Words from Dr. David Rosenblum

6/21/2010 12:00:00 AM

We are all here today with a shared interest- and passion- to help the CT chapter and- importantly- to help make a difference for people with SCI. Gaylord has specialized in the care of people with SCI for over 30 years, and has enjoyed a close collaboration with the CT chapter of the NSCIA – with their office at Gaylord- for that entire time. And we have all gained not only from their focus on education, information, and resources, but also from their exceptional peer assistance program. We are both proud, and grateful, to be recognized by them today. We were all chatting in the chapter office the other day- about the years of collaboration- and I started thinking about where we were 30 years ago, even where we were 1 year ago- and the exciting road ahead of us as we all work together to help in the cause for SCI. Some say this past decade was the decade of technology. Some say this coming decade is the decade of healthcare. With the recent senatorial election in Massachusetts, well have to see. But I believe we are entering what will be known as the decade of progress in spinal cord injury. Why? Let’s start with prevention: We used to not pay too much attention to injury prevention. Now we have better sports protective gear, technological advances in our cars to help prevent injury, and – importantly- education such as our Think First program.

How about spinal cord damage? We used to think that there was no way to protect the spinal cord from further damage after injury. Now we understand that injury triggers chemicals to cause more injury, and we may be able block this – based on animal studies. Steroids are used to try and attenuate this secondary injury, but it is controversial outside of the US. Johnson and Johnson recently patented an agent, and it is going into clinical trial. They’re working on it now.

And now we believe that there may be something useful in cooling people after injury to prevent further injury-brought to popular attention by the football player in Buffalo who was cooled and had a significant recovery. It’s not without side effects, and clinical trials are underway. Now. How about repair the spinal cord? We used to think we could not repair the spinal cord. Some of you may remember an exciting announcement in 2004 when researchers used specialized cells to try to repair injured rat cords- and 70% walked after acute injury

A new phase I study, looking at safety of this technique, is starting this year. We used to think that nerves in the central nervous system can’t regrow. Now we know that with the right growth factors and other agents, it is possible. Cethrin, one such compound, was recently found to be safe. Further studies are planned. We used to think that a cell is a cell is a cell. Now we better understand that stem cells- or blank slates of cells-can turn into what we want given the right encouragement. And Regenerative Medicine- regenerating broken body parts- was born, and now we know that cells in adult nerve tissue can be encouraged to replace lost cells-discovered in 2008.

On January 21, 2010, CNN and other news outlets announced the first US stem cell transplantation into the spinal cord as part of an FDA approved study- a 60 year old gentleman with ALS had the lumbar injection to see if it is safe- and to see if the cells are safe. 12 people will be recruited at Emory. And there are new medications which may become available. Just two weeks ago, the FDA approved Amprya.

This tablet has a sustained release formulation of 4-AP, which some of you may have heard about, which blocks tiny pores, or potassium channels, on the surface of nerve fibers, which may improved the conduction of nerve signals. Research started a decade ago, and in 1994 trials in spinal cord injury did not find robust results, so the company changed gears and focused on multiple sclerosis. In 2 trials with 301 people, walking speed increased by 25%. Although not yet approved in SCI, many studies have shown promise in, for example, spasticity, bladder management, and gait. It will be available by prescription in March. There are many more studies that are more clinically based- and too many to summarize here. At Gaylord, for example, we are fortunate to be designated, with Boston University, a Model SCI Center- there are only 14 in the country, and we are proud to have been recognized and feel even more fortunate to have the associated funding and opportunities for collaboration with other Model SCI centers for research. We are, for example, well on our way to developing a new outcome tool for SCI that, if successful, has the potential to have an international impact.

We are also working on a project that will allow people with SCI and MS to get access to healthcare at home via telemedicine- so far, the response has been terrific. And what else is going on in Rehabilitation? The field is exploding- there are so many examples, but here is a quick sampling of some technologies that are either here are about to be available-We have bicycles that work by stimulating muscles too weak to work on their own. There is a new tongue drive system- from the Georgia Institute of Technology, for wheelchairs recently released. And a new wheelchair hub braking system- braking assistance for steep grades with spring loaded push rims- is being tested. We have body weight supported ambulation- devices which support standing and allow ambulation with assistance as part of therapy- and there is lots of research activity on its potential role. The now famous Wii has adaptations being developed so people with little to no arm movement can play Wii too- And the IPOD now has a Sip and Puff control adaptation

We have new electronic applications that interact with nervous system such as a Bladder system that is being tested. We have electrical stimulation devices for drop foot or weak ankles, and there is an implantable device in Europe that does that as well which is coming to North America this year The Cleveland Clinic FES center is working on implantable electrode technology, placing them on nerve endings, using wireless systems to aid mobility. There’s the Rewalk- an innovative device from Israel being tested in the US, which is designed to allow walking, standing and climbing stairs with paraplegia using an exoskeleton- or external support, sensors, computer based system.

There’s also the BrainGate 2- an investigational system that uses brain signals to control assistive devices- there is a human pilot trial at MGH and Brown. And there is even a Green wheelchair in development- powered by methanol- cleaner and more dependable than batter power There is so much promise, so much research- and so much work to be done. I will make sure that the CT chapter has specific information on what we have discussed if any of you want more information. All of these devices and technologies, though, are tools-designed to help make a difference. They are a very small part of rehabilitation- and what can be done. Together, with your support, we will continue to strive to more effectively treat acute injuries, and continue searching for effective treatments for people with SCI, and remain focused on true rehabilitation- in other words, on improved mobility, self care, functional independence, reintegration into our community, recreational and sports involvement or adaptation and- ultimately- improvement in quality of life. That’s what Gaylord is about. Thank you all for supporting our CT chapter, and on behalf of all my friends and colleagues at Gaylord, we thank the chapter for recognizing our passion to make a difference.

Dr. Rosenblum is Medical Director of Physical Medicine and

Rehabilitation, Gaylord Hospital, Wallingford as well as

Director of Gaylord Hospital’s

Model Spinal Cord Injury Center—part of

The New England Regional Spinal Cord Injury Center



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