Studies of human movement have proliferated in recent years, and there have been many studies of spinal pathways in humans, their role in movement, and their dysfunction in neurological disorders. ...This comprehensive reference surveys the literature related to the control of spinal cord circuits in human subjects, showing how they can be studied, their role in normal movement, and how they malfunction in disease states. Chapters are highly illustrated and consistently organised, reviewing, for each pathway, the experimental background, methodology, organisation and control, role during motor tasks, and changes in patients with CNS lesions. Each chapter concludes with a helpful resume that can be used independently of the main text to provide practical guidance for clinical studies. This will be essential reading for research workers and clinicians involved in the study, treatment and rehabilitation of movement disorders.
Sarah D. Phillips examines the struggles of disabled persons in Ukraine
and the other former Soviet states to secure their rights during the tumultuous
political, economic, and social reforms of the ...last two decades. Through participant
observation and interviews with disabled Ukrainians across the social spectrum --
rights activists, politicians, students, workers, entrepreneurs, athletes, and
others -- Phillips documents the creative strategies used by people on the margins
of postsocialist societies to assert claims to mobile citizenship. She
draws on this rich ethnographic material to argue that public storytelling is a
powerful means to expand notions of relatedness, kinship, and social responsibility,
and which help shape a more tolerant and inclusive society.
Spinal cord injury (SCI) is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions. Its pathophysiology comprises acute and chronic phases and ...incorporates a cascade of destructive events such as ischemia, oxidative stress, inflammatory events, apoptotic pathways and locomotor dysfunctions. Many therapeutic strategies have been proposed to overcome neurodegenerative events and reduce secondary neuronal damage. Efforts have also been devoted in developing neuroprotective and neuro-regenerative therapies that promote neuronal recovery and outcome. Although varying degrees of success have been achieved, curative accomplishment is still elusive probably due to the complex healing and protective mechanisms involved. Thus, current understanding in this area must be assessed to formulate appropriate treatment modalities to improve SCI recovery. This review aims to promote the understanding of SCI pathophysiology, interrelated or interlinked multimolecular interactions and various methods of neuronal recovery i.e., neuroprotective, immunomodulatory and neuro-regenerative pathways and relevant approaches.
Epidural electrical stimulation (EES) of lumbosacral sensorimotor circuits improves leg motor control in animals and humans with spinal cord injury (SCI). Upper-limb motor control involves similar ...circuits, located in the cervical spinal cord, suggesting that EES could also improve arm and hand movements after quadriplegia. However, the ability of cervical EES to selectively modulate specific upper-limb motor nuclei remains unclear. Here, we combined a computational model of the cervical spinal cord with experiments in macaque monkeys to explore the mechanisms of upper-limb motoneuron recruitment with EES and characterize the selectivity of cervical interfaces. We show that lateral electrodes produce a segmental recruitment of arm motoneurons mediated by the direct activation of sensory afferents, and that muscle responses to EES are modulated during movement. Intraoperative recordings suggested similar properties in humans at rest. These modelling and experimental results can be applied for the development of neurotechnologies designed for the improvement of arm and hand control in humans with quadriplegia.
The blood–spinal cord barrier (BSCB) is the functional equivalent of the blood–brain barrier (BBB) in the sense of providing a specialized microenvironment for the cellular constituents of the spinal ...cord. Even if intuitively the BSCB could be considered as the morphological extension of the BBB into the spinal cord, evidence suggests that this is not so. The BSCB shares the same principal building blocks with the BBB; nevertheless, it seems that morphological and functional differences may exist between them. Dysfunction of the BSCB plays a fundamental role in the etiology or progression of several pathological conditions of the spinal cord, such as spinal cord injury, amyotrophic lateral sclerosis, and radiation‐induced myelopathy. This review summarizes current knowledge of the morphology of the BSCB, the methodology of studying the BSCB, and the potential role of BSCB dysfunction in selected disorders of the spinal cord, and finally summarizes therapeutic approaches to the BSCB. Ann Neurol 2011;
Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults worldwide. DCM encompasses various acquired (age-related) and congenital pathologies related to ...degeneration of the cervical spinal column, including hypertrophy and/or calcification of the ligaments, intervertebral discs and osseous tissues. These pathologies narrow the spinal canal, leading to chronic spinal cord compression and disability. Owing to the ageing population, rates of DCM are increasing. Expeditious diagnosis and treatment of DCM are needed to avoid permanent disability. Over the past 10 years, advances in basic science and in translational and clinical research have improved our understanding of the pathophysiology of DCM and helped delineate evidence-based practices for diagnosis and treatment. Surgical decompression is recommended for moderate and severe DCM; the best strategy for mild myelopathy remains unclear. Next-generation quantitative microstructural MRI and neurophysiological recordings promise to enable quantification of spinal cord tissue damage and help predict clinical outcomes. Here, we provide a comprehensive, evidence-based review of DCM, including its definition, epidemiology, pathophysiology, clinical presentation, diagnosis and differential diagnosis, and non-operative and operative management. With this Review, we aim to equip physicians across broad disciplines with the knowledge necessary to make a timely diagnosis of DCM, recognize the clinical features that influence management and identify when urgent surgical intervention is warranted.
