Archive for the ‘Spinal Cord Injury’ Category

ScienceDaily (June 15, 2012) Justin M. Brown, MD, reconstructive neurosurgeon at UC San Diego Health System, is one of only a few specialists in the world who have pioneered a novel technique to restore hand function in patients with spinal cord injury. In a delicate four-hour procedure, Brown splices together tiny nerve endings, only one millimeter in width, to help restore hand mobility. Most patients return home 24 hours after surgery.

"Even if a patient appears to have lost total hand function, as long as there is some nerve in the arm or shoulder under the patient's control, some mobility may be regained," said Brown, director of the Neurosurgery Peripheral Nerve Program and co-director of the Center for Neurophysiology and Restorative Neurology at UC San Diego Health System. "With a nerve transfer, the goal is to reverse paralysis. This means achieving functional grasp and release so that patients can eat independently, operate a computer or hold a loved one's hand."

Brown and his team treat hand impairments at cervical level 5 and below. Operating under a microscope, Brown disconnects the damaged nerve and reconnects it to a healthy one. The healthy nerve is taken from underneath the muscles of the upper arm and then connected to a nerve branch that provides finger function. In contrast to muscle transfers, nerve transfers allow whole muscle groups to be restored in the arm without visibly changing the body's anatomy.

"The nerves grow at a rate of 1 millimeter per day," said Brown, who is also founding member and first president of the International Society for Restorative Neurology. "Over a period of six to 12 months, patients can essentially wake up their arms and hands and return to a satisfying level of functionality and improved quality of life."

Brown said that patients occasionally experience temporary weakness where the original healthy nerve is taken. These muscles, however, can recover their original strength. Casting and immobilization is seldom needed after the surgery. He added that the overall result is that multiple hand functions can be restored with a single transplant.

"The recovery of hand function is consistently rated as the highest priority for persons with quadriplegia," said Brown. "While nerve transfers take longer to heal so that axons can regenerate, patients often experience better long-term biomechanical outcomes."

In the United States there are approximately 300,000 people living with spinal cord injuries with 12,000 new injuries occurring each year. More than half of these injuries result in neck-level injures that lead to loss of hand and arm function. Brown said this technique may also be offered in select cases to patients with paralysis as a result of trauma, stroke, or brain injury.

Brown earned his medical degree from the Eastern Virginia Medical School in Norfolk. He completed a surgical internship and neurosurgical residency at Baylor College of Medicine in Houston and a peripheral nerve fellowship in the Division of Plastic and Reconstructive Surgery at Washington University School of Medicine. He was formerly co-director of the Peripheral Nerve Center at Washington University in St. Louis.

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New surgery may reverse hand paralysis

EAST RUTHERFORD, N.J. (AP) -- Paralyzed Rutgers football player Eric LeGrand has been selected to receive the Jimmy V Perseverance Award at ESPN's ESPYS next month.

LeGrand suffered a spinal cord injury in a game against Army in 2010. Initially told he would be a quadriplegic and would remain on a ventilator, the defensive tackle is now breathing on his own and can stand upright with the aid of a metal frame.

LeGrand has vowed to walk again.

The Jimmy V Award is given to someone in sports who has overcome great obstacles through perseverance and determination. It is named for Jim Valvano, the North Carolina State coach who gave an emotional acceptance speech at the 1993 ESPYS that included his famous words "Don't Give Up . . . Don't Ever Give Up!"

"I can relate to that because I am never giving up in my situation," LeGrand said in a telephone interview with The Associated Press, "I am never giving up in my situation. I know I will fight through it. Now getting this, this is a dream come true, especially on the 20th anniversary of the ESPYs. I was even thinking about it last year, thinking that could be me."

LeGrand plans to make the trip to Los Angles for the award presentation on July 11.

While travel isn't easy, LeGrand made a recent trip to Tampa, Fla., to spend a day with the Buccaneers and Greg Schiano. The former Rutgers coach and current Bucs leader signed LeGrand to an NFL contract after the draft in a heartwarming gesture.

Since suffering the injury, LeGrand has remained remarkably positive. He has been aggressive with his rehabilitation, resumed his studies and works as an analyst on the pre-game, halftime and postgame radio broadcasts of Rutgers games. He also will have a weekly show on Wednesday during the season with new Scarlet Knights coach Kyle Flood.

LeGrand admitted there are moments when he gets down, but they are rare.

"I have so much going on with my life, so many things that have happened, amazing things that I could only dream about," LeGrand said. "When I go to therapy every day, I look at people who don't have as much support as I have or are not getting the opportunities that I am getting, so how could I complain about anything.

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Eric LeGrand to receive Valvano award at ESPYs

From Staff Reports

According to a report from USA Today, boxer Paul Williams is sliding himself in and out of bed after suffering a spinal cord injury May 27.

FILE PHOTO

Paul Williams

Williams, the three-time world champion boxer from Aiken, was paralyzed below his chest when he was thrown more than 100 feet from his motorcycle after losing control on a curve.

Williams was diagnosed with a thoracic level (T 10-11) spinal cord injury. He was admitted to Shepherd Centers Spinal Cord Injury Program for care and observation, where doctors have determined an appropriate treatment plan. Williams was undergoing rehabilitation this morning and was unable to attend a press conference, where doctors updated his progress.

In a previous article in The Augusta Chronicle, Williams said hes approaching his new obstacle like a title shot with the ultimate goal of proving to the experts he will walk again.

Its like were training for a fight, said George Peterson, Williams trainer since he turned professional 14 years ago. Like Paul has been so many times before, he likes proving people wrong. And hes been doubted so many times and proven people wrong so many times, he made a believer out of me. And if he says hes going to fight again, I cant do anything but believe him.

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Aiken boxer Paul Williams recovery updated

GUELPH Three young adults with spinal cord injuries are to be key participants in the citys annual Wheels in Action event Sunday.

The event to raise money, support and awareness for people with spinal cord injuries will again be staged at the University of Guelph. The three featured young people with spinal cord injuries all have ties to the university. They are undergraduate student Drew Cumpson graduate student Sandra Burton and resident Jesse Redden.

Cumpson was the subject of a community benefit function earlier this year in Guelph. He suffered his injury on the final day of a two-week volunteer trip to Peru in May 2011. Burton suffered a spinal cord injury just before her 18th birthday. She graduated from Guelph with a child studies degree in 1998 and earned a masters degree in speech language therapy. She is now a speech pathologist for preschoolers and made media headlines earlier this year when she gave birth to twin girls.

A car accident led to an incomplete spinal cord injury for Redden, now 23. Initially in a Hamilton hospital, he is now completing rehabilitation in Guelph, including taking part in the SpinFit exercise program at St. Josephs Health Centre. He can now walk with assistance.

We are also happy to bring the focus of the Wheels in Action event to our Guelph community and the amazing folks that live here, said Cyndy McLean, director of the Health and Performance Centre, who brought the original Wheels event to Guelph.

