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Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
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INDEX

A

Action potentials, 39, 48

Activities of daily living

outcomes by level of injury, 15–19

See also Functional outcomes

Acute care

clinical practice guidelines, 96

current state of, 25, 95

decompression of spinal cord, 98–99

during transport, 97–98

effectiveness, 97

goals, 23

immobilization, 97

informed consent issues, 160–161

at injury scene, 97

neuroprotective interventions, 99–100

research needs, 98

research prospects, 25

research recommendations, 5, 143

scope, 97

strategies, 122–125

targets of intervention, 122–123

Acute phase of injury, 36, 39–40

animal models, 68

research prospects, 25

Age at injury, 14

costs of injury and, 20–22

Alternative therapies, 275–277

Ambulation

outcomes by level of injury, 17, 19

See also Movement

American Association of Neurological Surgeons, 96, 192

American Paralysis Association, 192

American Paraplegia Society, 192

American Spinal Injury Association (ASIA), 32, 191–192

Impairment Scale, 34, 35, 168

4-Aminopyridine, 133, 161, 174

Amyotrophic Lateral Sclerosis Functional Rating Scale, 171

Animal models, 10, 64

assessment techniques, 74–76

generalizability, 70–73

primates, 73

rationale, 65, 66

recommendations for research, 88–89

research needs, 73–74

selection, 66–69

standardization, 70, 73–74, 88

training for research using, 74, 88

transgenic, 87

for validation of new therapies, 154–155

Apoptosis

biomarkers, 77–78

interventions to prevent, 123, 125–126

spinal cord injury pathophysiology, 2–3, 42–43, 125

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

Assessment

biomarker applications, 77–79

of complications of spinal cord injury, 76

experimental models, 65

of functional outcomes of spinal cord injury, 74–76

imaging technologies, 83–88

injury classification, 32–36

injury outcomes, 260–267

pain, 53

recommendations for research, 89

research needs, 8, 10

standardization of outcome measures, 168–172, 178–179

technical development, 64

Astrocytes, 37

in glial scarring, 43

Atrophy, muscle, 112

Autonomic dysreflexia, 105

Autonomic nervous system

motor function and, 48

research goals, 2, 24

Axon anatomy and function, 31

embryonic development, 130

spinal cord pathophysiology, 43

Axonal regrowth, 3

animal models, 65–66, 70, 71–73

barriers to, strategies to remove, 127–129

cell transplantation to promote, 132, 135–136

combination therapies to promote, 140–141

environmental conditions for, 45–46, 129

gene therapies to improve, 130–132

glial scarring in inhibition of, 43–45, 127

guidance, 129–130

in vitro studies, 65

macrophage therapy to improve, 123

molecular processes, 65

muscle spasticity and, 52

neurotrophic factors to promote, 135

pain outcomes and, 101–102

research needs, 58

research recommendations, 4, 8, 143

restoration of impulse conduction, 133–134

spontaneous healing, 47

strategies for promoting, 129

synaptic connections, 129

tissue scaffolding to promote, 132

Axon anatomy and function, 31

embryonic development, 130

spinal cord pathophysiology, 43

B

Baclofen, 102

Basal ganglia, 48

Basso, Beattie, and Bresnahan (BBB) scale, 74–76, 260

Basso Mouse Scale (BMS), 74–76, 260–261

Bathing abilities, 17, 19

Bed mobility, 16, 18

Biomarkers, 8, 89

applications, 77–79

current technology, 77

future prospects for research, 81–83

in imaging technologies, 85–87

Bladder function, 105

anatomy, 55

outcomes by level of injury, 16, 18

pathophysiology, 55–56, 103

research goals, 2, 24

therapeutic interventions, 103–104, 110–111

types of dysfunction, 103

Blood pressure, spinal cord injury and, 39

Body weight support training, 108–110

Bone disorders, 107

Bowel function, 104, 105

outcomes by level of injury, 16, 18

pathophysiology, 56–57

research goals, 2, 24

Brain-derived neurotrophic factor, 126

Brain stem, motor function, 48

Bryon Reisch Paralysis Foundation, 191

Buoniconti Fund to Cure Paralysis, 191

C

C fibers, 56

Calcium, intracellular, 126

in apoptosis, 42–43

in spinal cord injury pathophysiology, 41

California, 213, 223–227

Reeve-Irvine Research Center, 6, 155, 224

stem cell bill, Proposition 71, 226–227

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

Calpain, 125

Caspases, 125

CAT scan. See Computed tomography

Cauda equina, 55

Causes of spinal cord injury, 14–15

Cells

cell-based therapeutic interventions, 3, 123, 135–140

endothelial, 38, 39

glial, 65

meningeal, 43

olfactory ensheathing, 136, 157

pathiophysiology of spinal cord injury, 36–39

Schwann, 37, 45, 65, 133, 135–136

T-lymphocytes, 38, 41, 42, 123

transplantation, 132, 135–149

See also Apoptosis;

