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    New Frontiers in Spinal Cord Injury Research


    Although this work is very preliminary, Yu says that he sees it as a necessary task to prepare the next big step in spinal cord research: a link-up between those working in functional restoration, such as the Cleveland FES Center, and biologic researchers who are concentrating on nerve regeneration. Yu says that nerve regeneration has just "really taken off in the last 10 years, because it's only in the last 10 years that it has been apparent that something can be done."

    The studies now underway in Cleveland, such as Yu's study, will become especially useful in an era "when we have incomplete spinal cord injuries," says Yu. If nerve regeneration is successful in the future, it is likely to lead to only partial restoration, which will mean incomplete spinal cord injuries. In that case FES becomes even more important, as stimulation can be used not only to strengthen muscles but also to help nerve pathways begin working again, Yu says.

    The Cleveland team is hoping to put this theory to the test in a joint project with nerve regeneration researchers. The first steps toward that goal are preliminary talks slated to begin later this spring with researchers from Washington University in St. Louis.

    Ronald J. Triolo, PhD, professor of biomedical engineering at Case Western Reserve and senior research scientist at the Cleveland VA, is also eagerly awaiting collaboration with nerve regeneration researchers. Triolo specializes in movement restoration in the lower extremities at Cleveland FES. Working with E. Byron Marsolais, MD, PhD, Triolo is overseeing experimental work in stand-transfer, or helping patients to stand for a short period in order to change location (such as moving from bed to wheelchair) and to walk for a short distance. "Our goal is to provide power to lift the body weight, to maintain an upright position, and then to lower the body again," Triolo tells WebMD. The feasibility of their system has been tested in seven patients, but at this point numerous human studies will be necessary before it is available to spinal injury victims.

    Although the stand-transfer system and the limited walking system are impressive, Triolo says the real excitement will come with collaboration with biologic researchers. Already, he says, "medicine has progressed [to the point that we can reduce the damage after injury] so that we are seeing less and less damage from trauma," thus the number of incomplete spinal injuries is growing. However, he adds, "it is really best to mix caution with optimism."

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