Wheels in Action is a Guelph spin on the annual Wheels in Motion event started by Olympic wheelchair champion Rick Hansen and held by U of G since 2004.

The event will begin at noon at the U of Gs Athletics Centre; registration starts at 10:30 a.m.

Before Sundays event, local school teachers and students will also highlight the fundraiser and the challenges faced by people living with spinal cord injuries and other physical disabilities by spending time in wheelchairs. Stephanie Clarke, a U of G graduate and Grade 4 teacher at Paisley Road Public School, and student Jenica Centurione will spend the day in wheelchairs.

Guelph Wheels in Action will include a 2. 5 kilometre walk-roll-run, wheelchair activities, a free barbecue, entertainment and childrens activities. Participants collect pledges individually or as a team. The Canadian Disability Resource Council (a registered charitable organization) will help process pledges and donations in person and online, and will provide tax receipts for donations of $20 or more.

This is a great way to celebrate Fathers Day by wheeling, biking, skating, running or walking through the beautiful University of Guelph campus, said McLean, a former marathon runner who became paraplegic following a 2003 accident.

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Guelph’s Wheels in Action set for Sunday

The work of celebrated spinal cord injury activist and leading political scientist illustrates the benefits of strong Canada-Israel relations

TORONTO, June 12, 2012 /CNW/ - The Canadian Friends of the Hebrew University of Jerusalem (CFHU) today announced that Mr. Rick Hansen and Prof. Janice Gross Stein were awarded Honorary Doctorates by the Hebrew University of Jerusalem at a ceremony held in Jerusalem on June 10. Mr. Hansen was chosen to deliver the convocation address to 2012 PhD graduates at the opening session of the 75th meeting of the Hebrew University of Jerusalem's Board of Governors.

Last year, Rick Hansen signed an agreement with the Institute for Medical Research Israel Canada (IMRIC) of the Hebrew University of Jerusalem to further advance research into spinal cord injury (SCI). Specifically, this agreement broadens the Rick Hansen Spinal Cord Injury Registry, an international database used to collect and analyse information related to SCI and subsequent clinical treatments.

"I am very proud to have received an Honorary Doctorate from Hebrew University of Jerusalem," says Rick Hansen. "For the last 25 years, I have dedicated my life to finding a cure for SCI. This work has given me the opportunity to meet inspiring and passionate people from all over the world, including many research scientists and medical professionals. The IMRIC team at Hebrew University are world-class. I have consistently been impressed by their vision of bringing together the best minds in research science, across disciplines, across borders and irrespective of race or religion. As a Canadian, I am proud of the relationships that we have built with Israeli institutions and the personal friendships I now enjoy with many Israelis. I am particularly proud of the academic and research ties that unite our two countries. I would strongly urge any Canadian organization pursuing scientific research to reach out to IMRIC in order to investigate collaborative potential," adds Mr. Hansen.

As a scholar specializing in conflict resolution, Janice Gross Stein has forged strong ties between the Hebrew University of Jerusalem and the University of Toronto. Prof. Gross Stein's work has directly contributed to Canadians' understanding of politics and life in the Middle East.

"As an academic, I have devoted more than 40 years to the study of politics in the Middle East," continues Janice Gross Stein. "During that time, my work has permitted me to travel extensively throughout the region. I began working with scholars at Hebrew University many years ago. Over time, I have developed collaborative partnerships and personal friendships with members of the faculty. I have been impressed by the intellect, commitment and vision of these scholars seeking innovative solutions to enduring conflict. My research has focused on the psychological underpinnings of decision making and I have worked closely with scholars in Israel to deepen our knowledge and to inform public policy. As a Canadian, it is my hope that our research can help shape policy at home and especially in the Middle East, where conflict is entrenched," notes Prof. Gross Stein.

"The Hebrew University of Jerusalem is proud to recognize two very distinguished Canadians," says Menahem Ben-Sasson, President, Hebrew University of Jerusalem. "Rick and Janice come from very different worlds. But, both have pursued their life's work with great perseverance and conviction. And, we at Hebrew University have had the good fortune and the honour of getting to know each of them. In the spirit of acknowledging individual accomplishment and advancing Israel-Canada relations, we are delighted to welcome Rick Hansen and Janice Gross Stein as Honorary PhDs of our university", concludes Prof. Ben-Sasson.

About The Hebrew University of Jerusalem

The Hebrew University of Jerusalem, founded in 1918, is Israel's first university. The university's founders, including: Chaim Weizmann, Albert Einstein, Martin Buber and Sigmund Freud, were leaders, thinkers and humanitarians whose genius inspired their vision of a great university that would have no limits or borders. The founding charter declared that the institution would be open to every qualified man and woman irrespective of religion, race or nationality. Ranked as one of the world's leading research universities, The Hebrew University of Jerusalem's faculty and researchers are at the forefront of the international scientific and academic communities. Many top prizes and awards have been won by its graduates and faculty including eight Nobel Prizes. The Hebrew University of Jerusalem is a pluralistic institution where science and knowledge are advanced for the benefit of humankind in an atmosphere free of discrimination and prejudice. For more information, please visit: http://www.huji.ac.il/huji/eng/.

About the Canadian Friends of The Hebrew University of Jerusalem

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Hebrew University of Jerusalem awards honorary doctorates to two prominent Canadians: Rick Hansen and Janice Gross Stein

Mike Schroeder had the opportunity to meet and visit with Larry the Cable Guy. Larry and his wife are big contributors to Madonna Rehabilitation Hospital at Lincoln, Neb. where Mike is currently going through rehab for his spinal cord injuries.

A spinal cord injury which occurred early this spring has left Mike paralyzed. He nor his family will ever give up hope that someday he will walk again.

Currently he is at Madonna Rehabilitation Hospital in Lincoln, Neb. where he is working extremely hard to learn things he once took for granted. Madonna is one of the nation's foremost facilities for medical rehabilitation and research. Specializing in traumatic brain injury, spinal cord injury and pediatric rehabilitation, Madonna offers hope and healing to thousands of patients from throughout the country each year.

Madonna's team of highly specialized physiatrists, therapists, rehabilitation nurses and clinicians work with the most advanced technology and equipment to help each person achieve the highest level of independence.

Mike has come a long way.

He was on a ventilator for a few days following the accident and had slight movement in his arms when he arrived; now he is able to use his hands and has some sensation in his feet and legs.

He spends several hours a day working with an occupational therapist, physical therapist and recreational therapist. He works hard. Very hard. He is determined to make his life the best it can be.

He is learning how to do things such as putting on shoes and socks, relearning how to eat and shave and how to shower, things he has always taken for granted that he knew how to do without assistance.

He also works on his balance - something that has come a long way. "You take for granted that you are going to be able to sit without falling," he said, explaining that he toppled over many times at first because his muscles no longer do the job for him. He is building up his arm muscles - and hoping for football lineman arms - which are used in many ways including in the transferring process.

His recreational therapist is showing Mike that he can go out in public in his wheelchair and still enjoy fun activities (they have gone bowling and fishing.)

