INDEX

A

Action potentials, 39, 48

Activities of daily living

outcomes by level of injury, 15–19

See also Functional outcomes

Acute care

clinical practice guidelines, 96

current state of, 25, 95

decompression of spinal cord, 98–99

during transport, 97–98

effectiveness, 97

goals, 23

immobilization, 97

informed consent issues, 160–161

at injury scene, 97

neuroprotective interventions, 99–100

research needs, 98

research prospects, 25

research recommendations, 5, 143

scope, 97

strategies, 122–125

targets of intervention, 122–123

Acute phase of injury, 36, 39–40

animal models, 68

research prospects, 25

Age at injury, 14

costs of injury and, 20–22

Alternative therapies, 275–277

Ambulation

outcomes by level of injury, 17, 19

See also Movement

American Association of Neurological Surgeons, 96, 192

American Paralysis Association, 192

American Paraplegia Society, 192

American Spinal Injury Association (ASIA), 32, 191–192

Impairment Scale, 34, 35, 168

4-Aminopyridine, 133, 161, 174

Amyotrophic Lateral Sclerosis Functional Rating Scale, 171

Animal models, 10, 64

assessment techniques, 74–76

generalizability, 70–73

primates, 73

rationale, 65, 66

recommendations for research, 88–89

research needs, 73–74

selection, 66–69

standardization, 70, 73–74, 88

training for research using, 74, 88

transgenic, 87

for validation of new therapies, 154–155

Apoptosis

biomarkers, 77–78

interventions to prevent, 123, 125–126

spinal cord injury pathophysiology, 2–3, 42–43, 125



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Spinal Cord Injury: Progress, Promise, and Priorities INDEX A Action potentials, 39, 48 Activities of daily living outcomes by level of injury, 15–19 See also Functional outcomes Acute care clinical practice guidelines, 96 current state of, 25, 95 decompression of spinal cord, 98–99 during transport, 97–98 effectiveness, 97 goals, 23 immobilization, 97 informed consent issues, 160–161 at injury scene, 97 neuroprotective interventions, 99–100 research needs, 98 research prospects, 25 research recommendations, 5, 143 scope, 97 strategies, 122–125 targets of intervention, 122–123 Acute phase of injury, 36, 39–40 animal models, 68 research prospects, 25 Age at injury, 14 costs of injury and, 20–22 Alternative therapies, 275–277 Ambulation outcomes by level of injury, 17, 19 See also Movement American Association of Neurological Surgeons, 96, 192 American Paralysis Association, 192 American Paraplegia Society, 192 American Spinal Injury Association (ASIA), 32, 191–192 Impairment Scale, 34, 35, 168 4-Aminopyridine, 133, 161, 174 Amyotrophic Lateral Sclerosis Functional Rating Scale, 171 Animal models, 10, 64 assessment techniques, 74–76 generalizability, 70–73 primates, 73 rationale, 65, 66 recommendations for research, 88–89 research needs, 73–74 selection, 66–69 standardization, 70, 73–74, 88 training for research using, 74, 88 transgenic, 87 for validation of new therapies, 154–155 Apoptosis biomarkers, 77–78 interventions to prevent, 123, 125–126 spinal cord injury pathophysiology, 2–3, 42–43, 125

