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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, 1519 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, 191192 decompression of spinal cord, 9899 Impairment Scale, 34, 35, 168 during transport, 9798 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, 160161 assessment techniques, 7476 at injury scene, 97 generalizability, 7073 neuroprotective interventions, 99100 primates, 73 research needs, 98 rationale, 65, 66 research prospects, 25 recommendations for research, 8889 research recommendations, 5, 143 research needs, 7374 scope, 97 selection, 6669 strategies, 122125 standardization, 70, 7374, 88 targets of intervention, 122123 training for research using, 74, 88 Acute phase of injury, 36, 3940 transgenic, 87 animal models, 68 for validation of new therapies, 154155 research prospects, 25 Apoptosis Age at injury, 14 biomarkers, 7778 costs of injury and, 2022 interventions to prevent, 123, 125126 Alternative therapies, 275277 spinal cord injury pathophysiology, 23, 4243, 125 333
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From page 334... ...
, 7476, research needs, 8, 10 standardization of outcome measures, 260261 168172, 178179 Bathing abilities, 17, 19 Bed mobility, 16, 18 technical development, 64 Astrocytes, 37 Biomarkers, 8, 89 in glial scarring, 43 applications, 7779 current technology, 77 Atrophy, muscle, 112 Autonomic dysreflexia, 105 future prospects for research, 8183 Autonomic nervous system in imaging technologies, 8587 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, 5556, 103 embryonic development, 130 spinal cord pathophysiology, 43 research goals, 2, 24 Axonal regrowth, 3 therapeutic interventions, 103104, 110111 animal models, 6566, 70, 7173 barriers to, strategies to remove, 127129 types of dysfunction, 103 cell transplantation to promote, 132, Blood pressure, spinal cord injury and, 39 Body weight support training, 108110 135136 combination therapies to promote, 140 Bone disorders, 107 141 Bowel function, 104, 105 outcomes by level of injury, 16, 18 environmental conditions for, 4546, 129 gene therapies to improve, 130132 pathophysiology, 5657 glial scarring in inhibition of, 4345, 127 research goals, 2, 24 Brain-derived neurotrophic factor, 126 guidance, 129130 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, 101102 research needs, 58 C fibers, 56 research recommendations, 4, 8, 143 Calcium, intracellular, 126 restoration of impulse conduction, 133 in apoptosis, 4243 134 in spinal cord injury pathophysiology, spontaneous healing, 47 41 strategies for promoting, 129 California, 213, 223227 synaptic connections, 129 Reeve-Irvine Research Center, 6, 155, 224 tissue scaffolding to promote, 132 stem cell bill, Proposition 71, 226227
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From page 335... ...
, 83 of injury, 3236 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, 160162 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, 184190 Erectile dysfunction, 106 infrastructure construction, 213214 Erythropoietin, 126 state spending, 205, 206, 207, 208209, Ethical issues, 156 216 Excitotoxicity, 39 Costs of spinal cord injury, 2023 Cure, defining, 2, 2324 Cyclic AMP, 129, 140141, 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, 174178, Fas protein, 7778 190 Feedback systems Decompression of spinal cord, 9899 movement control, 4950 Decubitus ulcers. See Pressure sores in muscle spasticity, 52 Demographic characteristics of spinal cord Fibroblast growth factor, 126 injury victims, 1415 Fibroblasts, 70 Department of Education, U.S., 189190 Florida, 191, 207, 219221 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, 107108 formation after injury, 4041 treatment, 108 intervention to prevent formation of, Dermatomes, 33 123 Detrusor muscle, 5556, 103104 Functional electrical stimulation Dorsal horn, 32 applications, 110 Dressing abilities, 17, 19 bladder dysfunction treatment, 110111 Dysesthesia, 53 with body weight support training, 109 110 clinical acceptance of, 112113 E future prospects, 113114 lower-extremity, 111112 Early Detection Research Network, 8283 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, 23 84 Education and training for research, 9 Functional outcomes animal studies, 74, 88 hypothermia treatment, 125 clinical trials expertise, 164 level of injury and, 1520 federal support, 186187 measurement, 168, 260267 rationale for expanding, 200201 neurobiology, 4758 recommendations, 10, 1112, 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, 217219 Heparin therapy, 103 Heterotopic ossification, 107 Home modification costs, 20 L Hyperesthesia, 53 Hypothermia, therapeutic, 124125, 161 Laceration injuries, 32 Length of hospital stay, 20 Hypoxia, 23, 39
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From page 338... ...
