Hyperreflexia, Memory, Neurological Disorders, Pain, Spasticity, Spinal Cord Injury, Writing

Top 5 Challenges in SCI Repair

Here are the top five challenges in the race for a cure for SCI:

  1. Post-injury survival – Keep nerve cells that survive the initial injury alive and healthy
  2. Regeneration and growth – Promote the re-growth of injured nerve cells and their fibers
  3. Axon pathfinding – Guide growing axons toward their normal targets (i.e., muscles or other neural tissues)
  4. Electrical conduction – Nerve cells must conduct electrical impulses with reliability and fidelity to carry information needed to execute complex tasks
  5. Synaptic connection –  Axons that reach their targets must connect and stabilize a line of communication

Progress: In my opinion, in more than 10 years in this field, I firmly believe that we’ve grown exponentially in terms of knowledge and application for milestones #1, 2,  3, and 4. And this is great news because this means that we are more than halfway toward fixing SCI. In fact, there are ongoing clinical trials in various parts of the globe investigating ways to increase the survival of nerve cells (a critical first step!), enhancing the growth of spared fibers, and guiding those axons toward their normal targets.

Next Steps: While less is known about how to promote re-connections between injured nerve cells and their targets (#5), we have a firm grasp on the molecular mechanisms involved in this challenge. We know that specific proteins interact in the growing nervous system (i.e., those that functioned when you were still in the womb, or just an infant) and that they turn-off, don’t work, or are non-existent in adulthood. So, in essence, we need to learn how to turn these switches back on, or replace them with functional ones. While no easy task, there are emerging tools to do this, including genetic therapies which has become a huge advancement and addition to our repair tool box.

What I expect: In the next few years, we will see some very big pushes on various research fronts in the SCI battle space. I think the biggest successes and those soonest to arrive will be in the form of new strategies designed to overcome many of the serious quality-of-life issues associated with SCI, including pain, reflex disorders, and poor autonomic function. Hang on; stay alert; stay hopeful!

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Missions, Problems to Solve

The Quest for the Cure

We seek first to improve our interactions with our friends and family, and neighbors.

What are the nearest goals for helping people with SCI?

Freedom from abnormal pain: In the entire spectrum of SCI complications, the easiest (i.e., fastest) goal to reach, and a priority for so many, is to develop and apply treatment strategies for patients that will grant freedom from abnormal pain and discomfort.

Restoring natural bodily functions: The ability to control excretion is a complex orchestration of sensory-muscle function which is severely disrupted in SCI. Restoring voluntary control is a major step toward independence (see below).

A cure for paralysis: This goal has captured the imagination of the SCI community. This is the visual we have in our minds when we think about a cure. If a person with SCI can walk again, or reach for a glass of water with their hands after losing that ability, then we have moved into a new chapter.

A brief note on the above: The spinal cord and brain are the most complicated tissues in the human body. Wires run everywhere, connect with other cells using chemically-based synapses, and rely on other cell types to function normally. All of a sudden, an SCI event crushes and severs these wires. Information traveling up or down the spinal cord is cut-off or disrupted (signals don’t transmit normally).

A major challenge for SCI researchers is to understand how to get the wires to grow again, directing where they should go; and then once at their targets, they need to reconnect.

Independence: This is such a big word…. I myself don’t even know what this means. Is this just freedom from another’s help? Based on my experience and talking with people with SCI, it may simply be the ability to not need to think about their injury anymore.


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