Spinal Cord Injury - Science topic

Please note that you wrote to the ResearchGate community, not personally to Mr. Wu. He may not see your request.

Unfortunately, currently it is not possible to send messages personally to ResearchGate users. Most probably, the change was due to scam attacks by fake accounts, see this discussion started by Rob Keller : https://www.researchgate.net/post/New_type_of_scam_New_approach_using_fake_accounts.

I recommend to find out the email address of the author from his publications and send him a message this way.

Thank you very much Saif Wahid

From 1990 to 2013, methylprednisolone was a standard treatment for acute traumatic spinal cord injury administered as an intravenous bolus at a dose of 30 mg/kg and subsequently as an intravenous infusion at a dose of 5.4 mg/kg/hour for 24 hours if there were <3 hours after the injury and the same dose but for 48 hours if the evolution time of the injury was between 3 and 8 hours. If the injury time was >8h, methylprednisolone was considered contraindicated.

After several studies and analyzes it was confirmed that NASCIS I (National Acute Spinal Cord Injury Study) demonstrated negative results, the detailed analysis of NASCIS II had multiple scientific irregularities and the results of NASCIS III demonstrated non-significant benefits with an increase in complications such as sepsis, pneumonia and mortality.

The administration of steroids in the treatment of acute traumatic spinal cord innjury to improve neurological prognosis is currently not recommended. There is no scientific evidence to support the clinical benefit of methylprednisolone in the treatment of acute traumatic spinal cord injury. However, there is Class I, II, and III evidence that high-dose steroids are associated with significant side effects, including death (American Association of Neurological Surgeons 2013; Guidelines-French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury 2020).

On the other hand, in the case of acute traumatic spinal cord injury with neurological deterioration, the administration of corticosteroids (dexamethasone or methylprednisolone) could be started in the first hours, with short regimens and considering the possible side effects.

Hi,

Here is a link from Google:

Thank you Ragab

Dear Lawal,

I am not worked with rehabilitation of spinal cord injury subject, now working with people don't have spinal cord issues but with neurons problems. i found one article sharing for your reference.

Dear Rawaa Salim Al-Mayyahi ,

I have no experience with neural cell cultures. Moreover, it will be extra difficult for me to obtain and purify a primary culture. I think it is better to prefer to buy cells commercially.

Thanks a lot for your answer!

Dear Marjan

Unfortunately, I have no experience in rats, but in comatose patients or intraoperative monitoring, the somatosensory evoked potentials are obtained during the use of midazolam, clobazam, or propofol.

Thank you - I did think that but I might buy the article to see. I work both in the NHS and for a manufacturing company specialising in pressure redistributing devices in the uk so im

trying to evidence the products we manufacture. I saw an article about lateral pressure that I thought was interesting.

Hello Nima,

I am curious about your need, what type of images do you acquire: brightfield, fluorescence of some kind, other...?

I am currently working on an automated serial block face system which allows image acquisition and 3D reconstruction of unstained samples based on autofluorescence signal. This system could typically be useful for the question you ask. Maybe we can discuss?

Try feeding them after surgery

Cholera toxin subunit B conjugated with Alexa Fluor 488 or 594 (Invitrogen-Molecular Probes, Eugene, OR, USA) is a proper choice. 3 days after injection is OK for observing the motor neurons in the spinal ventral horn.

Stem cell therapy is a rapidly evolving and promising treatment for spinal-cord injuries. ... Mesenchymal stem cells (MSCs), most commonly harvested from bone marrow, can prevent activation of inflammatory responses that lead to cell death. Functional recovery using MSCs in spinal cord injury patients has been mixed.

for further information please check a link;

At least you can try once or twice to prove on. It is difficult task but not impossible

Emmanuelle Cugy Firstly, physical activity guidelines expressed using Metabolic Equivalent Tasks (METs) are not useful for the general public. The concept of METs is difficult to understand and few people are familiar with it. It is really challenging for the public to know the MET values for any/all the activities they do.

Secondly, The energy consumption in people with limb amputation would be certainly much higher for amputees. To my knowledge METs values and disability have not been worked on very much. See systematic review

Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis. https://www.ncbi.nlm.nih.gov/pubmed/30893346

Thirdly, there has been some work on METs and paraplegia which may help guide you.

The lowest level of SCI where AD was documented is T10.... Neurological level of injury not always correspond with autonomic level of injury....