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'It is what it is'

by Claude Solnik Published: June 8, 2012 Tags: Long Island, Multiple sclerosis, New York, NextStep Fitness, paralysis, spinal cord injuries, Stony Brook University

NextStep Fitness founder Janne Kouri (seated)

Stony Book is collaborating with Los Angeles-basedNextStep Fitness to build the organizations first fitness and wellness facility in New York for people with paralysis and spinal cord injuries.

Stony Brooks School of Health Technology and Management is helping the California firm develop the facility, which would be located at and connected to the university.

The Stony Brook facility will be the first NextStep location linked to an academic research center, which has the expertise to quickly disseminate important research findings related to fitness and wellness facilities, Stony Brook President Samuel Stanley said.

NextStep, a nonprofit founded by Janne Kouri, a former Georgetown University football player paralyzed in a swimming accident in 2006, hopes to raise $1.5 million to launch the facility at Stony Brook, to be named NextStep Fitness Center at Stony Brook Medicine.

Stony Brook estimates there are 80,000 people with spinal cord injuries nationwide, with 600 injuries a year occurring in New York. There are another 9,000 people with multiple sclerosis.

There are no acute spinal cord rehabilitation facilities located in New York state, said Craig Lehman, dean of the School of Health Technology and Management. People with spinal cord injuries must travel to Manhattan or New Jersey to get the level of rehabilitative care they need.

The NextStep facility at Stony Brook be the only one of its kind in the state and the first planned in addition to the original Los Angeles facility. The nonprofit, which hopes to open locations around the country, also is planning a facility for the Washington, D.C., area.

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Stony Brook to build spinal cord injury rehab center

AP

Buccaneers defensive tackle Eric LeGrand knew his hopes of playing in the NFL ended when he suffered a severe spinal cord injury during his junior season at Rutgers. But when LeGrands coach at Rutgers, Greg Schiano, became the coach in Tampa Bay, he decided to sign Legrand and treat him like a member of the team, and today that meant bringing LeGrand to practice and having him address the Buccaneers.

LeGrands message was simple: Play every down like its your last.

I want them to appreciate everything they have, LeGrand said at a press conference after his talk to the Buccaneers. Not too many people get paid to do what they love to do every day. . . . Really appreciate that dont take for granted things that other people dont have.

LeGrands No. 52 Buccaneers jersey is now on sale, with proceeds benefitting the Eric LeGrand Foundation, which will fund research into spinal cord injuries and help people who suffer such injuries and lack health insurance.

Schiano said he has long viewed LeGrand as one of the most positive, upbeat players he has ever coached, and he thinks its important for LeGrands attitude to rub off on the rest of the team.

This is a guy that Ive known for a long time, a guy who played for us at Rutgers, and as I said to the team earlier today, long before his injury and a lot of notoriety that hes received, this was a guy who came every day to our football building and had just a tremendous attitude, Schiano said. I dont know, if this happened to me, if I could be the man that Eric is.

LeGrand acknowledged today that there have been times when he was scared: I didnt know if I was going to die right there is this going to be the end of my life?

But now LeGrand says nothing scares him anymore, and hes as confident in himself as hes ever been.

My next goal is to get back on my feet, LeGrand said. And that will happen.

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Eric LeGrand spreads a positive message to his Tampa teammates

CARLSBAD Before heading in to his 2 p.m. therapy session for a spinal cord injury, Sadru Dada enjoyed a couple of slices of freshly made margherita pizza and anchovies from a food truck parked in front of the building.

Project Walk, a spinal cord injury recovery center that opened in Carlsbad in 1999, started Food Truck Wednesdays in February. Each Wednesday a different truck sets up from 11 a.m. to 2 p.m. and offers a tasty lunch, including burgers and seafood. This week it hosted Red Oven Pizza, wood-fired pizza made using an Italian made Mugnaini mobile oven.

Lunch costs about $10 and part of the proceeds benefit the center.

Whatever helps Project Walk we want to do, Dada said from his wheelchair. They know what theyre doing, and its a unique place. Theyre trying to make me walk.

Project Walk does not offer traditional rehabilitation, instead it concentrates on exercise to get the client out of a wheelchair to work their entire bodies.

Were looking at trying to do any type of reconnection, getting the body to remember the walking patterns and breaking down each of the movements, said Gigi Betancourt, client services manager at the center. Whether it be on the table, in our track system, or any of our elliptical machines.

Dada, who lives in Dubai, suffered his injury seven years ago when he was struck by a car as he was walking down a street. Four weeks ago he made the more than 30-hour trip to Carlsbad with his wife, Firoza. Hes hoping to take his first steps before his sessions wrap up at the end of July and he heads to New Jersey to visit his two sons and two grandchildren.

Food Truck Wednesdays are part of a recent effort made to draw more attention to the center, which upgraded to a new location seven months ago. Project Walk occupies part of the business center at 5850 El Camino Real that used to be The Boxing Club and Raphaels Party Rentals. The 24,000 square-feet of space is 9,000 square feet bigger than its previous location on Loker Avenue.

The program currently has 80 clients, with one to five new ones starting every week. Programs are tailored to a clients needs and what the person can afford. Insurance doesnt cover the cost. The typical program is four days a week, two to three hours a day. Programs average four weeks to six months.

Clients are paired one on one with certified specialists, who have a background in kinesiology or sports science. Currently 27 certified specialists work at the center.

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Food trucks serve lunches for a cause

A previously paralyzed rat climbs steps after several weeks of neurorehabilitation. Paralyzed rodents learned to walk again after intensive training and electrical stimulation of the brain and the spine, scientists reported. (EPFL via The New York Times)

Rats with a spinal cord injury that left their hind legs completely paralyzed learned to walk again on their own after an intensive training course that included electrical stimulation of the brain and the spine, scientists reported this week.

The study is the most comprehensive and rigorous presentation to date of what is possible in recovering from such injuries, and the Swiss research team is already working on technology to test the techniques in humans.

The report, published online Thursday in the journal Science, provides a striking demonstration of what, until recently, few scientists thought possible: complete rehabilitation after a disabling blow to the spinal cord. After weeks of training, many of the rats could walk as well as before the injury, and some could run.

The findings do not apply to all spinal injuries. The animals' spinal columns were cut without being completely severed. There were still some nerve connections that extended intact through the injured area.

In the study, a research team led by Gregoire Courtine of the University of Zurich and the Swiss Federal Institute of Technology gave a group of 10 rats the same surgical injury, cutting all direct nerve connections to the hind legs but stopping short of severing the spinal cord. The rats lost the use of their back legs but not their front legs.

The rats began a daily regimen. Outfitted with tiny vests, held upright on their back legs but left to bear their full weight, the rats tried to move toward a piece of cheese nearby. The scientists provided stimulation in three places: electrically, in the motor area of the brain and in the spinal cord below the injury, and chemically, infusing the wound area with drugs thought to promote growth.

