Rehab Centers: Combination Therapies.

Combination therapies.

Filed under: Rehab Centers

Handb Clin Neurol. 2012; 109: 617-36
Oudega M, Bradbury EJ, Ramer MS

Spinal cord injury (SCI) has multiple consequences, ranging from molecular imbalances to glial scar formation to functional impairments. It is logical to think that a combination of single treatments implemented in the right order and at the right time will be required to repair the spinal cord. However, the single treatments that compose the combination therapy will need to be chosen with caution as many have multiple outcomes that may or may not be synergistic. Single treatments may also elicit unwanted side-effects and/or effects that would decrease the repair potential of other components and/or the entire combination therapy. In this chapter a number of single treatments are discussed with respect to their multiplicity of action. These include strategies to boost growth and survival (such as neurotrophins and cyclic AMP) and strategies to reduce inhibitory factors (such as antimyelin-associated growth inhibitors and digestion of glial scar-associated inhibitors). We also present an overview of combination therapies that have successfully or unsuccessfully been tested in the laboratory using animal models. To effectively design a combination therapy a number of considerations need to be made such as the nature and timing of the treatments and the method for delivery. This chapter discusses these issues as well as considerations related to chronic SCI and the logistics of bringing combination therapies to the clinic.
HubMed – rehab


Brain-machine interfaces and transcranial stimulation: future implications for directing functional movement and improving function after spinal injury in humans.

Filed under: Rehab Centers

Handb Clin Neurol. 2012; 109: 435-44
Carmena JM, Cohen LG

Since its origins, the primary goal of transforming thought into action and sensation into perception has been to improve the quality of life for the physically impaired. Brain-machine interfaces (BMI) aim to improve the quality of life for large numbers of neurological patients. In particular, this novel technology is meant to play a major role in the near future as a serious contribution to spinal cord rehabilitation. During the last decade we have witnessed a dramatic increase in BMI research with impressive demonstrations of rodents, nonhuman primates, and humans controlling robots, wheelchairs, and graphical cursors in real time through signals collected from the brain. In this chapter we first review the different techniques used in the field of BMI, including electroencephalography (EEG), electrocorticography (ECoG), magnetoencephalography (MEG), and chronic multielectrode recordings. In addition we review the use of transcranial magnetic stimulation (TMS) for noninvasive modulation of excitability in relatively focal cortical areas. The chapter concludes with a discussion on the future implications of BMIs for directing functional movement and improving function after spinal injury in humans.
HubMed – rehab


Translating preclinical approaches into human application.

Filed under: Rehab Centers

Handb Clin Neurol. 2012; 109: 399-409
Dietz V, Curt A

In recent decades, several novel approaches of spinal cord repair have revealed promising findings in animal models. However, for a successful translation of these into a clinical trial in humans the specific conditions pertaining to human spinal cord injuries (SCI) have to be appreciated. Firstly, transection of the spinal cord is commonly applied in animal models, whereas spinal cord contusion is the predominant type of injury in humans, and generally leads to more extensive injury in two to three spinal cord segments. Secondly, the quadrupedal organization of locomotion in animals and the more complex autonomic functions in humans challenge the translation of animal behavior into recovery from human SCI. Thirdly, so far, no adequate animal model has been developed to resemble spastic movement disorder in human SCI. Fourthly, the extensive damage to spinal motor neurons and nerve roots in human cervical and thoracolumbar in spine trauma is but little addressed in current translational studies. This damage has direct implications for rehabilitation and repair strategies. Fifthly, there is increasing evidence for a neuronal dysfunction below the level of the lesion in chronic complete SCI. The relevance of this dysfunction for a regeneration-inducing treatment needs to be investigated. Lastly, an approach to facilitate an appropriate reconnection of regenerating tract fibers by functional training in the postacute stage has yet to be confirmed.
HubMed – rehab


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