Dear sir Patrick Frank ..nice project I am interesting to know the final results.... good luck...

Hossain, M. Z., Unno, S., Ando, H., Masuda, Y., & Kitagawa, J. (2017). Neuron–Glia crosstalk and neuropathic pain: Involvement in the modulation of motor activity in the orofacial region. International journal of molecular sciences, 18(10), 2051.

Dear,

impact depends on the level of the SCI.

--> elearnsci.org

Sarah

Thank you Tamrat Befekadu!

Thanks Dr. Ritzmann,

I'd gone through the document you mentioned above, I'd also seen few other articles on this very topic. It seems my understanding to the statement of the authors that i mentioned in the above question, is wrong. if you can please go through that document and comment on that particular statement.

Thank you for your answers.

Hi, This is a very unfortunate issue. As you know, beside possible infections caused by the surgery itself, spinal cord injury also affect the urination system causing it to to also paralyzed. Therefore, if you don't "help" them to release the liquids in their urinary bladder, it inflate and explode causing their death. You should note also that by "helping" them, which is done by pressing the bladder, you need to be careful not to harm their internal organs as well.

I hope I helped you.

Hi Chris,

I agree that the small spikes do look a little suspicious. Did you use surface or needle electrodes?

Nevertheless, in EMG you would usually expect deflections in both directions. Since there is no clear meaning to that you can simply rectify.

Have a look at this:

In my clinical experience of 25 years as a orthopaedic trauma surgeon I have not seen any SCI related to blast in civilian population in Lothian, SE Scotland. However may be more commonly seen by military surgeons.

Dear Dewan,

Hercules has provided some of the classic reviews for the glial scar field.

However, in addition to the inhibitory nature of the glial scar, CNS axon regeneration is also inhibited due to developmental changes in the neurons themselves. The links below are to a couple of recent reviews:

These are just suggestions as to where to start your reading.

Best,

Jill

Please note, RG changed my links to the abstracts in PubMed to the articles in RG itself. I did not do this, and I am not trying to evade copyright protection of these articles.

Hercules, how did you get your links to stay as the original PubMed Central links? Inquiring minds want to know!

Hello Dewan,

atrogliosis is a process which occurs after SCI and leads to expression of numerous signaling molecules. Two scar types form after SCI , the glial scar and the fibrotic scar. The fibrotic scar in the lesion core is packed with growth inhibiting molecules like NG2. The glial scar area also contains molecules which inhibit axon growth like NOGO. Beside these growth inhibiting structures there are multiple factors influencing axonal growth cones like immune cells etc. I guess I didn‘t answer your question on the molecular pathways causing astrogliosis, but I felt like adding this bit of general information might be useful. Best regards, Nicole

Another new study:

Regards,

Joachim

There are a handful of companies trying to solve this particular problem - how to use stem cells to treat SCI.  One of those is Q therapeutics in Salt Lake City, Utah.  See http://www.qthera.com/live/Technology/Our-Solution.aspx for more details.

Hi Kenichi,

if the joint is assisted, the individual is learning to move the joint in an manner that does not activate the sensory and motor systems necessary for normal movement. The individual may learn to move in an assisted manner, but the carry over to normal movement will still require additional training.  As for restoring normal movement, we anticipate roughly 4000 repetitions, however the joint movements are task specific, therefore the carry over to similar movements may require additional training. 

Monica Rivera 

I've used a dose of 2ml/Kg of a cocktail of: ketamine (25 mg/ml), xylazine (1.3 mg/ml) and acepromazine (0.25 mg/ml) and it worked ok. Are you using a heat pad during your surgery to keep the animals warm?

I'm now using isoflurane and it's much more convenient.

What level is your injury?

Dear dr Mandari, Thanks for your interest. I am the coordinator of the Dutch participation of this international study. The overall organization is in hands of the Swisci. You can find information concerning this worldwide survey at the website. Here, you can also find contact information. The website is: https://www.insci.network/insci/T1/en/welcome.php

Best Regards, Karin Postma

Ciao Cesare...mi potresti mandare per favore il protocollo...grazie mille!!