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Spinal Cord Injury: Progress, Promise, and Priorities Assessment biomarker applications, 77–79 of complications of spinal cord injury, 76 experimental models, 65 of functional outcomes of spinal cord injury, 74–76 imaging technologies, 83–88 injury classification, 32–36 injury outcomes, 260–267 pain, 53 recommendations for research, 89 research needs, 8, 10 standardization of outcome measures, 168–172, 178–179 technical development, 64 Astrocytes, 37 in glial scarring, 43 Atrophy, muscle, 112 Autonomic dysreflexia, 105 Autonomic nervous system motor function and, 48 research goals, 2, 24 Axon anatomy and function, 31 embryonic development, 130 spinal cord pathophysiology, 43 Axonal regrowth, 3 animal models, 65–66, 70, 71–73 barriers to, strategies to remove, 127–129 cell transplantation to promote, 132, 135–136 combination therapies to promote, 140–141 environmental conditions for, 45–46, 129 gene therapies to improve, 130–132 glial scarring in inhibition of, 43–45, 127 guidance, 129–130 in vitro studies, 65 macrophage therapy to improve, 123 molecular processes, 65 muscle spasticity and, 52 neurotrophic factors to promote, 135 pain outcomes and, 101–102 research needs, 58 research recommendations, 4, 8, 143 restoration of impulse conduction, 133–134 spontaneous healing, 47 strategies for promoting, 129 synaptic connections, 129 tissue scaffolding to promote, 132 Axon anatomy and function, 31 embryonic development, 130 spinal cord pathophysiology, 43 B Baclofen, 102 Basal ganglia, 48 Basso, Beattie, and Bresnahan (BBB) scale, 74–76, 260 Basso Mouse Scale (BMS), 74–76, 260–261 Bathing abilities, 17, 19 Bed mobility, 16, 18 Biomarkers, 8, 89 applications, 77–79 current technology, 77 future prospects for research, 81–83 in imaging technologies, 85–87 Bladder function, 105 anatomy, 55 outcomes by level of injury, 16, 18 pathophysiology, 55–56, 103 research goals, 2, 24 therapeutic interventions, 103–104, 110–111 types of dysfunction, 103 Blood pressure, spinal cord injury and, 39 Body weight support training, 108–110 Bone disorders, 107 Bowel function, 104, 105 outcomes by level of injury, 16, 18 pathophysiology, 56–57 research goals, 2, 24 Brain-derived neurotrophic factor, 126 Brain stem, motor function, 48 Bryon Reisch Paralysis Foundation, 191 Buoniconti Fund to Cure Paralysis, 191 C C fibers, 56 Calcium, intracellular, 126 in apoptosis, 42–43 in spinal cord injury pathophysiology, 41 California, 213, 223–227 Reeve-Irvine Research Center, 6, 155, 224 stem cell bill, Proposition 71, 226–227

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Spinal Cord Injury: Progress, Promise, and Priorities Calpain, 125 Caspases, 125 CAT scan. See Computed tomography Cauda equina, 55 Causes of spinal cord injury, 14–15 Cells cell-based therapeutic interventions, 3, 123, 135–140 endothelial, 38, 39 glial, 65 meningeal, 43 olfactory ensheathing, 136, 157 pathiophysiology of spinal cord injury, 36–39 Schwann, 37, 45, 65, 133, 135–136 T-lymphocytes, 38, 41, 42, 123 transplantation, 132, 135–149 See also Apoptosis; Neuron function; Stem cell therapies Center for International Blood and Marrow Transplant Research, 175 Centers for Disease Control and Prevention, 188–189 Central pattern generator, 50 Cerebellum, motor function, 48 Cerebral cortex central pattern generator and, 50 motor control, 48 in pain experience, 55 Cervical spine, 32 Chondroitin sulfate, 65, 127–128 Chondroitinase ABC, 128 Christopher Reeve Clinical Trials Network, 171, 176, 192 Chronic phase of injury, 36, 43–45 clinical practice guidelines, 96 treatment strategies, 127–135 Circulatory system acute response to spinal cord injury, 39–40 autonomic dysreflexia, 105 thromboembolism risk, 102–103 Classification of injury, 32–36 of pain, 53 Clinical trials challenges in spinal cord injury research, 160–162 clinician expertise, 164 collaborative multicenter studies, 164–167 coordination with care resources, 167–168 criteria for entering into, 154 future prospects, 159 historical review, 278–319 industry involvement, 172–174 informed consent issues, 160–161 interpretation of results, 172 patient recruitment, 161–162 phases, 153 purpose, 152–153 quality of past studies, 156–157 recommendations, 11, 12, 178–179, 239 research opportunities, 8–9 small population studies, 162–164, 179 spontaneous recovery in, 162 standardization of outcome measures, 168–172 Clip compression, 68 Collaborative research centers of excellence for, 195, 196–197 clinical trials, 164–167 to develop imaging technology, 88 international efforts, 193–194 network for, 195, 197–199 rationale, 5, 8–9 recommendations, 11, 239 strategies for enhancing, 195–199, 230 Combination therapies, 3 challenges to development, 141 current state, 140–141 neurotrophic factors in, 127 rationale, 140, 141 research recommendations, 5, 8, 10, 141, 143 Communication abilities, spinal cord injury and, 17, 19 Completeness of injury, 20, 34–35 Compression injury animal models, 68–70 decompression interventions, 98–99 Computed tomography, 84 Computed tomography (CT/CAT scan), 83 Congress of Neurological Surgeons, 96, 192 Consortium for Spinal Cord Medicine, 96, 193 Consortium of Multiple Sclerosis Centers, 175 Contusion injuries, 32 animal models, 68

