Training for Reducing Caregiver Burden and Stress

Caregivers for eterans with spinal cord injury (SCI) face insurmountable challenges every day. This can result in high level of caregiving burden and stress and lead to potential emotional conflicts between caregivers and care recipients.

Conflict resolution is a skill set that can be used to promote effective solutions among conflicting parties. Providing caregivers with appropriate conflict resolution training may have the potential to lessen caregiving burden and stress.

This project has two main objectives: 1) To determine the root causes of conflict arise in caregiving settings by conducting focus group discussions with caregivers and Veterans with SCI; and 2) To develop a conflict resolution training program tailored specifically for caregivers for Veterans with SCI. Caregivers and Veterans with SCI will be involved in the design and development of this training program.

Robert Kriel, MD
University of Minnesota – Twin Cities

Clinical

Dose Escalation Study of Intravenous Baclofen in Healthy Adult Volunteers

The purpose of this study is to reduce some of the problems which sometimes happen in people who are taking baclofen. Baclofen is the most effective and commonly used medicine to reduce spasticity or abnormal tightness of muscles that commonly occurs in people with spinal cord injuries, traumatic brain injuries, and cerebral palsy.

The body develops a reliance on baclofen and, if it is stopped suddenly for any reason, a potentially severe withdrawal syndrome can develop. Currently, baclofen can only be given by mouth or by an infusion pump into the spinal canal.

The goal of this study is to test an intravenous formulation of baclofen. The results of our study be helpful for planning studies to design intravenous baclofen therapy to prevent baclofen withdrawal in people who may need to temporarily stop taking the medicine, and to manage people who are having baclofen withdrawal symptoms.

Toshiki Tazoe, PhD
University of Pittsburgh

Clinical

Targeting the Ipsilateral M1 to Improve Hand Opening-Closing after Spinal Cord Injury (SCI)

The ability to open and close the hand is largely impaired in individuals with cervical spinal cord injury. These movements are fundamental motor skills in daily-life activities such as eating, writing, and many other object manipulations. Hand movements are mainly controlled by the motor cortex contralateral to the moving hand, but some involvement of the ipsilateral motor cortex has been demonstrated.

The goals of this proposal are to investigate the physiological contribution of the ipsilateral motor cortex to hand opening-closing movements in individuals with chronic incomplete cervical spinal cord injury and study strategies to elicit neural plasticity in the ipsilateral motor cortex to promote the recovery of hand function.

To achieve these research goals, we will conduct neurophysiological experiments using transcranial magnetic stimulation and peripheral nerve electrical stimulation techniques on individuals with and without spinal cord injury. The proposed experiments will provide new knowledge on the neural substrates contributing to hand motor function and might contribute to develop novel interventional approaches to enhance the recovery of hand motor function after spinal cord injury.

Brian Kwon, MD, PhD, CSC
University of British Columbia

Design and Development

Characterization of Intraparenchymal Pressures after Spinal Cord Injury

This research proposal is focused on this severe swelling of the human spinal cord that is typically observed after traumatic injury, which is poorly understood. Characterizing the physiologic and biologic effects of this phenomenon and determining how they can be mitigated to reduce secondary injury will guide the optimal clinical management for these acute spinal cord injury (SCI) patients.

To interrogate this phenomenon, we will utilize our recently developed large animal (porcine) model of SCI which shares similar size and anatomic characteristics to the human spinal cord, thus allowing us to model the swelling and filling of the intrathecal space that is observed after human injury.

Fan Ye, PhD
University of Florida

Fellowship

Therapeutic Strategies to Promote Musculoskeletal Recover After SCI

Spinal cord injuries (SCIs) occur mainly among males, with a high prevalence in young adults. SCI was once deemed irreversible and untreatable but recent approaches have shown great promise in facilitating functional recovery. One promising strategy is to provide specific hormonal factors that improve muscle and bone recovery following SCI either alone or in combination with locomotor training in order to improve functional recovery.

Our proposed studies combine the high-dose testosterone (a male hormone) treatment with body weight supported treadmill or motor driven bicycle locomotor training to promote muscle, bone, and neural recovery following severe chronic spinal cord contusion in adult male rats. In addition, we will co-administer MK-434 (a drug that limits the conversion of testosterone to dihydrotestosterone) with testosterone in order to prevent prostate enlargement, a primary side effect associated with testosterone treatment.

