1
|
Zeng CW. Advancing Spinal Cord Injury Treatment through Stem Cell Therapy: A Comprehensive Review of Cell Types, Challenges, and Emerging Technologies in Regenerative Medicine. Int J Mol Sci 2023; 24:14349. [PMID: 37762654 PMCID: PMC10532158 DOI: 10.3390/ijms241814349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Spinal cord injuries (SCIs) can lead to significant neurological deficits and lifelong disability, with far-reaching physical, psychological, and economic consequences for affected individuals and their families. Current treatments for SCIs are limited in their ability to restore function, and there is a pressing need for innovative therapeutic approaches. Stem cell therapy has emerged as a promising strategy to promote the regeneration and repair of damaged neural tissue following SCIs. This review article comprehensively discusses the potential of different stem cell types, such as embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), mesenchymal stem cells (MSCs), and neural stem/progenitor cells (NSPCs), in SCI treatment. We provide an in-depth analysis of the unique advantages and challenges associated with each stem cell type, as well as the latest advancements in the field. Furthermore, we address the critical challenges faced in stem cell therapy for SCIs, including safety concerns, ethical considerations, standardization of protocols, optimization of transplantation parameters, and the development of effective outcome measures. We also discuss the integration of novel technologies such as gene editing, biomaterials, and tissue engineering to enhance the therapeutic potential of stem cells. The article concludes by emphasizing the importance of collaborative efforts among various stakeholders in the scientific community, including researchers, clinicians, bioengineers, industry partners, and patients, to overcome these challenges and realize the full potential of stem cell therapy for SCI patients. By fostering such collaborations and advancing our understanding of stem cell biology and regenerative medicine, we can pave the way for the development of groundbreaking therapies that improve the lives of those affected by SCIs.
Collapse
Affiliation(s)
- Chih-Wei Zeng
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
- Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| |
Collapse
|
2
|
Sabre L, Niinemets M, Asser A, Asser T, Kõrv J. Trends in traumatic spinal cord injuries in Estonia from 1997 to 2018. J Spinal Cord Med 2023; 46:83-90. [PMID: 35007476 PMCID: PMC9897800 DOI: 10.1080/10790268.2021.1947680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To analyze time trends in incidence, causes and risk factors for traumatic spinal cord injuries (TSCI) in Estonia between 1997-2007 and 2008-2018. DESIGN Retrospective, population-based cohort study. SETTING Specialized trauma centres in Estonia. PARTICIPANTS Medical records of patients with TSCI from 1997 to 2018. INTERVENTION None. OUTCOME MEASURES Demographical data, crude and age- and sex-adjusted incidence rates, causes of TSCI, level and extent of injury, associated injuries. RESULTS A total of 940 new patients with TSCI were identified for the period of 1997-2018. The average annual incidence rate (standardized to the Estonian population by age and sex in 2011) decreased significantly from 37.8 (95% confidence interval (CI) 34.6-41.1) in the first period (1997-2008) to 28.2 per million population (95% CI 25.3-31.0) during the second period (2008-2018) (incidence rate ratio 0.74 (95% CI 0.65-0.85), P < 0.0001). The decrease in incidence was most significant among young men. The mean age at injury increased from 38.7 (±16.7) years to 46.6 (±19.9) years, P < 0.0001. Falls were the leading cause of injury during both periods followed by traffic accidents and sports injuries. Still, traffic accidents as a cause of TSCI decreased significantly (from 30.5% to 20.6%, P = 0.001) and falls increased (from 39.9% to 59.5%, P < 0.0001) during the second period. Alcohol consumption prior to injury also decreased significantly from 66.0% to 55.1% (P = 0.006). CONCLUSION Estonia has become closer to other European countries regarding TSCI during the last decade; TSCI incidence has significantly decreased, the mean age at injury and the percentage of falls have increased.
