Viewing archives for Completed
Electroencephalograph predictors of central neuropathic pain (CNP) in subacute spinal cord injury
What you need to know
Institution:
Glasgow University
Lead researcher:
Dr. Aleksandra Luckovic
Functional target:
Pain and spasticity
- Central neuropathic pain (CNP) is a term used to describe pain that results from injury to the central nervous system. Common characteristics of CNP include burning, uncomfortable cold, prickling, tingling, pins-and-needles sensations.
- Researchers have used electroencephalography (EEG) – a technique which measures the naturally occurring electrical activity in the brain to – to identify characteristic patterns which can be used to assess a patient’s risk of developing CNP.
- Researchers hope that by identifying these individuals at earlier stages, it may be possible to intervene more effectively and offer preventative treatment.
In a nutshell
Electroencephalography (EEG) is a non-invasive technique that involves the application of electrodes to the scalp, these electrodes are used to record the naturally occurring electrical activity in the brain. The activity typically presents as a series of characteristic patterns which are associated with specific neurological conditions. Currently, EEG is widely used in hospitals to diagnose conditions such as epilepsy. Researchers are now using EEG to investigate new patterns of electrical activity associated with the risk of developing central neuropathic pain.
Over half of all patients with spinal cord injury will develop neuropathic pain and once developed it is particularly difficult to treat and will often remain for life, severely affecting quality of life. Treating neuropathic pain is a challenging task. There is a real need for non-invasive drug-free treatments as CNP stubbornly resists medication, leaving many patients to continue to experience untreatable pain a long time after injury.
Current lines of treatment include anti-seizure drugs, these are commonly used in the treatment of neuropathic pain, however patients have reported unpleasant side-effects including dizziness and drowsiness. Antidepressants and opioids can also work in some cases but there is a danger of dependency and need to be used with caution.
How this supports our goal to cure paralysis.
When paralysis occurs, whether partial or complete, it often involves damage to the spinal cord and nerves. This damage can lead to a breakdown in the normal transmission of signals between the body and the brain.
The nerves affected by the injury may start sending abnormal signals or become hypersensitive, resulting in the sensation of pain that isn’t necessarily triggered by external factors or stimuli. This phenomenon is known as neuropathic pain, and it can affect over 50% of individuals with a spinal cord injury. CNP can significantly impact an individual’s quality of life, as the pain can vary from mild to excruciating, and may consequently interfere with daily activities and sleep.
The benefits of this research for the spinal cord injury (SCI) community are two-fold. Firstly, establishing a standardized diagnostic tool capable of identifying individuals at risk of developing central neuropathic pain, individuals can receive earlier interventions, thus improving clinical outcomes and quality of life. Secondly, researchers are keen to use EEG data to identify treatments that can counteract these EEG signals. This presents potential opportunities to develop more targeted approaches to treatment.
You may also be interested in
Remodelling target-reinnervation following axotomy in a novel human brain organoid-spinal astrocyte-neuron network model
What you need to know
Institution:
Cambridge University
Lead researcher:
Dr. Andras Lakatos
Functional target:
Plasticity and regeneration
Treatment type:
Pharmacological
- Animal studies show promise in spinal cord injury recovery, but differences between animal and human spinal cords pose challenges in translating findings.
- Researchers have developed a “human brain-spinal cord in a dish” model which aims to mimic the complexities of the human nervous system.
- Using this model, researchers will focus on studying the intricate biochemical pathways which influence the formation of neuronal connections, which underpin muscle function, enabling recovery of function.
In a nutshell
Recent results from animal studies have been very promising, with some achieving axonal regrowth, demonstrating a potential for recovery of function following spinal cord injury. However, the spinal cord is significantly different in animals and humans due to the complexities of their anatomical structure, neural organization, and functional capabilities. This poses a significant challenge in translating research findings to humans.
To bridge this gap in translatability, a research team in Cambridge have developed a pioneering model that they are calling a “human brain-spinal cord in a dish”. The model aims to represent the complex cellular environment of the human central nervous system and will allow researchers to study how neuronal connections are made and identifying molecules that can be targeted to promote recovery of function. Researchers are particularly interested in a molecule called ephrin-B1 which interacts with other molecules such as STAT3 and TSP-1 to influence how neurons connect with one another. It is hoped that once researchers can better understand the intricacies of these neuronal pathways, they are able to identify new drug targets that can promote spinal circuit recovery following injury.