See Magnetic resonance imaging costs, 20 mRNA, 8182 immunosuppressant drugs, 123124 Multiple sclerosis, 184, 187 to improve nerve conduction, 133 Muscle incentives for research, 173174 atrophy, 112 neuropathic pain treatment, 100101 feedback control of movement, 4950 research and development process, 152 functional electrical stimulation, 110 154, 173 motor function, 48 sexual dysfunction, 106, 107 strength assessment, 35 sodium channel regulators, 133134 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, 4647 Methylprednisolone, 99, 159, 269272 olfactory ensheathing cells, 136, 157 Miami Project to Cure Paralysis, 6, 155, oligodendrocytes, 37, 43, 44, 4647, 65, 191, 213, 220223 8586 Microglia, 38 replacement, 3 spinal cord injury pathophysiology, 41 Schwann cells, 37, 46, 65, 133, 135136 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, 167168, 176, 190, 197 Monocytes, 38, 41 National Acute Spinal Cord Injury Study acute intervention to prevent infiltration (NASCIS) , 159, 268271 of, 124 National Cancer Institute, 82, 88, 175 Motor function National Center for Medical Rehabilitation assessment, 7476 Research, 188
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From page 339... ...
INDEX 339 National Institute of Child Health and research needs, 58, 141142 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, 8283 secondary phase of injury, 4043, 125 recommendations for, 5, 10, 11, 141, 143 127 research program, 5, 141, 143, 187188 sexual function, 5758 National Institute on Disability and spontaneous healing, 4547 Rehabilitation Research, 189190 T-cells in, 38, 41, 42, 123 National Institutes of Health, 6, 195, 197, trophic factors in, 126127 236 types and levels of injury, 1520, 3234, fellowship awards, 200, 201 6669 recommendations for, 4, 6, 7, 10, 11, See also Axonal regrowth; Neuron 12, 143, 179, 201 function research funding, 184187, 201, 213214 Neurogenic bowel, 5657, 104 National Spinal Cord Injury Research Neurological level, 3334 Network, 7, 11, 197199, 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, 23, See also Motor neurons 42 Neuropathic pain, 5354, 100101 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 122125 definition, 125 animal models, 6574 effectiveness, 99100 astrocytes in, 37, 43 glutamate receptor blockers, 126 basic research, 194195 goals, 125 bladder function and dysfunction, 5556 immunosuppressant drugs for, 123124 body weight support training effects, protease inhibition, 125 109 research recommendations, 4, 143 bowel dysfunction, 5657 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, 126127 current understanding of injury and gene therapy to promote expression of, repair, 1, 25, 26, 58, 121 131 imaging technologies, 8384, 8687 Neutrophils, 38 in vitro research, 65 acute intervention to prevent infiltration injury pathophysiology, 23 of, 124 macrophages in, 123 spinal cord injury pathophysiology, 41 microglia in, 38, 4142 New Jersey, 191, 207208 motor function, 4850 New York State Spinal Cord Injury pain pathophysiology, 5355, 100, 101 Research Board, 1, 7, 12, 26, 190 102 191, 229230 phases of spinal cord injury, 3639 administration, 234, 240 remyelination, natural and therapeutic, benefits to state, 211212, 215 4647, 133, 136 CART awards, 230
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From page 340... ...
340 INDEX challenges, 232234 historical development, 1314, 95 CORE awards, 230, 231, 234 individual differences, 15 funding source, 207, 228, 236 macrophage therapy, 123 future prospects, 238239 neuroprotective therapies, 99100 grants, 229230, 232233 pain prevention interventions, 100101 IDEA awards, 230 pain risk, 52, 53 motivation, 210 reproductive, 106, 107 number of researchers, 232233, 239 research needs, 8 origin, 227228 sensory function therapy, 135 performance evaluations, 228229, 240 spasticity interventions, 102, 133 private sector linkages, 237238 standardization of measures, 168172, program strengths, 228, 235238 178179 proposal review process, 228, 229 stem cell therapies, 137 recommendations for, 239240 therapeutic hypothermia, 124125 research areas, 230231 See also Functional outcomes resources, 236237 significance of, 205206 spending, 207, 230, 234 P Nitric oxide, 56 Nociceptive pain, 5354, 100 P01 grants, 188 Nogo-A, 44, 128 P30 grants, 188 P50 grants, 188 knockout mice, 71, 128 Nogo receptor blockade, 128129 Pain Nonprofit organizations definition and classification, 5253, 100 hypersensitivity, 5354 recommendations for, 4, 143 research role, 4, 5, 11, 191194 neurophysiology, 5355, 100, 101102 research goals, 2, 24 risk of, in spinal cord injury, 52, 53 O therapeutic interventions, 100102 Paralysis Project of America, 191 Olfactory ensheathing cells, 136, 157 Paralyzed Veterans of America, 193 Oligodendrocytes, 37, 65 Paraplegia, 1520 precursor cells, 44, 47 prognosis, 20 radiolabeled, 8586 Parkinson's disease, 21, 184, 187 spinal cord injury pathophysiology, 43, Pathophysiology, 23, 30, 58 44 acute phase, 3940 in spontaneous healing, 4647 bladder dysfunction, 5556, 103 Opioid therapy, 101 bowel dysfunction, 5657 