Sequelae Of Spinal Cord Injury Research Articles

“Meet the patient” session: a strategy to teach medical students about autonomic dysfunction after spinal cord injury

Dysregulation of the autonomic nervous system is an important long-term consequence of spinal cord injury (SCI). Yet, there is a scarcity of teaching resources about this topic for preclinical medical students. Given the association of SCI sequelae with emergency complications and mortality, it is imperative to equip medical students with the ability to recognize them. We designed a “Meet the Patient” (MTP) session with the primary goal to enhance student learning about SCI sequelae by interacting with patients and listening to real-life stories. The session primarily focused on recognizing triggers and symptoms of autonomic dysreflexia (AD) and discussing the loss of bowel and bladder control, while providing opportunities to learn more about living with SCI from patients’ real-life experiences. During the MTP session, patients living with SCI discussed their experience with AD, neurogenic bowel and bladder, and spasticity, among other SCI sequelae. We evaluated the outcomes of the MTP session by assessing numerical performance in questions related to the session (post-session quiz and final exam) and students’ satisfaction (post-session survey) in two subsequent academic years. The numerical performance in SCI-questions was high for both academic years (and higher than national average for the final exam question), indicating adequate acquisition of knowledge. Satisfaction with the session was high, with most students indicating that the session helped them consolidate their knowledge about the topic.

Recent advances in the combination of cellular therapy with stem cells and nanoparticles after a spinal cord injury.

Currently, combined therapies could help to reduce long-term sequelae of spinal cord injury (SCI); stem cell therapy at the site of injury in combination with other therapies has shown very promising results that can be transferred to the clinical field. Nanoparticles (NPs) are versatile technologies with applications to medical research for treatments of SCI since they could deliver therapeutic molecules to the target tissue and may help to reduce the side effects of non-targeted therapies. This article's purpose is to analyze and concisely describe the diverse cellular therapies in combination with NPs and their regenerative effect after SCI. We reviewed the literature related to combinatory therapy for motor impairment following SCI that has been published by Web of Science, Scopus, EBSCO host, and PubMed databases. The research covers the databases from 2001 to December 2022. Animal models of SCI have shown that the combination of NPs plus stem cells has a positive impact on neuroprotection and neuroregeneration. Further research is required to better understand the effects and benefits of SCI on a clinical level; therefore, it is necessary to find and select the most effective molecules that are capable of exacerbating the neurorestorative effects of the different stem cells and then try them out on patients after SCI. On the other hand, we consider that synthetic polymers such as poly [lactic-co-glycolic acid] (PLGA) could be a candidate for the design of the first therapeutic strategy that combines NPs with stem cells in patients with SCI. The reasons for the selection are that PLGA has shown important advantages over other NPs, such as being biodegradable, having low toxicity levels, and high biocompatibility; In addition, researchers could control the release time and the biodegradation kinetics, and most importantly, it could be used as NMs on other clinical pathologies (12 studies on www.clinicaltrials.gov) and has been approved by the Federal Food, Drug, and Cosmetic Act (FDA). The use of cellular therapy and NPs may be a worthwhile alternative for SCI therapy; however, it is expected that the data obtained from interventions after SCI reflect an important variability of molecules combined with NPs. Therefore, it is necessary to properly define the limits of this research to be able to continue to work on the same line. Consequently, the selection of a specific therapeutic molecule and type of NPs plus stem cells are crucial to evaluate its application in clinical trials.