Neuron function;

Stem cell therapies

Center for International Blood and Marrow Transplant Research, 175

Centers for Disease Control and Prevention, 188–189

Central pattern generator, 50

Cerebellum, motor function, 48

Cerebral cortex

central pattern generator and, 50

motor control, 48

in pain experience, 55

Cervical spine, 32

Chondroitin sulfate, 65, 127–128

Chondroitinase ABC, 128

Christopher Reeve Clinical Trials Network, 171, 176, 192

Chronic phase of injury, 36, 43–45

clinical practice guidelines, 96

treatment strategies, 127–135

Circulatory system

acute response to spinal cord injury, 39–40

autonomic dysreflexia, 105

thromboembolism risk, 102–103

Classification

of injury, 32–36

of pain, 53

Clinical trials

challenges in spinal cord injury research, 160–162

clinician expertise, 164

collaborative multicenter studies, 164–167

coordination with care resources, 167–168

criteria for entering into, 154

future prospects, 159

historical review, 278–319

industry involvement, 172–174

informed consent issues, 160–161

interpretation of results, 172

patient recruitment, 161–162

phases, 153

purpose, 152–153

quality of past studies, 156–157

recommendations, 11, 12, 178–179, 239

research opportunities, 8–9

small population studies, 162–164, 179

spontaneous recovery in, 162

standardization of outcome measures, 168–172

Clip compression, 68

Collaborative research

centers of excellence for, 195, 196–197

clinical trials, 164–167

to develop imaging technology, 88

international efforts, 193–194

network for, 195, 197–199

rationale, 5, 8–9

recommendations, 11, 239

strategies for enhancing, 195–199, 230

Combination therapies, 3

challenges to development, 141

current state, 140–141

neurotrophic factors in, 127

rationale, 140, 141

research recommendations, 5, 8, 10, 141, 143

Communication abilities, spinal cord injury and, 17, 19

Completeness of injury, 20, 34–35

Compression injury

animal models, 68–70

decompression interventions, 98–99

Computed tomography, 84

Computed tomography (CT/CAT scan), 83

Congress of Neurological Surgeons, 96, 192

Consortium for Spinal Cord Medicine, 96, 193

Consortium of Multiple Sclerosis Centers, 175

Contusion injuries, 32

animal models, 68

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

Corticospinal tract, 48

Corticosteroid therapy, 166

Cost of research, 173

federal spending, 184–190

infrastructure construction, 213–214

state spending, 205, 206, 207, 208–209, 216

Costs of spinal cord injury, 20–23

Cure, defining, 2, 23–24

Cyclic AMP, 129, 140–141, 223

Cyclosporin A, 123

Cytokines, 42

D

Data collection and management, 174–178, 190

Decompression of spinal cord, 98–99

Decubitus ulcers. See Pressure sores

Demographic characteristics of spinal cord injury victims, 14–15

Department of Education, U.S., 189–190

Department of Veterans Affairs, U.S., 6, 189

Depression

research goals, 2, 24

risk, 107–108

treatment, 108

Dermatomes, 33

Detrusor muscle, 55–56, 103–104

Dorsal horn, 32

Dressing abilities, 17, 19

Dysesthesia, 53

E

Early Detection Research Network, 82–83

Eating function, 16, 18

Edema, 40

acute intervention, 122

spinal cord injury pathophysiology, 2–3

Education and training for research, 9

animal studies, 74, 88

clinical trials expertise, 164

federal support, 186–187

rationale for expanding, 200–201

recommendations, 10, 11–12, 201

trends, 200

Endothelial cells, 38, 39

Ephrins, 130

Epidemiology, 1, 14

Epilepsy, 184

Erectile dysfunction, 106

Erythropoietin, 126

Ethical issues, 156

Excitotoxicity, 39

F

F30 fellowships, 200

F31 fellowships, 200

