IPHREHAB:SPINAL CORD INJURY CURE AND TREATMENT VIA OLFACTORY ENSHEATHING CELLS

IPHREHAB


SPINAL CORD INJURY CURE AND TREATMENT VIA OLFACTORY ENSHEATHING CELLS


Olfactory En-sheathing Cells & Spinal Cord Injury Cure:
Damage to the spinal cord
Damaging the spinal cord prevents nerve messages travelling to and from the brain. 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.


Can nerves in the spinal cord re grow after injury?
Repairing damage to the spinal cord is very complex, as there are many spinal neurons killed by not only the initial injury, but in the hours, days and weeks following the accident. More neurons are also killed as the body begins to kill neurons close to the injury site (secondary damage). 


As the nervous system develops in the foetus, some nerves cells are programmed to die after they have finished their usefulness. In a spinal cord injury, this self destructive mechanism is triggered again, and some of the neurons around the injury site begin to self destruct or commit suicide in a process called apoptosis.


During the body's response to an injury to the spinal cord, the body forms an impenetrable scar tissue at the site of the injury which acts as a barrier to any neurons that might be trying to grow. Any neurons which have escaped damage may lose their insulating myelin sheath, and so can’t function and pass messages to and from the brain via the spinal cord.


To repair a spinal cord injury, scientists not only have to solve all the problems above, but would then need to find a treatment which makes the neurons grow in exactly the right part of the spinal cord, and form synapses with exactly the right neurons.


Regenerating spinal cord neurons:
In order to encourage the damaged neurons to grow again, a way needs to be found to stimulate the neurons by introducing growth factors.


One of the most recent discoveries is the olfactory ensheathing cell (OEC), also known as the olfactory ensheathing glial cell (OEGC), which is taken from the lining of the nose.


When the olfactory cells are added to a solution containing a scar reducing compound, and the combined solution is added to a damaged spinal cord in rats, the spinal cord was shown to regenerate resulting in a recovery of sensation and movement. The olfactory ensheathing cells provide an environment that promotes axon growth.
Geoff Raisman and his group in London have found ways of injecting these olfactory ensheathing cells into the spinal cord of humans.


The results have been very encouraging and human trials will begin in collaboration with The Royal National Orthopaedic Hospital, Stanmore. When these olfactory ensheathing cells come in contact with the normally barrier-like astrocytes of the glial scar. ‘It’s almost like they knock on the door and the astrocytes open up’ said Geoff Raisman.


Further research and trials are ongoing which include an enzyme to break down the inhibitory proteoglycans in the glial scar tissue to allow neurons to grow, the use of Schwann cells (from the peripheral nervous system) to encourage nerves to grow, and Olfactory ensheathing cells to ensure the axons could grow out of the graft and back into the spinal cord.

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 : Vertebrae and Spinal Cord Segmental Levels

IPHREHAB

Vertebral vs. Cord Segmental Levels

The spinal cord is situated within the spine. The spine consists of a series of vertebral segments. The spinal cord itself has "neurological" segmental levels which are defined by the spinal roots that enter and exist the spinal column between each of the vertebral segments. As shown in the figure the spinal cord segmental levels do not necessarily correspond to the bony segments. The vertebral levels are indicated on the left side while the cord segmental levels are listed for the cervical (red), thoracic (green), lumbar (blue), and sacral (yellow) cord.

Vertebral segments. 

There are 7 cervical (neck), 12 thoracic (chest), 5 lumbar (back), and 5 sacral (tail) vertebrae. The thoracic vertebrae are defined by The spinal cord segments are not necessarily situated at the same vertebral levels. For example, while the C1 cord is located at the C1 vertebra, the C8 cord is situated at the C7 vertebra. While the T1 cord is situated at the T1 vertebra, the T12 cord is situated at the T8 vertebra. The lumbar cord is situated between T9 and T11 vertebrae. The sacral cord is situated between the T12 to L2 vertebrae.

Spinal Roots. 

The spinal roots for C1 exit the spinal column at the atlanto-occiput junction. The spinal roots for C2 exit the spinal column at the atlanto-axis. The C3 roots exit between C2 and C3. The C8 root exits between C7 and C8. The first thoracic root or T1 exits the spinal cord between T1 and T2 vertebral bodies. The T12 root exits the spinal cord between T1 and L1. The L1 root exits the spinal cord between L1 and L2 bodies. The L5 root exits the cord between L1 and S1 bodies.

The Cervical Cord. 

The first and second cervical segments are special because this is what holds the head. The lower back of the head is called the Occiput. The first cervical vertebra, upon which the head is perched is sometimes called Atlas, after the Greek mythological figure who held up earth. The second cervical vertebra is sometimes called the Axis, upon which Atlas pivots. The interface between the occiput and the atlas is therefore called the atlanto-occiput junction. The interface between the first and second vertebra is called the atlanto-axis junction. The C3 cord contains the phrenic nucleus. The cervical cord innervates the deltoids (C4), biceps (C4-5), wrist extensors (C6), triceps (C7), wrist extensors (C8), and hand muscles (C8-T1).

