Passive activity enhances residual control ability in patients with complete spinal cord injury

Patients with complete spinal cord injury retain the potential for volitional muscle activity in muscles located below the spinal injury level.However,because of prolonged inactivity,initial attempts to activate these muscles may not effectively engage any of the remaining neurons in the descending pathway.A previous study unexpectedly found that a brief clinical round of passive activity significantly increased volitional muscle activation,as measured by surface electromyography.In this study,we further explored the effect of passive activity on surface electromyographic signals during volitional control tasks among individuals with complete spinal cord injury.Eleven patients with chronic complete thoracic spinal cord injury were recruited.Surface electromyography data from eight major leg muscles were acquired and compared before and after the passive activity protocol.The results indicated that the passive activity led to an increased number of activated volitional muscles and an increased frequency of activation.Although the cumulative root mean square of surface electromyography amplitude for volitional control of movement showed a slight increase after passive activity,the difference was not statistically significant.These findings suggest that brief passive activity may enhance the ability to initiate volitional muscle activity during surface electromyography tasks and underscore the potential of passive activity for improving residual motor control among patients with motor complete spinal cord injury.

Long-term clinical observation of patients with acute and chronic complete spinal cord injury after transplantation of Neuro Regen scaffold

Spinal cord injury(SCI)often results in an inhibitory environment at the injury site.In our previous studies,transplantation of a scaffold combined with stem cells was proven to induce neural regeneration in animal models of complete SCI.Based on these preclinical studies,collagen scaffolds loaded with the patients’own bone marrow mononuclear cells or human umbilical cord mesenchymal stem cells were transplanted into SCI patients.Fifteen patients with acute complete SCI and 51 patients with chronic complete SCI were enrolled and followed up for 2 to 5 years.No serious adverse events related to functional scaffold transplantation were observed.Among the patients with acute SCI,five patients achieved expansion of their sensory positions and six patients recovered sensation in the bowel or bladder.Additionally,four patients regained voluntary walking ability accompanied by reconnection of neural signal transduction.Among patients with chronic SCI,16 patients achieved expansion of their sensation level and 30 patients experienced enhanced reflexive defecation sensation or increased skin sweating below the injury site.Nearly half of the patients with chronic cervical SCI developed enhanced finger activity.These long-term follow-up results suggest that functional scaffold transplantation may represent a feasible treatment for patients with complete SCI.

Influence of the intelligent standing mobile robot on lower extremity physiology of complete spinal cord injury patients

Background:Spinal cord injury(SCI)remains a high rate of disability.In order to improve the quality of their lives,the application of robots in rehabilitation is increasing.However,few studies have assessed the applicability and the effect of robots in patients with complete injury.Objective:The current study aims to assess the efficacy of robots training on the lower extremity physiology in complete SCI patients.Methods:24 patients were recruited and randomly divided into experimental and control group.The two groups spent the same amount of time on regular training.Besides,a 1-h standing training twice daily was offered to both groups five days per week,for four weeks.The experimental group used robot for standing training,while the control group used standing frame.Before and after the experiment,muscle girth and bone mineral density(BMD)were measured as lower extremity physiology.Results:The experimental group showed increased muscle girth differences(left=0.08±0.40 cm,right=0.75±0.72 cm),while the control group showed decreased girth differences(left=-0.78±0.54 cm,right=-0.56±0.54 cm).The increases in the experimental group showed significant differences compared with the control group(left,P=0.0002;right,P=0.023).Both groups showed decreased BMD.The decreases in the experimental group were significantly smaller than those in the control group.Conclusions:Training with aid of robots combined with the regular rehabilitation treatment can benefit complete SCI patients,in aspect of postponing amyotrophy of lower extremities and reducing bone loss and osteoporosis.

Allotransplantation of adult spinal cord tissues after complete transected spinal cord injury: long-term survival and functional recovery in canines

Spinal cord injury(SCI), especially complete transected SCI, leads to loss of cells and extracellular matrix and functional impairments. In a previous study, we transplanted adult spinal cord tissues(aSCTs) to replace lost tissues and facilitate recovery in a rat SCI model. However, rodents display considerable differences from human patients in the scale, anatomy and functions of spinal cord systems, and responses after injury. Thus, use of a large animal SCI model is required to examine the repair efficiency of potential therapeutic approaches. In this study, we transplanted allogenic aSCTs from adult dogs to the lesion area of canines after complete transection of the thoracic spinal cord, and investigated the long-term cell survival and functional recovery. To enhance repair efficiency, a growth factor cocktail was added during aSCT transplantation, providing a favorable microenvironment. The results showed that transplantation of a SCTs, in particular with the addition of growth factors, significantly improves locomotor function restoration and increases the number of neurofilament-, microtubule-associated protein2-, 5-hydroxytryptamine-, choline acetyltransferase-and tyrosine hydroxylase-positive neurons in the lesion area at 6 months post-surgery. In addition, we demonstrated that donor neurons in a SCTs can survive for a long period after transplantation. This study showed for the first time that transplanting aSCTs combined with growth factor supplementation facilitates reconstruction of injured spinal cords, and consequently promotes long lasting motor function recovery in a large animal complete transected SCI model, and therefore could be considered as a possible therapeutic strategy in humans.