24. Biotherapeutics Training following CNS and PNS injury Flashcards
How often does our research in a particular field double?
Every Decade
What are the three strategies of tissue engineering?
Replace damaged tissue
Rescue surviving tissue
Regenerate new circuits from surviving ones
How many clinical trials have there been in 2011 testing cells?
6
How many clinical trials have there been in 2011 testing drugs?
23
How many clinical trials was there in 2011 to do with spinal cord injury?
76
What therapies do we have for acute or chronic therapies?
Medical management
Rehabilitation
What system acts as a model for CNS injury?
The visual model
What does the visual model describe?
Neurons survive
Axons regrow
Topography restored
Useful function (vision)
Can lizards regenerate control?
Yes
What are some examples of brain training?
Rat-transplants in huntingtons
Spinalised cells
SCI and treadmill training
Stroke patients
- Executive vs social functions
Dose dependont
Not stressful
Task specific
What does training do in lizard model?
Restores maps
Improves excitatory neurotransmittion and decreases inhibition
What is facial nerve injury (PNS injury)?
Temporal bone fractures damaging facial nerves
Poor recovery of facial tone, voluntary movement and facial expressions
How has the mouse model shown potential for regeneration?
When facial nerve is cut at foramen stylomastoideum
Mouse undergoes whisker training
Restores connections
What has treadmill training shown?
Improves stepping
Limits dieback
Induces Sprouting
Increases synaptogenesis
What happens in the body due to spinal cord injury/
Catabolic assault - Muscle, bone and kidney damage
- Bone resorption
- Osteoporosis
Metabolic Syndrome
- Muscle loss
- fat gain, insulin resistance
- Cardiovascular disease
Endocrine changes
Vascular Changes
Bladder, Bowel and sexual dysfunction
Inflammation
Mind
Exercise does after spinal cord injury?
1) Looks after neural circuits
2) Looks after the body
How does exercise look after neural circuits?
Increase growth factors Prevents die back Promotes new piggy back circuits Prevents demyelination Promotes remyelination Entrains intrinsic circuitry Pain, depression
How does exercise after SCI look after the body?
Muscle Bone Circulation Oedema Urinary output Cardiovascular
What is SCIPA?
Spinal cord injury & Physical Activity
8 spinal units in australia
Exercise paralysed limbs
Multi-centre assessor blinded randomised controlled trials
What is SCIPA swtich-on, phase 1/2?
ICU and Acute Care
- Functional electrical stimulation cycling in bed
- Limit early muscle and bone loss
- Improves vascular tone
- Maximise long term gain
What is SCIPA Hands-on phase 3?
Instrumented Re-Joyce workstation
- Reach
- Pinch
- Squeeze
- Grasp
- Release
- Twist
- Lift
- Push
- Pull
Treadmill Training
Has treadmill training shown distributed plasticity in the damaged spinal cord?
Yes
What is SCIPA full on, phase 3?
Full upper body exercise
Where can you get SCIPA?
WA
Victoria
Queensland
New Zealand
What happens during spinal cord injury?
Fracture dislocation / burst fracture Few complete transections Spinal canal narrowing Oedema, swelling Secondary metabolic damage
What are the injury cascades due to SCI?
Oxidative stress Inflammation Blood brain barrier disruption Excitotoxicity Mitochondrial dysfunction Cell death
How can spinal cord damage spread?
Hemorrhagic transformation
Progressive catastrophic spread of tissue damage
Loss of function
What is decompression?
The relieving of pressure and swelling early in tissue rescue after SCI
Reinstates CSF and blood flow
what sparked the use of induction of hypothermia to prevent injury from stroke or cardiac arrest?
It buys time
What is ICED?
Immediate Cooling and Emergency Decompression
Aim to reduce core temp to ~33 degrees followed by decompression
What are the two stages of ICED?
Stage 1 - Feasibility & Study Design
Stage 2 - Random Controlled Trials
