Announcement

Collapse
No announcement yet.

ChinaSCINet Update

Collapse
This is a sticky topic.
X
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

    Not much recovery, so far. Wise.

    Comment


      Jhope, I found the slides and videos at the Open House both amazing and confusing. These ASIA As are actually bearing their full weight and are able to initiate hip flexors to step. I'm a C6/7 incomplete ASIA C. I couldn't do that amount of stepping or walking after 10 years of PT and quads that scored 5/5s. But when it comes to moving legs in bed like pulling a knee up I beat them hands down. So why aren't they showing cervical improvement was confusing for me. Wise is obviously on to something here but it almost seems he's found a way to connect the brain directly to the central pattern generator. It is obviously a huge leap and more than I expected but why the ability to do so much while upright but not when lying down? And no, I didn't see any stupid American style tests like being asked to spread legs while lying on a padded, overly sheeted bed while wearing sweats. This open house left me very impressed and rather confused. Overall I think this is a huge step forward.
      Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

      Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

      Comment


        well walking is great but I would love my arms hands and fingers improved...........However any viable chronic treatment would be amazing!
        Han: "We are all ready to win, just as we are born knowing only life. It is defeat that you must learn to prepare for"

        Comment


          We are currently doing a phase II/III trial, multicenter, double-blind, randomized clinical trial in China. The study started this August and should be completed by this coming summer. The original phase II trial reporting the incidental finding of lithium reducing neuropathic pain was published.

          1. Yang ML, Li JJ, So KF, Chen JY, Cheng WS, Wu J, Wang ZM, Gao F and Young W (2012). Efficacy and safety of lithium carbonate treatment of chronic spinal cord injuries: a double-blind, randomized, placebo-controlled clinical trial. Spinal Cord 50: 141-6. Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, China. STUDY DESIGN: Lithium has attracted much attention as a neuroregenerative agent for spinal cord injury in animal models. We hypothesized that the lithium can be beneficial to patients with spinal cord injury. The safety and pharmacokinetics of lithium has been studied in our earlier phase I clinical trial, indicating its safety. This is a phase II clinical trial to evaluate its efficacy on chronic spinal cord injury patients. OBJECTIVES: The aim of this study was to investigate the efficacy of lithium on chronic spinal cord injury patients. SETTING: A major spinal cord injury rehabilitation center in Beijing, China. METHODS: Randomized, double-blind, placebo-controlled 6-week parallel treatment arms with lithium carbonate and with placebo. A total of 40 chronic spinal cord injury subjects were recruited. Oral lithium carbonate was titrated or placebo was simulated to maintain the serum lithium level of 0.6-1.2 mmol l(-1) for 6 weeks, followed by a 6-month follow-up. The functional outcomes and the neurological classifications, as well as the safety parameters, adverse events and pharmacokinetic data were carefully collected and monitored. RESULTS: No significant changes in the functional outcomes and the neurological classifications were found. The only significant differences were in the pain assessments using visual analog scale comparing the lithium and the placebo group. No severe adverse event was documented in the study. CONCLUSION: The lithium treatment did not change the neurological outcomes of patients with chronic spinal cord injury. It is worth to investigate whether lithium is effective in the treatment of neuropathic pain in chronic spinal cord injury. SPONSORSHIP: China Spinal Cord Injury Network Company Limited.

          Comment


            So basicly so far the trial results for the UCB+LI is a CPG activator that worked on 75% of the volunteered patients?

            Pardon me, I don';t intend to sound negative or unappreciated, I'm aware that the data is still being processed, but as I read previous posts, nerve fibres grow average the speed of hair, wouldn't 2-3yrs after the beginning of the trial would have grown from one end to another by now and reconnect more than just the CPG?
            "Talk without the support of action means nothing..."
            ― DaShanne Stokes

            ***Unite(D) to Fight Paralyses***

            Comment


              The followup is one year, not 2-3 years. I don't expect gratitude but you shouldn't expect miracles. Wise.