Alessio

Dear Emmanuelle

BrainQ is a company that was created to resolve neurological deficits by means of enhancing natural rehabilitation processes of neural networks. It started where my son, Lear, was born with a rare genetic disorder that affect the CNS. In the process of understanding what is his exact "problem" I've discovered that many other nervous syndromes and impairments share similar characteristics to my son syndrome. Then I've developed a conceptual model for intensify rehabilitation processes in the brain (and spinal cord). Once pre-clinical trials have shown first signs that the concept is feasible, BrainQ (Brain cue to cure) was formed. The principle of the treatment is a very low intensity and frequency electromagnetic stimulation which sync to the way neural networks work, and by that, promote their re-growth, and by that, increase the chances and extent of rehabilitation after impairment. Since BrainQ have showed very impressive pre-clinical results (TBI, Stroke, SCI), BrainQ, as a compaby was formed. Right now we are conducting a clinical trial that is focused on spinal cord injury (were he people are about 6 months and longer after the injury, which brought me to ask how "post acute" .vs. "chronic" are they). We are seeking collaboration with researchers who are interested in clinical trials. We have published two papers about Stroke and SCI, and now in the process of publishing our paper about TBI.

First of all - make sure optimum positioning is secured, using appropriately fitted wheelchair, supports and patient education about what is optimum so he/she can request modifications, if necessary.  Secondly, training in ProprioceptiveNeuromuscularFacilitation (PNF) is strongly recommended for achieving maximum conditioning for available musculature, including the diaphragm.  (That is one of my specializations and the most effective form of therapeutic exercise for any patient suffering muscle weakness for any reason.)  Hope that helps.

Vicki

The main puropose to investigate complete and fresh neural systems should be to learn more of the flexibility and other neuromechanical and neurodynamical characteristics .

In the period 1960-1985 the neuroscientist and neuroradiologist Milan Roth investigated the neuro-osseous growth realtions, that can be disturbed by internal factors ( lack of O2 at birth, poison, drugs) but it offers a good explantion too, how the sedenatary lifestyle of children hinders this groth by stretch of the CNS and priovide the western world with bad postures , early and seroious degenration, but also ( from own observations) very thight central cords that look  responsble for Arnold Chiari, syringomeylie and : skeletal deformations as scoliosis. A spinal fracture will give central cord injuries much easier as the cord is thight already.

Roth did fsh cadaveric studies to show that the cord stays in central position in bending the spine in a young  healthy boy, killed by accident ( to show the imortance of Holzer's Neuroprotective Mechanism )  In modern youth this would show inevitably a cord that will be pulled against the wall, if it is not already attached to it ( you can see this on many MRI's )

Focus on biochemic substances blurs the more important neuromechanic characteristics that make cords vulnerable for overstretch. If injures, the both parts of the cord will retract immediately, so sponteanous repair is impossible.  

Just another thought: von Frey measures allodynia thus in an ideal setting there should be no response from a normal animal. The filament to be used very much depends on the strain, line, gender experimental setting.. thus you should best establish which one to use for your specific situation as the largest one that does not provoke a response. It might also be good to use different pain assessments in parallel e.g. spontaneous pain, thermal allodynia, mechanical or thermal hyperalgesia.., 

Dear Meredith Van Damme

please check the resources pertaining to your topic

Thank you very much for your answer.

Regards!

please check it

www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)

www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC

www.healio.com/.../pharmacologic-treatment-of-neuropathic-pain-following-spinal-c..

Hellow  Syed,

please check the pdf and links

www.nature.com › Journal home › Archive › Reviews

www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)

patients with non-neurogenic bowel dysfunction such as IBS and functional constipation often experience abdominal pain without any change to bowel movements. The evidence suggests that this is due to perturbed gut-neuronal communication systems. I would presume (not evidence based of course) that the same is true for your patients.

I am a rotating physiotherapist who has some recent experience in spinal cord injury. While working with the more senior experienced physios immediately have often put patients in tilt in space wheelchair as soon as tolerable. This can be as early as week 2 as long as they are haemodymanically stable. While the patient is at intensive care we try to sit them up or tilt bed to start the gradual process early as long as the spin is stable. Abdo binder pass 30 degrees is used to help with coughing and BP. It is important to start the process early so quite often when patients arrive at the acute wards from ICU they can start trialling to sit in wheelchair as mentioned above while monitoring BP, and slowly increasing the sitting time. This really helps with future standing practices.

Hi Michele,

it's great that you are looking into this. In addition to th literature mentioned above, I would suggest considering the rationale behind and techniques of Acceptance and Commitment Therapy (ACT, for example Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York, NY: Guilford Press.).