103 Cerebrospinal Fluid Drainage in Acute Spinal Cord Injury: A Multi-Center, Randomized, Controlled Trial

INTRODUCTION: The devastating sequelae of spinal cord injury (SCI) are worsened by ischemia and inflammation that occur following the primary mechanical damage to the cord. Optimizing spinal cord perfusion pressure (SCPP), calculated as the difference between mean arterial pressure (MAP) and intrathecal pressure (ITP), may improve long-term neurological outcomes. MAP augmentation is frequently used to improve perfusion; however, the efficacy of ITP reduction is less clear. METHODS: Patients with acute cervical SCI presenting within 24 hours were screened for eligibility. All patients received lumbar drain placement and appropriate decompressive surgery. Patients in the control group received MAP elevation only, while patients in the interventional group received MAP elevation and CSFD for a target ITP of below 10 mm Hg for 5 days. ITP and MAP were recorded hourly. Patients underwent functional assessments at enrollment, 72 hours, 90 days, and 180 days after injury. RESULTS: A total of 11 patients were enrolled, and four were randomized to receive CSFD. Patients in the CSFD cohort had a mean ITP of 5.3 ± 2.5 mm Hg compared to 15 ± 3.0 mm Hg in the control group. SCPP improved significantly from 77 ± 4.5 mm Hg in the control group to 101 ± 6.3 mm Hg in the experimental group (p < 0.01). Total motor scores improved by 15 ± 8.4 points and 57 ± 24 points in the control and CSFD groups, respectively, over 180 days. No adverse events were attributable to CSFD. CONCLUSIONS: CSFD is feasible and an effective mechanism for reducing ITP and improving SCPP in the acute period after SCI. The complication profile was similar between both groups, and long-term improvements in motor and sensory function were seen with CSFD.

MP52-05 BLADDER MANAGEMENT IS THE TOP HEALTH CONCERN AMONG ADULTS WITH A SPINAL CORD INJURY

You have accessJournal of UrologyCME1 Apr 2023MP52-05 BLADDER MANAGEMENT IS THE TOP HEALTH CONCERN AMONG ADULTS WITH A SPINAL CORD INJURY John P. Ratanawong, Christopher J. Loftus, Jeremy B. Myers, Sara M. Lenherr, John T. Stoffel, Blayne Welk, and Sean P. Elliott John P. RatanawongJohn P. Ratanawong More articles by this author , Christopher J. LoftusChristopher J. Loftus More articles by this author , Jeremy B. MyersJeremy B. Myers More articles by this author , Sara M. LenherrSara M. Lenherr More articles by this author , John T. StoffelJohn T. Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , and Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder management has been shown to be the most important health concern for people with spinal cord injury (SCI), outranking even ambulation. Incontinence, urinary tract infections (UTI) and clean intermittent catheterization (CIC) compared to other bladder management methods, have been shown to predict poor urinary quality of life (QoL) in people with SCI. But, it is unclear if these factors impact ranking bladder management as a top health concern. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to confirm whether bladder management is the top health concern and whether this is associated with urinary incontinence, UTI, or CIC utilization. METHODS: Participants in the NBRG registry were asked: “What are the top 3 problems that affect you on a daily basis? (Rank top 3): bladder management/issues, bowel management/issues, pressure ulcer, mobility issues, autonomic dysreflexia, spasticity/stiffness, pain, depression/anxiety, heart problems, lung problems, sexual function, fertility, or other.” Incontinence and urinary QoL were assessed using the Neurogenic Bladder Symptom Score (NBSS). We performed a multivariate regression to identify factors related to their primary choice. RESULTS: Among our 1460 participants, 882 (60%) were men, mean age was 44.9 years, and mean time since injury was 14.4 years. 574 (39%) ranked bladder management as their primary issue, followed by pain and bowel management (Figure 1). Factors associated with choosing bladder as the top concern included more years since injury (OR 1.02 [1.00,1.03], p<0.02), worse NBSS incontinence domain score (OR 1.06 [1.02, 1.09], p<0.01), and worse NBSS QoL (OR 1.20 [1.04, 1.37], p=0.01); UTI≥1/year (OR 1.03 [0.70, 1.50], p=0.89) and CIC (OR 1.40 [0.92, 2.14], p=0.12) were not significant. CONCLUSIONS: In this group, bladder management was ranked as the top health issue, over other sequelae of SCI. The farther out from injury people are, the more important bladder management becomes. Bladder QoL and, in particular, incontinence also drive people to view bladder issues as their top health concern. By managing incontinence in people with SCI, urologists can impact the top health concern of people with SCI. Source of Funding: PCORI-1409-21348 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e704 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John P. Ratanawong More articles by this author Christopher J. Loftus More articles by this author Jeremy B. Myers More articles by this author Sara M. Lenherr More articles by this author John T. Stoffel More articles by this author Blayne Welk More articles by this author Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Translation, cross-cultural adaptation, and analysis of the measurement properties of the Brazilian Portuguese version of the spinal cord injury pain instrument.