Joseph O’Doherty, PhD
University of California, San Francisco

Fellowship

Restoring Somatosensory Function through Intracortical Microstimulation

Individuals with spinal cord injury (SCI) typically lose the ability to move their limbs, but they often lose limb sensations as well. One key component of this lost sensation is proprioception, the feeling of where the body is in space. Even if there were therapies that could restore movement after SCI, without proprioception those movements would be slow and uncoordinated. The goal of this work is to develop strategies for restoring proprioception.

We focus on restoring proprioception in the context of brain machine interfaces (BMIs), devices that harness brain activity to control assistive devices. We will develop and test “bidirectional” BMIs, which additionally create patterns of activity in the brain that are interpreted as proprioception. Since these precise neural patterns are not known in advance, we will focus on the brain’s ability to learn to interpret new signals. If successful, this project will move us closer to restoring movement and sensation for persons with paralysis.

Paralyzed Veterans of America: 2014 Research Foundation Grant Recipients

Spinal Cord Injury and Disease (SCI/D)
2014 Research Foundation Grant Recipients [PVA]

John Cirillo, PhD
University of Pittsburgh

Fellowship – 2014 Fritz Krauth Memorial Fellow

Synchronization of Corticospinal Volleys after Tetraplegia

The control of hand movements is largely disrupted in individuals with cervical spinal cord injury (SCI). During voluntary movement multiple descending volleys are generated in the corticospinal tract, which travel from the motor cortex down to the spinal cord. An efficient synchronization of these descending corticospinal volleys is fundamental for proper generation of movement. Partial loss and demyelination of corticospinal axons after SCI is likely to impair synchronization of descending volleys.

At present, it is possible to investigate noninvasively synchronization of descending volleys in humans by using paired-pulse transcranial magnetic stimulation (TMS) protocols. Using these protocols, we will first examine time-dependent intervals of descending volleys targeting finger muscles at rest and during voluntary activity after SCI. Second, we propose to promote hand motor function recovery after SCI by enhancing the synchronization of descending volleys.

The proposed research will increase our understanding on the mechanisms contributing to the generation of voluntary movement and may support the development of novel and more effective therapeutic interventions in individuals with SCI.

Rosalyn Adam, PhD
Boston Children’s Hospital

Basic Science

Inosine: A New Treatment for Urinary Tract Complications following SCI

Spinal cord injury (SCI) has devastating and often life-long effects on its victims and their caregivers. Due to the risks associated with military training and service, military personnel are at greater risk of SCI than others. A major complication resulting from SCI is the loss of bladder control, which is associated with physical, economic and psychological distress.

In recent studies, we have identified significant improvements in bladder function in spinal cord injured rats that are given a substance called inosine. A daily dose of inosine was able to significantly reduce the abnormal overactivity of the bladder that results from SCI.

The goal of our studies is to investigate how inosine improves bladder control and to determine the treatment regimen that best improves bladder function. Successful completion of the study would provide the basis for translating this approach to human patients with SCI.

David Stirling, PhD
University of Louisville Research Foundation

Basic Science

Microglia Polarization Protects White Matter and Promotes Regeneration

Spinal cord injury (SCI) often destroys axons, a vital component of the body’s wiring that allows us to sense and move within our environment. Once axons are severed they are unable to regenerate due in part to inhibitory cellular debris and scar formation.

Through this proposal we will investigate whether promoting an alternative activation state of microglia — the immune cells of the central nervous system —will provide a more permissive environment so axons can regenerate. We will accomplish this by using state-of-the-art microscopy that allows us to track microglia, other immune cells, and axon growth after injury, as these dynamic changes occur after spinal cord injury. The information obtained may identify novel targets that stimulate microglial-mediated spinal cord repair.

Peter Hunt, PhD, MPH
Southern California Institute for Research and Education

Clinical

Conflict Resolution Training for Reducing Caregiver Burden and Stress

Caregivers for eterans with spinal cord injury (SCI) face insurmountable challenges every day. This can result in high level of caregiving burden and stress and lead to potential emotional conflicts between caregivers and care recipients.

Conflict resolution is a skill set that can be used to promote effective solutions among conflicting parties. Providing caregivers with appropriate conflict resolution training may have the potential to lessen caregiving burden and stress.

This project has two main objectives: 1) To determine the root causes of conflict arise in caregiving settings by conducting focus group discussions with caregivers and Veterans with SCI; and 2) To develop a conflict resolution training program tailored specifically for caregivers for Veterans with SCI. Caregivers and Veterans with SCI will be involved in the design and development of this training program.

