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From page 333... ... INDEX A Ambulation outcomes by level of injury, 17, 19 Action potentials, 39, 48 See also Movement Activities of daily living American Association of Neurological outcomes by level of injury, 15�19 Surgeons, 96, 192 See also Functional outcomes American Paralysis Association, 192 Acute care American Paraplegia Society, 192 clinical practice guidelines, 96 American Spinal Injury Association (ASIA) , current state of, 25, 95 32, 191�192 decompression of spinal cord, 98�99 Impairment Scale, 34, 35, 168 during transport, 97�98 4-Aminopyridine, 133, 161, 174 effectiveness, 97 Amyotrophic Lateral Sclerosis Functional goals, 23 Rating Scale, 171 immobilization, 97 Animal models, 10, 64 informed consent issues, 160�161 assessment techniques, 74�76 at injury scene, 97 generalizability, 70�73 neuroprotective interventions, 99�100 primates, 73 research needs, 98 rationale, 65, 66 research prospects, 25 recommendations for research, 88�89 research recommendations, 5, 143 research needs, 73�74 scope, 97 selection, 66�69 strategies, 122�125 standardization, 70, 73�74, 88 targets of intervention, 122�123 training for research using, 74, 88 Acute phase of injury, 36, 39�40 transgenic, 87 animal models, 68 for validation of new therapies, 154�155 research prospects, 25 Apoptosis Age at injury, 14 biomarkers, 77�78 costs of injury and, 20�22 interventions to prevent, 123, 125�126 Alternative therapies, 275�277 spinal cord injury pathophysiology, 2�3, 42�43, 125 333 Read the entire page →
From page 334... ... , 74�76, research needs, 8, 10 standardization of outcome measures, 260�261 168�172, 178�179 Bathing abilities, 17, 19 Bed mobility, 16, 18 technical development, 64 Astrocytes, 37 Biomarkers, 8, 89 in glial scarring, 43 applications, 77�79 current technology, 77 Atrophy, muscle, 112 Autonomic dysreflexia, 105 future prospects for research, 81�83 Autonomic nervous system in imaging technologies, 85�87 Bladder function, 105 motor function and, 48 research goals, 2, 24 anatomy, 55 Axon anatomy and function, 31 outcomes by level of injury, 16, 18 pathophysiology, 55�56, 103 embryonic development, 130 spinal cord pathophysiology, 43 research goals, 2, 24 Axonal regrowth, 3 therapeutic interventions, 103�104, 110�111 animal models, 65�66, 70, 71�73 barriers to, strategies to remove, 127�129 types of dysfunction, 103 cell transplantation to promote, 132, Blood pressure, spinal cord injury and, 39 Body weight support training, 108�110 135�136 combination therapies to promote, 140� Bone disorders, 107 141 Bowel function, 104, 105 outcomes by level of injury, 16, 18 environmental conditions for, 45�46, 129 gene therapies to improve, 130�132 pathophysiology, 56�57 glial scarring in inhibition of, 43�45, 127 research goals, 2, 24 Brain-derived neurotrophic factor, 126 guidance, 129�130 in vitro studies, 65 Brain stem, motor function, 48 macrophage therapy to improve, 123 Bryon Reisch Paralysis Foundation, 191 Buoniconti Fund to Cure Paralysis, 191 molecular processes, 65 muscle spasticity and, 52 neurotrophic factors to promote, 135 C pain outcomes and, 101�102 research needs, 58 C fibers, 56 research recommendations, 4, 8, 143 Calcium, intracellular, 126 restoration of impulse conduction, 133� in apoptosis, 42�43 134 in spinal cord injury pathophysiology, spontaneous healing, 47 41 strategies for promoting, 129 California, 213, 223�227 synaptic connections, 129 Reeve-Irvine Research Center, 6, 155, 224 tissue scaffolding to promote, 132 stem cell bill, Proposition 71, 226�227 Read the entire page →
From page 335... ... , 83 of injury, 32�36 Congress of Neurological Surgeons, 96, 192 of pain, 53 Consortium for Spinal Cord Medicine, 96, Clinical trials 193 challenges in spinal cord injury research, Consortium of Multiple Sclerosis Centers, 160�162 175 clinician expertise, 164 Contusion injuries, 32 collaborative multicenter studies, 164� animal models, 68 167 Read the entire page →