Collapse
Affiliation(s)
- Liis Sabre
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia,Department of Neurology and Neurosurgery, Neurology Clinic, Tartu University Hospital, Tartu, Estonia,Correspondence to: Liis Sabre, Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, 8 L. Puusepa Street, 50406Tartu, Estonia; Ph: 37 27 318 553, Fax: 37 27 318 509.
| | | | - Andres Asser
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia,Neurosurgery Centre, North Estonia Medical Centre, Tallinn, Estonia
| | - Toomas Asser
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia,Department of Neurology and Neurosurgery, Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia,Department of Neurology and Neurosurgery, Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| |
Collapse
|
3
|
Temporal changes in demographic and injury characteristics of traumatic spinal cord injuries in Nordic countries - a systematic review with meta-analysis. Spinal Cord 2022; 60:765-773. [PMID: 35220414 DOI: 10.1038/s41393-022-00772-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Systematic review with meta-analysis. OBJECTIVES To explore temporal changes in incidence rates, demographic and injury characteristics of incident traumatic spinal cord injury (TSCI) in Nordic countries. METHODS Peer-reviewed publications and periodic reports about epidemiology of TSCI in the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) are identified, reviewed and included in the meta-analysis. Data are stratified into 20-year intervals to allow for chronological comparisons. Pooled estimates are derived using random effects meta-analysis. RESULTS Twenty-three data sources are included presenting a total of 5416 cases. The pooled incidence rate for 2001-2020 is 15.4 cases/million/year compared to 17.6 and 18.3 cases/million/year during the two previous 20-year intervals. The proportion of cases with TSCI in the 15-29 age-group decreases from 50% (1961-1980) to 20% (2001-2020), while it increases from 9% to 35% in 60+ age-group. Transportation-related injuries decrease from 44% (1961-1980) to 27% (2001-2020). Conversely, fall-related injuries increase from 32% (1961-1980) to 46% (2001-2020). The proportion of individuals with incomplete tetraplegia increases from 31% (1961-1980) to 43% (2001-2020), while complete paraplegia decreases from 25% to 16%. CONCLUSION The characteristics of TSCI in the Nordic countries have changed drastically over the last six decades, in line with clinical experiences, and limited research evidence from other countries. These changes indicate the need for adapting research focus, prevention strategies, design and provision of care, rehabilitation and community services towards older individuals, fall-related injuries, and incomplete injuries in Nordic countries and other settings internationally where such changes occur.
Collapse
|
4
|
Khalili M, Berlin M, Pettersson K, Lindgren C, Hultling C, Ekéus C. Pregnancy, delivery, and neonatal outcomes among women with spinal cord injury in Sweden 1997-2015: A population-based cohort study. Acta Obstet Gynecol Scand 2022; 101:1282-1290. [PMID: 36031797 PMCID: PMC9812202 DOI: 10.1111/aogs.14440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The aim of this study was to describe the rate of pregnancy in spinal cord injured women in Sweden as well as pregnancy, delivery, and neonatal outcomes. MATERIAL AND METHODS This study was based on data from the Swedish Medical Birth Register and the National Patient Register. The study population included women with spinal cord injury who gave birth in Sweden during the period 1997 to 2015. The general population was used as reference and included all non-spinal cord injured patients who gave birth during the same period of time. RESULTS In the spinal cord injury group, 109 births were identified. Eighty-nine (82%) of them were among paraplegic women and 20 (18%) were among tetraplegic women. Women with spinal cord injury in our study population had urinary tract infections during pregnancy in five cases (5%) and anemia during pregnancy in nine cases (8%), compared with 0.2% and 4%, respectively, in the general population. Compared with the general population more deliveries were induced in the study population, 18 (17%) in the spinal cord injury group and 12% in the general population. Vaginal delivery was achieved in 52 (48%) of the births with 42 of them (39%) being non-instrumental and 10 (9%) being instrumental vaginal deliveries. Elective cesarean section rate was 34% (n = 37). Sixteen infants (15%) were born preterm (gestational week <37). We found an overall low rate of pregnancy and delivery complications. CONCLUSIONS Our results show predominantly favorable outcomes of pregnancy and delivery in women with spinal cord injury as well as their infants. These results are in concordance with previous research.