Robert Kriel, MD
University of Minnesota – Twin Cities

Clinical

Dose Escalation Study of Intravenous Baclofen in Healthy Adult Volunteers

The purpose of this study is to reduce some of the problems which sometimes happen in people who are taking baclofen. Baclofen is the most effective and commonly used medicine to reduce spasticity or abnormal tightness of muscles that commonly occurs in people with spinal cord injuries, traumatic brain injuries, and cerebral palsy.

The body develops a reliance on baclofen and, if it is stopped suddenly for any reason, a potentially severe withdrawal syndrome can develop. Currently, baclofen can only be given by mouth or by an infusion pump into the spinal canal.

The goal of this study is to test an intravenous formulation of baclofen. The results of our study be helpful for planning studies to design intravenous baclofen therapy to prevent baclofen withdrawal in people who may need to temporarily stop taking the medicine, and to manage people who are having baclofen withdrawal symptoms.

Toshiki Tazoe, PhD
University of Pittsburgh

Clinical

Targeting the Ipsilateral M1 to Improve Hand Opening-Closing after Spinal Cord Injury (SCI)

The ability to open and close the hand is largely impaired in individuals with cervical spinal cord injury. These movements are fundamental motor skills in daily-life activities such as eating, writing, and many other object manipulations. Hand movements are mainly controlled by the motor cortex contralateral to the moving hand, but some involvement of the ipsilateral motor cortex has been demonstrated.

The goals of this proposal are to investigate the physiological contribution of the ipsilateral motor cortex to hand opening-closing movements in individuals with chronic incomplete cervical spinal cord injury and study strategies to elicit neural plasticity in the ipsilateral motor cortex to promote the recovery of hand function.

To achieve these research goals, we will conduct neurophysiological experiments using transcranial magnetic stimulation and peripheral nerve electrical stimulation techniques on individuals with and without spinal cord injury. The proposed experiments will provide new knowledge on the neural substrates contributing to hand motor function and might contribute to develop novel interventional approaches to enhance the recovery of hand motor function after spinal cord injury.

Brian Kwon, MD, PhD, CSC
University of British Columbia

Design and Development

Characterization of Intraparenchymal Pressures after Spinal Cord Injury

This research proposal is focused on this severe swelling of the human spinal cord that is typically observed after traumatic injury, which is poorly understood. Characterizing the physiologic and biologic effects of this phenomenon and determining how they can be mitigated to reduce secondary injury will guide the optimal clinical management for these acute spinal cord injury (SCI) patients.

To interrogate this phenomenon, we will utilize our recently developed large animal (porcine) model of SCI which shares similar size and anatomic characteristics to the human spinal cord, thus allowing us to model the swelling and filling of the intrathecal space that is observed after human injury.

Fan Ye, PhD
University of Florida

Fellowship

Therapeutic Strategies to Promote Musculoskeletal Recover After SCI

Spinal cord injuries (SCIs) occur mainly among males, with a high prevalence in young adults. SCI was once deemed irreversible and untreatable but recent approaches have shown great promise in facilitating functional recovery. One promising strategy is to provide specific hormonal factors that improve muscle and bone recovery following SCI either alone or in combination with locomotor training in order to improve functional recovery.

Our proposed studies combine the high-dose testosterone (a male hormone) treatment with body weight supported treadmill or motor driven bicycle locomotor training to promote muscle, bone, and neural recovery following severe chronic spinal cord contusion in adult male rats. In addition, we will co-administer MK-434 (a drug that limits the conversion of testosterone to dihydrotestosterone) with testosterone in order to prevent prostate enlargement, a primary side effect associated with testosterone treatment.

Joseph O’Doherty, PhD
University of California, San Francisco

Fellowship

Restoring Somatosensory Function through Intracortical Microstimulation

Individuals with spinal cord injury (SCI) typically lose the ability to move their limbs, but they often lose limb sensations as well. One key component of this lost sensation is proprioception, the feeling of where the body is in space. Even if there were therapies that could restore movement after SCI, without proprioception those movements would be slow and uncoordinated. The goal of this work is to develop strategies for restoring proprioception.

We focus on restoring proprioception in the context of brain machine interfaces (BMIs), devices that harness brain activity to control assistive devices. We will develop and test “bidirectional” BMIs, which additionally create patterns of activity in the brain that are interpreted as proprioception. Since these precise neural patterns are not known in advance, we will focus on the brain’s ability to learn to interpret new signals. If successful, this project will move us closer to restoring movement and sensation for persons with paralysis.

