Research for Spinal Cord Injury

Posted by Nurse Linda in Daily Dose on October 07, 2020 # Research

Many individuals think there is a differentiation of treatment between spinal cord injury from trauma and spinal cord injury from disease. When health care professionals speak of spinal cord injury, they are referring to both causes. Trauma happens from some type of accident. It is typically quick and sudden onset. Spinal cord injury from disease or a health issue is a process that occurs in the body that might take time for symptoms to appear. Some people feel that the focus of spinal cord injury research is only on trauma. However, this is not accurate. As healthcare professionals, disease is medical can cause onset trauma. We might not know the exact onset time as with a documented accident, but all spinal cord injury is trauma to the nervous system either from an accident or disease.

The study of spinal cord injuries uses trauma as a source for research because of one little detail; the exact time of onset is typically known. In experimentation, controls in studies are very important to maintain consistency. In accidents, the onset is meticulously documented by EMTs. This gives the researcher an advantage for the exact time of onset.research lab

In disease, the exact time of onset might not be able to be determined. For instance, someone might have a genetic disorder or slow onset of a neurological problem that causes spinal cord injury. That level of experimental control about how long the disease has been occurring might not be able to be pinpointed. The question is, has the person just started their spinal cord injury, or has it been evolving since before birth or elsewhere along with the lifespan?

In either case, accident or disease, spinal cord injury is all trauma. The trauma could be an accident, but trauma also occurs from disease. To the researcher, this is a fine line difference but important none the less. The ultimate answer is for research clarification or to add that extra layer of control for experimentation. Scientists and healthcare providers think equally about spinal cord injury from accidents and spinal cord injury from trauma. Both are spinal cord injury trauma.

Research of other neurological diseases is also used in the research of spinal cord injury. A treatment for one nerve injury is attempted to be translated to other nerve injuries, no matter the source of the trauma, accident, or disease. In other words, research in one area of neurological study can be translated into other areas of neurological research. Researchers are interested in reducing the outcomes of spinal cord injury regardless of the onset. The division is only for practicality. Adding controls to research is a way of expediting experiments for more conclusive results.

The Association of Spinal Cord Injury Professionals (ASCIP) just concluded their 2020 research conference. Individuals who are interested in SCI research present their findings. There is a lot of research that is being conducted in spinal cord injury; this is just a small representation of that work. I will mention some of the presentations as there are so many, it would not be possible to mention them all.

There are always some historical presentations that review SCI research in different areas. When you listen to these, it is amazing how far treatments have come, especially with the rapid growth over the last few decades. To pause and think about how things were, even when I first started in this specialty to today, is extremely motivating to keep pushing for tomorrow. Since so much has been accomplished to improve the quality of life for individuals with SCI and with new technologies, it seems that we should be able to propel treatments even faster in the future.

A keynote presentation was about electric cigarettes (Ecigs) and vaping. Packaging of these products has been evaluated, with only 10% being accurately labeled. The flavorings used have been developed for food, not inhalation. Flavorings are to be metabolized in the digestive system, not in the respiratory system. Flavorings inhaled into the lungs has not been tested. The digestive system breaks down substances for digestion, whereas the lungs do not have the same ability. Use may increase cardiovascular problems. It may increase COVID risks. Ecigs used by individuals with SCI can be particularly detrimental due to secondary complications compounding, especially in the lungs and circulation.

Ecigs are used by some individuals to curb their addiction to regular (combustible) cigarettes; however, at 12 months, 80% are still using Ecigs. That is an exchange of one addiction for another. Some might find the use of Ecigs beneficial for cigarette withdrawal, but the data does not point to success. You can find more information about Ecigs and vaping at these sites: https://e-cigarettes.surgeongeneral.gov/ https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/index.htm

Everyone is interested in the hot topic of nerve stimulation. It is having success as a step to return of function. A great review article, in medical terms, is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773077/

