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| Admin: Hello all and welcome to the first Gaylord Chat. Today, welcome Dr. Naomi Kleitman and Dr. David Rosenblum answering questions on spinal cord injury. Susan: I have heard that the nerves in the spinal cord can regenerate. How soon before they start human clinical trials? Naomi, Ph.D: Hello, Susan. To answer that question, we have to get a little more specific. What have you heard? Susan: I have heard about schwann cells regenerating. Naomi, PhD: We have had some real successes, but it is a progression. By combining the cells with growth-promoters we have gotten thousands of nerves growing. We're now working on getting those nerves to their targets. Susan: Thank you for answering my question. Ikema: Hello. Janet: How many new spinal cord injuries occur each year? Naomi, Ph.D.: The best estimate we have is about 10,000 in the U.S. alone. There aren't good numbers worldwide, probably over a million per year. Fran: How long can heterotopic ossification last? What can it affect? Janet: I understand that most of those injured are men…Is that true? Naomi, Ph.D: Janet, yes about four out of every five injuries in the U.S. are in men. Ikema: Dr. Naomi, could you explain where current efforts are at in regards to bio-genetic work and the possibility of cloning a person's spinal cells to possibly replace damaged cells? Susan: Once someone has become paralyzed, do they still feel any sensations or pain? Naomi, Ph.D: Looking back at my earlier answer about worldwide, I mis-typed. I think the number worldwide is as high as 100,000, not 1,000,000 per year. David, MD: Fran, heterotopic ossification is the formation of bone where it should not be-usually around joints such as the hip. It can cause decreased range of motion, and sometimes pain. It does not resolve on its own. Fortunately, most cases do not require surgical removal. Naomi, Ph.D: Ikema, the cloning technology at the cellular level is very promising. We are learning that cells can be put into the brain and spinal cord, and mature there. We have to differentiate that from "cloning people." And we're still learning how to teach the "cloned" cell lines to become the types of cells we need. Naomi, Ph.D: Thank you all in the cyber-world for being a bit patient with the delay. You are asking good questions and it takes a second for us to type in an adequate answer! David, MD: Susan, it depends on how sever the spinal cord injury is. Some people have mild injury, with some weakness and some decreased sensation for example. If the cord is severed, there is no feeling such as light touch. However, there can be pain even in those who cannot feel or move. Jeff D: Hi, this is Jeff. Susan: Are there any studies underway on how to reduce the pain experience after injury? Ikema: Yes, I understand how the public perception can be one of fear when new technologies are involved. My hope is that the scientific community isn't swayed away from research because of those fears. Naomi, PhD: Any more questions, or do you want follow-up? Ikema: Follow up :-) Naomi, PhD: Ikema, there are concerns in the public about "cloning people" that are not shared by scientists who use the term to refer to cells in laboratory dishes. Public concerns can, however, block research if the government bans us of embryonic tissues, etc. We have to let them know how important the work is. David, MD: Susan, yes there are studies evaluating pain and its treatment. For example, there are medications being studied for the treatment of "central pain," or nerve-type pain, in spinal cord injury. Ikema: Oops. I apologize for the repetition. Fran: What is FES? Janet: I understand that the Miami Poject is conducting studies for men who are spinal cord injured who are having difficulty fathering a child. How well is this study progressing and are you having much success? Ikema: thank u Dr. Naomi, PhD: That's ok! Anything more than a 2-sentence answer takes a minute to type, but we appreciate the questions ;-) Jeff D: What is FES? David, MD: Fran, FES stands for Functional Electrical Stimulation. This refers to electrically stimulating the muscles to cause movement. Naomi, PhD: Janet, the research on fathering children has had great success. They are helping dispel old preconceptions (men CAN father children) and also we are learning what's going wrong in the first place. Fran: How would that improve my function or muscle strength. Ikema: Dr. Dave, have there been any developments of FES for upper body muscle groups for higher level quads? Say for example c4/5 