Collapse
Affiliation(s)
- Molly Khalili
- Department of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Marie Berlin
- National Board of Health and WelfareStockholmSweden
| | - Karin Pettersson
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and TechnologyKarolinska Institute and Karolinska University Hospital HuddingeStockholmSweden
| | - Carl Lindgren
- Department of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstituteStockholmSweden
| | - Cecilia Ekéus
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| |
Collapse
|
5
|
Cakici OU, Kaya C, Sanci A, Gencler OS, Mammadkhanli O, Cindas A. Gabapentin add-on therapy for patients with spinal cord injury associated neurogenic overactive detrusors that are unresponsive to combined anticholinergic and beta-3 adrenergic therapy. Cent European J Urol 2022; 74:547-551. [PMID: 35083075 PMCID: PMC8771127 DOI: 10.5173/ceju.2021.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Spinal cord injury is a major cause of lifelong morbidity and functional micturition problems. Some patients are refractory to the available therapeutics, even when used in combination. In this paper we report our results of using gabapentin as an add-on treatment in refractory overactive detrusor cases secondary to spinal cord injury. Material and methods A total of 27 patients who had a spinal cord injury between the levels of the second thoracic and fourth lumbar vertebrae and had an overactive detrusor in urodynamic studies were included in this retrospective study. The patients were selected due to the fact that they also had not responded to a combination of an anticholinergic and mirabegron and had neuropathic pain. Gabapentin treatment was added to the previous therapy. Demographics, previous treatments, chronic conditions, urodynamic findings, clinical and urodynamic responses are reported in this paper. Results We observed a response to treatment in the urodynamic studies of 11 patients (40.17%), in terms of decreased detrusor contractions, maximal detrusor pressure, and the number of incontinence episodes. Sixteen patients did not respond to the gabapentin add-on therapy and were referred for Botulinum toxin injections to the bladder. Conclusions Gabapentin add-on therapy can be considered as a third or further option, before Botulinum toxin injection, for patients with neurogenic overactive detrusor who did not respond to the combination of anticholinergics and mirabegron. The approved usage of gabapentin for neurogenic pain justifies its usage in this area. In our selected patient group, who had not responded to the combination therapy, we observed a clinical benefit in one-third of the patients.
Collapse
Affiliation(s)
- Ozer Ural Cakici
- Department of Urology, Yuksek Ihtisas University affiliated Medical Park Ankara Hospital, Ankara, Turkey
| | - Coskun Kaya
- Department of Urology, Eskisehir State Hospital, Eskisehir, Turkey
| | - Adem Sanci
- Department of Urology, Ankara University, Ankara, Turkey
| | - Onur Serdar Gencler
- Department of Neurology, Yuksek Ihtisas University affiliated Medical Park Ankara Hospital, Ankara, Turkey
| | - Orkhan Mammadkhanli
- Department of Neurosurgery, Yuksek Ihtisas University affiliated Medical Park Ankara Hospital, Ankara, Turkey
| | - Abdullah Cindas
- Department of Physical Therapy and Rehabilitation, Yuksek Ihtisas University affiliated Medical Park Ankara Hospital, Ankara, Turkey
| |
Collapse
|
6
|
Johansson E, Luoto TM, Vainionpää A, Kauppila AM, Kallinen M, Väärälä E, Koskinen E. Epidemiology of traumatic spinal cord injury in Finland. Spinal Cord 2020; 59:761-768. [PMID: 33149235 PMCID: PMC7610166 DOI: 10.1038/s41393-020-00575-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
Study design Prospective cohort study. Objectives To determine the incidence and evaluate the characteristics of newly injured patients admitted to two spinal cord injury (SCI) centers during a 4-year period. Setting Oulu and Tampere University Hospital, Finland. Methods A dedicated multidisciplinary team evaluated all of the patients with new traumatic SCI (TSCI). The data were recorded according to the International Spinal Cord Injury Core Data Sets. Results In a 4-year period, 346 new patients with TSCI were admitted to the study centers. In the Oulu and Tampere University Hospitals’ catchment areas, the mean annual incidence of TSCI was 36.6 per million. The leading causes of injury were low-level falls (36.2%), high-level falls (25.5%), and transport-related accidents (19.2%). In the patients >60 years, 72.6% were injured by falling and the proportion of low-level falls was 49.7%. In the patients ≤60 years old, 47.4% were alcohol-related. The proportion of cervical injuries in the patients >60 years was 77.1%, while in the patients ≤60 years the proportion was 59.6%. The incidence of TSCI was higher during the Summer and Autumn months. Conclusion The mean annual incidence of TSCI was 36.6 per million corresponding to 200 new annual cases in Finland. Incomplete tetraplegia due to falling among elderly was overrepresented in the study population. Alcohol-consumption preceded injury in nearly half of the cases in the younger population. The prevention should focus on alcohol-related injuries and falls in the elderly.