From page 336... ... 336 INDEX Corticospinal tract, 48 Ephrins, 130 Corticosteroid therapy, 166 Epidemiology, 1, 14 Cost of research, 173 Epilepsy, 184 federal spending, 184�190 Erectile dysfunction, 106 infrastructure construction, 213�214 Erythropoietin, 126 state spending, 205, 206, 207, 208�209, Ethical issues, 156 216 Excitotoxicity, 39 Costs of spinal cord injury, 20�23 Cure, defining, 2, 23�24 Cyclic AMP, 129, 140�141, 223 F Cyclosporin A, 123 Cytokines, 42 F30 fellowships, 200 F31 fellowships, 200 Facilities of Research Excellence in Spinal D Cord Injury, 155, 187 Fampridine, 102 Data collection and management, 174�178, Fas protein, 77�78 190 Feedback systems Decompression of spinal cord, 98�99 movement control, 49�50 Decubitus ulcers. See Pressure sores in muscle spasticity, 52 Demographic characteristics of spinal cord Fibroblast growth factor, 126 injury victims, 14�15 Fibroblasts, 70 Department of Education, U.S., 189�190 Florida, 191, 207, 219�221 Department of Veterans Affairs, U.S., 6, See also Miami Project to Cure Paralysis 189 Food and Drug Administration, U.S., 153, Depression 179, 223 research goals, 2, 24 Free radicals, 42 risk, 107�108 formation after injury, 40�41 treatment, 108 intervention to prevent formation of, Dermatomes, 33 123 Detrusor muscle, 55�56, 103�104 Functional electrical stimulation Dorsal horn, 32 applications, 110 Dressing abilities, 17, 19 bladder dysfunction treatment, 110�111 Dysesthesia, 53 with body weight support training, 109� 110 clinical acceptance of, 112�113 E future prospects, 113�114 lower-extremity, 111�112 Early Detection Research Network, 82�83 to maintain muscle fitness, 112 Eating function, 16, 18 mechanism of action, 110 Edema, 40 upper-extremity, 111 acute intervention, 122 Functional magnetic resonance imaging, 83� spinal cord injury pathophysiology, 2�3 84 Education and training for research, 9 Functional outcomes animal studies, 74, 88 hypothermia treatment, 125 clinical trials expertise, 164 level of injury and, 15�20 federal support, 186�187 measurement, 168, 260�267 rationale for expanding, 200�201 neurobiology, 47�58 recommendations, 10, 11�12, 201 recommendations for research, 89 trends, 200 research goals, 2, 24 Endothelial cells, 38, 39 Read the entire page →
From page 337... ... , 177 Center, 6, 191, 217�219 Heparin therapy, 103 Heterotopic ossification, 107 Home modification costs, 20 L Hyperesthesia, 53 Hypothermia, therapeutic, 124�125, 161 Laceration injuries, 32 Length of hospital stay, 20 Hypoxia, 2�3, 39 Read the entire page →
From page 338... ... See Magnetic resonance imaging costs, 20 mRNA, 81�82 immunosuppressant drugs, 123�124 Multiple sclerosis, 184, 187 to improve nerve conduction, 133 Muscle incentives for research, 173�174 atrophy, 112 neuropathic pain treatment, 100�101 feedback control of movement, 49�50 research and development process, 152� functional electrical stimulation, 110 154, 173 motor function, 48 sexual dysfunction, 106, 107 strength assessment, 35 sodium channel regulators, 133�134 See also Spasticity spasticity treatment, 102 Musculoskeletal pain, 53 thromboembolism prevention, 103 Myelin, 31 Meningeal cells, 43 in impulse conduction, 133 N-Methyl-D-aspartate, 86 natural remyelination after injury, 46�47 Methylprednisolone, 99, 159, 269�272 olfactory ensheathing cells, 136, 157 Miami Project to Cure Paralysis, 6, 155, oligodendrocytes, 37, 43, 44, 46�47, 65, 191, 213, 220�223 85�86 Microglia, 38 replacement, 3 spinal cord injury pathophysiology, 41� Schwann cells, 37, 46, 65, 133, 135�136 42 spinal cord injury pathophysiology, 43 Microlesions, 68, 69 therapeutic remyelination, 133, 136 Minocycline, 125 Mitochondria, 40 Model Spinal Cord Injury Care System, 6, N 20, 167�168, 176, 190, 197 Monocytes, 38, 41 National Acute Spinal Cord Injury Study acute intervention to prevent infiltration (NASCIS) , 159, 268�271 of, 124 National Cancer Institute, 82, 88, 175 Motor function National Center for Medical Rehabilitation assessment, 74�76 Research, 188 Read the entire page →
From page 339... ... INDEX 339 National Institute of Child Health and research needs, 58, 141�142 Human Development, 195 research recommendations, 4, 8, 10, 201 National Institute of Neurological Disorders Schwann cells in, 37, 45, 65, 133, 135� and Stroke, 155 136 biomarker research, 82�83 secondary phase of injury, 40�43, 125� recommendations for, 5, 10, 11, 141, 143 127 research program, 5, 141, 143, 187�188 sexual function, 57�58 National Institute on Disability and spontaneous healing, 45�47 Rehabilitation Research, 189�190 T-cells in, 38, 41, 42, 123 National Institutes of Health, 6, 195, 197, trophic factors in, 126�127 236 types and levels of injury, 15�20, 32�34, fellowship awards, 200, 201 66�69 recommendations for, 4, 6, 7, 10, 11, See also Axonal regrowth; Neuron 12, 143, 179, 201 function research funding, 184�187, 201, 213�214 Neurogenic bowel, 56�57, 104 National Spinal Cord Injury Research Neurological level, 33�34 Network, 7, 11, 197�199, 201 Neuron function, 37 Necrosis animal research, 68 acute response to spinal cord injury, 39 in vitro studies, 65 intervention to prevent, 123 motor system, 48, 50 spinal