Facilities of Research Excellence in Spinal Cord Injury, 155, 187

Fampridine, 102

Fas protein, 77–78

Feedback systems

movement control, 49–50

in muscle spasticity, 52

Fibroblast growth factor, 126

Fibroblasts, 70

Florida, 191, 207, 219–221

See also Miami Project to Cure Paralysis

Food and Drug Administration, U.S., 153, 179, 223

Free radicals, 42

formation after injury, 40–41

intervention to prevent formation of, 123

Functional electrical stimulation

applications, 110

bladder dysfunction treatment, 110–111

with body weight support training, 109–110

clinical acceptance of, 112–113

future prospects, 113–114

lower-extremity, 111–112

to maintain muscle fitness, 112

mechanism of action, 110

upper-extremity, 111

Functional magnetic resonance imaging, 83–84

Functional outcomes

hypothermia treatment, 125

level of injury and, 15–20

measurement, 168, 260–267

neurobiology, 47–58

recommendations for research, 89

research goals, 2, 24

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

G

Gamma-aminobutyric acid (GABA), 102

Gene expression, 36

biomarkers of spinal cord injury progression, 77–79

research protocols, 83

Gene therapy

gene delivery techniques, 131

gene types in, 131

outcomes, 132

to promote neuronal repair, 130–132

rationale, 130–131

Genetics, generalizability of animal research, 70–71

Geoffrey Lance Foundation for Spinal Cord Injury Research and Support, 191

Glial cells, 65

Glial circuitry, 4

Glial-derived neurotrophic factor, 126

Glial scarring, 3

as barrier to axonal regrowth, 43–45, 127

therapeutic interventions, 127–128

Glucose metabolism, 86

Glutamate, 40

in apoptosis, 126

neuroprotective blocking of, 126

GM-1 ganglioside, 99

Gray matter, 32

acute response to spinal cord injury, 40

Grooming abilities, 17, 19

Growth cones, 65

Growth factors, 126

gene therapy to promote expression of, 131

in neuronal regeneration, 47

in spinal cord injury pathophysiology, 42

H

Hand control, 111

Health Insurance Portability and Accountability Act (HIPAA), 177

Heparin therapy, 103

Heterotopic ossification, 107

Home modification costs, 20

Hyperesthesia, 53

Hypothermia, therapeutic, 124–125, 161

Hypoxia, 2–3, 39

I

Imaging technology

clinical applications, 87–88

computed tomography, 83, 84

functional magnetic resonance imaging, 83–84

future prospects, 85–87

magnetic resonance imaging, 83, 84, 85

modalities, 83–85

positron emission tomography, 83, 85, 86

recommendations for research, 89

Immune function

acute care interventions, 123–124

spinal cord injury pathophysiology, 41–42

Indiana, 191, 207

Informed consent, 156–157, 160–161, 176–177

Injury prevention, 23

Inosine, 129

Institutional review boards, 165–167, 178

Interleukins, 77–78

International Campaign for Cures of Spinal Cord Injury Paralysis, 193–194

International Collaboration on Repair Discoveries, 170, 194

International Spinal Research Trust, 159, 168, 171, 194

Ion channel function, 39, 43, 133

in apoptosis, 126

in muscle spasticity, 52, 133

in pain pathophysiology, 55

response to axon demyelination, 133

in sensory neuron hyperexcitability, 102

therapeutic interventions targeting, 133–134

Ischemia, 40

acute intervention, 122

K

Kentucky, 207, 216–219

Kentucky Spinal Cord Injury Research Center, 6, 191, 217–219

L

Laceration injuries, 32

Length of hospital stay, 20

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

Level of injury, 15–20, 32

sensory and motor levels, 32–34

Limbic system, 57

Lipid peroxidation, 40, 41

Lumbar spine, 32

M

Macrophage therapy, 123

Magnetic resonance imaging (MRI), 83, 84, 85.

