24. Biotherapeutics Training following CNS and PNS injury

Question 1

How often does our research in a particular field double?

Answer 1

Every Decade

Question 2

What are the three strategies of tissue engineering?

Answer 2

Replace damaged tissue
Rescue surviving tissue
Regenerate new circuits from surviving ones

Question 3

How many clinical trials have there been in 2011 testing cells?

Answer 3

6

Question 4

How many clinical trials have there been in 2011 testing drugs?

Answer 4

23

Question 5

How many clinical trials was there in 2011 to do with spinal cord injury?

Answer 5

76

Question 6

What therapies do we have for acute or chronic therapies?

Answer 6

Medical management

Rehabilitation

Question 7

What system acts as a model for CNS injury?

Answer 7

The visual model

Question 8

What does the visual model describe?

Answer 8

Neurons survive
Axons regrow
Topography restored
Useful function (vision)

Question 9

Can lizards regenerate control?

Answer 9

Yes

Question 10

What are some examples of brain training?

Answer 10

Rat-transplants in huntingtons
Spinalised cells
SCI and treadmill training
Stroke patients
    - Executive vs social functions

Dose dependont
Not stressful
Task specific

Question 11

What does training do in lizard model?

Answer 11

Restores maps

Improves excitatory neurotransmittion and decreases inhibition

Question 12

What is facial nerve injury (PNS injury)?

Answer 12

Temporal bone fractures damaging facial nerves

Poor recovery of facial tone, voluntary movement and facial expressions

Question 13

How has the mouse model shown potential for regeneration?

Answer 13

When facial nerve is cut at foramen stylomastoideum
Mouse undergoes whisker training
Restores connections

Question 14

What has treadmill training shown?

Answer 14

Improves stepping
Limits dieback
Induces Sprouting

Increases synaptogenesis

Question 15

What happens in the body due to spinal cord injury/

Answer 15

Catabolic assault - Muscle, bone and kidney damage
- Bone resorption
- Osteoporosis
Metabolic Syndrome
- Muscle loss
- fat gain, insulin resistance
- Cardiovascular disease
Endocrine changes
Vascular Changes
Bladder, Bowel and sexual dysfunction
Inflammation
Mind

Question 16

Exercise does after spinal cord injury?

Answer 16

1) Looks after neural circuits

2) Looks after the body

Question 17

How does exercise look after neural circuits?

Answer 17

Increase growth factors
Prevents die back
Promotes new piggy back circuits
Prevents demyelination
Promotes remyelination
Entrains intrinsic circuitry
Pain, depression

Question 18

How does exercise after SCI look after the body?

Answer 18

Muscle 
Bone
Circulation
Oedema
Urinary output
Cardiovascular

Question 19

What is SCIPA?

Answer 19

Spinal cord injury & Physical Activity

8 spinal units in australia

Exercise paralysed limbs

Multi-centre assessor blinded randomised controlled trials

Question 20

What is SCIPA swtich-on, phase 1/2?

Answer 20

ICU and Acute Care

• Functional electrical stimulation cycling in bed
• Limit early muscle and bone loss
• Improves vascular tone
• Maximise long term gain

Question 21

What is SCIPA Hands-on phase 3?

Answer 21

Instrumented Re-Joyce workstation

• Reach
• Pinch
• Squeeze
• Grasp
• Release
• Twist
• Lift
• Push
• Pull

Treadmill Training

Question 22

Has treadmill training shown distributed plasticity in the damaged spinal cord?

Answer 22

Yes

Question 23

What is SCIPA full on, phase 3?

Answer 23

Full upper body exercise

Question 24

Where can you get SCIPA?

Answer 24

WA
Victoria
Queensland
New Zealand

Question 25

What happens during spinal cord injury?

Answer 25

``` Fracture dislocation / burst fracture Few complete transections Spinal canal narrowing Oedema, swelling Secondary metabolic damage ```

Question 26

What are the injury cascades due to SCI?

Answer 26

``` Oxidative stress Inflammation Blood brain barrier disruption Excitotoxicity Mitochondrial dysfunction Cell death ```

Question 27

How can spinal cord damage spread?

Answer 27

Hemorrhagic transformation Progressive catastrophic spread of tissue damage Loss of function

Question 28

What is decompression?

Answer 28

The relieving of pressure and swelling early in tissue rescue after SCI Reinstates CSF and blood flow

Question 29

what sparked the use of induction of hypothermia to prevent injury from stroke or cardiac arrest?

Answer 29

It buys time

Question 30

What is ICED?

Answer 30

Immediate Cooling and Emergency Decompression | Aim to reduce core temp to ~33 degrees followed by decompression

Question 31

What are the two stages of ICED?

Answer 31

Stage 1 - Feasibility & Study Design | Stage 2 - Random Controlled Trials