cord injury pathophysiology, 2�3, See also Motor neurons 42 Neuropathic pain, 53�54, 100�101 NEP1-40 peptide, 128 Neuroprostheses Nerve growth factor, 126, 131 clinical trials, 164, 165 Netrins, 130 research needs, 143 Neurobiology of spinal cord See also Functional electrical stimulation acute effects of spinal cord injury, 39, Neuroprotection 122�125 definition, 125 animal models, 65�74 effectiveness, 99�100 astrocytes in, 37, 43 glutamate receptor blockers, 126 basic research, 194�195 goals, 125 bladder function and dysfunction, 55�56 immunosuppressant drugs for, 123�124 body weight support training effects, protease inhibition, 125 109 research recommendations, 4, 143 bowel dysfunction, 56�57 Neurotransmitters causes of muscle spasticity, 52 acute response to spinal cord injury, 39 central pattern generator role, 50 in pain pathophysiology, 54 chronic phase of spinal cord injury, 43� Neurotrophic factor-3, 126, 135 45 Neurotrophic factors, 3, 126�127 current understanding of injury and gene therapy to promote expression of, repair, 1, 25, 26, 58, 121 131 imaging technologies, 83�84, 86�87 Neutrophils, 38 in vitro research, 65 acute intervention to prevent infiltration injury pathophysiology, 2�3 of, 124 macrophages in, 123 spinal cord injury pathophysiology, 41 microglia in, 38, 41�42 New Jersey, 191, 207�208 motor function, 48�50 New York State Spinal Cord Injury pain pathophysiology, 53�55, 100, 101� Research Board, 1, 7, 12, 26, 190� 102 191, 229�230 phases of spinal cord injury, 36�39 administration, 234, 240 remyelination, natural and therapeutic, benefits to state, 211�212, 215 46�47, 133, 136 CART awards, 230 Read the entire page →
From page 340... ... 340 INDEX challenges, 232�234 historical development, 13�14, 95 CORE awards, 230, 231, 234 individual differences, 15 funding source, 207, 228, 236 macrophage therapy, 123 future prospects, 238�239 neuroprotective therapies, 99�100 grants, 229�230, 232�233 pain prevention interventions, 100�101 IDEA awards, 230 pain risk, 52, 53 motivation, 210 reproductive, 106, 107 number of researchers, 232�233, 239 research needs, 8 origin, 227�228 sensory function therapy, 135 performance evaluations, 228�229, 240 spasticity interventions, 102, 133 private sector linkages, 237�238 standardization of measures, 168�172, program strengths, 228, 235�238 178�179 proposal review process, 228, 229 stem cell therapies, 137 recommendations for, 239�240 therapeutic hypothermia, 124�125 research areas, 230�231 See also Functional outcomes resources, 236�237 significance of, 205�206 spending, 207, 230, 234 P Nitric oxide, 56 Nociceptive pain, 53�54, 100 P01 grants, 188 Nogo-A, 44, 128 P30 grants, 188 P50 grants, 188 knockout mice, 71, 128 Nogo receptor blockade, 128�129 Pain Nonprofit organizations definition and classification, 52�53, 100 hypersensitivity, 53�54 recommendations for, 4, 143 research role, 4, 5, 11, 191�194 neurophysiology, 53�55, 100, 101�102 research goals, 2, 24 risk of, in spinal cord injury, 52, 53 O therapeutic interventions, 100�102 Paralysis Project of America, 191 Olfactory ensheathing cells, 136, 157 Paralyzed Veterans of America, 193 Oligodendrocytes, 37, 65 Paraplegia, 15�20 precursor cells, 44, 47 prognosis, 20 radiolabeled, 85�86 Parkinson's disease, 21, 184, 187 spinal cord injury pathophysiology, 43, Pathophysiology, 2�3, 30, 58 44 acute phase, 39�40 in spontaneous healing, 46�47 bladder dysfunction, 55�56, 103 Opioid therapy, 101 bowel dysfunction, 56�57 Orphan Drug Act, 173�174 cellular processes, 36�39 Outcomes, 25 chronic phase of injury, 43�45 assessment, 74�76, 260�267 of pain, 53�55, 100, 101�102 biomarker expression data, 79 pressure ulcers, 105 challenges to improving, 26 secondary phase of spinal cord injury, data collection and management, 174� 40�43 178, 198 spontaneous healing, 45�47 decompression interventions, 98�99 Peripheral nerve transplantation, 132 defining, 2, 23�24, 260�267 Personal assistance depression, 107�108 costs, 20 emergency response, 97�98 requirements by level of injury, 17, 19 ensheathing cell therapies, 136 PET scan. See Positron emission gene therapy, 132 tomography Read the entire page →