See also Functional magnetic resonance imaging

MAP kinase, 102

Maryland, 191, 208

Medical industry. See Pharmaceutical and medical device industry

Medications

acute care, 98, 123–124

apoptosis inhibitors, 125

biomarkers to study effectiveness of, 86

bladder dysfunction treatment, 104

combination therapies, 140–141

costs, 20

immunosuppressant drugs, 123–124

to improve nerve conduction, 133

incentives for research, 173–174

neuropathic pain treatment, 100–101

research and development process, 152–154, 173

sexual dysfunction, 106, 107

sodium channel regulators, 133–134

spasticity treatment, 102

thromboembolism prevention, 103

Meningeal cells, 43

N-Methyl-D-aspartate, 86

Methylprednisolone, 99, 159, 269–272

Miami Project to Cure Paralysis, 6, 155, 191, 213, 220–223

Microglia, 38

spinal cord injury pathophysiology, 41–42

Microlesions, 68, 69

Minocycline, 125

Mitochondria, 40

Model Spinal Cord Injury Care System, 6, 20, 167–168, 176, 190, 197

Monocytes, 38, 41

acute intervention to prevent infiltration of, 124

Motor function

assessment, 74–76

central pattern generator role, 50

cortical control, 48

feedback control of movement, 49–50

functional electrical stimulation, 110–114

injury classification, 32–34

neurophysiology, 48–50

prognostic factors, 20

research goals, 2, 24

therapeutic interventions, 108–114

zone of partial preservation, 35–36

See also Motor neurons

Motor neurons, 48

in muscle spasticity, 52

Motor vehicle accidents, 14, 207

injury prevention strategies, 23

Movement

body weight support training, 108–110

feedback control, 49–50

lower-extremity functional electrical stimulation, 112

proprioception in, 134–135

MRI. See Magnetic resonance imaging

mRNA, 81–82

Multiple sclerosis, 184, 187

Muscle

atrophy, 112

feedback control of movement, 49–50

functional electrical stimulation, 110

motor function, 48

strength assessment, 35

See also Spasticity

Musculoskeletal pain, 53

Myelin, 31

in impulse conduction, 133

natural remyelination after injury, 46–47

olfactory ensheathing cells, 136, 157

oligodendrocytes, 37, 43, 44, 46–47, 65, 85–86

replacement, 3

Schwann cells, 37, 46, 65, 133, 135–136

spinal cord injury pathophysiology, 43

therapeutic remyelination, 133, 136

N

National Acute Spinal Cord Injury Study (NASCIS), 159, 268–271

National Cancer Institute, 82, 88, 175

National Center for Medical Rehabilitation Research, 188

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

National Institute of Child Health and Human Development, 195

National Institute of Neurological Disorders and Stroke, 155

biomarker research, 82–83

recommendations for, 5, 10, 11, 141, 143

research program, 5, 141, 143, 187–188

National Institute on Disability and Rehabilitation Research, 189–190

National Institutes of Health, 6, 195, 197, 236

fellowship awards, 200, 201

recommendations for, 4, 6, 7, 10, 11, 12, 143, 179, 201

research funding, 184–187, 201, 213–214

National Spinal Cord Injury Research Network, 7, 11, 197–199, 201

Necrosis

acute response to spinal cord injury, 39

intervention to prevent, 123

spinal cord injury pathophysiology, 2–3, 42

NEP1-40 peptide, 128

Nerve growth factor, 126, 131

Netrins, 130

Neurobiology of spinal cord

acute effects of spinal cord injury, 39, 122–125

animal models, 65–74

astrocytes in, 37, 43

basic research, 194–195

bladder function and dysfunction, 55–56

body weight support training effects, 109

bowel dysfunction, 56–57

causes of muscle spasticity, 52

central pattern generator role, 50

chronic phase of spinal cord injury, 43–45

current understanding of injury and repair, 1, 25, 26, 58, 121

imaging technologies, 83–84, 86–87

in vitro research, 65

injury pathophysiology, 2–3

macrophages in, 123

microglia in, 38, 41–42

motor function, 48–50

pain pathophysiology, 53–55, 100, 101–102

phases of spinal cord injury, 36–39

remyelination, natural and therapeutic, 46–47, 133, 136

research needs, 58, 141–142

research recommendations, 4, 8, 10, 201

Schwann cells in, 37, 45, 65, 133, 135–136

secondary phase of injury, 40–43, 125–127

sexual function, 57–58

spontaneous healing, 45–47

T-cells in, 38, 41, 42, 123

trophic factors in, 126–127

types and levels of injury, 15–20, 32–34, 66–69

See also Axonal regrowth;