Study designA questionnaire validity study.ObjectivesTo perform the translation, cross-cultural adaptation, and analysis of the measurement properties of the Brazilian Portuguese version of the Spinal Cord Injury Pain Instrument (SCIPI) for the screening of neuropathic pain in spinal cord injury.SettingNeurorehabilitation hospital in north-eastern Brazil.MethodsWe performed the translation and cross-cultural adaptation of the SCIPI. The pre-final version was applied in 10 patients with spinal cord injury sequelae and pain report. The final version of the SCIPI was applied to 100 patients. The measurement properties evaluated were structural validity, test-retest reliability, internal consistency, construct validity, and diagnostic accuracy.ResultsNone of the items in the pre-final version of the SCIPI had any comprehension problems. The one-dimensional structure of the final version of the SCIPI was adequate. There were significant correlations between the SCIPI and the Douleur Neuropathique 4 (rho = 0.546), as well as adequate test-retest reliability (intraclass correlation coefficient = 0.89, kappa ≥ 0.79), internal consistency (Cronbach’s alpha ≥ 0.76), and diagnostic accuracy (area under the curve = 0.860).ConclusionThe Brazilian version of the SCIPI presents measurement properties that are suitable for measuring neuropathic pain related to spinal cord injury.

Baclofen Withdrawal With Reversible Posterior Leukoencephalopathy Syndrome: Bacterial Meningitis Mimicker

BackgroundThe intrathecal baclofen (ITB) pump is an effective treatment for patients with spasticity unresponsive to oral medication. Case ReportA 31-year-old woman with spinal cord injury sequelae was admitted to the emergency department due to sudden headache and excessive confusion. The patient was on ITB for lower limb spasticity. On presentation, her vital signs revealed blood pressure of 171/106 mm Hg, heart rate of 141 beats/min, and temperature of 39.0°C. Antibiotics were promptly administered intravenously for suspicion of bacterial meningitis. Based on magnetic resonance imaging and cerebrospinal fluid findings, as well as clinical signs such as marked lower limb spasticity, the final diagnosis was determined to be baclofen withdrawal syndrome complicated by reversible posterior leukoencephalopathy syndrome (RPLS). Improved consciousness was quickly achieved on blood pressure control. Resolution of spasticity was achieved after intravenous midazolam and intrathecal baclofen via lumbar puncture. Why Should an Emergency Physician Be Aware of This?Baclofen withdrawal syndrome is the leading differential diagnosis for impaired consciousness and fever among patients using ITB pumps. Moreover, baclofen withdrawal syndrome mimics a wide variety of conditions, including sepsis. This unique case was complicated by intrathecal baclofen withdrawal syndrome coexisting with RPLS, thus presenting more similarly to bacterial meningitis than the usual baclofen withdrawal, due to marked headache, altered consciousness, and generalized convulsive symptoms. In addition to general withdrawal management, commencement of antihypertensive therapy for RPLS may have an immediate effect on the improvement of impaired consciousness.

Neuropathic Pain and Spasticity Response to Traditional Acupuncture after Spinal Cord Injury

Introduction: One of the most relevant disabilities is caused by spinal cord injury (SCI). Typical causes of spinal cord damage are trauma, disease, or congenital disorders. Tetraplegia is a paralysis results in the partial or total loss of use of all limbs and torso; paraplegia is similar but does not affect the arms. Pain and spasticity are common sequelae of SCI [1]. Both pain and spasticity can have a late onset and develop slowly over time after SCI, and once developed, they often become chronic. In this paper we have provided to assess the effectiveness of acupuncture for treating SCI sequelae and summarize the potential mechanisms of acupuncture therapy. Method: We considered 30 patients with diagnosis of tetra or paraplegia after SCI complicated by neuropathic pain and spasticity. Neurologist trained in medical acupuncture conducted the therapeutic treatments. A specific set of acupuncture points was used in all sessions. Participants were treated for 8 sessions of acupuncture over 4 week’s period. Pain and spasticity were evaluated with Numeric Raiting Scale (VAS) (2) and the Modified Ashworth Scale [3] at the beginning of the first, the fourth an eighth treatment session. Results: 28 patients (93%) showed improvement in pain intensity and spasticity after two weeks of acupuncture treatment. The therapeutic effect continued until the eighth week of treatment. However, 15 patients (53,5%) reported an increase in spasticity and pain 2 months after acupuncture sessions. Conclusions: Acupuncture sessions using defined acupoint set reduced pain intentensity and spasticity in patients with SCI.

