IPHREHAB: Embryonic Stem Cell Therapy & Spinal Cord Injury Cure

IPHREHAB:

Embryonic Stem Cell Therapy & Spinal Cord Injury Cure

Traumatic Injury to the Spinal Cord

Traumatic injury to the spinal cord prevents electrical nerve messages travelling to and from the brain. When injured, the substance coating the nerves breaks down, along with cellular damage to the neurons, and the electrical signals short circuit, stopping the signals from reaching their destination. These messages control most functions of the human body, including touch and sensation, muscle movement, bladder control and sexual function. With the loss of these messages, the body is paralysed below the level of injury.

Clearing the Way for Stem Cell Therapy to Re-Grow Spinal Cord Nerves

Just days after the inauguration of President Barack Obama, the FDA decided to clear the way for the world's first study on human embryonic stem cell therapy. Geron Corp, the company behind the research, plans to initiate a clinical trial in patients newly paralysed due to spinal cord injury. Initially, a handful of patients with severe spinal cord injuries will be eligible for injections of specialised nerve cells, designed to enable electrical signals to travel between the brain and the rest of the body. When the cells were administered to rats that had lost control of their hind legs, they regained the ability to walk and run, although with a limp.

As a Phase I trial, the study by Geron will primarily assess the safety of the treatment, which has been under development by Geron Corp. for nearly a decade. Scientists, doctors and patients said they were most eager to see whether low doses of the cells would produce any therapeutic benefit.

Embryonic stem cells are coveted by researchers because they theoretically have the ability to grow into any kind of cell in the body. Even if the experimental therapy in spinal cord therapy doesn't make paralyzed patients walk again, it could still substantially improve their quality of life.

Regenerating Spinal Cord Neurons

To treat spinal cord injuries, scientists first needed to reverse the damage to oligodendrocytes, cells that insulate nerve fibers with myelin so that signals can be transmitted to and from the brain. The hard part was figuring out the complex combination of growth factors and other chemicals that would turn stem cells into oligodendrocyte progenitor cells that could make new myelin.

When this method was tested on rats, seven days after the rat's injury, scientists injected the rats at the site of the injury with the progenitor cells. After four weeks, the rats could walk, run and stand on their hind legs, and their coordination had fully recovered, UC Irvine researchers spent two years studying hundreds of rats to make sure the injections were safe. Pure embryonic stem cells tend to grow into tumors, but the rats showed no such signs for a year after treatment. Blood and urine tests turned up none of the chemicals that would signal a toxic reaction.

Embryonic Stem Cell Therapy Clinical Trials

Geron plans to start a Phase I multi-center trial that is specifically designed to assess the safety and tolerability of GRNOPC1 in spinal cord injury patients with "complete" American Spinal Injury Association (ASIA) grade A subacute thoracic spinal cord injuries.

The selected patients eligible for the Phase I trial must have documented evidence of functionally complete spinal cord injury with a neurological level of T3 to T10 spinal segments and agree to have GRNOPC1 injected into the lesion sites between seven and 14 days after injury.

If the cells are administered sooner, they could be damaged by inflammation from the injury. If doctors wait too long, there might be too much scar tissue for the cells to find room to grow,

Patients will be given a low-dose anti-rejection drug for 60 days to ensure their bodies don't reject the GRNOPC1 cells, even though research indicates that the cells won't be recognized by the human immune system.

IPHREHAB: Spinal Cord Injury : Quadriplegic and Paraplegic Injuries

IPHREHAB

Spinal Cord Injury : Quadriplegic and Paraplegic Injuries

Paraplegic and quadriplegic (tetraplegic) are terms used to describe the medical condition, for a person who has been paralysed due to a spinal cord injury. This classification depends on the level and severity of a persons paralysis, and how it affects their limbs.

This  provides patient information about acute spinal cord injuries, as well as treatment, symptoms, information on long term rehabilitation issues and peer support, to help improve the quality of life of those affected by a spinal cord injury.

What is a Spinal Cord Injury ?

A spinal cord injury (SCI) is typically defined as damage or trauma to the spinal cord that in turn results in a loss or impaired function resulting in reduced mobility or feeling.

