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Spinal Cord Injury: Progress, Promise, and Priorities
and clinical neuroscience research, trauma surgery, health care, biomedical engineering, clinical research methods, and research management.
This report by the IOM Committee on Spinal Cord Injury provides a broad overview of the current status of spinal cord injury research, examines the research and infrastructure needs, and provides recommendations for advancing and accelerating progress in the treatment of spinal cord injuries with particular attention to issues regarding translational research. The committee also addresses the contributions that the New York State program can make to complement the scientific efforts of other state, federal, and private supporters of research in this area.
DEFINING A CURE
Defining what constitutes a “cure” is an integral part of discussions on future directions for spinal cord injury research. In large part, the general public’s perception of a cure for spinal cord injury has been the restoration of motor function, that is, restoration of the ability to walk. However, a spinal cord injury affects many systems and functions of the body that are vital to the health and well-being of the injured person. Neural control of motor, sensory, autonomic, bowel, and bladder functions is compromised, often leading to pain, pressure sores, infection, and diminished physiological well-being.
After carefully considering input from the community of individuals with spinal cord injuries, researchers, and clinicians, the committee decided to take a broad approach to “defining a cure” and to frame its definition around alleviating the multiple disabilities that result from spinal cord injury.
Spinal cord injury research should focus on preventing the loss of function and on restoring lost functions—including sensory, motor, bowel, bladder, autonomic, and sexual functions—with the elimination of complications, particularly pain, spasticity, pressure sores (decubitus ulcers), and depression, with the ultimate goal of fully restoring to the individual the levels of activity and function that he or she had before injury.
By setting forth a set of goals for spinal cord injury research, the committee wishes to emphasize the different stages of the injury during which interventions are needed and the multiple health impairments that affect an individual’s daily quality of life and that require the development of effective therapeutic interventions.
IDENTIFYING RESEARCH DIRECTIONS
Spinal cord injury results in a cascading biological response ranging from the changes in blood pressure and blood volume and hypoxia (reduc-