Growth is what they got. After two to three weeks of 30-minute daily sessions, the rats began to take their first voluntary steps. After six weeks, all of the rats could walk on their own, and some could run and climb stairs. A comparison group of rats did not recover nearly as well.

"The way I think about it is that there is this little island of spare tissue in the injured area, and the neurons in that island begin to act as a relay center, bypassing the injury," Courtine said in a telephone interview.

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Rat experiment gives hope for recovery from spinal injuries

The last time I interviewed Jenna Privette was in late February. She was back home and attending classes at St. Croix Lutheran High School less than two months after a spinal cord injury in a hockey game had left her legs temporarily paralyzed. At the time, she predicted she would recover and play softball again. She was right.

Privette played high school softball this season and excelled. She played catcher and batted over .400 with 30 runs batted in.

It was the second time in four years Privette recovered from a paralyzing injury. In 2008, while playing hockey, she said her "entire body" was paralyzed for several days.

I talked to Privette on Friday, June 1, about her latest recovery.

BS: How are you feeling?

JP: Good. About to graduate (Sunday), so I'm doing pretty good.

BS: Have there been any aftereffects from when you were unable to move your legs?

JP: Things have been going good. I still have pain sometimes in my legs and back. Softball is great to get me moving. I couldn't have done this softball season without my team. They knew sometimes I was in pain, but they helped me push through it. If I needed a break, I would come in and sit on the bench.

BS: Isn't catcher the worst position for leg and back pain?

JP: Sometimes. My physical therapist told me to stay active. It worked my legs so much, and it worked my back. It was good from a physical therapist standpoint.

Continued here:
Jenna Privette overcame paralysis, played softball, awaits diploma: 'I have a smile on my face now'

Editor's Choice Academic Journal Main Category: Neurology / Neuroscience Article Date: 01 Jun 2012 - 9:00 PDT

Current ratings for: 'Paralyzed Rat With Spinal Injury Walks Again With Robot Rehabilitation'

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The scientists, from the University of Zurich and the Swiss Federal Institute of Technology reported their findings in the journal Science.

The authors explained that researchers and experts have been trying for years to find ways of getting patients with spinal cord injuries to walk again. Approximately half of all human spinal cord injuries lead to long-term paralysis.

Although previous studies have had some success in restoring some kind of movement in the limbs, even helping patients to walk in a limited way, this experiment uses a completely novel technique.

In an Abstract in the journal Science, the authors wrote:

The scientists managed to get the rats to walk and climb stairs. They stimulated the spinal nerve circuits of rats, and used physical training. Electrodes had been implanted and the rats were given injections with a neuron-activating chemical mix.

The scientists fitted the rats with harnesses, so that their back legs could reach the ground. They were then placed on a conveyor belt which only moved if their feet pushed (reflexive stepping). They were also placed on stationary ground. In order to reach a piece of chocolate (on fixed ground) they would have to move their hind legs.

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Paralyzed Rat With Spinal Injury Walks Again With Robot Rehabilitation

Category: Science & Technology Posted: June 1, 2012 12:08PM Author: Guest_Jim_*

One of the most amazing characteristics of the brain is its plasticity. After even some severe traumas, like having a hemisphere removed, the brain can adapt and move functions around to continue functioning. In the past it has appeared that only the brain was plastic because the spinal cord would not adapt in a similar way to injuries. Researchers at Ecole Polytechnique Fdrale de Lausanne (EPFL) have changed that though and given rats with severe paralysis the ability to walk again.

The first step of the experiment was to 'wake up' the dormant part of the spinal cord found beneath the injury. This was accomplished with a special chemical solution that replaced neurotransmitters normally released by the brainstem in order to stimulate dormant neurons. Next the researchers used electrodes to stimulate the spinal cord further, making it ready to operate.

The brain is not the only controller in the nervous system. Other networks of neurons, including the spinal cord, are able to respond to external stimuli, which is what causes involuntary motions. The researchers placed the rats on a treadmill and discovered it could walk. The spinal cord was taking in the information of the treadmill moving beneath it, and responded by having the legs move. This involuntary action was truly great to see, but the researchers, inspired by this success, decided to go a step further.

A new rig was created for the rats to use, but instead of a treadmill, the rats were gently suspended, to put all of their weight on their hind legs. With a chocolate treat at the end of the rig, the rats wanted to move forward; to voluntarily walk with their previously paralyzed legs. The rats got their chocolate, even when it required that they walk up steps.

The spinal cord, after being reactivated by the chemicals and electricity, grew new connections around the lesion that originally caused paralysis. The connection between the legs and the brain may not have been as strong as it would have been without the lesion, but it was enough for the rats to walk. It may be some time before we see humans benefiting from a similar treatment, but now we know complete recuperation of voluntary movement is possible.

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Recovering From Spinal Cord Injury Possible

ZURICH, Switzerland, May 31 (UPI) -- Rats with spinal cord injuries and severe paralysis were able to walk after their dormant spinal column was woken up, Swiss researchers said.

Lead author Gregoire Courtine of the University of Zurich said it was unclear whether similar rehabilitation techniques could work for humans, but the observed nerve growth hinted at new methods for treating paralysis.

"After a couple of weeks of neurorehabilitation with a combination of a robotic harness and electrical-chemical stimulation, our rats are not only voluntarily initiating a walking gait, but they are soon sprinting, climbing up stairs and avoiding obstacles when stimulated," Courtine, chairman of the International Paraplegic Foundation, said in a statement.

The brain and spinal cord can adapt and recover from moderate injury, a quality known as neuroplasticity, but until now, the spinal cord expressed so little plasticity after severe injury that recovery was impossible.

Courtine said his findings prove, under certain conditions, plasticity and recovery can take place in these severe cases after the spinal cord was injected a chemical solution of monoamine agonists.

These chemicals trigger cell responses by binding to specific dopamine, adrenaline and serotonin receptors located on the spinal neurons, Courtine said.

Five to 10 minutes after the injection, the scientists electrically stimulated the spinal cord with electrodes implanted in the outermost layer of the spinal canal, which sent continuous electrical signals through nerve fibers to the chemically excited neurons that control leg movement, the researchers said.

The findings are scheduled to be published in the June 1 issue of Science.

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Rats with spinal cord injuries are walking

After severe spinal cord damage, paralyzed rats are able to walk again with the help of a robot to hold them up and stimulate their nerves, a new study shows.

After the rats are trained on the machine for about two months, they gained the ability to control their hind legs -- which had previously been cut off from communicating with the brain -- with enough dexterity to climb stairs and navigate around objects. This control means that the brain has forged new connections to get around the spinal cord injury.

NEWS: Bionic Suit Helps Paralyzed Woman Complete Marathon

"We expected they would recover to some degree, but the extent was amazing. They were able to avoid obstacles and walk up stairs," study researcher Janine Heutschi, of the Swiss Federal Institute of Technology in Switzerland, told LiveScience. "Not only that, but the consistency was really amazing. Every single animal we trained in this robot was able to perform these tasks."

What this means for humans is unclear, but the team is working to adapt the procedure for clinical trials.