Typical common causes of damage to the spinal cord, are trauma (car/motorcycle accident, gunshot, falls, sports injuries, etc), or disease (Transverse Myelitis, Polio, Spina Bifida, Friedreich's Ataxia, etc.). The resulting damage to the spinal cord is known as a lesion, and the paralysis is known as quadriplegia or quadraplegia / tetraplegia if the injury is in the cervical (neck) region, or asparaplegia if the injury is in the thoracic, lumbar or sacral region.

The spinal cord injury level is usually refered to alpha numerically, relating to the affected segment in the spinal cord, ie, C4, T5, L5 etc.

It is possible for someone to suffer a broken neck,or a broken back without becoming paralysed. This occurs when there is a fracture or dislocation of the vertebrae, but the spinal cord has not been damaged.

What is a Complete and Incomplete Spinal Cord Injury

There are typically two types of lesions associated with a spinal cord injury, these are known as a complete spinal cord injury and an incomplete spinal cord injury. A complete type of injury means the person is completely paralysed below their lesion. Whereas an incomplete injury, means only part of the spinal cord is damaged. A person with an incomplete injury may have sensation below their lesion but no movement, or visa versa. There are many types in incomplete spinal cord injuries, and no two are the same.

Such injuries are known as Brown Sequard Syndrome, Central Cord Syndrome, Anterior Cord Syndrome and Posterior Cord Syndrome.

What is Spinal Cord Injury Rehabilitation

Someone with a spinal cord injury will have a long road of rehabilitation ahead of them, usually at a spinal cord injury rehabilitation centre or spinal injury unit, and it is important that they keep their sense of humor on their bad days to help them maintain a positive attitude.

Generally, paraplegics will be in hospital for around 5 months, where as quadriplegics can be in hospital for around 6 - 8 months, whilst they undergo rehabilitation. Both paraplegics and quadriplegics should have some kind of rehabilitation and physiotherapy before they are discharged from hospital, to help maximise their potential, or help them get used to life in a wheelchair, and to help teach techniques which make everyday life easier.

Disabled sports, and wheelchair based sports can be an excellent way to build stamina, and help in rehabilitation by giving confidence and better social skills. The ultimate reward for many disabled sportsmen and women, is to win at the paralympic games, which will be coming to London in 2012.

Spinal Cord Injury Cure and Treatment

A cure for long term paralysis is still some years in the future, but clinical trials are taking place with Olfactory Ensheathing Glial (OEG) cells and Embryonic Stem Cell based Therapy.

and conservative treatment via physiotherapy and rehabilitation approaches.

Paraplegic and Quadriplegic Discussion Forum

If you have any spinal cord injury related questions, please visit our discussion forums and join in on the many topics there. We will do our best to help you, or at the very least, put you in contact with someone who can if we can't. The discussion forum is intended to be a free flow of information between spinally injured people, carers, and their friends, and everyone is welcome.

Even if you don't have any questions, take a look at the forum anyway, as you may be able offer help and advice to others who have questions.

Quadriplegic, Tetraplegic, Paraplegic and it's Definition

Quadraplegic is derived from two separate words from two different languages, Latin and Greek. The word “Quadra”, meaning “four” which is derived from latin, relates to the number of limbs. “Plegic”, is derived from the Greek word “Plegia”, meaning paralysis.

Put the two together, and you have “Quadraplegia”.

“Tetra” is derived from the Greek word for “Four”. “Para” is derived from the Greek word for "two" Hence: Tetraplegic and Paraplegic.

In Europe, the term for 4 limb paralysis has always been tetraplegia. The Europeans would never dream of combining a Latin and Greek root in one word.

In 1991, when the American Spinal Cord Injury Classification system was being revised, the definition of names was discussed. The British are more aware of Greek versus Latin names. Since Plegia is a greek word and quadri is Latin, the term quadriplegia mixes language sources. Upon review of the literature, it was recommended that the term tetraplegia be used by the American Spinal Cord Association so that there are not two different words in English referring to the same thing.