Mesenchymal Stem Cell Sheet Promotes Functional Recovery and Palliates Neuropathic Pain in a Subacute Spinal Cord Injury Model.

Stem cell therapy has been shown to reverse the sequelae of spinal cord injury (SCI). Although the ideal treatment route remains unknown, providing a large number of stem cells to the injured site using less invasive techniques is critical to achieving maximal recovery. This study was conducted to determine whether administration of bone marrow stem cell (BMSC) sheet made on its own without a scaffold is superior to intramedullary cell transplantation in a rat subacute SCI model. Adult female Sprague-Dawley rats were subjected to SCI by 30 g clip compression at the level of Th6 and Th7 and were administered BMSC cell sheet (7 × 104 cells, subdural), cell suspension (7 × 104 cells, intramedullary), or control seven days after the injury. Motor and sensory assessments, as well as histological evaluation, were performed to determine the efficacy of the different cell transplantation procedures. While both the cell sheet and cell intramedullary injection groups showed significant motor recovery compared to the control group, the cell sheet group showed better results. Furthermore, the cell sheet group displayed a significant sensory recovery compared to the other groups. A histological evaluation revealed that the cell sheet group showed smaller injury lesion volume, less inflammation, and gliosis compared to other groups. Sensory-related fibers of μ-opioid receptors (MOR, interneuron) and hydroxytryptamine transporters (HTT, descending pain inhibitory pathway), located around the dorsal horn of the spinal cord at the caudal side of the SCI, were preserved only in the cell sheet group. Stem cells could also be found inside the peri-injured spinal cord in the cell sheet group. BMSC cell sheets were able to promote functional recovery and palliate neuropathic pain more effectively than intramedullary injections, thus serving as a good treatment option for SCI.

Excretory dysfunction and quality of life after a spinal cord injury: A cross-sectional study.

To determine the aspects of excretory dysfunction most influential in determining the quality of life of survivors of spinal cord injury. Excretory dysfunction is one of the most common and troublesome sequelae of spinal cord injury. Previous studies have shown that it can restrict social participation restriction, cause readmission and generally influence quality of life substantially. A cross-sectional survey of hospital inpatients following STOBE guidelines. A convenience sample of 101 patients with traumatic or non-traumatic spinal cord injury were asked about their experiences of excretory dysfunction, and management and their self-perceived quality of life. Univariate analysis and multiple linear regression were performed to isolate the most important relationships. Only 2 of the 101 subjects professed to be unaffected by excretion dysfunction. Bladder-related dysfunction was the most frequently mentioned type of problem. Quality of life impairment was found to be most often associated with bladder accidents, bowel accidents and having more than one bladder complications. Excretory dysfunction substantially impacts quality of life after a spinal cord injury. Bladder accidents, bowel accidents and more than one bladder complication are factors independently influencing the quality of life of spinal cord injury survivors. To improve excretion-related QOL, patients' bladder and bowel self-management training should be strengthened seeking to prevent complications and reduce the risk of bladder and bowel accidents.

A Primary Care Provider's Guide to Spasticity Management in Spinal Cord Injury.

Background: Muscle spasticity is a common sequela of spinal cord injury (SCI) that may impact daily function. Spasticity dynamically varies and is an important physiologic response to illness or other stressors. The challenge for the general practitioner is in recognizing, treating, and developing an effective plan focused on the patient's individual goals. Objective: To provide the general practitioner with a basic contextual, diagnostic, and therapeutic approach to spasticity management for individuals with neurologic injury such as SCI. Discussion: Muscle spasticity can be disabling and can be managed effectively by using a comprehensive approach. We discuss a representative case and the assessment and planning for individuals with SCI and spasticity. Through an understanding of pathophysiology, careful history taking, and physical exam, a cause for increased spasticity can be identified, such as infection, constipation, or pregnancy. Symptomatology of these triggers is often quite different in the SCI population than in the general population. Management includes the treatment of this causative stressor as well as the thoughtful management of spasticity itself. Conclusion: Muscle spasticity is dynamic and requires a patient-centered approach. The general practitioner can play a key role in recognizing and treating spasticity in an individual with SCI. Comprehensive management to meet patient and caregiver goals involves primary care providers, specialists, and allied health practitioners.