Paralyzed Rats

The researchers simulated spinal cord damage in the rats by making two cuts halfway through the spinal cord; the cuts were two vertebra apart and came from opposite sides, so every nerve of the spinal cord was cut. The paralyzed rats can't use their hind legs, but can get around and act like normal rats using their front limbs.

They let the rats heal for a week, and then started their treatment. They were strapped into a robot that supported them on their rear legs, so they couldn't use their front limbs to propel themselves. The harness held them up without pushing them in any one direction, akin to swimming with a life vest.

"It is complexly passive. It just follows the rat in whatever she does," Heutschi said. "It just supports the body weight and balance; otherwise, they would fall to the side. Whenever the rat wants to walk forward, it has to initiate the movement itself."

ANALYSIS: Paralyzed Athlete Sit-Skiis to the North Pole

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Paralyzed Rats Regain Strut

Public release date: 31-May-2012 [ | E-mail | Share ]

Contact: Michael Mitchell michael.mitchell@epfl.ch 41-798-103-107 Ecole Polytechnique Fdrale de Lausanne

Rats with spinal cord injuries and severe paralysis are now walking (and running) thanks to researchers at EPFL. Published in the June 1, 2012 issue of Science, the results show that a severed section of the spinal cord can make a comeback when its own innate intelligence and regenerative capacitywhat lead author Grgoire Courtine of EPFL calls the "spinal brain"is awakened. The study, begun five years ago at the University of Zurich, points to a profound change in our understanding of the central nervous system. It is yet unclear if similar rehabilitation techniques could work for humans, but the observed nerve growth hints at new methods for treating paralysis.

"After a couple of weeks of neurorehabilitation with a combination of a robotic harness and electrical-chemical stimulation, our rats are not only voluntarily initiating a walking gait, but they are soon sprinting, climbing up stairs and avoiding obstacles," explains Courtine, who holds the International Paraplegic Foundation (IRP) Chair in Spinal Cord Repair at EPFL.

Neuroplasticity after severe injury

It is well known that the brain and spinal cord can adapt and recover from moderate injury, a quality known as neuroplasticity. But until now the spinal cord expressed so little plasticity after severe injury that recovery was impossible. Courtine's research proves that, under certain conditions, plasticity and recovery can take place in these severe casesbut only if the dormant spinal column is first woken up.

To do this, Courtine and his team injected a chemical solution of monoamine agonists into the rats. These chemicals trigger cell responses by binding to specific dopamine, adrenaline, and serotonin receptors located on the spinal neurons. This cocktail replaces neurotransmitters released by brainstem pathways in healthy subjects and acts to excite neurons and ready them to coordinate lower body movement when the time is right.

Five to 10 minutes after the injection, the scientists electrically stimulated the spinal cord with electrodes implanted in the outermost layer of the spinal canal, called the epidural space. "This localized epidural stimulation sends continuous electrical signals through nerve fibers to the chemically excited neurons that control leg movement. All that is left was to initiate that movement," explains Rubia van den Brand, contributing author to the study.

The innate intelligence of the spinal column

In a paper published in Nature Neuroscience in 2009, Courtine reported that a stimulated rat spinal columnphysically isolated from the brain from the lesion downdeveloped in a surprising way: It started taking over the task of modulating leg movement, allowing previously paralyzed individuals to walk, albeit involuntarily, over treadmills. These experiments revealed that the movement of the treadmill created sensory feedback that initiated walking: the spinal brain took over, and walking essentially occurred without any input from the rat's actual brain. This surprised the researchers and led them to believe that only a very weak signal from the brain was needed for the animals to initiate movement of their own volition.

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Walking again after spinal cord injury

ScienceDaily (May 31, 2012) Rats with spinal cord injuries and severe paralysis are now walking (and running) thanks to researchers at EPFL. Published in the June 1, 2012 issue of Science, the results show that a severed section of the spinal cord can make a comeback when its own innate intelligence and regenerative capacity is awakened. The study, begun five years ago at the University of Zurich, points to a profound change in our understanding of the central nervous system. According to lead author Grgoire Courtine, it is yet unclear if similar rehabilitation techniques could work for humans, but the observed nerve growth hints at new methods for treating paralysis.

"After a couple of weeks of neurorehabilitation with a combination of a robotic harness and electrical-chemical stimulation, our rats are not only voluntarily initiating a walking gait, but they are soon sprinting, climbing up stairs and avoiding obstacles when stimulated," explains Courtine, who holds the International Paraplegic Foundation (IRP) Chair in Spinal Cord Repair at EPFL.

Waking up the spinal cord

It is well known that the brain and spinal cord can adapt and recover from moderate injury, a quality known as neuroplasticity. But until now the spinal cord expressed so little plasticity after severe injury that recovery was impossible. Courtine's research proves that, under certain conditions, plasticity and recovery can take place in these severe cases -- but only if the dormant spinal column is first woken up.

To do this, Courtine and his team injected a chemical solution of monoamine agonists into the rats. These chemicals trigger cell responses by binding to specific dopamine, adrenaline, and serotonin receptors located on the spinal neurons. This cocktail replaces neurotransmitters released by brainstem pathways in healthy subjects and acts to excite neurons and ready them to coordinate lower body movement when the time is right.

Five to 10 minutes after the injection, the scientists electrically stimulated the spinal cord with electrodes implanted in the outermost layer of the spinal canal, called the epidural space. "This localized epidural stimulation sends continuous electrical signals through nerve fibers to the chemically excited neurons that control leg movement. All that is left was to initiate that movement," explains Rubia van den Brand, contributing author to the study.

The innate intelligence of the spinal column

In 2009, Courtine already reported on restoring movement, albeit involuntary. He discovered that a stimulated rat spinal column -- physically isolated from the brain from the lesion down -- developed in a surprising way: It started taking over the task of modulating leg movement, allowing previously paralyzed animals to walk over treadmills. These experiments revealed that the movement of the treadmill created sensory feedback that initiated walking -- the innate intelligence of the spinal column took over, and walking essentially occurred without any input from the rat's actual brain. This surprised the researchers and led them to believe that only a very weak signal from the brain was needed for the animals to initiate movement of their own volition.

To test this theory, Courtine replaced the treadmill with a device that vertically supported the subjects, a mechanical harness did not facilitate forward movement and only came into play when they lost balance, giving them the impression of having a healthy and working spinal column. This encouraged the rats to will themselves toward a chocolate reward on the other end of the platform. "What they deemed willpower-based training translated into a fourfold increase in nerve fibers throughout the brain and spine -- a regrowth that proves the tremendous potential for neuroplasticity even after severe central nervous system injury," says Janine Heutschi, co-author in the study.

First human rehabilitation on the horizon

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Walking and running again after spinal cord injury

Paralyzed Rats Walk Again

Spinal stimulation combined with assisted walking therapy generates new neural circuits and restores voluntary leg movement.