IPHREHAB : ANKLE SPRAIN CAUSE AND TREATMENT

IPHREHAB

ANKLE SPRAIN:

An ankle sprain is a common injury and usually results when the ankle is twisted, or inverted. The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle. On the lateral side of the ankle, there are three ligaments that make up the lateral ligament complex. These include the anterior talofibular ligament (ATF), the calcaneo–fibular ligament (CF) and the posterior talofibular ligament (PTF). The very common inversion injury to the ankle usually injures the anterior talofibular ligament and the calcaneo–fibular ligament. The ATF ligament keeps the ankle from sliding forward and the CF ligament keeps the ankle from rolling over on its side.

Causes of Ankle Sprain

ANKLE SPRAIN

A ligament is made up of multiple strands of tissue–similar to a nylon rope. A sprain results in tearing of the ligaments. The tear can be a complete tear of all the strands of the ligament or a partial tear, where a portion of the strands of the ligament are torn. The ligament is weakened by the injury which depends on the degree of the tear. The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. An inversion injury simply means that the ankle tilts over to the inside (towards the other foot), and the pressure of all your body weight is forced onto the outside edge of the foot. This causes the ligaments on the outside of the ankle to stretch and possibly tear.

Symptoms of Ankle Sprain

Initially the ankle is swollen, becomes painful, and may turn eccyhmotic (bruised). The bruising, and the initial swelling, is due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. This initial swelling due to bleeding then increases due to edema fluid leaking into the tissues as well over the next 24 hours.

Diagnosis of Ankle Sprain

The diagnosis of an ankle sprain is usually made by examination of the ankle and x–rays to make sure that there is no fracture of the ankle. If there is a complete rupture of the ligaments suspected, your doctor may order stress x–rays as well. These x–rays are taken while someone twists or stresses the ligaments.

Treatment of Ankle Sprain

Elevation will help control the swelling.

Gentle compression and ice will control swelling.

Mild pain relievers will help with the pain.

Crutches will prevent weight bearing.

Healing of the ligaments usually takes about six weeks. The swelling may be present for several months. A physical therapist may be suggested to help you regain full function of your injured ankle.

Treatment may vary depending on how bad your ankle sprain is.

 In each case, the first line of treatment is to calm the inflammation and halt the swelling. 

The RICE (Rest, Ice, Compression, Elevation) principle can help address each of these needs.

Rest: 

A brace or splint will keep the ankle in a safe position, helping you avoid more strain to the sore area. In severe cases, you may require a pair of crutches to limit weight through the foot.

Ice:

Cold therapy, in the form of an ice pack, can aid in slowing the inflammatory process and in limiting pain.

Compression:

An elastic wrap can compress the sore area, keeping the swelling to a minimum.

Elevation:

Keeping the ankle elevated above the level of your heart will help drain the extra fluid (edema) back into the blood system and reduce swelling.

Range of motion exercises:

As healing gets underway, it is important to begin a series of movement exercises for the range of motion (ROM). At first, you’ll work on simply bending and straightening the ankle. These exercises will keep the ankle from becoming stiff.

Strength progression: 

Next, you’ll begin strengthening the muscles around the ankle. Isometrics may be chosen in the early stages of rehabilitation. These are strengthening exercises in which the muscles are working but the joint stays still. Isometrics allow you to exercise with the ankle at different angles, helping you stay away from painful positions of the ankle. These exercises provide the benefit of reducing overall pain and swelling.

Balance exercises:

Balance exercises are especially important following an ankle ligament injury. Remember, healthy ligaments send information to the brain about the position of a joint. Once a ligament has been injured, these nerves are unable to receive and send the needed information to the brain. Balance exercises help retrain the new nerves and help you regain your proprioceptive sense around the joint.

IPHREHAB: UPPER LIMB ORTHOTICS AND NERVE INJURY

IPHREHAB


UPPER LIMB ORTHOTICS and NERVE INJURIES


PERIPHERAL NERVE INJURIES


AIM OF ORTHOTICS
—  To keep denervated muscle from remaining in an overstretched position
—  To prevent joint contracture
—  To improve functional use of the hand
—  Imp. issue to consider before prescribing an orthoses- etiology & prognosis for neuropathy
—  If injury- Neuropraxic - prefabricated orthotics & cheap


RADIAL NERVE INJURY: 


Ideal splints allows
—  Tenodesis action
—  Finger extension with wrist flexion
—  Wrist extension with finger flexion
—  Protects against over-lengthening of paralyzed wrist extensors & shortening of flexors.