Best regards

Franziska

There are several activities and different treatment interventions you can use, it depends on your initial goals and what are the expectations for your client (patient). As a rehabilitation professional you may want to start with short term goals, these are important to engage you and your client. However it is important to emphasize that a long term goal may be something that will become more functional and improve the quality of life of this individuals. It is important to get these info from a proper book. A book will give a broad idea of your goals and what are the best intervention for your client, based on what he/she is capable of doing. (Remember Area of lesion and muscle function must be very sharp in your mind - it will help your to decide what activities you can re-introduce). When you say upper limb, you have to think whether his upper limb has some movement. Is there some elbow and wrist movement? is he/she able to make a fist? If yes, measure his/her strength with a handgrip dynamometer. http://www.topendsports.com/testing/tests/handgrip.htm

 All those things must be assessed first, once you have an idea of what he/she is capable of doing, then you can think about activities to enhance his abilities. Please, be careful as some activities could not be appropriate and may generate frustration. Scientific articles are great, when you start searching for specific concepts and activities. Mary Ann McCall is an Occupational Therapist with vast scientific publication in Spinal Cord. You can get a lot info, from her publications, even the old ones.  

Good Luck with your search,

Kamary

Cher Anthony,

You'll find the (poor) available evidence about this topic here:

About pressure sores, look at this topic too:

For the treatment of PU in SCI, there is level 4 evidence (from one pre-post study; Brewer et al. 2010) for arginine supplementation for pressure ulcer Healing.

Notice the works of W.O.Seiler

Have also a look at this publication of our swiss cohort study on spinal cord injured patients (SwiSCI)

En restant à disposition pour en discuter!

X. Jordan

Dear Erwin,

Look the materials that I sent to you. I believe that you should find your responses.

I hope this helps.

Once I did some reconstruction of the image of an aortic dissection using Osirix but never attempted to do it with the brain. This may be possible, at least in the professional version.

In our experience, we've used quite a few histological techniques, such as quantifying the total lesion volume, monitoring adjacent tissue for activated microglia and reactive astrocytes, cell counting for NeuN, and Propidum Iodide staining post-SCI.

I am  sorry I do not k\now

is this what you're looking for Mr. Subhashisa?

please find both links

Are you talking about a lower or upper motor neuron lesion? Send me a private text if you want, i am currently doing my research in that area as part of my PhD.

Cheers!

thanks a lot Guillaume, but when you implant an aligned nanofiber in a site far from of SCI defect, out of cavity, how it directs cells around the cavity?

Hi Eric,

No special type of data or number of subjects are necessarily needed. However, please be aware of the following term and condition:

"8. All applications must be suitable for chronic SCI models. If acute models are used, the application must clearly state how and why the additional effort of using a chronic model is not justified and how the idea would be translated to a chronic model."

In essence, we are looking for lessons learned from chronic SCI-related research to help minimize the duplication of experiments and narrow down pathways of innovation.

Thanks,

Michael

Dear Zhu,

To stain for fibrosis it depends a lot on what you want to look for. In my experience, staining for alpha smooth muscle actin positive cells is a reflection of the activation of myofibroblasts, which are the main cells involved in fibrotic responses. Therefore, I would try to investigate their presence in the areas of lesion. Abcam has a very good antibody (ab7817). I have used it for IFHC using an alexa fluor 488 green antimouse as secondary and the staining was beautiful. For scar tissue, I think you should look at collagen deposition in the areas of lesion. Masson's staining or picro-sirius red can give you a very good staining for collagen and do not require use of antibodies. I personally prefer picro-sirius red that is also cheaper in terms of reagents. 

I hope this information is of help,

Good luck!

Perfect question about This subject. There are many reports about gliosis after spinal cord injury. however,  especially two of them have been  specially included This subject. One of these report authors have been suggested that gliosis which occurs following the spinal cord injury may a factor for poor recovery.  But  in the other report the authors have been showed that decreasing of gliosis does not improve the healing of the spinal cord after spinal cord injury. so that this subject is a dilemma for authors  

Indeed, a fascinating topic. Thank you Dr. Sutter to bring this up. I came across a recent article by the Cambridge/London group that has enormous experience with ICP. Intra-spinal cord pressure seems to be closely matched to epidural pressure at the level of the lesion in spine-injured patients, which would make pressure monitoring less invasive and still reliable. Regarding spinal perfusion pressure, the evidence being gathered is most convincing for a principle analogous to CCP.