How this supports our goal to cure paralysis.
This project uses a human stem cell derived “model in a dish” to understand the complex neuronal pathways that are affected following spinal cord injury. Through investigating these pathways, researchers hope to identify relevant molecules that can be targeted by drugs. This can promote re-connections of neurons which are otherwise damaged as a result of spinal cord injury, re-establishing these lost connections is crucial for muscle function and movement.
Importantly, these experiments use a human model, results are therefore anticipated to be easily translatable to clinical trial stage and therefore quickly available to the spinal cord injury community.
You may also be interested in
Non-invasive spinal cord stimulation combined with activity-based rehabilitation in chronic spinal cord injury
What you need to know
Lead researcher:
Ms Jane Symonds
Functional target:
Upper limb function
Treatment type:
Neuromodulation, Rehabilitation
- The aim of this research was to document both short term and lasting functional changes that could be safely and comfortably achieved through the combination of spinal stimulation and activity based rehabilitation in patients with a C4-T12 spinal cord injury.
- Participants were assessed using various evaluation criteria including the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), the ISNCSCI is a widely used examination tool which allows clinicians and researchers to understand the level and severity of a spinal cord injury.
- Results showed that five out of six participants demonstrated a change in either level of injury or severity of injury when assessed using the ISNCSCI classification.
In a nutshell
This study aimed to assess the effects of transcutaneous electrical stimulation combined with activity-based rehabilitation (ABR) in individuals with a chronic spinal cord injury. Transcutaneous electrical stimulation of the spinal cord (tSCS) was delivered using the ARCEX System (ONWARD Medical). A total of six individuals participated in three, two hour, ABR sessions a week, during which they received at least 45 minutes of transcutaneous spinal cord stimulation (tSCS). Participants each underwent a total of 120 sessions.
The study measured changes across three key domains, (sensory, motor, and autonomic function) using a set of internationally recognized evaluation criteria. These assessments were performed at baseline (prior to intervention), and then repeated after 40 and 120 sessions of rehabilitation.
Residual sensory and motor function was assessed and graded using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Lower extremity motor function was assessed using the NeuroRecovery Scale (NRS), this involved participants undertaking various task-based exercises which researchers scored numerically. Autonomic function was assessed using a set of standardized questionnaires.
The most significant findings were associated with sensorimotor function gains, which were observed after a minimum of 60 sessions of tSCS-ABR. More specifically, results showed that five out of six participants demonstrated a change in either level of injury or severity of injury when assessed using the ISNCSCI classification; and all six participants demonstrated an improvement by at least one phase according to the neuromuscular recovery scale. Researchers hope to replicate these findings in individuals with cervical spinal cord injuries.
How this supports our goal to cure paralysis.
This study’s findings demonstrate that transcutaneous stimulation may be a promising approach to treating spinal cord injuries. Early results indicate that tSCS, when combined with activity-based therapy as the ability to produce tangible improvements in sensory and motor function. By demonstrating changes in injury levels and severity classifications in the majority of participants, it is clear that this combined approach has considerable promise in reshaping the landscape of spinal cord injury rehabilitation and functional recovery
You may also be interested in
Transcutaneous electrical stimulation for recovery of arm and hand function in individuals with cervical spinal cord injury
What you need to know
Institution:
Leeds University
Lead researcher:
Dr. Ronaldo Ichiyama
Functional target:
Upper limb function
Treatment type:
Neuromodulation, Rehabilitation
- Transcutaneous electrical stimulation (tCES) is a non-invasive technique that involves applying electrodes on the skin, these are used to pass electrical currents through the skin to stimulate specific nerves and muscles.
- Previous studies have investigated the safety tCES. These studies not only confirmed safety but also demonstrated improvements in hand strength.
- Researchers are now keen to explore the most effective ways to fine-tune tCES settings and maximize improvement in arm and hand functionality in individuals with cervical spinal cord injuries (cSCI).
