Dr. John MacDonald

This is a relatively sophisticated audience, so I'm going to show a few more slides than I normally would . . . He works at the International Center for SCI. They focus on designing individualized, life-long in-home, restoration therapy rehabilitation program.

Talking points:
Most mechanisms of regeneration are activity-dependent
Micro-repair is sufficient for functional recovery
Delayed recovery is possible
Activity-based restoration therapies (ABRT) work
ABRT is important for meeting the cure half way

It requires more than just movement; you have to be focusing on muscle mass.

He's showing a conventional wisdom ASIA A slide . . . very depressing old set of thoughts, followed by a some images of injured cords. Says that the brain is organized differently from the cord. Puts Pat Rummerfield's cord up; clearly can see that he's got 30% of his cord left, and then asks Pat to stand up.

You don't need the whole cord. You have a lot redundancy, and the nervous system can deal with bad injuries if you give it half a chance.

We've done a series of studies in people with ASIA A, and the majority of them have 10 to 30% of their cords intact, and yet they don't have a lot of function. Why? We think that many of them have BAD information going through that remnant of a cord.

The goals for restoration therapy are:
Partial repair -- a full "cure" is not necessary to regain function.
Reduction of complications, like infection, skin breakdown, spasticity, fractures, DVT, pain, AD . . . 30% of people with sci have to go to the hospital at least once a year.

What do we do? What are regeneration strategies?

In order of level of difficulty: Optimize spontaneous regeneration, create bridges, reduce expression of inhibitory proteins, achieve neuronal cell birth and replacement, create appropriate re-connectivity and long tract regrowth.

The lowest hanging fruit is to make the most of spontaneous regeneration.

And it turns out that patterned neural acitvity is fundamental to development and regeneration. How can you tell if regeneration is happening? the indicators are cell birth, migration, myelination, and formation of circuits. Drugs like baclofen inhibit the nervous system, while FES stimulates it. The nervous system responds to lack of activity by increasing spasticity.

Describing an experiment in which they did a complete transection at T8/9 and put a chip into the rat's lower back that let them give her e-stim. They got a lot cell birth below the injury site, just as expected -- 70% more than in their control.

He's saying that the activity caused new cells to come into being. Similar study with dramatic proliferation of oligodendrocytes due to FES.

Showing what happens if you take baclofen . . . lowers population of both axons and oligodendrocytes. They also gave it to rats and then treated them with embryonic stem cells, and saw that fewer neurons were created.

video: Riding an FES bike for one hour is equivalent to walking 6,000 steps . .. I'm sure this is online.

Are there clinical studies of ABRT? Sure, more of them all the time. They all show that it reverses physical deterioration and has many other benefits.

Sadowsky et al, 2005 . . . I will look this up and post the link; John is showing the data, but too fast for me to type. The bottom line is that 70% of the people in the study got at least some function back, and 40% of them jumped a full level on the ASIA scale.

(having a little problem watching these slides because he keeps swinging the green fluorescent pointer wildly and quickly around the screen . . . giving me the spins)

Q: What about people who can't get to a center?

We have to set up a better system; what we need is to get beyond the walls.