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‘Life-changing’ discovery for people with spinal cord injury

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University of Calgary's Cumming School of Medicine led the research

Blood pressure can be controlled without drugs after spinal cord injury, new research has revealed.

Spinal cord stimulators can bridge the body’s autonomous regulation system, controlling blood pressure without medication, the study found.

Led by Dr Aaron Phillips at the University of Calgary’s Cumming School of Medicine (CSM) and Grégoire Courtine, from the Swiss Federal Institute of Technology (EPFL), the study has been hailed as having “life-changing” consequences for people with spinal cord injury.

“The spinal cord acts as a communication line allowing the brain to send signals to tell the body such as when and how to move, as well as how to control vital functions, including blood pressure,” says Dr Phillips, co-principal investigator and assistant professor at the CSM.

Dr Richi Gill and his family

“This communication line is broken after a spinal cord injury. We created the first platform to understand the mechanisms underlying blood pressure instability after spinal cord injury, which allowed us to develop a new cutting-edge solution.”

And the solution is already delivering rewards, with Dr Richi Gill, the study’s first participant in a series of clinical trials.

Dr Gill broke his neck three years ago in a boogie board accident while on holiday with his young family.

Getting mobile again with the use of a wheelchair is the first thing most people notice, he says. However, for those with a spinal cord injury, what is happening inside the body also severely affects their quality of life.

“What many people don’t realise is that a spinal cord injury prevents some systems within the body from regulating automatically,” says the 41-year-old.

“My blood pressure would drop drastically, leaving me fatigued, dizzy, and unable to focus. The condition can be life threatening, requiring medication for life.

“It’s exciting to see the science help push things forward. I’m excited that Calgary will be one of the sites for a clinical trial. Research made a positive effect on my life and I’m glad others will benefit, too.”

In the study, targeted epidural electrical stimulation (EES) of the spinal cord was used to stabilise haemodynamics, or blood flow throughout the body, allowing for vital organs to maintain an appropriate supply of blood.

The researchers discovered the exact placement on the spine for their stimulator, and the circuitry of the sympathetic nervous system underlying blood pressure control.

This new knowledge allowed for the development of a neuroprosthetic closed-loop communication system, to replace lost haemodynamic control.

“We are really excited that people with spinal cord injury are able to stop their blood pressure medication and get back to enjoying a full daily routine with improved blood flow to their brain and organs,” says Dr Sean Dukelow, clinician scientist at the CSM and author on the study.

“People feel more alert, are able to be upright and in their wheelchair without losing consciousness, and over the long-term we think this will reduce the risk of heart disease and stroke.”

Work is already underway to take the project forward into mainstream use, adds Dr Courtine.

“We are going to collaborate with a company called Onward to develop a neurostimulation system dedicated to the management of blood pressure in people with spinal cord injury,” he says.

News

Neurokinex unveils winning Christmas card design

Eight-year-old Jasper’s creation will be this year’s festive fundraiser for the specialist neurophysio

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Over the past four years, the team at Neurokinex and some of its young clients at Neurokinex Kids have taken part in a fun and festive Christmas card charity design competition.

All the children’s designs are put forward to a public vote with the winner’s design then made up into a Christmas card that is sold to help raise awareness and vital funds for the charity. 

This year’s winning design

This year’s winning Neurokinex Kids Christmas card was designed by Jasper, eight, who also drew the winning design of the very first Neurokinex Christmas Card in 2018 when he was just four years old.

Jasper was the first paediatric client to attend Neurokinex aged just two in March 2016. Born fit and well, he contracted Hand, Foot & Mouth disease at a children’s party. A rare complication resulted in an enlarged heart and Jasper was admitted to hospital and put on life support. However, when the doctors brought him round, Jasper couldn’t move his legs: a blood clot had damaged his lower spinal cord and he was paralysed from the waist down.

After Jasper was discharged from Stoke Mandeville spinal care hospital in March 2016, his mum Kate started to look for specialist rehabilitation to give Jasper his best chance of recovery. She was initially recommended to visit the NeuroRecovery Network facility in Louisville and the family flew to the US in May 2015. At that time, the ground-breaking work being done in Louisville was only available at a select few NRN affiliated sites in America.