Stair master: After training in a supportive robotic device while receiving spinal stimulation, a rat paralyzed by a spinal-cord injury regained enough control of its hind limbs to climb stairs. EPFL (Swiss Federal Institute of Technology)

Rats paralyzed by spinal-cord injury can learn to control their hind limbs again if they are trained to walk in a rehabilitative device while their lower spine is electrically and chemically stimulated. A clinical trial using a similar system built for humans could begin in the next few years.

Researchers in Switzerland used electrical and chemical stimulation to excite neurons in the lower spinal cord of paralyzed rats while the rodents were suspended by a vest that forced them to walk using only their hind legs. The rehabilitative procedure led to the creation of new neuronal connections between the movement-directing motor cortex of the brain and the lower spine, the researchers report in Science.

Previous research has shown that it is possible to reverse some of the effects of spinal-cord injury by circumventing the normal connection between the brain and legs, which is broken by the injury. For example, walking can be triggered in spinal-cord-injured rats if their spine is stimulated. But until now, such movement has been involuntary. This new research shows that with a specialized training system, similar rats can regain voluntary control over their legs.

A report published last year showed the proof of principle "that this kind of approach can work in patients," says Grgoire Courtine, senior author of the rat study. In May 2011, 25-year-old Rob Summers, who had been paralyzed from the chest down in a car accident, was reported to stand on his own for a few minutes with electrical stimulation of his spinal cord. He could also take repeated steps on a treadmill with the stimulation, which activates regions in the lower spinal cord that control walking. The locomotion resulting from this kind of stimulation is automatic and involuntary and is thought to require no direct communication from the brain.

Courtine had previously shown that this type of automatic walking could initiate walking patterns in the hind limbs of spinal-cord-injured rats that were spinally stimulated while on a treadmill. Because the spinal column could control the walking pattern, Courtine suspected that only a weak signal from the brain would be necessary for the animals to start walking voluntarily.

To test whether the rats could recover brain-directed control of these movements, he and his team developed a robotic support system that suspends rats in a bipedal standing posture and helps with balance but does not provide any forward momentum. Ten paralyzed rats were trained daily to walk with stimulation both on a treadmill and in the robotic system. After two to three weeks, the rats took their first voluntary steps. "This is the first time we have seen voluntary control of locomotion in an animal with [an injury] that normally leaves it completely paralyzed," says Courtine.

Key to this recovery was the active role of the rat's brain in wanting to move forward. The electrical and chemical stimulation puts the rat's nervous system in a state where walking is possible, says study co-author Janine Heutschi, and "then you need to make the rat to want to walk." The rats' desire to walk was motivated by chocolate rewards and vocal encouragement from the researchers (which you can hear in this video from the Swiss Federal Institute of Technology). The robotic suspension system forces the rodents to use their dormant hind limbs and not drag themselves forward with their still functional forelimbs.

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Paralyzed Rats Walk Again

Public release date: 24-May-2012 [ | E-mail | Share ]

Contact: Gary Mans gary.mans@louisville.edu 502-852-7504 University of Louisville

LOUISVILLE, Ky. The University of Louisville has received $6.3 million from the Leona M. and Harry B. Helmsley Charitable Trust to support research in the Department of Neurological Surgery and the Kentucky Spinal Cord Injury Research Center at UofL developing the next generation of technology to help paralyzed people regain movement in their limbs and enhance their quality of life.

In May 2011, Susan Harkema, Ph.D., professor of neurological surgery, and Jonathan Hodes, M.D., chair of neurological surgery, and their colleagues published a study in "The Lancet" demonstrating that the use of continual direct electrical stimulation of a patient's lower spinal cord using "off the shelf" technology designed for pain relief can allow a person to go from being wheelchair-bound to being able to stand, remain standing and bear weight. Researchers at the University of California, Los Angeles (UCLA) and California Institute of Technology (Cal Tech) collaborated on the study.

Since that time, the team has replicated its findings in at least two more patients, and the Helmsley Charitable Trust grant will help the team develop the technology needed to advance the research. Researchers from UofL, UCLA, Cal Tech and Case Western Reserve are involved in the development of the new technology.

"One of the biggest issues we face is the limitations imposed by the technology," Harkema said. "We need to develop the next generation of electrical stimulator containing the best possible circuitry and a new control system so that patients can have the ability to take advantage of this therapy at home and in their communities. Currently, it is limited to use in the laboratory here in Louisville."

"This most generous grant from the Helmsley Charitable Trust enables our researchers within the Department of Neurological Surgery and the Speed School of Engineering, and their colleagues at prestigious institutions across the country to move forward with the goal of improving the lives of millions of people," said UofL President James R. Ramsey. "This grant recognizes the innovative work taking place at UofL. Through this support and the work of our researchers and their subjects, we will continue to translate science into applications that transform people's lives."

"We're excited that this work has already proven what many thought was impossible: patients with absolutely no motor function can stand and step with assistance," said John Codey, trustee of the Helmsley Trust. "We hope the innovative work conducted by the faculty and staff of the University of Louisville and its partners continues to advance the technology and research base needed to treat more patients, resulting in improved outcomes."

In the paper from May, Harkema and her colleagues demonstrated that continual direct epidural electrical stimulation of the subject's lower spinal cord mimics signals the brain normally transmits to initiate movement. Once that signal is given, the research shows, the spinal cord's own neural network combined with the sensory input derived from the legs to the spinal cord is able to direct the muscle and joint movements required to stand and step with assistance on a treadmill.

The other crucial component of the potential therapy is an extensive regime of intensive physical therapy training called Locomotor Training while the spinal cord is being stimulated and the subject suspended over the treadmill. Assisted by rehabilitation specialists, an individual's spinal cord neural network is retrained to produce the muscle movements necessary to stand and to take assisted steps.

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Helmsley Charitable Trust grants $6.3 million to University of Louisville for neurosurgery

As Dan Via lay face down in the surf in Corolla, unable to move his arms and legs, the thought flashed through his mind: "I'll probably never ride my bike again."

It was Labor Day weekend and the Williamsburg pediatrician, then 51, was relaxing at the North Carolina beach with his wife, Susan, and their younger son, Nathan. The family had had an emotionally grueling summer with the acute illness of his 90-year-old mother-in-law; and a week earlier, his older son, Forrest, had left for his freshman year at Radford University.

At midday, in slightly choppy chest-deep water, Via was lying on a boogie board, when a strong wave caught the board and propelled him forward face-first into the sand. He remembers the blow. His neck hyper-extended, the force of the water tore the ligaments and ruptured a disc in his upper neck. But he never lost consciousness not as strangers dragged him to safety, not while the local emergency crew stabilized him, and not in the Nightingale helicopter as it transported him to a hospital in Norfolk. Later that same day, after extensive screening tests, he had a bone graft and a steel plate and screws inserted in his spine to fuse discs C3 and C4.

He was effectively a quadriplegic with an uncertain future. His doctors weren't optimistic that he'd walk again. They thought he might learn to feed himself.

