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When there is true regeneration will rehab be necessary to detect initial recovery?

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    #31
    Originally posted by ay2012 View Post
    To any of the scientists or more informed members than me (most): I was wondering why, when true regeneration occurs, would rehab be needed to detect (at least initial) functional recovery? Don't get me wrong, for strengthening the connections, for improving the extent of recovery, for developing more complex functions like walking or other coordinated movements, I can see why rehab would be important. But (for example in the case of a complete injury) why wouldn't the individual be able to detect the new sensation, why wouldn't autonomic functions begin to work, why wouldn't at least basic movement be possible almost immediately (that is when axons have actually been regenerated)? Admittedly, my thinking here is simplistic but I think of a newborn.... No matter how crudely, he/she can move his/her arms and legs immediately. Those nerve fibers are new, like truly regenerated ones would be.
    Like most of my posts here I imagine I'll get a swift response with some misunderstanding so please note the word detect here. I'm not saying to improve recovery rehab won't be necessary. I just question the necessity of having a huge rehab component as a part of a trial and saying "lets wait, more rehab could be necessary". A true biological cure that induces regeneration, it seems to me, wouldn't require this to detect at least some functional outcomes. If I'm way off here I would welcome an explanation...
    I too think that a true biological cure that induce regeneration should not require intense rehab to produce some functional outcome.

    Paolo
    In God we trust; all others bring data. - Edwards Deming

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      #32
      Let me first say that I’m not saying intensive rehab is unnecessary. I would guess it would be very helpful in any potential treatment. I am saying that I don’t think it is a requirement in order to see any signs of regeneration. That is my unprofessional opinion, but based on what I've heard/read.

      Thank you for the papers, that is what I was looking for. I read the one on using Bone Marrow stromal cells on chronic & complete rats. My thoughts:

      a) It was not intensive rehab. It was “After surgery, all the animals were subjected to daily rehabilitation procedures, consisting of passive mobilization of hind legs for 15 min every day(pg. 51).

      b) I call bullsh*t on his results

      “Fig. 1. Bone marrow stromal cells promote functional recovery in chronic paraplegic rats. Graph showing the motor recovery in the treated rats, according to the BBB scale (the maximum score in this scale is 21). The number of treated animals studied was 20 during months 1 and 2 of follow-up, 17 during months 3–6 of follow-up, and 14 until the end of the follow-up period. The mean BBB score (± standard deviation), 1 year after intralesional BMSC administration, was 17.7 ± 1.3. The 10 animals of the control group (treated with intralesional administration of saline alone) remained completely paraplegic throughout the entire study (BBB score of 0)” (pg. 52).

      So the treated groups averaged a BBB score of 17.7 vs. control groups which averaged 0. I don’t believe that. The scale goes to 21. That means these mice could walk almost normal…after a chronic and motor complete injury. The injury was at T6-8. So axons grew all the way to the Lumbar section? These results are nowhere near replicable in any of today’s current studies using any treatment. This paper was from 2006. It’s 2013. When something looks too good to be true, it probably is. Dr. Vaquero is almost certainly a bullsh*tter.

      Mind you the rationale for UCB therapy is based on animal studies where BBB scores improved by 1-2 points in subacute, incomplete rats. 17.7 point increase in chronic, complete! Hahaha
      Last edited by NowhereMan; 18 Jun 2013, 5:32 PM.

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        #33
        I've had another researcher, in correspondence, tell me that these results have not been independently replicated, are on the order of "too good to be true", and are not believed by the SCI research community at large, unfortunately....

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          #34
          Originally posted by ay2012 View Post
          I've had another researcher, in correspondence, tell me that these results have not been independently replicated, are on the order of "too good to be true", and are not believed by the SCI research community at large, unfortunately....
          Hence the need for replication studies to be done before getting too excited. A therapy is of no use if the results cannot be produced by another researcher in an independent lab. There are 3 NIH funded replication labs in the USA that consistently work on studies to test lab results for sci. I'm thankful we have them rather than chasing every concoction written up in thesis papers and various magazine articles.
          http://spinalcordresearchandadvocacy.wordpress.com/

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            #35
            Originally posted by GRAMMY View Post
            Hence the need for replication studies to be done before getting too excited. A therapy is of no use if the results cannot be produced by another researcher in an independent lab. There are 3 NIH funded replication labs in the USA that consistently work on studies to test lab results for sci. I'm thankful we have them rather than chasing every concoction written up in thesis papers and various magazine articles.
            Not disagreeing with you...