From page 341... ... See also injury; Secondary phase of injury Sexual functioning Plasticity, nervous system, 45, 56, 195 Research Pons, 55 basic, 194�195 Positron emission tomography (PET scan) , biochemical, 58 83, 85, 86 biomarker development, 81�83 Potassium metabolism, 126, 133 challenges, 9, 172�173 Pressure sores, 52 clinical priorities, 3�5, 8, 10, 141�143 classification, 105 combination therapies, 5, 8, 10, 141 pathophysiology, 105 costs, 173 prevention and treatment, 105�106 current state of, 9, 25�26, 184 research goals, 2, 24 data collection and management, 174� risk, 105 178 Preventive interventions, 23, 192 development of new therapies, 152�154 Primary motor cortex, 48 funding, 4, 5, 7, 12, 143, 183, 184�194, Privacy issues, 177 201 Private sector goals, 2, 24 collaboration in state-sponsored imaging technology development, 85�88 research, 237�238 in vitro techniques, 65 research role, 11 industry incentives, 172�174, 179 See also Pharmaceutical and medical infrastructure requirements, 5�9, 11�12, device industry 183, 195, 213 Prognostic factors, 20 patient safety concerns, 156�157 biomarkers, 77�78, 79 performance monitoring, 12 duration of spinal cord compression, 98 prospects, 25�26 Proprioception, 49�50, 134�135 publishing, 155 Proteases, 125 recommendations, 201 Protein expression requirements for progress in, 5, 8�9, 183 clinical significance, 77�78 strategies for accelerating, 194�201 future prospects for research, 81�82 validation of new therapies, 154�157 in spinal cord injury, 79�81 See also Animal models; Clinical trials; Protein kinase C inhibition, 127�128 Collaborative research; Translational Proteoglycans, 44�45, 65, 127�128 research Pulmonary embolism, 103 Research personnel goals for research infrastructure, 5, 9, 239 Q supply, 232�233 See also Education and training for Quadriplegia, 15, 20 research prognosis, 20 Respiratory function functional electrical stimulation, 111�112 outcomes by level of injury, 16, 18 Read the entire page →
From page 342... ... 342 INDEX Rho-asssociated kinase, 128�129 Sphincter muscle, 55, 56, 103�104 Rick Hansen Spinal Cord Injury Network, Spinal cord anatomy, 31�32 198 areas of control, 32 Robert Packard Center for ALS Research, Spinal Cord Injury Research Centers of 197�198 Excellence, 5 Rolipram, 140�141, 223 collaborative research relationships, Roman Reed Research Grants Program, 196�197 224�226 infrastructure, 196 number of, 197, 201 purpose, 195, 196 S recommendation for, 6, 11, 201 Spinal Cord Society, 191 Sacral spine, 32 Spontaneous healing, 45�47, 162 Safety, patient, 142, 152, 153, 154, 156�157 Sprouting, 52, 55 Schwann cells, 37, 46, 65 Standards of care, 95�97 to promote axonal regrowth, 135�136 State-sponsored research, 320�322 remyelination with, 133 advantages, 212�214 Secondary phase of injury, 36, 40�43 allocation of resources, 191, 209�210 treatment strategies, 125�127 data management, 176 Sensory function funding sources, 7, 190�191, 207�208, anatomy, 31�32 209�210, 213, 214, 217�220, 226 in control of movement, 49�50, 134 infrastructure for, 213 injury classification, 32�34 model programs, 205�206, 214�227 prognostic factors, 20 motivation, 205, 207, 210�211 reflex reactions, 50 recommendations, 4, 12, 143 research goals, 2, 24 returns to states, 211�212 therapeutic interventions to restore, spending, 7, 190, 205, 206, 207, 208� 134�135 209, 216, 220, 224, 225 zone of partial preservation, 35�36 trends, 205, 206�207, 208, 210�211 Sensory neurons See also New York State Spinal Cord C fibers, 56 Injury Research Board hyperexcitability, 102 Stem cell therapies, 135, 136�140, 226�227 pain pathophysiology, 53, 102 Synaptic connections Severity of injury, 35 in axonal regrowth, 129 Sexual functioning research recommendations, 4, 8, 143 neurophysiology, 57�58 Syringomyelia, 45, 85 research goals, 2, 24 therapeutic interventions, 106�107 See also Reproductive health T Shock, 39 Sildenafil, 106, 107 Tendon transfer surgery, 111 Sodium, intracellular, 133�134 Tetraplegia. See Quadriplegia Solid cord injury, 32 Therapeutic interventions South Carolina, 191, 208 alternative therapies, 275�277 Spasticity assessment, 8, 89 complications, 50�52 autonomic dysreflexia, 105 definition, 52 biomarker analysis in, 78�79 neurophysiology, 52 bladder dysfunction, 103�104 research goals, 2, 24 bone disorders, 107 risk, 52 bowel dysfunction, 104 therapeutic interventions, 102, 133 cell-based, 135�140 Read the entire page →
From page 343... ... See also Acute care; Axonal regrowth; Violence, 14 Combination therapies Visceral pain, 53 Think First National Injury Prevention Voiding reflex, 55 Foundation, 192 Thoracic spine, 32 Thromboembolism, 102�103 W Thyrotropin-releasing hormone, 100 Tissue engineering, 132 Wheelchair use, 17, 19 T-lymphocytes, 38 White matter, 31 spinal cord injury pathophysiology, 41, Work-related injury, 14 42 therapeutic application, 123 Transection injuries, 68�70 Z Transgenic animals, 87 Zone of partial preservation, 35�36 Read the entire page →