Luckily for Jasper, the NRN had just named the Neurokinex rehabilitation centre in Crawley as its first and only affiliate outside of the US, bringing this amazing treatment much closer to home. Kate flew the family home and Jasper started at Neurokinex. Two years later, in March 2018, Neurokinex opened Neurokinex Kids, a purpose-built activity gym upstairs at the main Neurokinex rehab centre to fully cater for their younger clients. 

Not just for fun, but providing therapy too 

Whilst designing the Christmas card is great festive fun for the kids, it’s also another opportunity to provide important therapy. 

Neurokinex Kids delivers ground-breaking work and defies diagnoses, focusing above and below the child’s point of injury in a bid to stimulate sensation and rehabilitation. It looks more like a play centre than a therapy suite with its bright and cheerful set-up. Here, children aged six months to 12 years engage in specialist rehab therapy through play, largely unaware how hard they are working because they’re having so much fun.

Designing the Christmas cards works many different muscle groups for the children as part of their vital therapy and gives the opportunity to focus on something different. It builds engagement, strengthens their relationship with their trainers and helps their families ‘give back’ to Neurokinex Kids. 

Last year, Ryan, eight, wowed everyone by using only his mouth and a paintbrush to create his design of a snowman. He did this at Neurokinex Kids as part of his ongoing therapy and was placed into a standing position to paint it, which made keeping his head in control even more challenging. 

In 2019, aged just two, Ralph’s design of snowmen using his footprints was chosen as the winning picture. A charming card, it was poignant because when Ralph first arrived at Neurokinex his hips were out of alignment and his feet were twisted backwards – meaning his ‘side by side’ snowmen wouldn’t have been possible. This was because when Ralph was just two weeks old he suffered a spinal stroke which had caused damage to his spinal cord and left him paralysed from the waist down. 

Raising vital funds 

Each year the Neurokinex Christmas card raises awareness and vital funds for the charity. A pack of 10 cards costs £6.50 and you can buy them here https://neurokinex.org/christmas-cards/

 

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Brain injury

Saliva test to diagnose concussion set to trial in football

Through a new joint action plan on brain health, education and research are identified as being at the heart of understanding concussion

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A breakthrough saliva test to diagnose concussion is set to be trialled in the Premier League, with a series of research projects also given backing, as efforts to protect players from the impact of head injury are stepped up within English football. 

In a new joint action plan on brain health, the need for research, education, awareness and support for players has been recognised, with a series of steps identified to better manage head injuries and to further understand the links between football and neurodegenerative disease.

The plan – from The FA, Premier League, EFL and PFA – includes a raft of measures, including the funding of an academic study to validate a diagnostic tool that uses salivary biomarkers, with reports that a trial could begin in the sport later this season.

It follows the publication of the SCRUM study findings in March, which showed a saliva biomarker tool was able to accurately detect concussion in elite male rugby players.

SCRUM, led by academics at the University of Birmingham, successfully predicted the outcome of head injury assessments in 94 per cent of cases during testing in the 2018-19 Premiership and Championship season. 

Furthermore, The FA is supporting the new BrainHOPE study, part of the wider Prevent Dementia study, which starts in 2022 at Glasgow University. 

The study will give an analysis of deterioration of cognitive function in the mid-life of ex-professional footballers to understand potential early interventions which could help reduce risk or speed of developing dementia. Its £1.2m investment will run until the 2024/25 season.

It is also partnering with the RFU and Premiership Rugby to expand the Advanced BRAIN Health Clinic, a new specialist clinical service and associated research programme for retired elite rugby players. The expansion to retired football players is due to start operating in 2022.

Trials of a new revolutionary mouthguard which includes a sensor that can relay real-time information to the sidelines – launched with players from Liverpool and Manchester City last season – is being expanded to include additional teams across the Premier League, EFL and The Barclays FA Women’s Super League (WSL).

Education is also highlighted as being of significant importance, and an expert working group formed by the Premier League is devising neck strengthening guidance. This will provide clubs with an introductory programme which is recommended to be implemented by strength and conditioning coaches.