In a nutshell
Researchers will investigate the optimum stimulation settings for each individual before combining stimulation with task specific practice on hand and arm function.
Researchers will then record baseline measurements over the course of four weeks across a range of criteria including a measurement tool called GRASSP (Graded and Redefined Assessment of Strength, Sensibility and Prehension test). This involves a trained researcher or clinician who will evaluate and score hand function as the participant is asked to perform various exercises.
Once baseline measurements are completed, participants will undergo upper limb therapy which includes a series of exercises tailored to the individuals’ needs and functional status. This will coincide with participants receiving tCES. During this time, participants will be continually reassessed, up to 3 months after receiving the intervention. Researchers will compare outcome measures before and after tCES, with the aim of demonstrating improved arm and hand function post intervention.
How this supports our goal to cure paralysis.
Injury to the cervical levels of the spinal cord is more common than injury to the lower segments of the spinal cord, thus tetraplegia is more common than paraplegia. Research has revealed that tetraplegics rank regaining arm and hand function as their main priority for rehabilitation, five times greater than bowel, bladder, sexual or lower extremity function. However, despite recent advances made in recovery of ambulatory function, research that strives to uncover how best to optimise arm/hand rehabilitation after SCI remains limited. Identifying and optimizing effective therapies to restore functional arm and hand recovery is an important clinical, economical, social and humanistic goal.
You may also be interested in
Promoting Restoration of Function of Co-ordinated Bladder Storage and Voiding following SCI
What you need to know
Institution:
London Spinal Cord Injury Centre
Lead researcher:
Dr. Sarah Knight
Functional target:
Bowel, bladder, sexual function
Treatment type:
Neuromodulation, Rehabilitation
- Normal bladder function includes a storage phase and a voiding phase, these processes work in a coordinated manner allowing for controlled maintenance of continence, until a socially convenient time.
- After a spinal cord injury, this control is lost, resulting in a profound impact on an individual’s quality of life as well as their physical health due to recurrent urinary tract infections and potential kidney damage.
- Researchers aim to combine transcutaneous spinal cord stimulation (tSCS) with a bladder training programme with a view to restore bladder function.
In a nutshell
Many pelvic functions including the bladder, bowel and sexual organs are controlled by a complex set of neurophysiological interactions which include lumbo-sacral reflexes of the spine. Following a spinal cord injury the pathways associated with these reflexes are disrupted, resulting in a loss of coordinated bladder, bowel, and sexual function.
In an attempt to restore bladder function, researchers will work with twenty individuals who sustained a complete or incomplete spinal cord injury in the past six months. These individuals will be assessed at baseline using a series of questionnaires which examine their symptoms and various aspects of their quality of life.
These individuals will receive transcutaneous spinal cord stimulation which involves the application of electrodes on the skin, positioned over the thoraco-lumbar spinal cord.
Researchers will then work with a group of participants to deliver specialised bladder reflex training techniques. The study will look to see the difference between these participants and a control group who would continue with their usual bladder management routine.
The expectation is that using a combined approach (stimulation plus specialist training) will result in increased bladder capacity and ultimately support voluntary bladder emptying.
How this supports our goal to cure paralysis.
By offering this potential improvement in bladder function, tSCS not only reduces the physical discomfort and inconvenience caused by bladder issues but also contributes significantly to an individual’s sense of independence and overall quality of life.
Transcutaneous spinal cord stimulation is a non-invasive technique which offers hope for enhancing bladder function in individuals with spinal cord injuries The stimulation delivered through tSCS can support communication between the spinal cord and the bladder, potentially restoring some spinal cord injuries (SCIs). This reduces the risks associated with invasive procedures and minimizes patient burden, empowering individuals to manage their condition outside clinical settings.
You may also be interested in
Development of epidural electrical stimulation for bladder control: animal model
What you need to know
Institution:
Leeds University
Lead researcher:
Dr. Ronaldo Ichiyama
Functional target:
Bowel, bladder, sexual function
Treatment type:
Neuromodulation
- Epidural electrical stimulation (EES) describes a technique whereby an electrode is implanted into in the epidural space. This electrode can transmit electrical currents to cause targeted muscle contractions.
- Researchers are using animal models to investigate the effectiveness of EES on the recovery of bladder function in the post-acute and chronic stages of spinal cord injury.