Via has defied the odds. Last weekend, as part of the 100-mile Cap2Cap ride from Williamsburg to Richmond, familiar territory for the cycling enthusiast, he rode a full 25 miles in a recumbent bike. "It eliminates the balance issue," he says, somewhat ruefully of his low-to-the-ground three-wheeler.

Family and community support

In January, just four months after the accident, he returned part-time to his medical practice, Sentara Pediatric Physicians. "I think he has increased the demands on himself and is now probably seeing the same number of patients as before," says Jennifer Altman, one of six physicians in the practice.

Initially, she says, his colleagues were concerned about how the emotional and physical demands dealing with a squirming 15-month-old, for example would affect his healing process. The fears proved unfounded. "It sounds trite, but he has been inspiring to us in the office and to his patients as well. Children don't notice his disability, they see past it," she says. "I'm able to see his improvements day to day and week to week. He has become much more his old self. This is his second home."

Slowly, but surely, Via is defying his doctors' gloomy prognosis and regaining full function. "When I look at him now, it's just like he has arthritis," says his wife, Susan, who took a leave of absence from her job teaching violin at the College of William and Mary to look after him. "She was steadfastly positive," he says.

The couple met as musicians for the Virginia Symphony, where Via played the double bass for 7 years prior to returning to his undergraduate alma mater Duke for his medical degree. "He's a really, really talented natural musician," says Susan, noting that he went to Juilliard, a top-ranked music school.

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Exclusive: 'On the road again' — Dr. Dan revels in return to (recumbent) biking

NEWARK, Calif., May 17, 2012 (GLOBE NEWSWIRE) -- StemCells, Inc. (Nasdaq:STEM - News) today announced completion of the first planned interim safety review of the Company's Phase I/II spinal cord injury clinical trial, which indicated that the surgery, immunosuppression and the cell transplants have been well-tolerated. The trial, which is designed to evaluate the safety and preliminary efficacy of the Company's proprietary HuCNS-SC(R) cells (purified human neural stem cells), represents the first time that neural stem cells have been transplanted as a potential therapeutic agent for spinal cord injury. A summary of the data will be presented by Armin Curt, M.D., principal investigator for the clinical trial, at the Interdependence 2012 Global SCI Conference, which is being held in Vancouver, British Columbia, from May 15 to 17, 2012.

The interim data is from the first cohort of patients, all of whom suffered a complete spinal cord injury in which there is no neurological function below the level of the injury. All patients enrolled were transplanted with a dose of 20 million cells at the site of injury in the thoracic spinal cord. There were no abnormal clinical, electrophysiological or radiological responses to the cells, and all the patients were neurologically stable through the first four months following transplantation of the cells. Changes in sensitivity to touch were observed in two of the patients. The data from multiple evaluations of the patients during this four month period have been reviewed by an independent Data Safety Monitoring Committee, which has recommended that the study advance to enrollment of patients with incomplete neurological injury. Enrollment is now underway and is open to patients in Europe, the United States and Canada with incomplete spinal cord injury. The trial, which is being conducted at Balgrist University Hospital, Zurich, Switzerland, is the only ongoing clinical trial evaluating neural stem cell transplantation in spinal cord injury.

"We are very encouraged by the interim safety outcomes for the first cohort," said Dr. Curt, who is Professor and Chairman of the Spinal Cord Injury Center at the University of Zurich, and Medical Director of the Paraplegic Center at Balgrist University Hospital. "The patients in the trial are being closely monitored and undergo frequent clinical examinations, radiological assessments by MRI and sophisticated electrophysiology testing of spinal cord function. The comprehensive battery of tests provides important safety data and is very reassuring as we progress to the next stage of the trial."

The Interdependence 2012 Global SCI Conference is intended to bring together international healthcare and research facilities to showcase their work through presentations, workshops and exhibits and to discuss how to advance research, implement new best practices and shape the next generation of spinal cord injury research. Interdependence 2012 is jointly organized by the Rick Hansen Institute, a Canadian not-for-profit organization committed to accelerating the translation of discoveries and best practices into improved treatments for people with spinal cord injuries, and the Rick Hansen Foundation.

About the Spinal Cord Injury Clinical Trial

The Phase I/II clinical trial of StemCells, Inc.'s HuCNS-SC(R) purified human adult neural stem cells is designed to assess both safety and preliminary efficacy. Twelve patients with thoracic (chest-level) neurological injuries at the T2-T11 level are planned for enrollment. The Company has dosed the first three patients all of whom have injuries classified as AIS A, in which there is no neurological function below the injury level. The second and third cohorts will be patients classified as AIS B and AIS C, those with less severe injury, in which there is some preservation of sensory or motor function. The injuries are classified according to the American Spinal Injury Association Impairment Scale (AIS). In addition to assessing safety, the trial will assess preliminary efficacy based on defined clinical endpoints, such as changes in sensation, motor and bowel/bladder function.

All patients will receive HuCNS-SC cells through direct transplantation into the spinal cord and will be temporarily immunosuppressed. Patients will be evaluated regularly in the post-transplant period in order to monitor and assess the safety of the HuCNS-SC cells, the surgery and the immunosuppression, as well as to measure any recovery of neurological function below the injury site. The Company intends to follow the effects of this therapy long-term, and a separate four-year observational study will be initiated at the conclusion of this trial.

The trial is being conducted at Balgrist University Hospital, University of Zurich, a world leading medical center for spinal cord injury and rehabilitation, and is open for enrollment to patients in Europe, Canada and the United States. If you believe you may qualify and are interested in participating in the study, please contact the study nurse either by phone at +41 44 386 39 01 or by email at stemcells.pz@balgrist.ch.

Additional information about the Company's spinal cord injury program can be found on the StemCells, Inc. website at http://www.stemcellsinc.com/Therapeutic-Programs/Clinical-Trials.htm and at http://www.stemcellsinc.com/Therapeutic-Programs/Spinal-Cord-Injury.htm, including video interviews with Company executives and independent collaborators.

About Balgrist University Hospital

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StemCells, Inc. Reports Positive Interim Safety Data From Spinal Cord Injury Trial

Instead of operating on the spine itself, the surgeons rerouted working nerves in the upper arms. These nerves still "talk" to the brain because they attach to the spine above the injury.

Following the surgery, performed at Barnes-Jewish Hospital, and one year of intensive physical therapy, the patient regained some hand function, specifically the ability to bend the thumb and index finger.

The unnamed patient can now feed himself bite-size pieces of food and write with assistance.

"This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is," says surgeon Ida K. Fox, MD, assistant professor of plastic and reconstructive surgery at Washington University.

"Instead, we go out to where we know things work, in this case the elbow, so that we can borrow nerves there and reroute them to give hand function."

The surgery was developed and performed by the study's senior author Susan E. Mackinnon, MD, chief of the Division of Plastic and Reconstructive Surgery at Washington University School of Medicine.

Specialising in injuries to peripheral nerves, she has pioneered similar surgeries to return function to injured arms and legs.