specifically arms or tricips? Naomi, PhD: Janet, the "what's going wrong" turns out to be functions of organs like the prostate gland that contribute to seminal fluids. We hope that learning to correct these problems will allow for much less complex medical procedures to help men with SCI father children. Jeff D: Naomi, PhD, what type of research do you believe will ultimately lead to the solution of SCI? Fran: How can heterotopic ossification affect the use of an FES bike? David, MD: Fran, by electrically stimulating the muscle, it will contract. It will not help return voluntary movement. It can be used functionally, for example, with a specially designed bike for people who cannot cycle. Naomi, PhD: Jeff, I believe that it is going to take a joint effort and several approaches. Anyone who's experienced SCI or worked with SCI persons knows not to underestimate the complexity of its effects. David, MD: Ikema, there is a system called the "Free Hand" system which uses implanted elecrtordes to certain muscles to improve activities such as grasp. David, MD: Fran, the FES bike requires a specific amount of range around the hip and knees. Heterotopic ossification can limit that range and limit one's ability to use the bike. Jeff D: Naomi, PhD, which technology IS moving the fastest: physical or mechanical? Ikema: Dr. Dave, how about FES exercising systems for the upper body or more specifically the arms? Naomi, PhD: Jeff, the therapies to improve rehab are definitely having the most effect TODAY. The ones to protect the nervous system after acute injury are probably next. The basic science of cell transplants is "moving" very fast, but it's further from clinical application. Wings: In someone who is 5 years post injury (T 10-12 incomplete) with no specific problems are there things that should be checked as preventive maintenance? Jeff D: How WILL the hospitals decide to "cure" patients once a cure is found? In what order? David, MD: Wings, your routine medical needs are similar to others without spinal cord injury for your age. In addition, routine evaluation of the urinary system is often important for those who catheterize. You should discuss routine immunizaitons (such as the flu shot) with your doctor as well. Fran: Naomi, will arm ergometry be the next step in a production type FES arm ergometer? Naomi, PhD: Jeff, the type of treatment that goes to clinical trials will decide that, mainly. Some people think safety is best, and mid-thoracic injuries have "less risk" but some say cervical injuries have more chance of showing functional changes with a few centimeters of nerve growth. We really don't know for sure yet. Naomi, PhD: Fran, the arm ergometer developed at the Miami Project uses FES to stimulate triceps contractions. We have published the schematics to adapt standard equipment. If it proves very workable, an entrepreneur may want to market something like it. Wings: Thanks, Dr. If the urninary system is working fine and UTI's are rare (less than once a year) what evaluations might be appropriate for someone who is 40ish? Fran: Is the video of Naomi, PhD: Fran, try again. Fran: Is the video of C Reeve really indicative of walking or just some kind of reflex activity? PeggyQ: Naomi, yesterday you showed a slide demonstrating regeneration of the rat's spinal cord after a section had been removed. Did the rate get any function back after the regeneration and to what degree, if any? Janet: Dr. Naomi, what is the success rate for men attempting to father a child under the study that the Maimi Project is conducting? Jeff D: Will the part of a person with SCI whose muscles don't have any spasticity be able to be "brought back to life"? Naomi, PhD: The video shown on TV shows Christerpher Reeve suspended over a treadmill, with his legs moving in a walking pattern. This is consistent with what we call a "spinal rhythm generator," a complex type of reflex activity…(more coming…) Naomi, PhD: The spinal rhythm generator can be "trained" and strengthened by use. Persons with incomplete injuries are being tested now to see if it can improve their walking. Fran: Is it functional? David, MD: Wings, you should discuss the urinary system with your doctor even if you believe it is "fine" because it also is important to know more about the bladder. Issue relating the bowel management, skin protection and monitoring, and reassesment of the appropriateness of any equipment is also important. A functional assessment is important as well… Naomi, PhD: PeggyQ, good question. I didn't address that. The legs did move better, but