Paralyzed Veterans of America: 2014 Research Foundation Grant Recipients

Spinal Cord Injury and Disease (SCI/D)
2014 Research Foundation Grant Recipients [PVA]

John Cirillo, PhD
University of Pittsburgh

Fellowship – 2014 Fritz Krauth Memorial Fellow

Synchronization of Corticospinal Volleys after Tetraplegia

The control of hand movements is largely disrupted in individuals with cervical spinal cord injury (SCI). During voluntary movement multiple descending volleys are generated in the corticospinal tract, which travel from the motor cortex down to the spinal cord. An efficient synchronization of these descending corticospinal volleys is fundamental for proper generation of movement. Partial loss and demyelination of corticospinal axons after SCI is likely to impair synchronization of descending volleys.

At present, it is possible to investigate noninvasively synchronization of descending volleys in humans by using paired-pulse transcranial magnetic stimulation (TMS) protocols. Using these protocols, we will first examine time-dependent intervals of descending volleys targeting finger muscles at rest and during voluntary activity after SCI. Second, we propose to promote hand motor function recovery after SCI by enhancing the synchronization of descending volleys.

The proposed research will increase our understanding on the mechanisms contributing to the generation of voluntary movement and may support the development of novel and more effective therapeutic interventions in individuals with SCI.

Rosalyn Adam, PhD
Boston Children’s Hospital

Basic Science

Inosine: A New Treatment for Urinary Tract Complications following SCI

Spinal cord injury (SCI) has devastating and often life-long effects on its victims and their caregivers. Due to the risks associated with military training and service, military personnel are at greater risk of SCI than others. A major complication resulting from SCI is the loss of bladder control, which is associated with physical, economic and psychological distress.

In recent studies, we have identified significant improvements in bladder function in spinal cord injured rats that are given a substance called inosine. A daily dose of inosine was able to significantly reduce the abnormal overactivity of the bladder that results from SCI.

The goal of our studies is to investigate how inosine improves bladder control and to determine the treatment regimen that best improves bladder function. Successful completion of the study would provide the basis for translating this approach to human patients with SCI.

David Stirling, PhD
University of Louisville Research Foundation

Basic Science

Microglia Polarization Protects White Matter and Promotes Regeneration

Spinal cord injury (SCI) often destroys axons, a vital component of the body’s wiring that allows us to sense and move within our environment. Once axons are severed they are unable to regenerate due in part to inhibitory cellular debris and scar formation.

Through this proposal we will investigate whether promoting an alternative activation state of microglia — the immune cells of the central nervous system —will provide a more permissive environment so axons can regenerate. We will accomplish this by using state-of-the-art microscopy that allows us to track microglia, other immune cells, and axon growth after injury, as these dynamic changes occur after spinal cord injury. The information obtained may identify novel targets that stimulate microglial-mediated spinal cord repair.

Peter Hunt, PhD, MPH
Southern California Institute for Research and Education

Clinical

Conflict Resolution Training for Reducing Caregiver Burden and Stress

Caregivers for eterans with spinal cord injury (SCI) face insurmountable challenges every day. This can result in high level of caregiving burden and stress and lead to potential emotional conflicts between caregivers and care recipients.

Conflict resolution is a skill set that can be used to promote effective solutions among conflicting parties. Providing caregivers with appropriate conflict resolution training may have the potential to lessen caregiving burden and stress.

This project has two main objectives: 1) To determine the root causes of conflict arise in caregiving settings by conducting focus group discussions with caregivers and Veterans with SCI; and 2) To develop a conflict resolution training program tailored specifically for caregivers for Veterans with SCI. Caregivers and Veterans with SCI will be involved in the design and development of this training program.

Robert Kriel, MD
University of Minnesota – Twin Cities

Clinical

Dose Escalation Study of Intravenous Baclofen in Healthy Adult Volunteers

The purpose of this study is to reduce some of the problems which sometimes happen in people who are taking baclofen. Baclofen is the most effective and commonly used medicine to reduce spasticity or abnormal tightness of muscles that commonly occurs in people with spinal cord injuries, traumatic brain injuries, and cerebral palsy.

The body develops a reliance on baclofen and, if it is stopped suddenly for any reason, a potentially severe withdrawal syndrome can develop. Currently, baclofen can only be given by mouth or by an infusion pump into the spinal canal.

The goal of this study is to test an intravenous formulation of baclofen. The results of our study be helpful for planning studies to design intravenous baclofen therapy to prevent baclofen withdrawal in people who may need to temporarily stop taking the medicine, and to manage people who are having baclofen withdrawal symptoms.