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Paralysed man regains use of hand after operation

Bob Langer, co-inventor of technology used by InVivo

Spinal cord injury treatment company InVivo Therapeutics Holdings Corp. (OTCBB:NVIV) reported a profit for the first quarter of 2012, and said its biopolymer scaffolding is slated to enter human clinical trials later this year.

InVivo shares were up about 6 percent in mid-morning trading to $2.45.

The company said it expects to start a pilot human clinical trial of the scaffolding in the second half of 2012, pending approval of an Investigational Device Exemption application by the U.S. Food and Drug Administration. Following a meeting with the FDA held in April, the company said it is expecting the product to be regulated under the Humanitarian Use Device/Humanitarian Device Exemption pathway that should accelerate commercialization.

The Cambridge company uses technology co-invented by MIT Professor Robert Langer and Mass General Hospitals Dr. Joseph P. Vacanti. Langer was among the team of InVivo scientists who met with the FDA in April.

The pilot test will be an open label study to evaluate the safety and efficacy in spinal cord injury patients following treatment with the biopolymer scaffolding. The study will follow promising pre-clinical studies completed in non-human primates, according to InVivo.

The company also expects this year to file with the FDA for its injectable hydrogel to treat peripheral nerve and spinal cord injuries. The company is conducting a preclinical study with Geisinger Health System to evaluate the injectable biocompatible hydrogel for the treatment of pain caused by peripheral nerve compression. Some 3.2 million pain injections are performed annually to treat back, neck and leg pain caused by peripheral nerve injuries. InVivos hydrogel is designed to time-release anti-inflammatory drugs for extended pain relief. The product addresses an estimated $15 billion market for peripheral nerve injuries, the company said.

We are off to a strong start for 2012 and the first quarter was marked by significant achievements and milestones for InVivo, Frank Reynolds, InVivos CEO, said in a prepared statement. By the end of 2012, we expect to have several product applications under review by the FDA.

He added that during the first quarter of 2012, InVivo strengthened its balance sheet by closing an oversubscribed $20 million public offering. Net proceeds to InVivo were approximately $18.1 million. InVivo also has the potential to receive an additional $18.6 million of capital from the exercise of previously issued outstanding warrants.

InVivo also has signed a multi-year lease for a 21,000 square foot facility at One Kendall Square in Cambridge that will house corporate offices, a vivarium, laboratory space and a current good manufacturing practices cleanroom for manufacturing.

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InVivo reports profit, expects to start human trial

Surgical Procedure May Benefit Some Spinal Cord Injury Patients

May 15, 2012 -- Surgeons in St. Louis have restored partial function to a 71-year-old man's hands, which had been paralyzed following a spinal cord injury sustained in a car accident two years before the surgery.

The man, who remains paralyzed from the waist down, can now write and feed himself. A case report published today in the online edition of the Journal of Neurosurgery describes the procedure.

"This is not a small step, this is a significant step," says UCLA neurosurgeon Nader Pouratian, MD, a specialist in nerve and movement disorders who was not involved in the case. "It is a novel application of an established surgical technique. It goes beyond what we thought was possible before."

The established technique that Pouratian refers to is one in which working nerves taken from one muscle replace damaged nerves in another. Such nerve transfers can restore arm and shoulder movement following what's called peripheral nerve injury, for example.

In this case, however, the damage was not to the nerve. It was to the spine.

"The nerve and muscle were still healthy, but the spine injury was blocking communication with the brain," says Ida Fox, MD, a plastic and reconstructive surgeon at Washington University School of Medicine in St. Louis and a colleague of the surgical team that performed the operation.

The patient's injury had left him without the use of his hands, but he retained a good deal of upper body function. That gave his medical team, led by Susan E. Mackinnon, MD, a pioneer in nerve transfer techniques, some materials to work with. They focused on the nerves that control elbow movement.

One of those nerves, the brachialis nerve, is considered to be redundant. That is, another nerve performs the same job, so no function would be lost if the brachialis nerve were to be moved. That allowed the surgeons to take it and attach it to the anterior interosseous nerve, which controls the thumb and the index finger.

"They're basically stealing a nerve and plugging it into another nerve that is below the level of the spinal injury," says Lewis Lane, MD, chief of hand surgery at North Shore University Hospital and Long Island Jewish Medical Center in New York. Lane was not involved with the surgery.

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Paralyzed Man's Hand Movement Partially Restored

ScienceDaily (May 15, 2012) Surgeons at Washington University School of Medicine in St. Louis have restored some hand function in a quadriplegic patient with a spinal cord injury at the C7 vertebra, the lowest bone in the neck. Instead of operating on the spine itself, the surgeons rerouted working nerves in the upper arms. These nerves still "talk" to the brain because they attach to the spine above the injury.

Following the surgery, performed at Barnes-Jewish Hospital, and one year of intensive physical therapy, the patient regained some hand function, specifically the ability to bend the thumb and index finger. He can now feed himself bite-size pieces of food and write with assistance.

The case study, published online May 15 in the Journal of Neurosurgery, is, to the authors' knowledge, the first reported case of restoring the ability to flex the thumb and index finger after a spinal cord injury.

"This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is," says surgeon Ida K. Fox, MD, assistant professor of plastic and reconstructive surgery at Washington University, who treats patients at Barnes-Jewish Hospital. "Instead, we go out to where we know things work -- in this case the elbow -- so that we can borrow nerves there and reroute them to give hand function."

Although patients with spinal cord injuries at the C6 and C7 vertebra have no hand function, they do have shoulder, elbow and some wrist function because the associated nerves attach to the spinal cord above the injury and connect to the brain. Since the surgeon must tap into these working nerves, the technique will not benefit patients who have lost all arm function due to higher injuries -- in vertebrae C1 through C5.

The surgery was developed and performed by the study's senior author Susan E. Mackinnon, MD, chief of the Division of Plastic and Reconstructive Surgery at Washington University School of Medicine. Specializing in injuries to peripheral nerves, she has pioneered similar surgeries to return function to injured arms and legs.

Mackinnon originally developed this procedure for patients with arm injuries specifically damaging the nerves that provide the ability to flex the thumb and index finger. This is the first time she has applied this peripheral nerve technique to return limb function after a spinal cord injury.

"Many times these patients say they would like to be able to do very simple things," Fox says. "They say they would like to be able to feed themselves or write without assistance. If we can restore the ability to pinch, between thumb and index finger, it can return some very basic independence."

Mackinnon cautions that the hand function restored to the patient was not instantaneous and required intensive physical therapy. It takes time to retrain the brain to understand that nerves that used to bend the elbow now provide pinch, she says.

Though this study reports only one case, Mackinnon and her colleagues do not anticipate a limited window of time during which a patient with a similar spinal cord injury must be treated with this nerve transfer technique. This patient underwent the surgery almost two years after his injury. As long as the nerve remains connected to the support and nourishment of the spinal cord, even though it no longer "talks" to the brain, the nerve and its associated muscle remain healthy, even years after the injury.

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Surgeons restore some hand function to quadriplegic patient