TASCI—transcutaneous tibial nerve stimulation in patients with acute spinal cord injury to prevent neurogenic detrusor overactivity: protocol for a nationwide, randomised, sham-controlled, double-blind clinical trial

IntroductionNeurogenic lower urinary tract dysfunction (NLUTD), including neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia, is one of the most frequent and devastating sequelae of spinal cord injury (SCI), as...

In utero myelomeningocele repair reduces intensification of inflammatory changes in the dura mater and the skin

Objective: Chemical and mechanical injury in myelomeningocele (MMC) during the fetal life results in functional disorders of multiple organs. Prenatal MMC repair reduces sequelae of spinal cord injury. Design: Histopathological evaluation of dura mater and skin specimens to assess the severity of inflammatory changes. Setting: Histopathological laboratory and operated patients. Participants: 45 cases (Group I)-intrauterine surgery due to MMC and 42 cases (Group II)-postnatal surgery. Outcome measures: Specimens of the skin and of the dura mater adjacent directly to the uncovered section of the spinal cord were collected for assessment. The specimens were histopathologically evaluated to assess the severity of inflammatory changes. Results: The analysis of the severity of inflammatory changes in the skin and the dura mater showed only small lymphocytic infiltration in 5 fetuses (Group I). Medium and large infiltration in the skin and the dura mater was found in all children who underwent postnatal surgery (Group II). Lymphocytic and granulocytic infiltration in the skin and the dura mater were statistically significantly more prevalent in children who underwent postnatal surgery compared to the group of children who underwent prenatal surgery (P < 0.000003). Conclusions: By reducing the time of exposure to damaging factors, prenatal MMC repair statistically reduces the risk of inflammatory changes in the exposed spinal cord and spinal nerves. Prenatal closure of spina bifida before 24 week of gestation does not reduce the severity of inflammatory changes in the exposed spinal cord.

Spinal cord injury leads to atrophy in pelvic ganglia neurons

Among the most devastating sequelae of spinal cord injury (SCI) are genitourinary and gastrointestinal dysfunctions. Post-ganglionic neurons in pelvic ganglia (PG) directly innervate and regulate the function of the lower urinary tract (LUT), bowel, and sexual organs. A better understanding of how SCI affects PG neurons is essential to develop therapeutic strategies for devastating gastrointestinal and genitourinary complications ensuing after injury. To evaluate the impact of SCI on the morphology of PG neurons, we used a well- characterized rat model of upper thoracic SCI (T3 transection) that causes severe autonomic dysfunction. Using immunohistochemistry for neuronal markers, the neuronal profile size frequency distribution was quantified at one-, four-, and eight-weeks post SCI using recursive translation. Our investigation revealed an SCI-dependent leftward shift in neuronal size (i.e. atrophy), observable as early as one-week post injury. However, this effect was more pronounced at four and eight-weeks post-SCI. These findings demonstrate the first characterization of SCI-associated temporal changes in morphology of PG neurons and warrant further investigation to facilitate development of therapeutic strategies for recovery of autonomic functions following SCI.

Rehabilitation of patients in late period after spinal cord injury: a meta-analysis of literature data

Material and Methods . The study design is a meta-analysis of publications with levels 1a, b, c, and 2a evidence and a level A recommendations. An electronic search was conducted in the PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, and MEDLINE databases, and in references of key articles. Inclusion criteria were systematic reviews, randomized controlled studies, multicenter cohort studies with a level 1a, b, c, and 2a evidence and level A recommendations for adult patients with long-term sequelae of spinal cord injury (more than 4 months after injury). Exclusion criteria were topic articles, clinical cases, observations, cohort uncontrolled studies, experimental articles, reports, articles with levels 2b, c, 3a, b, 4, and 5 evidence and level B, C, and D recommendations, pediatric patients, early period after spinal cord injury (less than 4 months), and non-traumatic lesions of the spinal cord. Results . The search returned 108 articles with publication date within 1997–2019. The inclusion criteria was met by 65 publications: 33 systematic reviews, 12 randomized controlled studies, 19 multicenter studies; and one open prospective study was included in the review due to the particular treatment method used. The greatest evidence base for the rehabilitation of patients in the long-term period after spinal cord injury is presented for physical methods of rehabilitation. The most effective are locomotor training to develop skills of movement. Auxiliary verticalization and robotic devices are needed to restore and improve proprioceptive innervation. In case of violation of the spinal tracts, the restoration of motor functions occurs due to the activation of supraspinal interneuronal connections. Epidural electrical stimulation of the lumbar thickening of the spinal cord activates a generator of voluntary movement of the limbs and, in combination with training of proprioceptive sensitivity, leads to a regression of movement disorders. The constant use of electrostimulation blocks proprioceptive sensitivity and inhibits the recovery of spinal conductivity. Parameters of clinical application are not defined for areas of regenerative medicine. Conclusion . The main problem in rehabilitation of patients in late period after spinal cord injury is the lack of a unified concept, developed strategies of rehabilitation technologies, and criteria for assessment of the initial status and treatment efficiency.

Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series

Objective. To describe the original technical surgical procedure simplifying the correction of kyphosis in children due to instrumental distraction of the anterior column of the spine, to analyze its effectiveness in the setting of clinical series. Level of evidence – IV. Material and Methods. The study included 9 patients aged 7 months to 14 years (median age: 4 years 8 months) with angular kyphosis (median magnitude 53°, min – 38°, max – 80°) associated with tuberculous (n = 4) and non-specific (n = 4) spondylitis and with a sequelae of spinal cord injury (n = 1). Deformity correction was achieved using temporary instrumental interbody distraction followed by anterior fusion with titanium mesh cage filled with autologous bone graft during a single-step two-stage reconstruction and stabilization surgery. Results. The duration of surgery was 3 hours 2 min ± 44 min, the volume of blood loss – 190 ml ± 39 ml. In all cases, the deformity was corrected by 75–85 % with restoration of physiological thoracic kyphosis and spinal profile. Conclusion. A safe and effective technique for intraoperative anterior instrumental distraction can be used to correct angular kyphosis in children, including infants.

Editors’ Note

Welcome to the first issue of SBC Journal on Interactive Systems in 2018.This edition starts with a special issue dedicated to Human-Computer Interaction. More specifically, it contains extended versions of five of the best full papers presented at the 14th Brazilian Symposium on Human Factors in Computing Systems (IHC’15). Our guest editors are Prof. Andreia Libório Sampaio, from the Federal University of Ceará (UFC), and Prof. Clodis Boscarioli, from the Western Paraná State University (UNIOESTE). We would like to thank them for preparing this special issue. You are invited to read their Guest Editors’ Note in the following.This issue also has a regular paper presenting the results of a joint work from groups of three Brazilian Universities: UFSCar, UNICAMP, and UFES. The paper is entitled “Applicability and evaluation of the GestureChair virtual game: comparison between people with and without spinal cord injury”, and produced evidence of relevant aspects of the use of VR games among people with spinal cord injury sequelae and a comparative group of people without injury.We hope you enjoy this issue of JIS and it encourages you to send us your own contributions.

Pain After Spinal Cord Injury Is Associated With Abnormal Presynaptic Inhibition in the Posterior Nucleus of the Thalamus

Pain after spinal cord injury (SCI-Pain) is one of the most debilitating sequelae of spinal cord injury, characterized as relentless, excruciating pain that is largely refractory to treatments. Although it is generally agreed that SCI-Pain results from maladaptive plasticity in the pain processing pathway that includes the spinothalamic tract and somatosensory thalamus, the specific mechanisms underlying the development and maintenance of such pain are yet unclear. However, accumulating evidence suggests that SCI-Pain may be causally related to abnormal thalamic disinhibition, leading to hyperactivity in the posterior thalamic nucleus (PO), a higher-order nucleus involved in somatosensory and pain processing. We previously described several presynaptic mechanisms by which activity in PO is regulated, including the regulation of GABAergic as well as glutamatergic release by presynaptic metabotropic gamma-aminobutyric acid (GABAB) receptors. Using acute slices from a mouse model of SCI-Pain, we tested whether such mechanisms are affected by SCI-Pain. We reveal 2 abnormal changes in presynaptic signaling in the SCI-Pain condition. The substantial tonic activation of presynaptic GABAB receptors on GABAergic projections to PO—characteristic of normal animals—was absent in mice with SCI-Pain. Also absent in mice with SCI-Pain was the normal presynaptic regulation of glutamatergic projections to the PO by GABAB receptors. The loss of these regulatory presynaptic mechanisms in SCI-Pain may be an element of maladaptive plasticity leading to PO hyperexcitability and behavioral pain, and may suggest targets for development of novel treatments. PerspectiveThis report presents synaptic mechanisms that may underlie the development and maintenance of SCI-Pain. Because of the difficulty in treating SCI-Pain, a better understanding of the underlying neurobiological mechanisms is critical, and may allow development of better treatment modalities.

