What Matters in Cellular Transplantation for Spinal Cord Injury: The Cells, the Rehabilitation, or the Best Mix?

Neurorehabil Neural Repair, 2010 · DOI: 10.1177/1545968309354457 · Published: January 1, 2010

Spinal Cord Injury Regenerative Medicine Neurorehabilitation

Simple Explanation

A recent study explored using cell transplants combined with rehabilitation to treat spinal cord injuries. Patients received cell transplants and intensive leg training to see if it could improve their motor control. The study found that some patients showed new signs of motor control, suggesting the treatment had a positive impact. However, the type of rehabilitation seemed to matter, with overground training being more effective than robotic stepping. This raises the question of how to best combine cell therapies with rehabilitation to maximize recovery after spinal cord injury. The right type and intensity of rehab might be key to making these treatments work.

Study Duration

1 to 3 years

Participants

20 patients with chronic sensorimotor or motor complete spinal cord injury

Evidence Level

Level 2, uncontrolled phase 2 study

Key Findings

1
75% of subjects developed electromyographic activity below their lesions.
2
The American Spinal Injury Association Impairment Scale of motor strength improved by 4 to 8 points in 5 subjects and by 14 to 20 in another 4.
3
The increase in voluntary movement was found only in the patients at the 2 sites that provided assisted overground stance and step training but not at the site that offered only the robotic stepper.

Research Summary

The article discusses the importance of rehabilitation in conjunction with cellular transplantation for spinal cord injury (SCI). It highlights a study by Lima et al., which combined cell transplantation with intensive task-related rehabilitation, and observed improvements in motor control in some patients. The author emphasizes the need to determine the optimal parameters of rehabilitation interventions to maximize the benefits of cellular therapies for SCI, suggesting that the type and intensity of rehabilitation may be critical for successful outcomes.

Practical Implications

Optimizing Rehabilitation Strategies

Further research is needed to determine the most effective rehabilitation strategies (e.g., overground vs. robotic training) to combine with cellular therapies for SCI.

Designing Clinical Trials

Clinical trials of biological interventions for SCI should incorporate a phase-in of task-related physical therapy for all subjects, followed by task-related therapy after the interventions, to ensure a scientifically sound comparison.

Ethical Considerations

Patients should be informed about the importance of post-operative rehabilitation and the potential limitations of cellular interventions offered at unregulated clinics.

Study Limitations

1
The study by Lima et al. was an uncontrolled trial, limiting the ability to draw definitive conclusions about the effectiveness of the combined therapy.
2
The specific mechanisms by which rehabilitation enhances the effects of cellular transplantation are not fully understood.
3
The modest improvements in highly impaired patients who have the least residual motor control.

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