Neuron function

Neurogenic bowel, 56–57, 104

Neurological level, 33–34

Neuron function, 37

animal research, 68

in vitro studies, 65

motor system, 48, 50

See also Motor neurons

Neuropathic pain, 53–54, 100–101

Neuroprostheses

clinical trials, 164, 165

research needs, 143

See also Functional electrical stimulation

Neuroprotection

definition, 125

effectiveness, 99–100

glutamate receptor blockers, 126

goals, 125

immunosuppressant drugs for, 123–124

protease inhibition, 125

research recommendations, 4, 143

Neurotransmitters

acute response to spinal cord injury, 39

in pain pathophysiology, 54

Neurotrophic factor-3, 126, 135

Neurotrophic factors, 3, 126–127

gene therapy to promote expression of, 131

Neutrophils, 38

acute intervention to prevent infiltration of, 124

spinal cord injury pathophysiology, 41

New Jersey, 191, 207–208

New York State Spinal Cord Injury Research Board, 1, 7, 12, 26, 190–191, 229–230

administration, 234, 240

benefits to state, 211–212, 215

CART awards, 230

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

challenges, 232–234

CORE awards, 230, 231, 234

funding source, 207, 228, 236

future prospects, 238–239

grants, 229–230, 232–233

IDEA awards, 230

motivation, 210

number of researchers, 232–233, 239

origin, 227–228

performance evaluations, 228–229, 240

private sector linkages, 237–238

program strengths, 228, 235–238

proposal review process, 228, 229

recommendations for, 239–240

research areas, 230–231

resources, 236–237

significance of, 205–206

spending, 207, 230, 234

Nitric oxide, 56

Nociceptive pain, 53–54, 100

Nogo-A, 44, 128

knockout mice, 71, 128

Nogo receptor blockade, 128–129

Nonprofit organizations

recommendations for, 4, 143

research role, 4, 5, 11, 191–194

O

Olfactory ensheathing cells, 136, 157

Oligodendrocytes, 37, 65

precursor cells, 44, 47

radiolabeled, 85–86

spinal cord injury pathophysiology, 43, 44

in spontaneous healing, 46–47

Opioid therapy, 101

Orphan Drug Act, 173–174

Outcomes, 25

assessment, 74–76, 260–267

biomarker expression data, 79

challenges to improving, 26

data collection and management, 174–178, 198

decompression interventions, 98–99

defining, 2, 23–24, 260–267

depression, 107–108

emergency response, 97–98

ensheathing cell therapies, 136

gene therapy, 132

historical development, 13–14, 95

individual differences, 15

macrophage therapy, 123

neuroprotective therapies, 99–100

pain prevention interventions, 100–101

pain risk, 52, 53

reproductive, 106, 107

research needs, 8

sensory function therapy, 135

spasticity interventions, 102, 133

standardization of measures, 168–172, 178–179

stem cell therapies, 137

therapeutic hypothermia, 124–125

See also Functional outcomes

P

P01 grants, 188

P30 grants, 188

P50 grants, 188

Pain

definition and classification, 52–53, 100

hypersensitivity, 53–54

neurophysiology, 53–55, 100, 101–102

research goals, 2, 24

risk of, in spinal cord injury, 52, 53

therapeutic interventions, 100–102

Paralysis Project of America, 191

Paralyzed Veterans of America, 193

Paraplegia, 15–20

prognosis, 20

Parkinson’s disease, 21, 184, 187

Pathophysiology, 2–3, 30, 58

acute phase, 39–40

bladder dysfunction, 55–56, 103

bowel dysfunction, 56–57

cellular processes, 36–39

chronic phase of injury, 43–45

of pain, 53–55, 100, 101–102

pressure ulcers, 105

secondary phase of spinal cord injury, 40–43

spontaneous healing, 45–47

Peripheral nerve transplantation, 132

Personal assistance

costs, 20

requirements by level of injury, 17, 19

PET scan. See Positron emission tomography

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

Pharmaceutical and medical device industry

collaboration in state-sponsored research, 237

incentives for spinal cord injury research, 173–174

obstacles to spinal cord injury research, 172–173

recommendations for, 4, 143, 179

research role, 9, 179

Phases of injury, 36–39.