Toshiki Tazoe, PhD
University of Pittsburgh

Clinical

Targeting the Ipsilateral M1 to Improve Hand Opening-Closing after Spinal Cord Injury (SCI)

The ability to open and close the hand is largely impaired in individuals with cervical spinal cord injury. These movements are fundamental motor skills in daily-life activities such as eating, writing, and many other object manipulations. Hand movements are mainly controlled by the motor cortex contralateral to the moving hand, but some involvement of the ipsilateral motor cortex has been demonstrated.

The goals of this proposal are to investigate the physiological contribution of the ipsilateral motor cortex to hand opening-closing movements in individuals with chronic incomplete cervical spinal cord injury and study strategies to elicit neural plasticity in the ipsilateral motor cortex to promote the recovery of hand function.

To achieve these research goals, we will conduct neurophysiological experiments using transcranial magnetic stimulation and peripheral nerve electrical stimulation techniques on individuals with and without spinal cord injury. The proposed experiments will provide new knowledge on the neural substrates contributing to hand motor function and might contribute to develop novel interventional approaches to enhance the recovery of hand motor function after spinal cord injury.

Brian Kwon, MD, PhD, CSC
University of British Columbia

Design and Development

Characterization of Intraparenchymal Pressures after Spinal Cord Injury

This research proposal is focused on this severe swelling of the human spinal cord that is typically observed after traumatic injury, which is poorly understood. Characterizing the physiologic and biologic effects of this phenomenon and determining how they can be mitigated to reduce secondary injury will guide the optimal clinical management for these acute spinal cord injury (SCI) patients.

To interrogate this phenomenon, we will utilize our recently developed large animal (porcine) model of SCI which shares similar size and anatomic characteristics to the human spinal cord, thus allowing us to model the swelling and filling of the intrathecal space that is observed after human injury.

Fan Ye, PhD
University of Florida

Fellowship

Therapeutic Strategies to Promote Musculoskeletal Recover After SCI

Spinal cord injuries (SCIs) occur mainly among males, with a high prevalence in young adults. SCI was once deemed irreversible and untreatable but recent approaches have shown great promise in facilitating functional recovery. One promising strategy is to provide specific hormonal factors that improve muscle and bone recovery following SCI either alone or in combination with locomotor training in order to improve functional recovery.

Our proposed studies combine the high-dose testosterone (a male hormone) treatment with body weight supported treadmill or motor driven bicycle locomotor training to promote muscle, bone, and neural recovery following severe chronic spinal cord contusion in adult male rats. In addition, we will co-administer MK-434 (a drug that limits the conversion of testosterone to dihydrotestosterone) with testosterone in order to prevent prostate enlargement, a primary side effect associated with testosterone treatment.

Joseph O’Doherty, PhD
University of California, San Francisco

Fellowship

Restoring Somatosensory Function through Intracortical Microstimulation

Individuals with spinal cord injury (SCI) typically lose the ability to move their limbs, but they often lose limb sensations as well. One key component of this lost sensation is proprioception, the feeling of where the body is in space. Even if there were therapies that could restore movement after SCI, without proprioception those movements would be slow and uncoordinated. The goal of this work is to develop strategies for restoring proprioception.

We focus on restoring proprioception in the context of brain machine interfaces (BMIs), devices that harness brain activity to control assistive devices. We will develop and test “bidirectional” BMIs, which additionally create patterns of activity in the brain that are interpreted as proprioception. Since these precise neural patterns are not known in advance, we will focus on the brain’s ability to learn to interpret new signals. If successful, this project will move us closer to restoring movement and sensation for persons with paralysis.

Three PVA-funded projects concentrate on neurologic stimulation and motor training to build muscle responsiveness. John Cirillo, Ph.D. at the University of Pittsburgh is using magnetic stimulation to investigate the synchronization of electrical potentials between the region of the brain that controls voluntary movement and nerves in the spinal cord as volunteers move their fingers. Toshiki Tazoe, Ph.D. also at the University of Pittsburgh is using magnetic stimulation to investigate motor control originating from the part of the brain that is on the same side as the moving hand. Joseph O’Doherty, Ph.D. at the University of California, San Francisco is investigating how the brain interacts with implanted assistive devices that create patterns of electrical activity to stimulate voluntary movement.

Three separate PVA-funded projects make use of model organisms and experimental systems to explore the molecular mechanisms of inflammation and regeneration. Brian Kwon, M.D., Ph.D., CSC at the University of British Columbia is using pigs to investigate swelling after injury in the space immediately adjacent to the spinal cord. Fan Ye, Ph.D. at the University of Florida is using rats to investigate the effect of high doses of testosterone in combination with exercise to promote muscle, bone, and neural recovery.