Hi Emilio,

To the best of my knowledge: the China Spinal Cord Injury Network (ChinaSCINet) is the largest spinal cord injury clinical trial network in the world, comprising more than 20 leading spinal cord injury centers in Mainland China, Hong Kong, and Taiwan.

Since 2010, Dr. Wise Young of Rutgers Univ W.M. Keck Center for Collaborative Neuroscience "ChinaSCINet CEO" conducted Phase I/II trials in Hong Kong and Kunming to assess the safety and feasibility of umbilical cord blood mononuclear cell transplants, to regenerate the spinal cord and improve recovery in people with chronic complete spinal cord injury. One year follow-up assessments of 28 spinal cord injury patients who were treated with cord blood mononuclear cell transplants showed promising results. These results are being prepared for publication soon.  Based on these results, they are now planning to initiate phase III clinical trials in China, India, Norway and the USA to test 120 subjects with chronic complete spinal cord injury and to test different combinations of therapies.

please check this out;

https://vimeo.com/110802892     and 

hope this is what you are looking for

best wishes

Thank you very much for your answers

I found it at: 

Spine (Phila Pa 1976). 2011 Nov 1;36(23):E1525-33. doi: 10.1097/BRS.0b013e3182118adf.

Converting SRS-24, SRS-23, and SRS-22 to SRS-22r: establishing conversion equations using regressionmodeling.

Lai SM1, Burton DC, Asher MA, Carlson BB.

 

Abstract

STUDY DESIGN: 

Cross-sectional mail questionnaire.

OBJECTIVE: 

Assess the feasibility of translating total and domain scores from Scoliosis Research Society (SRS)-24, SRS-23, and SRS-22 to SRS-22r.

SUMMARY OF BACKGROUND DATA: 

Three successive editions of the original SRS-24 health-related quality-of-life questionnaire have resulted from efforts to improve its psychometric properties and validate its use in patients down to 10 years of age. This resulted in the need to establish, if possible, conversion equations to the last and most thoroughly validated version, SRS-22r.

METHODS: 

A consolidated questionnaire of 49 questions that incorporated the various questions in the four questionnaires was mailed to a consecutive series of 235 patients who had received primary posterior or anterior instrumentation and arthrodesis to treat adolescent idiopathic scoliosis. Regression modeling was used to establish conversion equations from the SRS-24, SRS-23, and SRS-22 to the SRS-22r.

RESULTS: 

One hundred twenty-one of the 235 patients (51%), aged 23.3 ± 4.52 years (range 14.2-34.6 years), returned the questionnaire at 8.6 ± 4.00 years (range 2.3-15.9 years) following surgery. Estimation of SRS-22r questionnaire and nonmanagement domains total scores and mean scores from SRS-22 and SRS-23 scores is excellent (R2 scores of 0.97-0.99) and good for SRS-24 scores (R2 scores of 0.80-0.82, improving to 0.86 and 0.87 after minimal domain reconfiguration). Estimation of SRS-22r individual domain total scores and mean scores from SRS-22 and SRS-23 is good to excellent (R2 scores of 0.81-0.99). Minimal domain reconfiguration improves conversion from SRS-24 pain from R2 = 0.71 to 0.76, which are both fair; SRS-24 function from R2 = 0.69 and 0.74 to 0.83, from poor and fair to good; and SRS-24 satisfaction/dissatisfaction with management from R2 = 0.64 to 0.80, from poor to good. Conversion of SRS-24 self-image is poor (R2 = 0.60) despite the correlation being statistically significant.

CONCLUSION: 

With one exception, SRS-24, SRS-23, and SRS-22 questionnaire, nonmanagement domains, and individual domain total scores and mean scores can be translated to SRS-22r scores with fair to excellent accuracy, which is further improved in some instances by minimal domain reconfigurations. The sole exception is SRS-24 self-image, which translates poorly.

PMID:

 21289546

 [PubMed - indexed for MEDLINE]

I enjoyed the well thought responses represented above. In my current position the decision is usually made prior to thier arrival in the Rehabilitation center. At my prior Institution it was different. 1.The patient and or family had some say. 2. reflexive cough was a highly valued indicator of transition to oral VS gastrostomy or duodenal tube placement. 3. FEES was also utilized frequently to assure clearance, especially in anterior approach fixations and high cervical levels. This was of particular value in complex cervical occipital dissasociation injuries. 4. Forced expiratory measurements add value to wait and see decision scenarios. Lastly we favored duodenal tubes for very high level p [rly responsive injuries when the decision was made to place a feeding tube. 