Orphan Drug Act, 173174 cellular processes, 3639 Outcomes, 25 chronic phase of injury, 4345 assessment, 7476, 260267 of pain, 5355, 100, 101102 biomarker expression data, 79 pressure ulcers, 105 challenges to improving, 26 secondary phase of spinal cord injury, data collection and management, 174 4043 178, 198 spontaneous healing, 4547 decompression interventions, 9899 Peripheral nerve transplantation, 132 defining, 2, 2324, 260267 Personal assistance depression, 107108 costs, 20 emergency response, 9798 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, 194195 Positron emission tomography (PET scan) , biochemical, 58 83, 85, 86 biomarker development, 8183 Potassium metabolism, 126, 133 challenges, 9, 172173 Pressure sores, 52 clinical priorities, 35, 8, 10, 141143 classification, 105 combination therapies, 5, 8, 10, 141 pathophysiology, 105 costs, 173 prevention and treatment, 105106 current state of, 9, 2526, 184 research goals, 2, 24 data collection and management, 174 risk, 105 178 Preventive interventions, 23, 192 development of new therapies, 152154 Primary motor cortex, 48 funding, 4, 5, 7, 12, 143, 183, 184194, Privacy issues, 177 201 Private sector goals, 2, 24 collaboration in state-sponsored imaging technology development, 8588 research, 237238 in vitro techniques, 65 research role, 11 industry incentives, 172174, 179 See also Pharmaceutical and medical infrastructure requirements, 59, 1112, device industry 183, 195, 213 Prognostic factors, 20 patient safety concerns, 156157 biomarkers, 7778, 79 performance monitoring, 12 duration of spinal cord compression, 98 prospects, 2526 Proprioception, 4950, 134135 publishing, 155 Proteases, 125 recommendations, 201 Protein expression requirements for progress in, 5, 89, 183 clinical significance, 7778 strategies for accelerating, 194201 future prospects for research, 8182 validation of new therapies, 154157 in spinal cord injury, 7981 See also Animal models; Clinical trials; Protein kinase C inhibition, 127128 Collaborative research; Translational Proteoglycans, 4445, 65, 127128 research Pulmonary embolism, 103 Research personnel goals for research infrastructure, 5, 9, 239 Q supply, 232233 See also Education and training for Quadriplegia, 15, 20 research prognosis, 20 Respiratory function functional electrical stimulation, 111112 outcomes by level of injury, 16, 18
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From page 342... ...
342 INDEX Rho-asssociated kinase, 128129 Sphincter muscle, 55, 56, 103104 Rick Hansen Spinal Cord Injury Network, Spinal cord anatomy, 3132 198 areas of control, 32 Robert Packard Center for ALS Research, Spinal Cord Injury Research Centers of 197198 Excellence, 5 Rolipram, 140141, 223 collaborative research relationships, Roman Reed Research Grants Program, 196197 224226 infrastructure, 196 number of, 197, 201 purpose, 195, 196 S recommendation for, 6, 11, 201 Spinal Cord Society, 191 Sacral spine, 32 Spontaneous healing, 4547, 162 Safety, patient, 142, 152, 153, 154, 156157 Sprouting, 52, 55 Schwann cells, 37, 46, 65 Standards of care, 9597 to promote axonal regrowth, 135136 State-sponsored research, 320322 remyelination with, 133 advantages, 212214 Secondary phase of injury, 36, 4043 allocation of resources, 191, 209210 treatment strategies, 125127 data management, 176 Sensory function funding sources, 7, 190191, 207208, anatomy, 3132 209210, 213, 214, 217220, 226 in control of movement, 4950, 134 infrastructure for, 213 injury classification, 3234 model programs, 205206, 214227 prognostic factors, 20 motivation, 205, 207, 210211 reflex reactions, 50 recommendations, 4, 12, 143 research goals, 2, 24 returns to states, 211212 therapeutic interventions to restore, spending, 7, 190, 205, 206, 207, 208 134135 209, 216, 220, 224, 225 zone of partial preservation, 3536 trends, 205, 206207, 208, 210211 Sensory neurons See also New York State Spinal Cord C fibers, 56 Injury Research Board hyperexcitability, 102 Stem cell therapies, 135, 136140, 226227 pain pathophysiology, 53, 102 Synaptic connections Severity of injury, 35 in axonal regrowth, 129 Sexual functioning research recommendations, 4, 8, 143 neurophysiology, 5758 Syringomyelia, 45, 85 research goals, 2, 24 therapeutic interventions, 106107 See also Reproductive health T Shock, 39 Sildenafil, 106, 107 Tendon transfer surgery, 111 Sodium, intracellular, 133134 Tetraplegia. See Quadriplegia Solid cord injury, 32 Therapeutic interventions South Carolina, 191, 208 alternative therapies, 275277 Spasticity assessment, 8, 89 complications, 5052 autonomic dysreflexia, 105 definition, 52 biomarker analysis in, 7879 neurophysiology, 52 bladder dysfunction, 103104 research goals, 2, 24 bone disorders, 107 risk, 52 bowel dysfunction, 104 therapeutic interventions, 102, 133 cell-based, 135140
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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, 102103 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, 6870 Z Transgenic animals, 87 Zone of partial preservation, 3536
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