Finally, three PVA-funded projects are focused on improving the day-to-day experiences of patients with spinal cord injury. Rosalyn Adam, Ph.D. at Boston’s Children Hospital is exploring the mechanism by which inosine, a nucleoside found in transfer RNA that has been shown to be neuroprotective, improves bladder control. Robert Kriel, M.D. at the University of Minnesota, Twin Cities, is testing an intravenous form of the muscle relaxant Balcofen which may reduce the burden of care for patients who have become reliant on the drug for controlling muscle spasms. Peter Hunt, Ph.D., M.P.H. at the Southern California Institute for Research and Education is interested in identifying the main causes of conflict between caregivers and Veterans with spinal cord injury. Based on the results of his study, Peter Hunt will develop a training program for assisting with conflict resolution between patients and caregivers.

Research funding by PVA and other non-profit veterans service organizations is especially important as the Department of Veterans Affairs (DVA) faces an expanding population of disabled veterans. Despite protections set in place by the Americans with Disabilities Act, prohibiting discrimination against individuals with disabilities by failing to provide for access to public accommodation, employment, transportation, government services, and telecommunication services, many veterans with spinal cord injury find it difficult to access their federal benefits (8). In recent months, there has been a great deal of political controversy about who is responsible for ensuring that veterans receive sufficient and timely access to medical assistance. The national president and executive director of the Paralyzed Veterans of America responded to an open letter from Senator Richard Burr (R, North Carolina) with a firm confirmation that Veterans groups depend on support from the Department of Veterans affairs (9). The PVA, in turn, uses its resources to supplement Department care by providing direct assistance to veterans through research funding and civil rights advocacy.

Spinal Cord Injury Symptoms

  • SCI

    The level of Spinal Cord Injury (SCI) determines what parts of the body might be affected by paralysis and loss of function. The level of injury refers to the lowest point on the spinal cord where there is a decrease or absence of motor and/or sensory function. Generally speaking, the higher the spinal cord injury, the more effect the injury has on movement and/or feeling. For example, an injury of the cervical spinal cord may result in full paralysis and make it impossible to breathe without a respirator, while an injury of the lumbar spinal cord may result in paralysis or weakness in the legs and cause some loss of body function in the lower extremities.

  • Cervical SCI

    An injury of the cervical spinal cord (levels C1-C8) causes quadriplegia (also called tetraplegia), which refers to paralysis or weakness in both arms and legs. All parts of the body located below the neck may be affected. Involuntary functioning, such as breathing, regulating body temperature, and sweating may be impaired, necessitating a respirator and other mechanical devices. A person with quadriplegia may not be able to sense touch (or other sensations) may lose bladder and bowel control, and may experience sexual dysfunction.

  • Thoracic SCI

    An injury of the thoracic spinal cord (levels T1-T12) causes paraplegia, which means paralysis or weakness in the legs. Depending upon where the injury is located on the thoracic spinal cord, an individual with this level of SCI may also experience weakness in their torso, although will generally possess good control of their hands. These injuries may also result in loss of sensation, loss of bladder and bowel control, as well as sexual dysfunction. Due to the rib cage, thoracic spinal cord injuries occur less often, as the rib cage offers protection from such injuries.

  • Lumbar SCI

    An injury of the lumbar or sacral spinal cord (L1-L5) causes paraplegia, again referring to paralysis or weakness of the legs. Because of the lower location of this injury, upper body functions are usually not affected. However, a person with a lumbar SCI may experience the loss of many of the sensory functions associated with thoracic spinal cord injuries.

  • Sacral SCI

    An injury of the sacral spinal cord (S1-S4) is rare and generally causes loss of bladder and bowel function as well as sexual dysfunction. Some sacral injuries can result in weakness or paralysis of the hips and legs.

Spinal Cord Injury Symptoms

  • SCI

    The level of Spinal Cord Injury (SCI) determines what parts of the body might be affected by paralysis and loss of function. The level of injury refers to the lowest point on the spinal cord where there is a decrease or absence of motor and/or sensory function. Generally speaking, the higher the spinal cord injury, the more effect the injury has on movement and/or feeling. For example, an injury of the cervical spinal cord may result in full paralysis and make it impossible to breathe without a respirator, while an injury of the lumbar spinal cord may result in paralysis or weakness in the legs and cause some loss of body function in the lower extremities.