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Spinal Cord Injury: Progress, Promise, and Priorities Corticospinal tract, 48 Corticosteroid therapy, 166 Cost of research, 173 federal spending, 184–190 infrastructure construction, 213–214 state spending, 205, 206, 207, 208–209, 216 Costs of spinal cord injury, 20–23 Cure, defining, 2, 23–24 Cyclic AMP, 129, 140–141, 223 Cyclosporin A, 123 Cytokines, 42 D Data collection and management, 174–178, 190 Decompression of spinal cord, 98–99 Decubitus ulcers. See Pressure sores Demographic characteristics of spinal cord injury victims, 14–15 Department of Education, U.S., 189–190 Department of Veterans Affairs, U.S., 6, 189 Depression research goals, 2, 24 risk, 107–108 treatment, 108 Dermatomes, 33 Detrusor muscle, 55–56, 103–104 Dorsal horn, 32 Dressing abilities, 17, 19 Dysesthesia, 53 E Early Detection Research Network, 82–83 Eating function, 16, 18 Edema, 40 acute intervention, 122 spinal cord injury pathophysiology, 2–3 Education and training for research, 9 animal studies, 74, 88 clinical trials expertise, 164 federal support, 186–187 rationale for expanding, 200–201 recommendations, 10, 11–12, 201 trends, 200 Endothelial cells, 38, 39 Ephrins, 130 Epidemiology, 1, 14 Epilepsy, 184 Erectile dysfunction, 106 Erythropoietin, 126 Ethical issues, 156 Excitotoxicity, 39 F F30 fellowships, 200 F31 fellowships, 200 Facilities of Research Excellence in Spinal Cord Injury, 155, 187 Fampridine, 102 Fas protein, 77–78 Feedback systems movement control, 49–50 in muscle spasticity, 52 Fibroblast growth factor, 126 Fibroblasts, 70 Florida, 191, 207, 219–221 See also Miami Project to Cure Paralysis Food and Drug Administration, U.S., 153, 179, 223 Free radicals, 42 formation after injury, 40–41 intervention to prevent formation of, 123 Functional electrical stimulation applications, 110 bladder dysfunction treatment, 110–111 with body weight support training, 109–110 clinical acceptance of, 112–113 future prospects, 113–114 lower-extremity, 111–112 to maintain muscle fitness, 112 mechanism of action, 110 upper-extremity, 111 Functional magnetic resonance imaging, 83–84 Functional outcomes hypothermia treatment, 125 level of injury and, 15–20 measurement, 168, 260–267 neurobiology, 47–58 recommendations for research, 89 research goals, 2, 24