              Comment


                Sorry, I was in the impression that the trail started more than a year ago then calculating how long the nerve fibres could of grown by now. It was said here that nerve fibres grows about average the speed of hair does. I don't know what do you mean about me expecting miracles, I resent that. From what I asked had nothing to do about giving gratitude, I do appreciate all the hard work done. I'm just trying to follow up here based on what was said in this forum with all due respect. If i'd expect miracles instead of science i'd go to church instead.

                But going back to my question earlier, from the results so far mentioned here in this tread, (gained walking but with no locomotor or voluntary muscle movement, no upper recovery (post 2002.1) - I get the impression that the UCB+Li treatment results so far as a permanent CPG activator. Please correct me if I'm wrong!
                "Talk without the support of action means nothing..."
                ― DaShanne Stokes

                ***Unite(D) to Fight Paralyses***

                Comment


                  Moe, the idea that this trial combination appears to connect the brain to the central pattern generator is mine. I barely passed high school Biology... If this is true than Wise did way more than most think including probably Wise. The kind of movement I saw was indicative of routing through white matter to the cortical spinal tract in the gray matter. The cortico spinal tract is what creates volitional movement. No patients died. About 75% had enough correct hook ups to do this walking and many with severe pain lost it due to the lithium. Some of these trial participants were high T or low Cs and walking with no more than a binder and a walker that doesn't murder shoulders tells me that something else is going on. I have scoliosis on my right side since I quit PT and it was hard to walk or even stand in the bars after 9 serious years of working out. Don't dismiss this because I said it looks like a direct path to the CPG. It's more than that.
                  Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                  Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                  Comment


                    I understand completely. I have a contracture of my right hand and while immediiate innervation to make it work might hurt initially each winter is now rather painful from the arthritis and shrinking tendons. Even just getting the last head of my right triceps would improve my life tons.
                    I think Wise and a few others are on the right track or these people would fall in a heap each time they stopped initiating a step like the cats about a century ago. It's a matter of figuring out if the site of the injections is off or there are more inhibitors in the cervical region or something. This is what I find more confusing than seeing ASIA As bear weight.
                    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                    Comment


                      Originally posted by Moe
                      #2004.2
                      Moe commented
                      10-13-2013, 09:24 PM
                      Sorry, I was in the impression that the trail started more than a year ago then calculating how long the nerve fibres could of grown by now. It was said here that nerve fibres grows about average the speed of hair does. I don't know what do you mean about me expecting miracles, I resent that. From what I asked had nothing to do about giving gratitude, I do appreciate all the hard work done. I'm just trying to follow up here based on what was said in this forum with all due respect. If i'd expect miracles instead of science i'd go to church instead.

                      But going back to my question earlier, from the results so far mentioned here in this tread, (gained walking but with no locomotor or voluntary muscle movement, no upper recovery (post 2002.1) - I get the impression that the UCB+Li treatment results so far as a permanent CPG activator. Please correct me if I'm wrong!
                      Moe, I apologize for my tone earlier. In part, it is because I am frustrated by continued suggestions being made that the people are not walking because they don't show dramatic changes in motor or sensory scores. Let me try to put those suggestions to rest by describing the walking by these patients again.

                      Of 20 patients that were treated in Kunming with umbilical cord blood cells ranging from 1.6 to 6.4 million cells, with or without methylprednisolone, and with or without a 6-week course of lithium, 15 of the patients were able to walk long distances for many hours using a rolling walker with minimal help. Minimal help means that they have a person walking behind them with ropes to pull on their legs just in case their legs buckle because their muscles are tired, so that they don't fall. Two of the patients were able to walk with a four-point walker without any assistance.

                      How good is this walking? It is remarkably good walking considering that these are patients who average 7 years after spinal cord injury, had never walked after their injury, and were only able to stand in a standing frame before their treatment. They are not just walking ten feet and sitting down. Some of them are walking hundreds of meters every day and for many hours. This is real locomotion. The patients are able to start and stop walking, turn, speed up, slow down, and go from place to place. Many of them are household walkers. They are getting from one part of the house to another without help or their wheelchair.