In the grassroots game, authorities are working with brain injury charity Headway on a campaign – set to launch later this season – that will seek to improve awareness of concussion and ensure existing guidance is understood and accepted as standard practice. Referees will also be given greater support in dealing with concussion. 

“Understanding the risk factors of neurodegenerative disease in football is an incredibly complex area of medical science which requires exploration of many different lines of research,” said FA chief executive Mark Bullingham. 

“Football is working together to try to build a more complete picture by supporting a variety of projects.  Until we have a greater level of understanding, we are also reducing the potential risk factors. 

“This new joint action plan will further help to build our understanding across English football of this complex area.”

Richard Masters, Premier League chief executive, said: “It is important that football has come together to work collaboratively on this issue. With the help of experts, and alongside other sports with similar challenges, we want to ensure we have the right approach in place to protect the welfare of players.”

Trevor Birch, CEO of the EFL, said: “English football has a collective responsibility to understand and act upon the risk factors of neurodegenerative disease and therefore the EFL is pleased to support the game’s new joint action plan on brain health. 

“By working together in this collaborative approach, we will acquire the information to be better equipped to improve safeguarding measures for those who play football at all levels of competition.”

Maheta Molango, PFA Chief Executive – who has pledged to donate his brain to research to increase understanding of neurodegenerative illness – added: “A joined-up approach is essential to improve the health and safety of our current and future members. 

“A co-ordinated response is also required to provide comprehensive and dedicated support to our former players, and their families, currently living with dementia and other neurodegenerative diseases.

“This is a vital and complex area. It has to be the top priority for all involved in football.”

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News

Non-invasive technique ‘could replace need for brain surgery’

The new PING approach could help treat some of the most challenging and complex neurological diseases

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A new non-invasive technique has been developed to remove faulty brain circuits that could allow medics to treat debilitating neurological diseases without the need for conventional brain surgery.

If successfully translated into operating theatres, the breakthrough has been hailed as potentially revolutionary in the treatment of some of the most challenging and complex neurological diseases, including epilepsy, movement disorders and others. 

The PING approach, developed by the University of Virginia and Stanford University, uses low intensity focused ultrasound waves combined with micro-bubbles to briefly penetrate the brain’s natural defences and allow the targeted delivery of a neurotoxin. 

This neurotoxin kills the culprit brain cells while sparing other healthy cells and preserving the surrounding brain architecture.

“This novel surgical strategy has the potential to supplant existing neurosurgical procedures used for the treatment of neurological disorders that don’t respond to medication,” said researcher Dr Kevin S. Lee, of UVA’s departments of neuroscience and neurosurgery and the Center for Brain Immunology and Glia (BIG). 

“This unique approach eliminates the diseased brain cells, spares adjacent healthy cells and achieves these outcomes without even having to cut into the scalp.”

PING has already demonstrated exciting potential in laboratory studies. For instance, one of the promising applications for PING could be for the surgical treatment of epilepsies that do not respond to medication. 

Around a third of patients with epilepsy do not respond to anti-seizure drugs, and surgery can reduce or eliminate seizures for some of them. 

Dr Lee and his team, along with their collaborators at Stanford, have shown that PING can reduce or eliminate seizures in two research models of epilepsy. 

Dr Kevin S. Lee

The findings raise the possibility of treating epilepsy in a carefully-targeted and non-invasive manner without the need for traditional brain surgery.

Another important potential advantage of PING is that it could encourage the surgical treatment of appropriate patients with epilepsy who are reluctant to undergo conventional invasive or ablative surgery.

A key advantage of the approach is its incredible precision. PING harnesses the power of magnetic-resonance imaging (MRI) to let scientists peer inside the skull so that they can precisely guide sound waves to open the body’s natural blood-brain barrier exactly where needed. 

“If this strategy translates to the clinic,” the researchers write in their new paper, “the noninvasive nature and specificity of the procedure could positively influence both physician referrals for and patient confidence in surgery for medically intractable neurological disorders.”

“Our hope is that the PING strategy will become a key element in the next generation of very precise, noninvasive, neurosurgical approaches to treat major neurological disorders,” said Dr Lee, who is part of the UVA Brain Institute.

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