  • Cervical SCI

    An injury of the cervical spinal cord (levels C1-C8) causes quadriplegia (also called tetraplegia), which refers to paralysis or weakness in both arms and legs. All parts of the body located below the neck may be affected. Involuntary functioning, such as breathing, regulating body temperature, and sweating may be impaired, necessitating a respirator and other mechanical devices. A person with quadriplegia may not be able to sense touch (or other sensations) may lose bladder and bowel control, and may experience sexual dysfunction.

  • Thoracic SCI

    An injury of the thoracic spinal cord (levels T1-T12) causes paraplegia, which means paralysis or weakness in the legs. Depending upon where the injury is located on the thoracic spinal cord, an individual with this level of SCI may also experience weakness in their torso, although will generally possess good control of their hands. These injuries may also result in loss of sensation, loss of bladder and bowel control, as well as sexual dysfunction. Due to the rib cage, thoracic spinal cord injuries occur less often, as the rib cage offers protection from such injuries.

  • Lumbar SCI

    An injury of the lumbar or sacral spinal cord (L1-L5) causes paraplegia, again referring to paralysis or weakness of the legs. Because of the lower location of this injury, upper body functions are usually not affected. However, a person with a lumbar SCI may experience the loss of many of the sensory functions associated with thoracic spinal cord injuries.

  • Sacral SCI

    An injury of the sacral spinal cord (S1-S4) is rare and generally causes loss of bladder and bowel function as well as sexual dysfunction. Some sacral injuries can result in weakness or paralysis of the hips and legs.

Spinal Cord Injury Symptoms

  • SCI

    The level of Spinal Cord Injury (SCI) determines what parts of the body might be affected by paralysis and loss of function. The level of injury refers to the lowest point on the spinal cord where there is a decrease or absence of motor and/or sensory function. Generally speaking, the higher the spinal cord injury, the more effect the injury has on movement and/or feeling. For example, an injury of the cervical spinal cord may result in full paralysis and make it impossible to breathe without a respirator, while an injury of the lumbar spinal cord may result in paralysis or weakness in the legs and cause some loss of body function in the lower extremities.

  • Cervical SCI

    An injury of the cervical spinal cord (levels C1-C8) causes quadriplegia (also called tetraplegia), which refers to paralysis or weakness in both arms and legs. All parts of the body located below the neck may be affected. Involuntary functioning, such as breathing, regulating body temperature, and sweating may be impaired, necessitating a respirator and other mechanical devices. A person with quadriplegia may not be able to sense touch (or other sensations) may lose bladder and bowel control, and may experience sexual dysfunction.

  • Thoracic SCI

    An injury of the thoracic spinal cord (levels T1-T12) causes paraplegia, which means paralysis or weakness in the legs. Depending upon where the injury is located on the thoracic spinal cord, an individual with this level of SCI may also experience weakness in their torso, although will generally possess good control of their hands. These injuries may also result in loss of sensation, loss of bladder and bowel control, as well as sexual dysfunction. Due to the rib cage, thoracic spinal cord injuries occur less often, as the rib cage offers protection from such injuries.

  • Lumbar SCI

    An injury of the lumbar or sacral spinal cord (L1-L5) causes paraplegia, again referring to paralysis or weakness of the legs. Because of the lower location of this injury, upper body functions are usually not affected. However, a person with a lumbar SCI may experience the loss of many of the sensory functions associated with thoracic spinal cord injuries.

  • Sacral SCI

    An injury of the sacral spinal cord (S1-S4) is rare and generally causes loss of bladder and bowel function as well as sexual dysfunction. Some sacral injuries can result in weakness or paralysis of the hips and legs.

Spinal Cord Injury Symptoms

  • SCI

    The level of Spinal Cord Injury (SCI) determines what parts of the body might be affected by paralysis and loss of function. The level of injury refers to the lowest point on the spinal cord where there is a decrease or absence of motor and/or sensory function. Generally speaking, the higher the spinal cord injury, the more effect the injury has on movement and/or feeling. For example, an injury of the cervical spinal cord may result in full paralysis and make it impossible to breathe without a respirator, while an injury of the lumbar spinal cord may result in paralysis or weakness in the legs and cause some loss of body function in the lower extremities.

  • Cervical SCI

    An injury of the cervical spinal cord (levels C1-C8) causes quadriplegia (also called tetraplegia), which refers to paralysis or weakness in both arms and legs. All parts of the body located below the neck may be affected. Involuntary functioning, such as breathing, regulating body temperature, and sweating may be impaired, necessitating a respirator and other mechanical devices. A person with quadriplegia may not be able to sense touch (or other sensations) may lose bladder and bowel control, and may experience sexual dysfunction.

