The committee emphasizes the need to use a multifaceted approach to furthering the goal of curing spinal cord injuries. Strategies need to be developed to provide an organized approach to testing therapies in combination. The committee also recognizes that advances in science rely on novel breakthroughs, including those from other fields of research, and that there is a critical need to increase the awareness of spinal cord injury researchers of developments in other fields relevant to spinal cord injuries and to expand innovative approaches to spinal cord injury research. The discussion throughout this chapter emphasizes both the potential for progress and the numerous unknowns in the development of therapies. As more is learned about the pathways of the molecular and cellular events that result from a spinal cord injury, further therapeutic targets can be identified and approaches to promoting repair and restoring function can be refined.

RECOMMENDATIONS

Recommendation 5.1: Increase Efforts to Develop Therapeutic Interventions

The National Institutes of Health, other federal and state agencies, nonprofit organizations, and the pharmaceutical and medical device industries should increase research funding and efforts to develop therapeutic interventions that will prevent or reverse the physiological events that lead to chronic disability and interventions that are applicable to chronic spinal cord injuries. Specifically, research is needed to

  • improve understanding of the basic mechanisms and identify suitable targets to promote neuroprotection, foster axonal growth, enhance axonal guidance, regulate the maintenance of appropriate synaptic connections, and reestablish functional neuronal and glial circuitry; and

  • enhance understanding of proper postinjury care and rehabilitation, such as retraining, relearning, and the use of neuroprostheses, to create the groundwork required to maintain and enhance the maximal potential for full recovery.

Recommendation 5.2: Develop a Strategic Plan for Combination Therapeutic Approaches

The National Institute of Neurological Disorders and Stroke should develop a strategic plan to screen and assess the potential for compounds and therapies to be used in combination to treat acute and chronic spinal cord injuries.



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