Collapse
Affiliation(s)
- Elina Johansson
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Aki Vainionpää
- Department of Rehabilitation, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Anna-Maija Kauppila
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Mauri Kallinen
- Department of Rehabilitation Medicine, Central Finland Central Hospital, Central Finland Health Care District, Jyväskylä, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Eija Väärälä
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Eerika Koskinen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
7
|
Holmlund L, Guidetti S, Hultling C, Seiger Å, Eriksson G, Asaba E. Evaluating the feasibility of ReWork-SCI: a person-centred intervention for return-to-work after spinal cord injury. BMJ Open 2020; 10:e036000. [PMID: 32819984 PMCID: PMC7443280 DOI: 10.1136/bmjopen-2019-036000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of: (1) ReWork-SCI with regard to adherence and acceptability and (2) a study design for evaluating ReWork-SCI with regard to recruitment, retention and outcome measures. DESIGN Pre-test and post-test, single group, feasibility study. SETTING Spinal cord injury (SCI) unit at a regional rehabilitation centre in Sweden. PARTICIPANTS Two women and five men (n=7). Eligible criteria: (1) sustained traumatic or non-traumatic SCI; (2) completed the first acute care episode in a hospital; (3) between 18 to 65 years of age; (4) assessed by a physician as approachable for participation in the intervention; (5) history of permanent or temporary employment; (6) self-reported desire to return to work; and (7) ability to communicate in English or Swedish. INTERVENTION ReWork-SCI is a person-centred intervention for return-to-work (RTW), developed and evaluated using the Medical Research Council's guidelines. ReWork-SCI follows a person-centred, structured and coordinated intervention process led by a coordinator within a SCI rehabilitation team. OUTCOME MEASURES The feasibility of ReWork-SCI and a study design was evaluated using a set of outcome measurement tools, vocational data, logbooks and semi-structured interviews. RESULTS All eligible participants accepted enrolment and follow-up. All participants had a plan for RTW after 3 months and four participants had initiated part-time work or work trial 6 months after commencement of intervention. Adherence and acceptability were overall good. Challenges of the intervention related to the person-centred follow-up, staff shortage and rootedness in the SCI team. CONCLUSIONS ReWork-SCI was feasible and can contribute to a systematic design of an individualised plan, facilitate decision-making and build trust in the RTW process after SCI. Core features of the intervention was the systematic structure, use of a person-centred approach and dialogue with the employer. For the effectiveness of ReWork-SCI, modifications and considerations of study design are needed.