From page 333...

... INDEX A Ambulation outcomes by level of injury, 17, 19 Action potentials, 39, 48 See also Movement Activities of daily living American Association of Neurological outcomes by level of injury, 15�19 Surgeons, 96, 192 See also Functional outcomes American Paralysis Association, 192 Acute care American Paraplegia Society, 192 clinical practice guidelines, 96 American Spinal Injury Association (ASIA) , current state of, 25, 95 32, 191�192 decompression of spinal cord, 98�99 Impairment Scale, 34, 35, 168 during transport, 97�98 4-Aminopyridine, 133, 161, 174 effectiveness, 97 Amyotrophic Lateral Sclerosis Functional goals, 23 Rating Scale, 171 immobilization, 97 Animal models, 10, 64 informed consent issues, 160�161 assessment techniques, 74�76 at injury scene, 97 generalizability, 70�73 neuroprotective interventions, 99�100 primates, 73 research needs, 98 rationale, 65, 66 research prospects, 25 recommendations for research, 88�89 research recommendations, 5, 143 research needs, 73�74 scope, 97 selection, 66�69 strategies, 122�125 standardization, 70, 73�74, 88 targets of intervention, 122�123 training for research using, 74, 88 Acute phase of injury, 36, 39�40 transgenic, 87 animal models, 68 for validation of new therapies, 154�155 research prospects, 25 Apoptosis Age at injury, 14 biomarkers, 77�78 costs of injury and, 20�22 interventions to prevent, 123, 125�126 Alternative therapies, 275�277 spinal cord injury pathophysiology, 2�3, 42�43, 125 333