See also Acute phase of injury;

Chronic phase of injury;

Secondary phase of injury

Plasticity, nervous system, 45, 56, 195

Pons, 55

Positron emission tomography (PET scan), 83, 85, 86

Potassium metabolism, 126, 133

Pressure sores, 52

classification, 105

pathophysiology, 105

prevention and treatment, 105–106

research goals, 2, 24

risk, 105

Preventive interventions, 23, 192

Primary motor cortex, 48

Privacy issues, 177

Private sector

collaboration in state-sponsored research, 237–238

research role, 11

See also Pharmaceutical and medical device industry

Prognostic factors, 20

biomarkers, 77–78, 79

duration of spinal cord compression, 98

Proprioception, 49–50, 134–135

Proteases, 125

Protein expression

clinical significance, 77–78

future prospects for research, 81–82

in spinal cord injury, 79–81

Protein kinase C inhibition, 127–128

Proteoglycans, 44–45, 65, 127–128

Pulmonary embolism, 103

Q

Quadriplegia, 15, 20

prognosis, 20

R

Recreational sports, 14

Reeve-Irvine Research Center, 6, 155, 224

Registries, 174–178, 198

Rehabilitation

length of stay, 20

research funding, 188, 189–190

research recommendations, 5

Replication studies, 154–155

Reproductive health, 57, 106, 107.

See also Sexual functioning

Research

basic, 194–195

biochemical, 58

biomarker development, 81–83

challenges, 9, 172–173

clinical priorities, 3–5, 8, 10, 141–143

combination therapies, 5, 8, 10, 141

costs, 173

current state of, 9, 25–26, 184

data collection and management, 174–178

development of new therapies, 152–154

funding, 4, 5, 7, 12, 143, 183, 184–194, 201

goals, 2, 24

imaging technology development, 85–88

in vitro techniques, 65

industry incentives, 172–174, 179

infrastructure requirements, 5–9, 11–12, 183, 195, 213

patient safety concerns, 156–157

performance monitoring, 12

prospects, 25–26

publishing, 155

recommendations, 201

requirements for progress in, 5, 8–9, 183

strategies for accelerating, 194–201

validation of new therapies, 154–157

See also Animal models;

Clinical trials;

Collaborative research;