Collapse
Affiliation(s)
- Lisa Holmlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Rehab Station Stockholm/Spinalis, R&D Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, Karolinska Universitetssjukhuset, Solna, Sweden
| | - Åke Seiger
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Rehab Station Stockholm/Spinalis, R&D Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Research, Education, and Development Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
| |
Collapse
|
8
|
Holmlund L, Guidetti S, Eriksson G, Asaba E. Return-to-work: Exploring professionals' experiences of support for persons with spinal cord injury. Scand J Occup Ther 2020; 28:571-581. [PMID: 32755475 DOI: 10.1080/11038128.2020.1795245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To generate knowledge about how professional stakeholders organise and experience the support of the return-to-work (RTW) process for persons with spinal cord injury (SCI). METHODS Constructivist grounded theory approach. Professional stakeholders (n = 34) involved in the RTW process and representing three Swedish Regions were recruited into seven focus groups. Analysis followed initial, focussed, and theoretical coding. FINDINGS The core category - mediating intentions to support work and possibilities of working through social, labour market, and societal context - illustrates complexities of when and how to support a person with SCI in the RTW process, and a risk of delayed, unequal, or absent RTW processes. Analysis outlines: (1) Assessment of ability to work - uncertainty of how and when; (2) Planning RTW - divide between dynamic and rule-based perspectives; (3) Work re-entry - unequal paths towards viable solutions. CONCLUSIONS In RTW after SCI, it is critical to acknowledge how the RTW process is situated in relation to the person and context. A possible direction - grounded in an occupational perspective - through early identification of needs and resources and coordination derived from the SCI rehabilitation setting within healthcare is suggested. This can facilitate a time-sensitive and equal RTW process.
Collapse
Affiliation(s)
- Lisa Holmlund
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Spinalis SCI Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Research, Education, and Development Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.,Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| |
Collapse
|
9
|
Liu J, Li R, Huang Z, Huang Z, Li Y, Wu X, Lin J, Jiang H, Cheng Y, Kong G, Wu X, Liu Q, Liu Y, Yang Z, Li R, Chen J, Fu J, Ramer MS, Kwon BK, Liu J, Kramer JLK, Tetzlaff W, Hu Y, Zhu Q. A Cervical Spinal Cord Hemi-Contusion Injury Model Based on Displacement Control in Non-Human Primates (Macaca fascicularis). J Neurotrauma 2020; 37:1669-1686. [PMID: 32174266 DOI: 10.1089/neu.2019.6822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Non-human primate (NHP) spinal cord injury (SCI) models can be informative in the evaluation of treatments that show promise in rodent models prior to translation to humans. In the present study, we aimed to establish a cervical spinal hemi-contusion model with controlled displacement and evaluate the abnormalities in behavior, electrophysiology, histology, and magnetic resonance imaging. Twelve adult NHPs were divided into an SCI group (n = 8, 24 and 48 weeks) and a control group (n = 4). An impactor (Φ = 4 mm) was driven to compress the left C5 cord at 800 mm/sec. The contusion displacement and peak force was 4.08 ± 0.17 mm and 19.8 ± 4.6 N. The behavioral assessment showed a consistent dysfunction below the wrist and spontaneous recovery of limb function after injury. Lesion length and lesion area at the epicenter based on T2 hyperintensity were 5.68 ± 0.47 mm and 5.99 ± 0.24 mm2 at 24 weeks post-injury (wpi), and 5.29 ± 0.17 mm and 5.95 ± 0.24 mm2 at 48 wpi. The spared spinal cord area immuno-positive for glial fibrillary acidic protein was significantly reduced, while the staining intensity increased at 24 wpi and 48 wpi, compared with the sham group. Ipsilateral somatosensory and motor evoked potentials were dynamic, increasing in latency and decreasing in amplitude compared with pre-operative values or the contralateral values, and correlated to varying degrees with behavioral outcomes. A shift in size-frequency distribution of sensory neurons of the dorsal root ganglia (DRG) was consistent with a loss of large-diameter cells. The present study demonstrated that the NHP SCI model resulted in consistent unilateral limb dysfunction and potential plasticity in the face of loss of spinal cord and DRG tissue.