Nice reference for the inhaled citric acid, I am going to pass that on to our acute hospital team.

Non specific Fc receptor binding seems a plausible explanation since the lesion + stem cells probably triggers an inflammation response and rat Fc receptors might bind mouse Ig. The inflammation may also lead to the presence of many rat antibodies, so make sure your anti- Mouse secondary antibodies do not cross react with rat Ig. Since I have never heard of secondary antibodies made in mouse I have some doubt if you mean "X anti- Mouse secondary antibody" or "Mouse anti- Rabbit secondary antibody". Which one gives non specific staining?

Hi Benoit, we are neuroscience researchers and carry out the histochemical and immunohistochemical studies in some rat models of central nervous system injury:  spinal cord (SC) injury caused by the SC hemisection; Alzheimer disease (AD) -  induced by the  beta-amyloid peptide injection; Parkinson disease (PD) - caused by the rotenone injection; vestibular nuclei injury - induced by the labyrintectomy; as well as immobilization stress. Many of these results are published.

you should look up clinical trial.gov

I would encourage you to do a search on rehabmeasures.org  If you entered the search term spinal cord injury - the site will come up with researched outcome measures and give you the validity, cut off scores etc.

Hope these might be of your interest

Hi Matteo, without decalcification you can't cut the vertebrae in a cryostat. Quick decalcification protocols normally use acids which is not very good to the spinal cord, longer decalcification protocols with e.g. EDTA might work reasonably ok, but in my opinion the sectioning and the staining will never be as good as if you would process the spinal cord alone. My question is why would you need to do that?

At some point in the management of neuropathic pain after SCI it should be explored whether there is a role for surgical interventions. These should be considered when pharmacologic and other therapies have been thoroughly tested and the patient remains with a degree of pain that is still eroding their quality of life. There are several surgical options that range from reversible with low invasiveness to more invasive procedures. These include epidural stimulation, deep brain stimulation, cortical stimulation, radiofrequency lesions of the dorsal grey matter segments based on abnormal recordings from this area at and locally above the lesion level.  There are even more invasive treatments that should be reserved for unique cases.

Thank you all for your very useful replies -- Am approaching the problem with R and MATLAB. -JT

If your goal is anterograde labeling of CST axons, you might consider switching to BDA. There is a lot of literature on this tracer in models of spinal cord injury. I cannot comment specifically on the labeling patterns that you see with FR outside the CST axons. Perhaps pericytes or activated microglia responding to axonal die-back at the site of injury with subsequent incorporation of the dye. This is not something that is observed with BDA. I would recommend checking out PMID: 18596159

Should not move unnecessarily, Careful position in transferring the patient, prevent further damage, There are aides to assist with the moving of the

spine-injured patient. Then take him for surgery.

I have used propidium iodide (PI) and found it very reliable, easy to use, not-so-easily-fading, giving great contrast with FITC. The colour is red with a slight tinge of orange and the nuclear staining is very crisp.

As far as I know no relaiable studies between SCI and able-bodied persons regadring RLS has been performed. In clinical practice, it is to my opinion not a major problem, spasticity is however, sometimes confused with RLS.

These patients didn't feel labor pains so we must palpate them frequently .evacuate the bladder regularly as common associated with retention and uterine atony.good analgesia is needed to avoid autonomic dysreflexia .

The small n problem with SCI research has been around for decades. Traditionally, exercise research has been conducted using the student population attending the university, so a large n was usually achievable. With SCI, one of the issues is the number of spinal injuries in the population near to the research institution. If the population is low it is very difficult to recruit participants, especially if the research is looking for a homogenous sample. A way to combat this is to collaborate with local hospitals, therapy clinics, and other institutions to recruit subjects and possibly to assist with the research itself.

Ependymal cells are generating neurospheres in cultures (Barnabe-Heider et al., 2011), hence behaving as neural stem cells. This is true for the intact spinal cord as well for the injured tissue. See Fiorelli et al., 2013, GLIA if you're interested in this technique.

You might also be interested in this website:

Maybe you can look for the Chedoke McMaster stroke assessment leg and foot or arm and hand.

You can also visit http://strokengine.ca/assess/ You will find an impressive review of the assessment tools available for stroke and often the links to have access to the tools.

Cheers

Have studied Cerebral Palsy under (congenital) 'disabilities'.. not a disease.

You're right in that its not genetic, though.