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From page 334...

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

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From page 335...

... , 83 of injury, 32�36 Congress of Neurological Surgeons, 96, 192 of pain, 53 Consortium for Spinal Cord Medicine, 96, Clinical trials 193 challenges in spinal cord injury research, Consortium of Multiple Sclerosis Centers, 160�162 175 clinician expertise, 164 Contusion injuries, 32 collaborative multicenter studies, 164� animal models, 68 167

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From page 336...

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

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From page 337...

... , 177 Center, 6, 191, 217�219 Heparin therapy, 103 Heterotopic ossification, 107 Home modification costs, 20 L Hyperesthesia, 53 Hypothermia, therapeutic, 124�125, 161 Laceration injuries, 32 Length of hospital stay, 20 Hypoxia, 2�3, 39

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From page 338...

... See Magnetic resonance imaging costs, 20 mRNA, 81�82 immunosuppressant drugs, 123�124 Multiple sclerosis, 184, 187 to improve nerve conduction, 133 Muscle incentives for research, 173�174 atrophy, 112 neuropathic pain treatment, 100�101 feedback control of movement, 49�50 research and development process, 152� functional electrical stimulation, 110 154, 173 motor function, 48 sexual dysfunction, 106, 107 strength assessment, 35 sodium channel regulators, 133�134 See also Spasticity spasticity treatment, 102 Musculoskeletal pain, 53 thromboembolism prevention, 103 Myelin, 31 Meningeal cells, 43 in impulse conduction, 133 N-Methyl-D-aspartate, 86 natural remyelination after injury, 46�47 Methylprednisolone, 99, 159, 269�272 olfactory ensheathing cells, 136, 157 Miami Project to Cure Paralysis, 6, 155, oligodendrocytes, 37, 43, 44, 46�47, 65, 191, 213, 220�223 85�86 Microglia, 38 replacement, 3 spinal cord injury pathophysiology, 41� Schwann cells, 37, 46, 65, 133, 135�136 42 spinal cord injury pathophysiology, 43 Microlesions, 68, 69 therapeutic remyelination, 133, 136 Minocycline, 125 Mitochondria, 40 Model Spinal Cord Injury Care System, 6, N 20, 167�168, 176, 190, 197 Monocytes, 38, 41 National Acute Spinal Cord Injury Study acute intervention to prevent infiltration (NASCIS) , 159, 268�271 of, 124 National Cancer Institute, 82, 88, 175 Motor function National Center for Medical Rehabilitation assessment, 74�76 Research, 188

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From page 339...