  • Thoracic SCI

    An injury of the thoracic spinal cord (levels T1-T12) causes paraplegia, which means paralysis or weakness in the legs. Depending upon where the injury is located on the thoracic spinal cord, an individual with this level of SCI may also experience weakness in their torso, although will generally possess good control of their hands. These injuries may also result in loss of sensation, loss of bladder and bowel control, as well as sexual dysfunction. Due to the rib cage, thoracic spinal cord injuries occur less often, as the rib cage offers protection from such injuries.

  • Lumbar SCI

    An injury of the lumbar or sacral spinal cord (L1-L5) causes paraplegia, again referring to paralysis or weakness of the legs. Because of the lower location of this injury, upper body functions are usually not affected. However, a person with a lumbar SCI may experience the loss of many of the sensory functions associated with thoracic spinal cord injuries.

  • Sacral SCI

    An injury of the sacral spinal cord (S1-S4) is rare and generally causes loss of bladder and bowel function as well as sexual dysfunction. Some sacral injuries can result in weakness or paralysis of the hips and legs.

References

  1. Spinal Cord Injury Fact Sheet [2009-01; Department of Veterans Affairs]
  2. A.J. Shoenfeld, M.D. Laughlin, B.J. McCriskin, J.O. Bader, B.R. Waterman, P.J. Belmont Jr. (2013) Spinal injuries in United States military personnel deployed to Iraq and Afghanistan: an epidemiological investigation involving 7877 combat casualties from 2005-2009. Spine, 38 (20): 1770-8 [National Center for Biotechnology Information]
  3. A.J. Shoenfeld, P.A. Carey. (2012) American combat spine surgery in the modern period (2001-present): A history and review of current literature. Journal of the Spinal Research Foundation, 7 (1): 33-39.
  4. Spinal Cord Injury [2014-10-08; Mayo Clinic]
  5. S.Res.533 – A resolution designating September 2014 as “National Spinal Cord Injury Awareness Month”. Expresses support for: (1) research to find better treatments, more effective therapies, and a cure for paralysis; and (2) clinical trials for new therapies for people living with paralysis. Commends the dedication of organizations, researchers, doctors and people across the United States that are working to improve the quality of life of people living with paralysis and their families. [2014-07-31; Congress.gov]
  6. J. Gomes-Osman, E.C. Field-Fote. (2014) Cortical vs. afferent stimulation as an adjunct to functional task practice training: A randomized comparative pilot study in people with cervical spinal cord injury. Clinical Rehabilitation. Nov. 7. Pii: 0269215514556087. [2014-11-07; National Center for Biotechnology Information]
  7. O. Cruciger, T.A. Schildhauer, R.C. Meindl, M. Tegenthoff, P. Schwenkreis, M. Citak, M. Aach. (2014) Impact of locomotion training with a neurologic controlled hybrid assistive limb (HAL) exoskeleton on neuropathic pain and health related quality of life (HRQoL) in chronic SCI: a case study. Disability and Rehabilitation: Assistive Technology 10: 1-6. [2014-11-10; National Center for Biotechnology Information]
  8. Veterans and the Americans with Disabilities Act: A guide for employers. [U.S. Equal Employment Opportunity Commission]
  9. Jonathan Weisman; Veterans Fire Back at Letter by Senator [2014-05-26; New York Times]

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Juliesta Sylvester, Ph.D. is a biochemist who promotes innovation and technology transfer at the interface of academia and industry. Her research has spanned pharmaceutical discovery, molecular diagnostics, bioinformatics, and quantitative systems analysis. She is an avid world traveler, invited speaker at national and international meetings, and enthusiastic consultant for startups.

Juliesta Sylvester, Ph.D. is a biochemist who promotes innovation and technology transfer at the interface of academia and industry. Her research has spanned pharmaceutical discovery, molecular diagnostics, bioinformatics, and quantitative systems analysis. She is an avid world traveler, invited speaker at national and international meetings, and enthusiastic consultant for startups.

Juliesta Sylvester, Ph.D. is a biochemist who promotes innovation and technology transfer at the interface of academia and industry. Her research has spanned pharmaceutical discovery, molecular diagnostics, bioinformatics, and quantitative systems analysis. She is an avid world traveler, invited speaker at national and international meetings, and enthusiastic consultant for startups.

Juliesta Sylvester, Ph.D. is a biochemist who promotes innovation and technology transfer at the interface of academia and industry. Her research has spanned pharmaceutical discovery, molecular diagnostics, bioinformatics, and quantitative systems analysis. She is an avid world traveler, invited speaker at national and international meetings, and enthusiastic consultant for startups.