Transcutaneous (electrodes placed on the skin) is one form of nerve stimulation. A study was presented where 5 out of 7 individuals improved function and decreased tone (spasticity) using a newer device on specific muscle groups. This type of stimulation may be covered by your healthcare payor as mobility training or activities of daily living (ADLs) education. You do need therapy to learn to use the devices properly so as not to do harm to yourself. If your payor does not cover the cost of the device for a home program, there are some available online, like at Amazon, at less expensive costs. Do not just buy a device but get input from your healthcare professional for what you need and how to use it. Buyer beware, there are various types of transcutaneous devices. If you are interested in this type of therapy, be sure to investigate if the technique used will be for nerve stimulation, which is more powerful than other electrostimulation devices. Advice from knowledgeable people is extremely valuable to avoid hurting yourself.

In conjunction with this thought, a session about upper motor neuron (UMN) injury and lower motor neuron (LMN) injury indicated that the different types of injuries respond to therapies differently. Most injuries are a mixed type of both UMN and LMN. If you stimulate nerves with a UMN injury, you will overdo the treatment leading to more damage. Pure LMN might not stimulate. So, self-treatment is something no one should be attempting. However, talk with your healthcare provider to move in the right direction for your specific type of injury.

There was a little hint at implanted nerve stimulators (surgically placed under the skin). This is because these studies are being conducted, so outcomes are not yet available. However, one notation was about lower spinal implanted nerve stimulation. An unexpected outcome has been the reduction of orthostatic hypotension (OH). OH, is that drop in blood pressure that individuals with SCI sometime have when they change positions. After SCI, the message to the blood vessels in the lower body to tighten so more blood is pushed to the head is affected. The response is less or not fast enough or both, which results in lightheadedness, dizziness, fainting, and a sudden drop in blood pressure. Currently, this is treated with compression garments and medication. The finding with lumbar or sacral implanted nerve stimulators to improve functional ability was serendipitously found that the OH is less or even resolves with the stimulation. More research about why this happens will be conducted, but what a happy finding.

There were several sessions about bladder issues. One was about what to do when an indwelling catheter balloon does not deflate for changing. If you have an indwelling catheter, you may have been faced with this issue. It does not happen often, but when you see a lot of indwelling catheters, you run across it. These researchers compared several techniques to resolve the issue. Under the care of a urologist, they burst the catheter balloon but found fragments could be left in the bladder. Therefore, after a burst catheter balloon, a cystoscopy is recommended to remove any fragments and avoid possible cancer or other injuries to the bladder.

Assessments of bone mineral density demonstrate how important it is to have a bone density screening every year. After SCI, there is often bone density loss. The presenters recommended bone density screening in SCI to be at the end of the femur (the long bone in your thigh) just above the knee. A new guideline for bone health will be published in about six months, so we will follow that for additional guidance to improve the health of bones after SCI. More surgical repairs of fractured bones after SCI are being done. This points to improved care for those with SCI.

Of course, no one can attend all the sessions at the conference. This year, due to COVID, the conference was virtual. The bad part was not being able to connect with my conference friends, people I don’t often see in life but those who, like me, are keenly interested in what is improving in SCI care. However, this did offer a chance for the ASCIP and conference sponsors to videotape the presentations. As attendees, we will be able to view more presentations later in the year. That is great because I will be able to report new things to you. Nurse Linda

Pediatric Consideration:

Unfortunately, I did not find any pediatric-specific sessions. This is unusual, but when the conference was being planned, COVID hit, and no one knew if the conference would even happen. However, many of the above new ideas can be easily applied to the pediatric population.

Talk with your child’s healthcare professional if any of the ideas sound like they might benefit your child. The Ecig information should be shared with age-appropriate children, especially teens. The provided website has connections that will address the issue on their level. If you think nerve stimulation might help your child, it is a good idea to discuss it with the healthcare professional to see if your child would benefit. The non-invasive nerve stimulation is available for the pediatric population, although the implanted surgical procedures are not-yet. If your child has a catheter and the balloon bursts, ask if a visual inspection of the bladder is needed.

Use the knowledge of the adult population to your advantage. Knowledge is power. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.