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Spinal Cord Injury: Progress, Promise, and Priorities G Gamma-aminobutyric acid (GABA), 102 Gene expression, 36 biomarkers of spinal cord injury progression, 77–79 research protocols, 83 Gene therapy gene delivery techniques, 131 gene types in, 131 outcomes, 132 to promote neuronal repair, 130–132 rationale, 130–131 Genetics, generalizability of animal research, 70–71 Geoffrey Lance Foundation for Spinal Cord Injury Research and Support, 191 Glial cells, 65 Glial circuitry, 4 Glial-derived neurotrophic factor, 126 Glial scarring, 3 as barrier to axonal regrowth, 43–45, 127 therapeutic interventions, 127–128 Glucose metabolism, 86 Glutamate, 40 in apoptosis, 126 neuroprotective blocking of, 126 GM-1 ganglioside, 99 Gray matter, 32 acute response to spinal cord injury, 40 Grooming abilities, 17, 19 Growth cones, 65 Growth factors, 126 gene therapy to promote expression of, 131 in neuronal regeneration, 47 in spinal cord injury pathophysiology, 42 H Hand control, 111 Health Insurance Portability and Accountability Act (HIPAA), 177 Heparin therapy, 103 Heterotopic ossification, 107 Home modification costs, 20 Hyperesthesia, 53 Hypothermia, therapeutic, 124–125, 161 Hypoxia, 2–3, 39 I Imaging technology clinical applications, 87–88 computed tomography, 83, 84 functional magnetic resonance imaging, 83–84 future prospects, 85–87 magnetic resonance imaging, 83, 84, 85 modalities, 83–85 positron emission tomography, 83, 85, 86 recommendations for research, 89 Immune function acute care interventions, 123–124 spinal cord injury pathophysiology, 41–42 Indiana, 191, 207 Informed consent, 156–157, 160–161, 176–177 Injury prevention, 23 Inosine, 129 Institutional review boards, 165–167, 178 Interleukins, 77–78 International Campaign for Cures of Spinal Cord Injury Paralysis, 193–194 International Collaboration on Repair Discoveries, 170, 194 International Spinal Research Trust, 159, 168, 171, 194 Ion channel function, 39, 43, 133 in apoptosis, 126 in muscle spasticity, 52, 133 in pain pathophysiology, 55 response to axon demyelination, 133 in sensory neuron hyperexcitability, 102 therapeutic interventions targeting, 133–134 Ischemia, 40 acute intervention, 122 K Kentucky, 207, 216–219 Kentucky Spinal Cord Injury Research Center, 6, 191, 217–219 L Laceration injuries, 32 Length of hospital stay, 20

