Improving Spinal Cord Injury Rehabilitation Interventions by Retraining the Brain
Abstract
WHAT PATIENTS WILL THE PROJECT HELP, AND HOW WILL IT HELP THEM? Spinal cord injury (SCI), a common cause of devastating paralysis, carries some sobering statistics: SCI affects nearly a million people in the United States (U.S.) alone. Of these, some 150,000 are U.S. Veterans, according to the Christopher & Dana Reeve Foundation. Almost 12,000 new cases are added each year, following road-vehicle and military service-related injuries. SCI patients often lose feeling and movement in the upper body and all four limbs. They must then depend on family members and caregivers to meet every personal need, from feeding, bathing/toileting, and dressing to participating in family and community activities. SCIs mostly occur in adults between the ages of 28 and 43, in what would normally be their most productive years. The lifetime costs of managing such a disability are staggering: about $4.7 million per patient. In this project, three healthcare centers will test a new nonsurgical approach to help SCI patients (veterans and civilians) more quickly regain some of their lost functions. REASONING BEHIND THE STUDY. The proposed study is based on a new concept of harnessing the brain s ability to change, its "plasticity." In pilot studies, we have already found a way to "recruit" spared nerve cells from brain pathways that are still working to help SCI patients reach a maximum level of recovery. After an SCI, the brain tends to put more force into stronger muscles and less into the weakened ones affected by the injury. We reason that targeting these spared nerves/pathways with mild electrical currents from atop the skull can re-establish the brain s memory of the paralyzed muscles. This "jump-starts" the communication and sprouting of the remaining nerve pathways that bypass the injured area and can instruct the paralyzed muscles below the level of the SCI to move again. For over 10 years, the investigator s team has shown the promise of applying noninvasive brain stimulation using weak electrical and/or magnetic currents. Applied currents can potentially restore activity of targeted brain regions and spared nerve pathways, calling forth some function in the paralyzed limbs. In a pilot study, the team showed that applying this kind of brain stimulation at the same time as patients pursued a course of physical rehabilitation exercises led to gains in strength of the paralyzed limbs twice as great as their doing exercises alone. In this project, the investigators hope to see whether these promising results can be repeated when other study teams perform the same study at other sites, and if the positive effects restoring use of muscles are seen in different clinical settings. The proposed multi-site clinical trial is designed to reveal the potential for noninvasive brain stimulation to be used in a variety of SCI clinics. IMPACT OF THE STUDY AND TIME FRAME TO FIND WHETHER THE APPROACH LEADS TO IMPROVEMENTS. The proposed approach of noninvasive brain stimulation is, we believe, a simple, safe, and affordable technique to restore upper-body function after SCI. This method can be delivered during standard rehabilitation, with no need for additional time or resources; it has the potential to become an easily applied, cost-effective, practical tool that can easily be offered at a number of sites. Also, since our evidence indicates that this technique can help generate promising gains in rehabilitation within a short time, it also has the potential to substantially reduce the costs of managing disability in SCI. POTENTIAL BENEFITS AND RISKS OF THE PROJECT. To improve their quality of life, the Number 1 wish of most SCI patients is to get back some use of their upper body and limbs to allow them to act independently. We believe our approach will help solve this significant unmet clinical need; it is low-cost, can be safely applied in those without other health complications, and it can be used in many rehabilitation locations. By combining ph
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810530
Entities
People
- Ela Plow
Organizations
- Cleveland Clinic
- United States Army