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Spinal Cord Injury: Progress, Promise, and Priorities
ity and promoting axonal growth and synaptic integrity to achieve improved and appropriate function (Table 5-4). The addition of information to the body of knowledge on neurological circuitry and mechanisms will be of benefit not only to improving function after a spinal cord injury but also to developing therapies for other neurological diseases and conditions. In the past several decades the breadth and depth of neuroscience discoveries relevant to spinal cord injury have widely expanded the horizons of potential therapies. These new opportunities require increased research support by federal and state agencies, academic organizations, pharmaceutical and device companies, and nonprofit organizations. Further details on the nature and extent of the funding and infrastructure for spinal cord injury research are provided in Chapter 7.
A note of caution is needed, as one of the concerns regarding experimental therapies for spinal cord injuries has been the willingness by some patients to try unvalidated experimental therapies before the interventions have been thoroughly tested for safety and efficacy in methodologically rigorous studies. The committee urges the careful consideration and thorough study of new therapies with the utmost attention to patient safety.
TABLE 5-4 Priorities for Spinal Cord Injury Research
Develop neuroprotection therapies: identify interventions that promote neuroprotective mechanisms that preserve the spinal cord.
Promote axonal sprouting and growth: enhance understanding of the molecular mechanisms that promote and inhibit axonal regeneration—including the roles of glia (astrocytes and oligodendrocytes), scar formation, and inflammation and inhibitory molecules—and develop therapeutic approaches to promote growth.
Steer axonal growth: determine the molecular mechanisms that direct axons to their appropriate targets and regulate the formation and maintenance of appropriate synaptic connections.
Reestablish essential neuronal and glial circuitry: advance the understanding of the molecular mechanisms that regulate the formation and maintenance of the intricate neuronal and glial circuitry, which controls the complex multimodal function of the spinal cord, including autonomic, sensory, and motor functions. Increase knowledge of the mechanisms that control locomotion, including the differences in the central pattern generator between bipeds and quadrupeds.
Prevent acute and chronic complications: develop interventions that prevent and reverse the evolution of events that lead to the wide range of outcomes that result from chronic injury and disability after a spinal cord injury.
Maintain maximal potential for recovery: expand the understanding of the requirements for proper postinjury care and rehabilitation that are needed to maintain the maximal potential for full recovery.