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Spinal Cord Injury: Progress, Promise, and Priorities Level of injury, 15–20, 32 sensory and motor levels, 32–34 Limbic system, 57 Lipid peroxidation, 40, 41 Lumbar spine, 32 M Macrophage therapy, 123 Magnetic resonance imaging (MRI), 83, 84, 85. See also Functional magnetic resonance imaging MAP kinase, 102 Maryland, 191, 208 Medical industry. See Pharmaceutical and medical device industry Medications acute care, 98, 123–124 apoptosis inhibitors, 125 biomarkers to study effectiveness of, 86 bladder dysfunction treatment, 104 combination therapies, 140–141 costs, 20 immunosuppressant drugs, 123–124 to improve nerve conduction, 133 incentives for research, 173–174 neuropathic pain treatment, 100–101 research and development process, 152–154, 173 sexual dysfunction, 106, 107 sodium channel regulators, 133–134 spasticity treatment, 102 thromboembolism prevention, 103 Meningeal cells, 43 N-Methyl-D-aspartate, 86 Methylprednisolone, 99, 159, 269–272 Miami Project to Cure Paralysis, 6, 155, 191, 213, 220–223 Microglia, 38 spinal cord injury pathophysiology, 41–42 Microlesions, 68, 69 Minocycline, 125 Mitochondria, 40 Model Spinal Cord Injury Care System, 6, 20, 167–168, 176, 190, 197 Monocytes, 38, 41 acute intervention to prevent infiltration of, 124 Motor function assessment, 74–76 central pattern generator role, 50 cortical control, 48 feedback control of movement, 49–50 functional electrical stimulation, 110–114 injury classification, 32–34 neurophysiology, 48–50 prognostic factors, 20 research goals, 2, 24 therapeutic interventions, 108–114 zone of partial preservation, 35–36 See also Motor neurons Motor neurons, 48 in muscle spasticity, 52 Motor vehicle accidents, 14, 207 injury prevention strategies, 23 Movement body weight support training, 108–110 feedback control, 49–50 lower-extremity functional electrical stimulation, 112 proprioception in, 134–135 MRI. See Magnetic resonance imaging mRNA, 81–82 Multiple sclerosis, 184, 187 Muscle atrophy, 112 feedback control of movement, 49–50 functional electrical stimulation, 110 motor function, 48 strength assessment, 35 See also Spasticity Musculoskeletal pain, 53 Myelin, 31 in impulse conduction, 133 natural remyelination after injury, 46–47 olfactory ensheathing cells, 136, 157 oligodendrocytes, 37, 43, 44, 46–47, 65, 85–86 replacement, 3 Schwann cells, 37, 46, 65, 133, 135–136 spinal cord injury pathophysiology, 43 therapeutic remyelination, 133, 136 N National Acute Spinal Cord Injury Study (NASCIS), 159, 268–271 National Cancer Institute, 82, 88, 175 National Center for Medical Rehabilitation Research, 188

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Spinal Cord Injury: Progress, Promise, and Priorities National Institute of Child Health and Human Development, 195 National Institute of Neurological Disorders and Stroke, 155 biomarker research, 82–83 recommendations for, 5, 10, 11, 141, 143 research program, 5, 141, 143, 187–188 National Institute on Disability and Rehabilitation Research, 189–190 National Institutes of Health, 6, 195, 197, 236 fellowship awards, 200, 201 recommendations for, 4, 6, 7, 10, 11, 12, 143, 179, 201 research funding, 184–187, 201, 213–214 National Spinal Cord Injury Research Network, 7, 11, 197–199, 201 Necrosis acute response to spinal cord injury, 39 intervention to prevent, 123 spinal cord injury pathophysiology, 2–3, 42 NEP1-40 peptide, 128 Nerve growth factor, 126, 131 Netrins, 130 Neurobiology of spinal cord acute effects of spinal cord injury, 39, 122–125 animal models, 65–74 astrocytes in, 37, 43 basic research, 194–195 bladder function and dysfunction, 55–56 body weight support training effects, 109 bowel dysfunction, 56–57 causes of muscle spasticity, 52 central pattern generator role, 50 chronic phase of spinal cord injury, 43–45 current understanding of injury and repair, 1, 25, 26, 58, 121 imaging technologies, 83–84, 86–87 in vitro research, 65 injury pathophysiology, 2–3 macrophages in, 123 microglia in, 38, 41–42 motor function, 48–50 pain pathophysiology, 53–55, 100, 101–102 phases of spinal cord injury, 36–39 remyelination, natural and therapeutic, 46–47, 133, 136 research needs, 58, 141–142 research recommendations, 4, 8, 10, 201 Schwann cells in, 37, 45, 65, 133, 135–136 secondary phase of injury, 40–43, 125–127 sexual function, 57–58 spontaneous healing, 45–47 T-cells in, 38, 41, 42, 123 trophic factors in, 126–127 types and levels of injury, 15–20, 32–34, 66–69 See also Axonal regrowth; Neuron function Neurogenic bowel, 56–57, 104 Neurological level, 33–34 Neuron function, 37 animal research, 68 in vitro studies, 65 motor system, 48, 50 See also Motor neurons Neuropathic pain, 53–54, 100–101 Neuroprostheses clinical trials, 164, 165 research needs, 143 See also Functional electrical stimulation Neuroprotection definition, 125 effectiveness, 99–100 glutamate receptor blockers, 126 goals, 125 immunosuppressant drugs for, 123–124 protease inhibition, 125 research recommendations, 4, 143 Neurotransmitters acute response to spinal cord injury, 39 in pain pathophysiology, 54 Neurotrophic factor-3, 126, 135 Neurotrophic factors, 3, 126–127 gene therapy to promote expression of, 131 Neutrophils, 38 acute intervention to prevent infiltration of, 124 spinal cord injury pathophysiology, 41 New Jersey, 191, 207–208 New York State Spinal Cord Injury Research Board, 1, 7, 12, 26, 190–191, 229–230 administration, 234, 240 benefits to state, 211–212, 215 CART awards, 230