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              #36
              Originally posted by NowhereMan View Post
              Let me first say that I’m not saying intensive rehab is unnecessary. I would guess it would be very helpful in any potential treatment. I am saying that I don’t think it is a requirement in order to see any signs of regeneration. That is my unprofessional opinion, but based on what I've heard/read.

              Thank you for the papers, that is what I was looking for. I read the one on using Bone Marrow stromal cells on chronic & complete rats. My thoughts:

              a) It was not intensive rehab. It was “After surgery, all the animals were subjected to daily rehabilitation procedures, consisting of passive mobilization of hind legs for 15 min every day(pg. 51).
              I agree with this. I meant rehab will be very advantageous.
              I change to "rehab" since intense probably means 666 threadmill training since this is what Wise does.

              I just think that in some way will the brain have to teach the spine.
              Last edited by void; 19 Jun 2013, 6:52 AM.
              Debating on CareCure is like participating in the special-olympics. You may win, but you're still disabled.

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                #37
                I agree with you all too....I mean you simply need rehab when there will be someday a cure for us. At least for coordination and to get strengh back. But you should see benefits from a treatment in sensory and contract muscles (not against gravity) without intense rehab programs

                KK11

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                  #38
                  My initial point was to question whether or not it was a red herring for any purported regenerative therapy to claim it necessary for trial patients to undergo significant (and costly) intensive PT. I suppose it's possible for a therapy to regenerate just enough of the spinal cord for there to be a necessity for 6 months of 6 days a week 6 hours a day walking (or something similar). It will take SIGNIFICANTLY more time and money to get therapies tested in clinical trial if we are always insisting this to be the case (and unconvincing re: the regenerative nature of the therapy if all the while there is NO accompanying motor, sensory, b/b/s, etc. improvements; this is why it's crucial to test the walking on its own)

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                    #39
                    Even if the spinal cord is truly regenerated to have 100% of the capability it did before the injury, movements will still need to be relearned because new connections will have been formed that the body has never used before. Whether or not it will take something on the scale of 6-6-6 to get full recovery, I don't know. I imagine a little rehab may be necessary but it wouldn't need to be as ambitious as 6-6-6 if, as I said, the spinal cord is regenerated back to 100% of it's pre-injury capabilities.

                    The problem is that the first cellular/regenerative therapies we're going to see will likely only bring partial regeneration of the spinal cord. Making the spinal cord just as functional as it was before injury is likely a long way off. So if we're going to start with therapies that only partially regenerate the spinal cord, I think intensive physical rehab would be necessary to maximize whatever the body is going to get from a cellular/regenerative surgery.

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                      #40
                      Originally posted by tomsonite View Post
                      Even if the spinal cord is truly regenerated to have 100% of the capability it did before the injury, movements will still need to be relearned because new connections will have been formed that the body has never used before. Whether or not it will take something on the scale of 6-6-6 to get full recovery, I don't know. I imagine a little rehab may be necessary but it wouldn't need to be as ambitious as 6-6-6 if, as I said, the spinal cord is regenerated back to 100% of it's pre-injury capabilities.

                      The problem is that the first cellular/regenerative therapies we're going to see will likely only bring partial regeneration of the spinal cord. Making the spinal cord just as functional as it was before injury is likely a long way off. So if we're going to start with therapies that only partially regenerate the spinal cord, I think intensive physical rehab would be necessary to maximize whatever the body is going to get from a cellular/regenerative surgery.
                      Fully in agreement. But again, in my first post I'm talking about detecting a regenerative effect in humans. I'd like to know why it wouldn't be possible to do so without intensive PT.
                      Because, again, if we require super intense PT in all trials the cost will be huge, the time longer, and also given the variability of effort I imagine it only confounds measuring the true biological effect of a therapy.