The Thoracic Cord. 

The thoracic vertebral segments are defined by those that have a rib. These vertebral segments are also very special because they form the back wall of the pulmonary cavity and the ribs. The spinal roots form the intercostal (between the ribs) nerves that run on the bottom side of the ribs and these nerves control the intercostal muscles and associated dermatomes.

The Lumbosacral Cord. 

The lumbosacral vertebra form the remainder of the segments below the vertebrae of the thorax. The lumbosacral spinal cord, however, starts at about T9 and continues only to L2. It contains most of the segments that innervate the hip and legs, as well as the buttocks and anal regions.

The Cauda Equina.

 In human, the spinal cord ends at L2 vertebral level. The tip of the spinal cord is called the conus. Below the conus, there is a spray of spinal roots that is frequently called the cauda equina or horse's tail. Injuries to T12 and L1 vertebra damage the lumbar cord. Injuries to L2 frequently damage the conus. Injuries below L2 usually involve the cauda equina and represent injuries to spinal roots rather than the spinal cord proper.

In summary, spinal vertebral and spinal cord segmental levels are not necessarily the same. In the upper spinal cord, the first two cervical cord segments roughly match the first two cervical vertebral levels. However, the C3 through C8 segments of the spinal cords are situated between C3 through C7 bony vertebral levels. Likewise, in the thoracic spinal cord, the first two thoracic cord segments roughly match first two thoracic vertebral levels. However, T3 through T12 cord segments are situated between T3 to T8. The lumbar cord segments are situated at the T9 through T11 levels while the sacral segments are situated from T12 to L1. The tip of the spinal cord or conus is situated at L2 vertebral level. Below L2, there is only spinal roots, called the cauda equina.

IPH REHAB : BIOMECHANICS OF SPINAL ORTHOSIS

IPHREHAB

Biomechanics of the spine orthosis

• The cervical spine is the most mobile spinal segment with flexion greater than extension. 
• The occiput and C1 have significant flexion and extension with limited side bending and rotation.
•  The C1-C2 complex accounts for 50% of rotation in the cervical spine.
•  The C5-C6 region has the greatest amount of flexion and extension. 
• The C2-C4 region has the most side bending and rotation. 

BIOMECHANICS

• When compared to the cervical and lumbar spine, the thoracic spine is the least mobile. 
• The thoracic spine has greater flexion than extension. 
• Lateral bending increases in a caudal direction, and axial rotation decreases in a caudal direction. 
• The lumbar spine has minimal axial rotation. The greatest movement in the lumbar spine is flexion and extension.

The biomechanical principles in orthotic design include: 

1. Balance of horizontal forces
2. Fluid compression, distraction
3. Construction of a cage around the patient
4. Placement of an irritant to serve as a kinesthetic reminder 
5. Skeletal fixation. 

Biomechanics of the spine orthosis

• Construction of a cage around the patient, like a thoraco-lumbar brace, increases intraabdominal pressure.
•  Increased intra-abdominal pressure converts the soft abdomen into a semirigid cylinder, which helps to relieve part of the vertebral load 

Orthosis can be divided as:-

• Cervical orthosis
• Head cervical orthosis
• Thoraco-lumbar orthosis
• Lumbo-sacral orthosis
• Orthosis for deformity (scoliosis)

Success of the orthosis may lead to:-

• Decreased pain 
• Increased strength 
• Improved function and posture  
• Correction of spinal curve deformity 
• Protection against spinal instability 
• Minimized complications 
• Healing of ligaments and bones 

IPH REHAB : SPINAL ORTHOSIS ADVANTAGE AND DISADVANTAGE

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Spinal orthosis: 

INTRODUCTION
An orthotic device  is an external device applied on the body to:-

• Limit motion 
• Correct deformity 
• Reduce axial loading
• Improve function in certain segment of the body. 

INDICATIONS:

• Pain relief 
• Mechanical unloading 
• Scoliosis management 
• Spinal immobilization after surgery 
• Spinal immobilization after traumatic injury 
• Compression fracture management 
• Kinesthetic reminder to avoid certain movements 

INTRODUCTION

Duration of orthotic use is determined by the individual situation. 

In situations where spinal instability is not an issue, recommend use of an orthosis until the patient can tolerate discomfort without the brace. 

When used for stabilization after surgery or acute fractures, allow 6-12 weeks to permit ligaments and bones to heal. 

Drawbacks of orthosis:-

• Discomfort 
• Local pain 
• Osteopenia 
• Skin breakdown 
• Nerve compression 

DISADVANTAGE:-

Muscle atrophy with prolonged use. 

Decreased pulmonary capacity .

Increased energy expenditure with ambulation.

Difficulty with transfers. 

Psychological and physical dependency. 

Increased segmental motion at ends of the orthosis. 

Unsightly appearance.

Poor patient compliance. 

Success of the orthosis may lead to:-

• Decreased pain 
• Increased strength 
• Improved function and posture  
• Correction of spinal curve deformity 
• Protection against spinal instability 
• Minimized complications 
• Healing of ligaments and bones