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Spinal Cord Injury: Progress, Promise, and Priorities challenges, 232–234 CORE awards, 230, 231, 234 funding source, 207, 228, 236 future prospects, 238–239 grants, 229–230, 232–233 IDEA awards, 230 motivation, 210 number of researchers, 232–233, 239 origin, 227–228 performance evaluations, 228–229, 240 private sector linkages, 237–238 program strengths, 228, 235–238 proposal review process, 228, 229 recommendations for, 239–240 research areas, 230–231 resources, 236–237 significance of, 205–206 spending, 207, 230, 234 Nitric oxide, 56 Nociceptive pain, 53–54, 100 Nogo-A, 44, 128 knockout mice, 71, 128 Nogo receptor blockade, 128–129 Nonprofit organizations recommendations for, 4, 143 research role, 4, 5, 11, 191–194 O Olfactory ensheathing cells, 136, 157 Oligodendrocytes, 37, 65 precursor cells, 44, 47 radiolabeled, 85–86 spinal cord injury pathophysiology, 43, 44 in spontaneous healing, 46–47 Opioid therapy, 101 Orphan Drug Act, 173–174 Outcomes, 25 assessment, 74–76, 260–267 biomarker expression data, 79 challenges to improving, 26 data collection and management, 174–178, 198 decompression interventions, 98–99 defining, 2, 23–24, 260–267 depression, 107–108 emergency response, 97–98 ensheathing cell therapies, 136 gene therapy, 132 historical development, 13–14, 95 individual differences, 15 macrophage therapy, 123 neuroprotective therapies, 99–100 pain prevention interventions, 100–101 pain risk, 52, 53 reproductive, 106, 107 research needs, 8 sensory function therapy, 135 spasticity interventions, 102, 133 standardization of measures, 168–172, 178–179 stem cell therapies, 137 therapeutic hypothermia, 124–125 See also Functional outcomes P P01 grants, 188 P30 grants, 188 P50 grants, 188 Pain definition and classification, 52–53, 100 hypersensitivity, 53–54 neurophysiology, 53–55, 100, 101–102 research goals, 2, 24 risk of, in spinal cord injury, 52, 53 therapeutic interventions, 100–102 Paralysis Project of America, 191 Paralyzed Veterans of America, 193 Paraplegia, 15–20 prognosis, 20 Parkinson’s disease, 21, 184, 187 Pathophysiology, 2–3, 30, 58 acute phase, 39–40 bladder dysfunction, 55–56, 103 bowel dysfunction, 56–57 cellular processes, 36–39 chronic phase of injury, 43–45 of pain, 53–55, 100, 101–102 pressure ulcers, 105 secondary phase of spinal cord injury, 40–43 spontaneous healing, 45–47 Peripheral nerve transplantation, 132 Personal assistance costs, 20 requirements by level of injury, 17, 19 PET scan. See Positron emission tomography