                      Of the 8 patients who received the mononuclear cell transplants in Hong Kong and who did not receive intensive locomotor training, none were able to walk at this level. In this trial, all the patients received cell transplants. However, the Kunming group has treated many patients with just untethering surgery without cell transplants. These patients also show some benefit but not as much as those who received cell transplants. We need to demonstrate this directly in a randomized controlled clinical trial comparing untethering surgery alone with untethering surgery and cell transplant.

                      There is ample evidence now from animal studies that one can get massive regeneration of axons, including reconnection of the axons to the lower spinal cord, without recovery of walking or other types of function. This was true of Paul Lu's studies where he treated animals with cells and other treatments causing massive regeneration of endogenous or implanted neural stem cells. Despite the regenerated fibers, the animals were not walking. Likewise, Kai Liu, who found that PTEN deletion stimulates massive corticospinal tract regeneration, the rats did not show much improvement in walking. It is likely that the rats did not show much recovery because they were not trained to walk.

                      There is also much evidence that rehabilitation has to be task-specific. I just went to a spinal cord regeneration meeting in Shenyang where James Fawcett gave a wonderful talk in which he showed that if rats were not trained to use their paws after a spinal cord lesion, they did not recover use of their paws. If they simply put the rats into an "enriched" environment where they simply climbed up and down everywhere, the rats not only did not recover use of their paws but, if they had been trained to use their paw on the lesioned side, they would lose their ability to do so. The requirement for so-called task-specific rehabilitation applies to both rats and humans. For example, if you train rats to swim, they get better at swimming but they do not improve their walking. Likewise, if you train rats to walk, they cannot swim. In other words, if you are not trained to do that particular activity, you will not recover.

                      Note that you don't need as much training to restore function of surviving axons. Surviving axons are still connected to their original targets. If the brain activates these axons, the old function occurs. Regenerated axons, however, are new. They are connecting to different neurons than they use to. The brain must activate new and different axons in order to activate the same function. Intensive and repetitive training with constant feedback is required for a person to learn which axons to activate in order to get the desired function. The training must be task specific. For example, I know a famous pianist who used biofeedback training after a traumatic brain injury to regain his piano playing but, surprisingly, even though he can play Mozart and Bach with his hands, he cannot use his hands to feed himself.

                      Wise.

                      Comment


                        Wise, some of us do believe what is happening here is truly amazing. Keep it up.

                        Comment


                          In some ways the retraining seems so, well, logical. Almost as soon as I was moved from the ICU to the neurology ward in Germany and could sit in a chair they started me on a tilt table. Part was to maintain my long bones and increase my lung and heart capacity again. But the entire 45 minutes I was up, and besides keeping an eye on my blood pressure, the PT was running through finger and hand exercises that are parts of everyday tasks. Then we did range of motion in my shoulders and upper body along with some very minor balance work. Once in a US rehab I got a group gig playing with craft tiles you see in grade school summer programs. I think we need to educate the American rehab system so they catch up with the less high tech, more hands on countries of the world. Most rehabs here are non-profit and that doesn't mean all money that might be construed as profit goes to increase admin and senior doctor salaries.
                          Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                          Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                          Comment


                            Wise you are telling us that the people in your study shortly lost the ability to walk when they stop training. This is no functional recovery. If new connections were made then they would stay and not go away. You have to show MRI's of the patients to also see if those new fibers which you are talking about produced myelin .....

                            Comment


                              If UCB + Lithium stays in this status no insurance in the world would pay for this because there are no real benefits of this. Those people still need a cath and still need a chair !

                              Comment


                                KK11, people in the study who went home and did no walking lost the ability to walk. However, Wise has said umpteen times that when they were brought back to the hospital for walking training, they returned to their previous walking abilities within approximately 2 weeks.
                                If you learn a movement and practice a movement, you will get good at the movement. Once you stop, you will get worse at executing this movement, or lose it altogether. However, if you have practiced a movement enough, once you start again, it can come back easily. This is a basic tenant of motor control and pretty much applies to almost all human populations, whether SCI or able-bodied, when it comes to almost all gross motor control and fine motor movements.

                                Comment

                                Working...
                                X