This is the most comprehensive text available, encompassing the breadth and depth of the field of spinal cord medicine, covering topics from acute medical and surgical management to cutting-edge ...research, rehabilitation, and psychosocial care. This book was developed for all physicians, research scientists, and other health care professionals involved in the management of individuals with SCI, multiple sclerosis, and other spinal cord disorders. This practical clinical guide is the ultimate single source of information on SCM. It will be especially useful for physicians taking the examination for Subspecialty Certification in Spinal Cord Injury Medicine. Spinal Cord Medicine has 74 chapters written by leaders in their fields, and is divided into sections that include: a review of anatomy and physiology, spinal cord imaging, and epidemiology; acute spinal cord injury management, including prehospital management, emergency room evaluation and intensive care, and considerations relating to spine surgery; overall medical management, including management of respiratory and sleep disorders, cardiovascular dysfunction, infection, endocrine and metabolic dysfunction, and bladder, bowel, and sexual dysfunction; the neurologic aspects of spinal cord care, including the neurologic assessment of SCI, electrophysiological evaluation of the spinal tracts, myelopathies, multiple sclerosis, spasticity and pain management, autonomic dysfunction, and concomitant SCI and traumatic brain injury; musculoskeletal care, including the management of overuse injuries, osteoporosis and long bone fractures, and interdisciplinary approaches to upper extremity and pressure ulcer management; wheelchair and seating assessment, orthotics, activity of daily living training, vocational and driving training, and functional electric stimulation; recent advances in spinal cord
research, including functional magnetic stimulation, spinal cord regeneration and repair strategies, and body weight supported ambulation; special topics on aging, women?s issues, pediatric care, and SCI prevention; psychosocial issues, cost of care, SCI systems of care, and various supportive environments for SCI and SCD care.
An increasing number of studies supports the view that transcutaneous electrical stimulation of the spinal cord (TESS) promotes functional recovery in humans with spinal cord injury (SCI). However, ...the neural mechanisms contributing to these effects remain poorly understood. Here we examined motor-evoked potentials in arm muscles elicited by cortical and subcortical stimulation of corticospinal axons before and after 20 min of TESS (30 Hz pulses with a 5 kHz carrier frequency) and sham-TESS applied between C5 and C6 spinous processes in males and females with and without chronic incomplete cervical SCI. The amplitude of subcortical, but not cortical, motor-evoked potentials increased in proximal and distal arm muscles for 75 min after TESS, but not sham-TESS, in control subjects and SCI participants, suggesting a subcortical origin for these effects. Intracortical inhibition, elicited by paired stimuli, increased after TESS in both groups. When TESS was applied without the 5 kHz carrier frequency both subcortical and cortical motor-evoked potentials were facilitated without changing intracortical inhibition, suggesting that the 5 kHz carrier frequency contributed to the cortical inhibitory effects. Hand and arm function improved largely when TESS was used with, compared with without, the 5 kHz carrier frequency. These novel observations demonstrate that TESS influences cortical and spinal networks, having an excitatory effect at the spinal level and an inhibitory effect at the cortical level. We hypothesized that these parallel effects contribute to further the recovery of limb function following SCI.
Accumulating evidence supports the view that transcutaneous electrical stimulation of the spinal cord (TESS) promotes recovery of function in humans with spinal cord injury (SCI). Here, we show that a single session of TESS over the cervical spinal cord in individuals with incomplete chronic cervical SCI influenced in parallel the excitability cortical and spinal networks, having an excitatory effect at the spinal level and an inhibitory effect at the cortical level. Importantly, these parallel physiological effects had an impact on the magnitude of improvements in voluntary motor output.
Malignant spinal cord compression (MSCC) is one of the most devastating complications of cancer. Patients often present with a history of progressive pain, paralysis, sensory loss, progressive spinal ...deformity, and loss of sphincter control. It is an emergency that requires rapid decision making on the part of several specialists, given the risk of permanent spinal cord injury or death. The goals of treatment in spinal metastases are pain control and improvement of neurological function in order to achieve better quality of life (QoL). The standard of care in most cases is rapid initiation of corticosteroids in combination with either surgical decompression in case of an operable candidate, followed by radiation therapy (RT) or RT alone. Surgery is associated with improved outcomes, but is not appropriate for many patients presenting with advanced symptoms of MSCC, such as paralysis, or those with a poor performance status, or cachexic state, as well as altered mental conditions, co-morbidities, surgical risks, and limited life expectancy. On the other hand, aggressive surgical treatment and post-operative RT is advocated for those with more favorable prognosis, or who are expected to have higher neurological recovery potential. Many candidates may require for combined anterior and posterior approaches to effectively deal with the compressive pathology and stabilize the spine. Most patients are presently treated by primary RT, given with the aim of improving function and symptom management. However, there is still debate regarding the most appropriate RT schedule. Rehabilitation can serve to relieve symptoms, QoL, enhance functional independence, and prevent further complications. Ambulatory status has been found to be an important prognostic factor for patients with MSCC.
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