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Spinal Cord Injury: Progress, Promise, and Priorities Pharmaceutical and medical device industry collaboration in state-sponsored research, 237 incentives for spinal cord injury research, 173–174 obstacles to spinal cord injury research, 172–173 recommendations for, 4, 143, 179 research role, 9, 179 Phases of injury, 36–39. See also Acute phase of injury; Chronic phase of injury; Secondary phase of injury Plasticity, nervous system, 45, 56, 195 Pons, 55 Positron emission tomography (PET scan), 83, 85, 86 Potassium metabolism, 126, 133 Pressure sores, 52 classification, 105 pathophysiology, 105 prevention and treatment, 105–106 research goals, 2, 24 risk, 105 Preventive interventions, 23, 192 Primary motor cortex, 48 Privacy issues, 177 Private sector collaboration in state-sponsored research, 237–238 research role, 11 See also Pharmaceutical and medical device industry Prognostic factors, 20 biomarkers, 77–78, 79 duration of spinal cord compression, 98 Proprioception, 49–50, 134–135 Proteases, 125 Protein expression clinical significance, 77–78 future prospects for research, 81–82 in spinal cord injury, 79–81 Protein kinase C inhibition, 127–128 Proteoglycans, 44–45, 65, 127–128 Pulmonary embolism, 103 Q Quadriplegia, 15, 20 prognosis, 20 R Recreational sports, 14 Reeve-Irvine Research Center, 6, 155, 224 Registries, 174–178, 198 Rehabilitation length of stay, 20 research funding, 188, 189–190 research recommendations, 5 Replication studies, 154–155 Reproductive health, 57, 106, 107. See also Sexual functioning Research basic, 194–195 biochemical, 58 biomarker development, 81–83 challenges, 9, 172–173 clinical priorities, 3–5, 8, 10, 141–143 combination therapies, 5, 8, 10, 141 costs, 173 current state of, 9, 25–26, 184 data collection and management, 174–178 development of new therapies, 152–154 funding, 4, 5, 7, 12, 143, 183, 184–194, 201 goals, 2, 24 imaging technology development, 85–88 in vitro techniques, 65 industry incentives, 172–174, 179 infrastructure requirements, 5–9, 11–12, 183, 195, 213 patient safety concerns, 156–157 performance monitoring, 12 prospects, 25–26 publishing, 155 recommendations, 201 requirements for progress in, 5, 8–9, 183 strategies for accelerating, 194–201 validation of new therapies, 154–157 See also Animal models; Clinical trials; Collaborative research; Translational research Research personnel goals for research infrastructure, 5, 9, 239 supply, 232–233 See also Education and training for research Respiratory function functional electrical stimulation, 111–112 outcomes by level of injury, 16, 18