Collapse
Affiliation(s)
- Junhao Liu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Li
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zucheng Huang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiping Huang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuefeng Li
- Guangdong Landau Biotechnology Co. Ltd., Guangzhou, China
| | - Xiaoliang Wu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junyu Lin
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Jiang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongquan Cheng
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ganggang Kong
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiuhua Wu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi Liu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yapu Liu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhou Yang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruoyao Li
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianting Chen
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Joey Fu
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matt S Ramer
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jie Liu
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wolfram Tetzlaff
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yong Hu
- Department of Orthopedics and Traumatology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Qingan Zhu
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
10
|
Conradsson D, Rhoda A, Mlenzana N, Nilsson Wikmar L, Wahman K, Hultling C, Joseph C. Strengthening Health Systems for Persons With Traumatic Spinal Cord Injury in South Africa and Sweden: A Protocol for a Longitudinal Study of Processes and Outcomes. Front Neurol 2018; 9:453. [PMID: 29963007 PMCID: PMC6011127 DOI: 10.3389/fneur.2018.00453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background: The provision of specialized care in a time-sensitive manner has shown to be crucial for survival and recovery of functioning after a traumatic spinal cord injury (TSCI). However, little is known about the provision of TSCI care in different international contexts; information which is required for strengthening policy and practice. Aims: The overarching aim of this study will be to explore health care processes and outcomes of TSCI care in South Africa and Sweden. Specific aims will be to: (1) describe acute processes of TSCI care, (2) determine acute- and long-term outcomes of TSCI care, and (3) identify predictors for survival, secondary complications, and functioning 12 months post-injury. Methods: A prospective (regional), population-based cohort study where adults with an acute TSCI will be recruited over at least a 1-year period from the City of Cape Town, South Africa, and Stockholm, Sweden. The anticipated sample size inclusive of both international contexts will be 200 participants—based on a power calculation for detecting differences in mortality. Information on the nature and timing of processes of acute care (e.g., transfer logistics, spinal surgery, and specialized SCI care) will be collected on acute care admission and discharge using a standardized form. Survival status, secondary complications, neurological symptoms, functional status, activity, and participation as well as health-related quality of life will be collected at discharge from SCI acute care and at 12-months post-injury. Secondary complications and functioning will be compared between South Africa and Sweden using inferential statistics. To address mortality specifically, the indirect standardization method for differences in mortality between contexts will be used whereby Stockholm will serve as standard for specialize care. For the assessment of factors related to mortality and other outcomes (e.g., neurological and secondary health conditions) multivariate regression analyses will be used to determine independent risk factors. Conclusion: This study offers a unique investigation of the relationship between health care processes and outcomes of TSCI care with the aim of strengthening management guidelines for SCI in South Africa and Sweden.
Collapse
Affiliation(s)
- David Conradsson
- Function Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.,Physiotherapy Division, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anthea Rhoda
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Nondwe Mlenzana
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Lena Nilsson Wikmar
- Physiotherapy Division, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Wahman
- Section Neurorehabilitation, Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Spinalis Research and Development Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Claes Hultling
- Section Neurorehabilitation, Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Spinalis Foundation, Stockholm, Sweden
| | - Conran Joseph
- Physiotherapy Division, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
11
|
Abstract
This chapter covers balance, gait, and falls in individuals with spinal cord injury (SCI) from a clinical perspective. First, the consequences of an SCI on functioning are explained, including etiology, clinical presentation, classification, and epidemiologic data. Then, the specific aspects of balance disorders, gait disorders, and falls are discussed with respect to motor complete (cSCI) and incomplete (iSCI) SCI. Typically, these activities are affected by impaired afferent and efferent nerves, but not by central nervous processing. Performance of daily life activities in cSCI depends on the ability to control the interaction between the center of mass and the base of support or limits of stability. In iSCI, impaired proprioception and muscle strength are important factors for completing balancing tasks and for walking. Falls are common in patients with SCI. Subsequent sections describe therapy approaches aimed at modifying balance, gait, and the risk for falls by means of therapeutic exercises, assistive devices like robots or functional electric stimulation, and environmental adaptations. The last part covers recent developments and future directions. These encompass interventions for maximizing residual neural function and regeneration of axons, as well as technical solutions like epidural or intraspinal electric stimulation, powered exoskeletons, and brain computer interfaces.
Collapse
Affiliation(s)
- Markus Wirz
- Institute of Physiotherapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland.
| | - Hubertus J A van Hedel
- Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland
| |
Collapse
|