                      Comment


                        #41
                        Originally posted by ay2012 View Post
                        Fully in agreement. But again, in my first post I'm talking about detecting a regenerative effect in humans. I'd like to know why it wouldn't be possible to do so without intensive PT.
                        Because, again, if we require super intense PT in all trials the cost will be huge, the time longer, and also given the variability of effort I imagine it only confounds measuring the true biological effect of a therapy.
                        You could well be right. The rehabilitation piece will be part of the balancing act to get maximum recovery with an interventional therapy. A person to watch is Dr. Keith Tansey from Shepherd Center. He has some interesting concepts and ideas on how to get us there. He'll be speaking at W2W 2013 in Boston. Keith Tansey, MD, PhD, Director, Spinal Cord Injury Research and Restorative Neurology Programs, Shepherd Center. Dr. Tansey joined Shepherd Center as Director of Spinal Cord Injury Research in 2008. He is interested in neural plasticity and repair that leads to functional recovery after spinal cord injury and how those processes could be facilitated. He is specifically interested in neural circuits for motor functions like locomotion, but also neural circuits related to pain and autonomic nervous system function. He is working to combine interventions like activity based therapies and robotics with electrical stimulation, pharmacology, and even cellular transplantation to improve neural recovery after injury.
                        Last edited by GRAMMY; 20 Jun 2013, 11:18 PM.
                        http://spinalcordresearchandadvocacy.wordpress.com/

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                          #42
                          Originally posted by ay2012 View Post
                          Fully in agreement. But again, in my first post I'm talking about detecting a regenerative effect in humans. I'd like to know why it wouldn't be possible to do so without intensive PT.
                          Because, again, if we require super intense PT in all trials the cost will be huge, the time longer, and also given the variability of effort I imagine it only confounds measuring the true biological effect of a therapy.
                          It probably would be cheaper to have a trial that looks only at the effects of a regenerative surgical procedure without a rehab therapy arm. However, in order to understand how effective a surgery alone might be, it would make sense to compare just the surgery to a combinatory approach (surgery + rehab therapy).

                          As far as answering your original question, it probably depends on how effective the regenerative procedure is in the first place. I'm pretty sure it was the Stem Cells Inc trial (is that the one that took place in Switzerland??) that showed sensory improvements in 3 ASIA A's, and there was no therapy component to that trial. A sensory improvement would imply regeneration, so I suppose it is possible to detect regeneration without intensive therapy.

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                            #43
                            Originally posted by tomsonite View Post
                            It probably would be cheaper to have a trial that looks only at the effects of a regenerative surgical procedure without a rehab therapy arm. However, in order to understand how effective a surgery alone might be, it would make sense to compare just the surgery to a combinatory approach (surgery + rehab therapy).

                            As far as answering your original question, it probably depends on how effective the regenerative procedure is in the first place. I'm pretty sure it was the Stem Cells Inc trial (is that the one that took place in Switzerland??) that showed sensory improvements in 3 ASIA A's, and there was no therapy component to that trial. A sensory improvement would imply regeneration, so I suppose it is possible to detect regeneration without intensive therapy.
                            If the injury is acute any therapy is paid like it is today by commercial coverage, workers compensation, charity, etc. If chronic AND in trial no worthy institution would or should charge.
                            You can always do therapy on your own as you do your health and wellness today.

                            Comment


                              #44
                              Originally posted by tomsonite View Post
                              As far as answering your original question, it probably depends on how effective the regenerative procedure is in the first place. I'm pretty sure it was the Stem Cells Inc trial (is that the one that took place in Switzerland??) that showed sensory improvements in 3 ASIA A's, and there was no therapy component to that trial. A sensory improvement would imply regeneration, so I suppose it is possible to detect regeneration without intensive therapy.
                              Not quite. I refer you to my post, post #19, letter c).

                              Comment


                                #45
                                Research Results

                                To build on what Wise said, the trials going on now are only addressing part of the problem with SCI and that is the nerves need to be regenerated. Once regeneration occurs the nerves need to be guided to their proper targets to restore the communication with the brain. There is no guidance for the new nerves so what happens is equivalent to putting a bunch of random network cables in a box and hoping that they arrange themselves in some meaningful way that will allow communications between computers. Some day there will be ways to guide the axons to their targets chemically or with scaffolding or some other way that is yet to be discovered. Until then researchers are using rehab as a way to train the new nerves to connect to their targets so that they can determine if regeneration is occurring and that it is successful. Also, with learned non-use and atrophied muscles even if the regenerated nerves made it to their proper targets you wouldn't be able to tell because your muscle scores would still be the same as they were before the therapy.
                                "The prospects for a cure today are better than they were yesterday."

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