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Spinal Cord Injury: Progress, Promise, and Priorities Rho-asssociated kinase, 128–129 Rick Hansen Spinal Cord Injury Network, 198 Robert Packard Center for ALS Research, 197–198 Rolipram, 140–141, 223 Roman Reed Research Grants Program, 224–226 S Sacral spine, 32 Safety, patient, 142, 152, 153, 154, 156–157 Schwann cells, 37, 46, 65 to promote axonal regrowth, 135–136 remyelination with, 133 Secondary phase of injury, 36, 40–43 treatment strategies, 125–127 Sensory function anatomy, 31–32 in control of movement, 49–50, 134 injury classification, 32–34 prognostic factors, 20 reflex reactions, 50 research goals, 2, 24 therapeutic interventions to restore, 134–135 zone of partial preservation, 35–36 Sensory neurons C fibers, 56 hyperexcitability, 102 pain pathophysiology, 53, 102 Severity of injury, 35 Sexual functioning neurophysiology, 57–58 research goals, 2, 24 therapeutic interventions, 106–107 See also Reproductive health Shock, 39 Sildenafil, 106, 107 Sodium, intracellular, 133–134 Solid cord injury, 32 South Carolina, 191, 208 Spasticity complications, 50–52 definition, 52 neurophysiology, 52 research goals, 2, 24 risk, 52 therapeutic interventions, 102, 133 Sphincter muscle, 55, 56, 103–104 Spinal cord anatomy, 31–32 areas of control, 32 Spinal Cord Injury Research Centers of Excellence, 5 collaborative research relationships, 196–197 infrastructure, 196 number of, 197, 201 purpose, 195, 196 recommendation for, 6, 11, 201 Spinal Cord Society, 191 Spontaneous healing, 45–47, 162 Sprouting, 52, 55 Standards of care, 95–97 State-sponsored research, 320–322 advantages, 212–214 allocation of resources, 191, 209–210 data management, 176 funding sources, 7, 190–191, 207–208, 209–210, 213, 214, 217–220, 226 infrastructure for, 213 model programs, 205–206, 214–227 motivation, 205, 207, 210–211 recommendations, 4, 12, 143 returns to states, 211–212 spending, 7, 190, 205, 206, 207, 208–209, 216, 220, 224, 225 trends, 205, 206–207, 208, 210–211 See also New York State Spinal Cord Injury Research Board Stem cell therapies, 135, 136–140, 226–227 Synaptic connections in axonal regrowth, 129 research recommendations, 4, 8, 143 Syringomyelia, 45, 85 T Tendon transfer surgery, 111 Tetraplegia. See Quadriplegia Therapeutic interventions alternative therapies, 275–277 assessment, 8, 89 autonomic dysreflexia, 105 biomarker analysis in, 78–79 bladder dysfunction, 103–104 bone disorders, 107 bowel dysfunction, 104 cell-based, 135–140

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Spinal Cord Injury: Progress, Promise, and Priorities chronic phase, 127–135 combination strategies, 3, 5 costs, 20 criteria for validating, 154–157 depression, 108 functional electrical stimulation, 110–114 generalizability of animal research, 70–73 historical and technical development, 1, 3, 13–14 imaging markers to monitor effectiveness of, 86–87 informed consent issues, 156–157, 160–161 motor dysfunction, 108–114 outcomes assessment, 74–76, 168–172 pain prevention and management, 53, 100–102 patient safety concerns, 142, 152, 153, 154, 156–157, 160 pressure ulcers, 105–106 research and development process, 152–154 research priorities, 3–5, 8, 10, 141–143 research recommendations, 178–179 secondary phase, 125–127 sexual dysfunction, 106–107 for spasticity, 102 standards of care, 95–97 strategic focus for development of new, 121 thromboembolism prevention, 102–103 using spontaneous healing, 45–47 See also Acute care; Axonal regrowth; Combination therapies Think First National Injury Prevention Foundation, 192 Thoracic spine, 32 Thromboembolism, 102–103 Thyrotropin-releasing hormone, 100 Tissue engineering, 132 T-lymphocytes, 38 spinal cord injury pathophysiology, 41, 42 therapeutic application, 123 Transection injuries, 68–70 Transgenic animals, 87 Translational research biomarker development, 82–83 current state, 183 ethical considerations, 156–157 goals, 5, 6 imaging technologies, 87–88 process, 152, 173 recommendations, 6, 11, 197, 201 research networks to facilitate, 8–9, 197–198 state-sponsored programs, 230, 231 Transplantation cell, 132, 135–140 in combination therapies, 140–141 tissue, 132 Trauma Care Systems Planning and Development Act, 176 Trophic factors, 126–127 U Unified Parkinson’s Disease Rating Scale, 171 United Spinal Association, 193 V Vasospasm, 40 VCAM-1 antibodies, 124 Vehicle modification costs, 20 Ventral horn, 32, 48 Veterans Administration. See Department of Veterans Affairs, U.S. Violence, 14 Visceral pain, 53 Voiding reflex, 55 W Wheelchair use, 17, 19 White matter, 31 Work-related injury, 14 Z Zone of partial preservation, 35–36

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