PROXIMAL RADIAL NERVE INJURY


DEFORMITIES                                                        ORTHOTIC OBJECTIVES


1. WRIST DROP                                                         PREVENT WRIST DROP
                                                                                  ASSIST WRIST EXTENSION


2. MCP AND IP CONTRACTURE                             PREVENT DERFORMITY  


3. THUMB WEB SPACE CONTRACTURE                ASSIST THUMB 
                                                                                      EXTENTION/ABDUCTION
                                                                                 MAINTAIN THUMB WEB SPACE


4. FLATENING OF PALMER ARCH                    MAINTAIN TRANSVERSE ARCH


   —  Forearm-based dorsal or volar static wrist extension splint with dynamic out triggering for the fingers (Directly over the proximal   phalanges)


PROXIMAL MEDIAN NERVE INJURY
—  As the recovery is poor, splinting of this level of deformity to maintain passive ROM is appropriate for tendon transfers


SPLINTS:
—   Thumb spica splint
            Resting hand splint
           Tendon transfers


DEFORMITY                                                ORTHOTIC OBJECTIVES


1.Forarm and Thenar Atrophy                       Prevention   


2. Thumb on Finger plane                               Maintain Thumb in Adduction/Abduction


3.Thumb web space contracture                    Maintain Thumb Web Space


4.Flattening of transverse palmer arch          Maintain transverse Palmer arch


5.Others                                                            Assist MIP / IP  Flexion
                                                                           Reduce pain by limited wrist thumb


 As the recovery is poor, splinting of this level of deformity to maintain passive ROM is appropriate for tendon transfers.


DISTAL MEDIAN NERVE INJURY


DEFORMITY                                          ORTHOTIC OBJECTIVES


1.Thenar Atrophy                                     Prevention   


2. Thumb on Finger plane                       Maintain Thumb in Adduction/Abduction


3.Thumb web space contracture             Maintain Thumb Web Space


4.Others                                                    Assist MIP / IP  Flexion
                                                                   Reduce pain by limiting wrist and thumb.


—  SOFT DYNAMIC THUMB ABDUCTION SPLINT
—  THUMB SPICA SPLINT
—  C-BAR/OPPONENS BAR TO STABILIZE THE THUMB IN OPPOSITION


CARPAL TUNNEL SYNDROME :


—  VOLAR WRIST ORTHOSIS
—  Wrist-between 10º of extension & neutral position


PROXIMAL & DISTAL ULNAR NERVE INJURY


DEFORMITY                                                            ORTHOTIC OBJECTIVES


1.Flattening of Transverse Palmer Arch            Maintain Transverse Palmer arch.


2.During Pinch, 1st IP hyperflex &/ 1st              Stabilize 1st MCP
   MCP hyperextends.


3. Partial Claw hand                                              Improve Grasp
                                                                               Limits 4th and  5th MCP extention
4.Interosseous atrophy
   Hypothenar atrophy
   5th MCP jt. contracture


ULNAR NERVE INJURY


—  LMB Ulnar Nerve Splint. For ulnar nerve injury and boxer’s fracture of 4th and 5th metacarpal.
—  Used to prevent shoulder subluxation in patient with
—  Brachial plexus injury
—  Hemiplegia
—  Central cord syndrome


SHOULDER SLINGS
 This restrict movement of the shoulder by keeping the shoulder by keeping the humerus in abduction & internal rotation & placing the elbow in flexion.


SPASTICITY
PRINCIPLES
—  Prolonged muscle stretch to reduce spasticity
—  Positioning opposite to patterns of spasticity to inhibit or prevent development of increased tone
—  Tactile stimulation to facilitate hypotonic muscles
—  Splint must incorporate both the wrist & fingers in order to stretch the long finger flexor muscles
—  Splints are moulded to provide 30º of wrist extension , 45º of MCP flexion & full IP extension, finger abduction & thumb extension & abduction