- Preliminary studies have shown that EES paired with bladder rehabilitation is associated with the recovery of certain biological markers associated with bladder function.
In a nutshell
The coordination of bladder muscles is complex. When they get disrupted after spinal cord injury, messages are no longer able to pass between the bladder and brain. Resulting complications include high bladder pressure, incontinence, incomplete emptying and reflux, along with recurrent bladder infections, stones, kidney distension and inflammation and even renal failure. Although current treatments can provide some recovery of function, none are able to fully restore function to its pre-injury condition.
Researchers have conducted a series of studies to better understand the physiological processes underlying bladder function that are affected by post spinal cord injury.
Measuring bladder function in animals is a challenging undertaking. To achieve this, researchers have worked on developing a first-of-its-kind catheter which can be used to measure specific physiological markers, these are (1) bladder pressure and (2) external urethral sphincter contraction.
This has laid the groundwork for further studies which have used mice to investigate the effects of epidural electrical stimulation, combined with a rehabilitation protocol. Early studies have demonstrated an improvement in bladder function in mice 48 hours after injury. Follow-up studies will work on fine tuning bladder training protocols and EES parameters and with a focus on how this procedure can benefit patients with a chronic spinal cord injury.
How this supports our goal to cure paralysis.
Recovery of bladder function has been widely considered one of the top priorities among individuals with SCI. The clinical benefits, and enhancement in quality of life that recovery of such autonomic functions can provide are multifaceted and far reaching. Such recovery could alleviate secondary issues related to bladder management, e.g. urinary infections and autonomic dysreflexia.
With the current advancements in EES implants, researchers are hopeful about swiftly applying this intervention in clinical settings. Collaborative efforts in partnership with major spinal centers are underway with the aim of trialing EES for individuals with SCI. While initial research has primarily concentrated on enhancing locomotion and bowel function, the focus is now expanding to include bladder function.
You may also be interested in
Novel regenerative therapies for restoring sensory function after spinal cord injury
What you need to know
Institution:
King's College London
Lead researcher:
Prof. Elizabeth Bradbury
Functional target:
Bowel, bladder, sexual function
Treatment type:
Pharmacological
- Spinal cord injuries often result in damage to sensory nerve fibers that carry signals from the body to the brain, this can result in impaired bladder, bowel, and sexual function. Researchers are now investigating how damaged sensory nerve fibers can be repaired.
- Studies conducted using animal models, have identified three molecules that are associated with neural regeneration (α9 integrin, kindlin-1 and chondroitinase), specifically for the benefit of upper limb function.
- Researchers now hope to deliver these molecules to additional nerves in the hopes of restoring bladder function. To do this, researchers will investigate the most effective methods for delivering these molecules at a biochemical level. They will then determine which nerves are best suited to receiving these injections.
In a nutshell
Sensory fibers are specialized nerve fibers responsible for transmitting sensory information from the body to the brain. This allows us to recognize certain sensations such as: the need for a bowel movement, bladder fullness, or sexual arousal. Damage to sensory fibers following spinal cord injury can affect various bodily functions, including those related to the bladder, bowel, and sexual activities.
Previous studies using animal models have demonstrated that injecting certain molecules can promote the regeneration of sensory fibers and improve sensory function in the upper limbs. Three molecules have been identified, the first two called α9 integrin and kindlin-1 have been shown to trigger a growth response in the fibers, whilst the third molecule called chondroitinase has shown that it can overcome scar tissue. Researchers will build on these findings to better understand how these same molecules can be delivered to other sensory nerves, responsible for bladder function.
How this supports our goal to cure paralysis.
The wall of the bladder is made up of a collection of muscle fibers which are known as the detrusor muscle. Muscle fibers are woven together in a way that allows the bladder to stretch and contract in response to the presence of urine.
To coordinate this activity, nerves send messages via the spinal cord to various muscles, including the detrusor muscle in the bladder. In individuals with spinal cord injury, these signals are disrupted due to damaged nerve fibers. Researchers hope that their work can allow for the regeneration of these nerve fibers to restore bladder function, ultimately allowing individuals to regain their dignity and independence.
You may also be interested in
