Basic Advances and New Avenues in Therapy of Spinal Cord Injury

Annu Rev Med, 2004 · DOI: 10.1146/annurev.med.55.091902.104338 · Published: January 1, 2004

Spinal Cord Injury Regenerative Medicine Neurorehabilitation

Simple Explanation

The review discusses strategies for lessening disability and enhancing quality of life for patients with acute and chronic myelopathies, primarily due to traumatic SCI. It highlights biological therapies to regenerate or remyelinate axons and incorporate new neural cells into the injured spinal cord. Rehabilitation therapies are essential to drive activity-dependent plasticity for walking, reaching, grasping, and bowel/bladder control.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Neurotrophic factors, such as BDNF, can reverse atrophy of rubrospinal neurons and promote spinal axon regeneration, even when administered long after SCI.
2
Transplantation of olfactory ensheathing cells (OECs) into spinal cord lesions can restore breathing and climbing abilities.
3
Reimplantation of avulsed ventral roots can lead to partial recovery of motor function by facilitating axonal regeneration and remyelination.

Research Summary

The prospects for successful clinical trials of neuroprotective and neurorestorative interventions for patients with acute and chronic myelopathies depend on preclinical animal models of injury and repair that reflect the human condition. To incorporate residual and new pathways, neural repair strategies must be coupled to rehabilitation therapies that drive activity-dependent plasticity for walking, for reaching and grasping, and for bowel and bladder control. These bench-to-bedside studies are defining the neurobiology of spinal cord injury rehabilitation.

Practical Implications

Combination Therapies

Neural repair strategies must be combined with rehabilitation to maximize functional recovery.

Timing of Intervention

The efficacy of biological interventions is highly dependent on the time from injury onset.

Personalized Medicine

Future research should focus on individualizing therapies based on the specific characteristics of the injury and the patient's response.

Study Limitations

1
Animal models may not fully replicate the complexity of human SCI.
2
Clinical trials for neuroprotection have shown limited clinically meaningful improvements.
3
Medical complications post-SCI can reduce the benefits of rehabilitation and neural repair interventions.

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