Alterations in autonomic cerebrovascular control after spinal cord injury.

Among chronic cardiovascular and metabolic sequelae of spinal cord injury (SCI) is an up-to four-fold increase in the risk of ischemic and hemorrhagic stroke, suggesting that individuals with SCI cannot maintain stable cerebral perfusion. In able-bodied individuals, the cerebral vasculature is able to regulate cerebral perfusion in response to swings in arterial pressure (cerebral autoregulation), blood gases (cerebral vasoreactivity), and neural metabolic demand (neurovascular coupling). This ability depends, at least partly, on intact autonomic function, but high thoracic and cervical spinal cord injuries result in disruption of sympathetic and parasympathetic cerebrovascular control. In addition, alterations in autonomic and/or vascular function secondary to paralysis and physical inactivity can impact cerebrovascular function independent of the disruption of autonomic control due to injury. Thus, it is conceivable that SCI results in cerebrovascular dysfunction that may underlie an elevated risk of stroke in this population, and that rehabilitation strategies targeting this dysfunction may alleviate the long-term risk of adverse cerebrovascular events. However, despite this potential direct link between SCI and the risk of stroke, studies exploring this relationship are surprisingly scarce, and the few available studies provide equivocal results. The focus of this review is to provide an integrated overview of the available data on alterations in cerebral vascular function after SCI in humans, and to provide suggestions for future research.

EXPERIMENTAL MODEL OF TRAUMATIC SPINAL CORD INJURY AND NEUROPROTECTIVE EFFECT OF KETAMINE IN ACUTE PHASE OF INJURY

Objective. To present experimental model of traumatic spinal cord injury and to assess the efficacy of ketamine for neuroprotection in multimodal treatment for spinal cord injury in acute phase. Material and Methods . The study was performed in 60 rabbits with modeled acute spinal cord injury. The standard open spinal cord injury was inflicted in the lower thoracic spine with graduated impact strength and area using impact device. Further, the multimodal therapy was conducted. Motor function, reflexes, pelvic organ function, and skin sensitivity were assessed. Experimental animals were divided into several groups depending on ketamine therapy start time. Results . The presented model of spinal cord injury is reproducible, graduated, same-type and similar to clinical injury. The model enables mastering the treatment for spinal cord injury sequelae. The method is easy to study and use, and does not require complex equipment. The study showed significantly better recovery of the motor function after early beginning of ketamine therapy. Conclusion . Ketamine is an effective neuroprotectant in spinal injury, and its administration in the acute phase of traumatic spinal cord injury improves the results of treatment and prognosis.

Kinematic analysis of the gait of adult sheep during treadmill locomotion: Parameter values, allowable total error, and potential for use in evaluating spinal cord injury

We are developing a novel intradural spinal cord (SC) stimulator designed to improve the treatment of intractable pain and the sequelae of SC injury. In-vivo ovine models of neuropathic pain and moderate SC injury are being implemented for pre-clinical evaluations of this device, to be carried out via gait analysis before and after induction of the relevant condition. We extend previous studies on other quadrupeds to extract the three-dimensional kinematics of the limbs over the gait cycle of sheep walking on a treadmill. Quantitative measures of thoracic and pelvic limb movements were obtained from 17 animals. We calculated the total-error values to define the analytical performance of our motion capture system for these kinematic variables. The post- vs. pre-injury time delay between contralateral thoracic and pelvic-limb steps for normal and SC-injured sheep increased by ~24s over 100 steps. The pelvic limb hoof velocity during swing phase decreased, while range of pelvic hoof elevation and distance between lateral pelvic hoof placements increased after SC injury. The kinematics measures in a single SC-injured sheep can be objectively defined as changed from the corresponding pre-injury values, implying utility of this method to assess new neuromodulation strategies for specific deficits exhibited by an individual.