Translational research

Research personnel

goals for research infrastructure, 5, 9, 239

supply, 232–233

See also Education and training for research

Respiratory function

functional electrical stimulation, 111–112

outcomes by level of injury, 16, 18

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

Rho-asssociated kinase, 128–129

Rick Hansen Spinal Cord Injury Network, 198

Robert Packard Center for ALS Research, 197–198

Rolipram, 140–141, 223

Roman Reed Research Grants Program, 224–226

S

Sacral spine, 32

Safety, patient, 142, 152, 153, 154, 156–157

Schwann cells, 37, 46, 65

to promote axonal regrowth, 135–136

remyelination with, 133

Secondary phase of injury, 36, 40–43

treatment strategies, 125–127

Sensory function

anatomy, 31–32

in control of movement, 49–50, 134

injury classification, 32–34

prognostic factors, 20

reflex reactions, 50

research goals, 2, 24

therapeutic interventions to restore, 134–135

zone of partial preservation, 35–36

Sensory neurons

C fibers, 56

hyperexcitability, 102

pain pathophysiology, 53, 102

Severity of injury, 35

Sexual functioning

neurophysiology, 57–58

research goals, 2, 24

therapeutic interventions, 106–107

See also Reproductive health

Shock, 39

Sildenafil, 106, 107

Sodium, intracellular, 133–134

Solid cord injury, 32

South Carolina, 191, 208

Spasticity

complications, 50–52

definition, 52

neurophysiology, 52

research goals, 2, 24

risk, 52

therapeutic interventions, 102, 133

Sphincter muscle, 55, 56, 103–104

Spinal cord anatomy, 31–32

areas of control, 32

Spinal Cord Injury Research Centers of Excellence, 5

collaborative research relationships, 196–197

infrastructure, 196

number of, 197, 201

purpose, 195, 196

recommendation for, 6, 11, 201

Spinal Cord Society, 191

Spontaneous healing, 45–47, 162

Sprouting, 52, 55

Standards of care, 95–97

State-sponsored research, 320–322

advantages, 212–214

allocation of resources, 191, 209–210

data management, 176

funding sources, 7, 190–191, 207–208, 209–210, 213, 214, 217–220, 226

infrastructure for, 213

model programs, 205–206, 214–227

motivation, 205, 207, 210–211

recommendations, 4, 12, 143

returns to states, 211–212

spending, 7, 190, 205, 206, 207, 208–209, 216, 220, 224, 225

trends, 205, 206–207, 208, 210–211

See also New York State Spinal Cord Injury Research Board

Stem cell therapies, 135, 136–140, 226–227

Synaptic connections

in axonal regrowth, 129

research recommendations, 4, 8, 143

Syringomyelia, 45, 85

T

Tendon transfer surgery, 111

Tetraplegia. See Quadriplegia

Therapeutic interventions

alternative therapies, 275–277

assessment, 8, 89

autonomic dysreflexia, 105

biomarker analysis in, 78–79

bladder dysfunction, 103–104

bone disorders, 107

bowel dysfunction, 104

cell-based, 135–140

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
×

chronic phase, 127–135

combination strategies, 3, 5

costs, 20

criteria for validating, 154–157

depression, 108

functional electrical stimulation, 110–114

generalizability of animal research, 70–73

historical and technical development, 1, 3, 13–14

imaging markers to monitor effectiveness of, 86–87

informed consent issues, 156–157, 160–161

motor dysfunction, 108–114

outcomes assessment, 74–76, 168–172

pain prevention and management, 53, 100–102

patient safety concerns, 142, 152, 153, 154, 156–157, 160

pressure ulcers, 105–106

research and development process, 152–154

research priorities, 3–5, 8, 10, 141–143

research recommendations, 178–179

secondary phase, 125–127

sexual dysfunction, 106–107

for spasticity, 102

standards of care, 95–97

strategic focus for development of new, 121

thromboembolism prevention, 102–103

using spontaneous healing, 45–47

See also Acute care;

Axonal regrowth;

Combination therapies

Think First National Injury Prevention Foundation, 192

Thoracic spine, 32

Thromboembolism, 102–103

Thyrotropin-releasing hormone, 100

Tissue engineering, 132

T-lymphocytes, 38

spinal cord injury pathophysiology, 41, 42

therapeutic application, 123

Transection injuries, 68–70

Transgenic animals, 87

Translational research

biomarker development, 82–83

current state, 183

ethical considerations, 156–157

goals, 5, 6

imaging technologies, 87–88

process, 152, 173

recommendations, 6, 11, 197, 201

research networks to facilitate, 8–9, 197–198

state-sponsored programs, 230, 231

Transplantation

cell, 132, 135–140

in combination therapies, 140–141

tissue, 132

Trauma Care Systems Planning and Development Act, 176

Trophic factors, 126–127

U

Unified Parkinson’s Disease Rating Scale, 171

United Spinal Association, 193

V

Vasospasm, 40

VCAM-1 antibodies, 124

Vehicle modification costs, 20

Ventral horn, 32, 48

Veterans Administration. See Department of Veterans Affairs, U.S.

Violence, 14

Visceral pain, 53

Voiding reflex, 55

W

Wheelchair use, 17, 19

White matter, 31

Work-related injury, 14

Z

Zone of partial preservation, 35–36

Suggested Citation:"Index." Institute of Medicine. 2005. Spinal Cord Injury: Progress, Promise, and Priorities. Washington, DC: The National Academies Press. doi: 10.17226/11253.
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Spinal Cord Injury: Progress, Promise, and Priorities Get This Book
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An estimated 11,000 spinal cord injuries occur each year in the United States and more than 200,000 Americans suffer from maladies associated with spinal cord injury. This includes paralysis, bowel and bladder dysfunction, sexual dysfunction, respiratory impairment, temperature regulation problems, and chronic pain. During the last two decades, longstanding beliefs about the inability of the adult central nervous system to heal itself have been eroded by the flood of new information from research in the neurosciences and related fields. However, there are still no cures and the challenge of restoring function in the wake of spinal cord injuries remains extremely complex.

Spinal Cord Injury examines the future directions for research with the goal to accelerate the development of cures for spinal cord injuries. While many of the recommendations are framed within the context of the specific needs articulated by the New York Spinal Cord Injury Research Board, the Institute of Medicine’s panel of experts looked very broadly at research priorities relating to future directions for the field in general and make recommendations to strengthen and coordinate the existing infrastructure. Funders at federal and state agencies, academic organizations, pharmaceutical and device companies, and non-profit organizations will all find this book to be an essential resource as they examine their opportunities.

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