that might be the good old "rhythm generator." We hope to restore voluntary movement, but it's difficult to prove. We're working on that now. Naomi, PhD: Janet, I'm coming to you… Janet: Thank you. I know you're busy. Wings: Thanks. What kind of functional assessment and what would be the recommended frequency? David, MD: Jeff, could you please repeat your question about muscles? Fran: Dave, what can you tell me about clearing secretions from the respiratory tract without suctioning. Is there anything new out there? Naomi, PhD: Janet, at the Miami Project, the success rate has been high. 28 babies have been born and sometimes to men who had very low sperm counts. We have an advantage of being a research institute and can try some proceudres more often than clinics might be able to. The information from the labs is helping the clinicians improve their techniques though. Jeff D: Will the part of a person with SCI whose muscles don't have any spasticity be able to be "brought back to life?" Janet: Is this procedure only being done at the Miami Project? Naomi, PhD: The procedures being used at the Project are available clinically. They include vibratory and electrical stimuli, We have worked on studies to show how best these can be used. (more to come) Peggy Q: After regeneration should the paralysis feeling go away to be more normal feeling? Naomi, PhD: The vibrator can't be used by all men because of sensory responsiveness. But the electrical stimuli have been shown to kill more sperm, so it's important to continue research on "best techniques" as Dr. Brackett is doing. Ikema: Dr. Naomi, with all the research being conducted over a vast amount of facilities, how is lab "A" keeping up with lab "B" as to keep overall research efficiency optimum? And how does the Miami Project fit in with this? PeggyQ: After regeneration should the paralysis feeling go away to be more normal. Fran: Prognostically is it better to have an incomplete or a complete injury? Naomi, PhD: PeggyQ, any regeneration therapy we try will also be aimed at restoring more normal sensation or to eliminate pain caused by the neural damage. We're working on both. Janet: Thank you, Naomi. David, MD: Fran, the muscles that help us cough, or clear secretions, can be weak after spinal cord injury. Interventions such as suctioning, turning/increasing mobiity, and having someone do an "assisted cough" (with help from someone else) can be very helpful. There is a device which we have found very effective for the right individual. I can help someone take a good deep breath and then it helps the person cough. Appropriately, it's called the coughalator. Naomi, PhD: Ikema, we meet throughout the year at scientific meetings and invited lectures. Most importantly, we publish our results so others can evaluate and repeat them to be sure they work as we hink they do. Naomi, PhD: They tell me to tell you we're down to 5 min… PeggyQ: Do you think there is hope to generate foot drop. David, MD: Fran, it is better prognostically to have an incomplete injury-that means that there is some movement/sensation below the level of injury. Naomi, PhD: As to the Miami Project fitting in, we are involved in many scientific collaborations, both national and international. It's actually a very exciting time to be in this field! Jeff D: How can I receive a list of programs at the Maimi Project in order to suite my personal goals? Naomi, PhD: PeggyQ, yes there's hope for all the muscle groups. Weakness in the muscle that causes "foot drop" has been a toughie. But ther's no reason we should lose hope on it. Fran: Thank you, Dave. Naomi, PhD: Jeff, the Miami Project's website (www.miamiproject.edu) has a description of many of our programs, or you can call 1-800 STAND UP and we'll send info. Ikema: Thanks Dr. that is encouraging news! Jeff D: Thank you for your help! David, MD: If anyone has any additional questions or comments, please e-mail them to lcrispino@gaylord.org and we will respond as soon as possible! Thank you for joining us! Naomi, PhD: Thanks to everyone for logging in. This has been a bit challenging to keep up, but a great exchange. Fran: Thank you all for your participation at the conferences and this chat room. It is great to share this kind of information and support. Ikema: J thank you Admin: Thank you all for participating in this excellent discussion. Thanks for a very informative chat. Feel free to stick around for awhile and continue chatting. Thanks again and we look forward to seeing you next time. |
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