... INDEX 339 National Institute of Child Health and research needs, 58, 141�142 Human Development, 195 research recommendations, 4, 8, 10, 201 National Institute of Neurological Disorders Schwann cells in, 37, 45, 65, 133, 135� and Stroke, 155 136 biomarker research, 82�83 secondary phase of injury, 40�43, 125� recommendations for, 5, 10, 11, 141, 143 127 research program, 5, 141, 143, 187�188 sexual function, 57�58 National Institute on Disability and spontaneous healing, 45�47 Rehabilitation Research, 189�190 T-cells in, 38, 41, 42, 123 National Institutes of Health, 6, 195, 197, trophic factors in, 126�127 236 types and levels of injury, 15�20, 32�34, fellowship awards, 200, 201 66�69 recommendations for, 4, 6, 7, 10, 11, See also Axonal regrowth; Neuron 12, 143, 179, 201 function research funding, 184�187, 201, 213�214 Neurogenic bowel, 56�57, 104 National Spinal Cord Injury Research Neurological level, 33�34 Network, 7, 11, 197�199, 201 Neuron function, 37 Necrosis animal research, 68 acute response to spinal cord injury, 39 in vitro studies, 65 intervention to prevent, 123 motor system, 48, 50 spinal cord injury pathophysiology, 2�3, See also Motor neurons 42 Neuropathic pain, 53�54, 100�101 NEP1-40 peptide, 128 Neuroprostheses Nerve growth factor, 126, 131 clinical trials, 164, 165 Netrins, 130 research needs, 143 Neurobiology of spinal cord See also Functional electrical stimulation acute effects of spinal cord injury, 39, Neuroprotection 122�125 definition, 125 animal models, 65�74 effectiveness, 99�100 astrocytes in, 37, 43 glutamate receptor blockers, 126 basic research, 194�195 goals, 125 bladder function and dysfunction, 55�56 immunosuppressant drugs for, 123�124 body weight support training effects, protease inhibition, 125 109 research recommendations, 4, 143 bowel dysfunction, 56�57 Neurotransmitters causes of muscle spasticity, 52 acute response to spinal cord injury, 39 central pattern generator role, 50 in pain pathophysiology, 54 chronic phase of spinal cord injury, 43� Neurotrophic factor-3, 126, 135 45 Neurotrophic factors, 3, 126�127 current understanding of injury and gene therapy to promote expression of, repair, 1, 25, 26, 58, 121 131 imaging technologies, 83�84, 86�87 Neutrophils, 38 in vitro research, 65 acute intervention to prevent infiltration injury pathophysiology, 2�3 of, 124 macrophages in, 123 spinal cord injury pathophysiology, 41 microglia in, 38, 41�42 New Jersey, 191, 207�208 motor function, 48�50 New York State Spinal Cord Injury pain pathophysiology, 53�55, 100, 101� Research Board, 1, 7, 12, 26, 190� 102 191, 229�230 phases of spinal cord injury, 36�39 administration, 234, 240 remyelination, natural and therapeutic, benefits to state, 211�212, 215 46�47, 133, 136 CART awards, 230

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From page 340...

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

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From page 341...

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

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

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... See also Acute care; Axonal regrowth; Violence, 14 Combination therapies Visceral pain, 53 Think First National Injury Prevention Voiding reflex, 55 Foundation, 192 Thoracic spine, 32 Thromboembolism, 102�103 W Thyrotropin-releasing hormone, 100 Tissue engineering, 132 Wheelchair use, 17, 19 T-lymphocytes, 38 White matter, 31 spinal cord injury pathophysiology, 41, Work-related injury, 14 42 therapeutic application, 123 Transection injuries, 68�70 Z Transgenic animals, 87 Zone of partial preservation, 35�36

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Index Pages 333-344

Index
Pages 333-344