spinal cord injury (sci)

Spasticity is a disabling complication of spinal cord injury (SCI). The administration of various medications is not satisfactory. Studies show the effects of onabotulinumtoxinA treatment for spasticity in patients with SCI. We designed this study to systematically review the effects of onabotulinumtoxinA toxin on spasticity status in patients with SCI.

PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and gray literature, including references and conference abstracts, were systematically searched by two researchers published before September 2023. Data regarding the total number of participants, first author, publication year, country of origin, mean age, follow-up time, the site of injection, main findings, and side effects were extracted and recorded.

A literature search revealed 2914 articles. After deleting duplicates, 1688 remained. After careful evaluation of the full texts, six articles remained. Two studies reported improvement in the modified Ashworth scale after treatment, while one showed opposite results. Improvement of spasticity and spasticity-related pain was observed in one study, and a decrease in the modified Tardieu scale was found in another study. Improvement in upper-extremity function, positioning, and pain after treatment was shown in a study done in the USA.

The results of this systematic review show that administration of onabotulinumtoxinA toxin may improve spasticity in patients with SCI.

Spinal cord injury (SCI) leads to sensory, motor, and autonomic dysfunctions and changes in different nerve fibers that can greatly impact the quality of life of many people. Neuroplasticity is a spontaneous mechanism of the nervous system to adapt to different molecular, physiological, and anatomical changes after SCI.

Methods and Materials/Patients:

 A literature search of relevant articles was made with a focus on recent publications.

This narrative review first discusses the definition of neuroplasticity in the nervous system and cellular processes of neuroplasticity in the synapses and their effects on synaptogenesis and neuroplasticity. We describe some of the important central and spinal neuronal pathways and their role in voluntary movements and the regenerative capacity in neuroplasticity and functional recovery. Then this review focuses on the effects of exercise and training programs and different neuromodulation techniques using electrical stimulation (ES) on the development of neuroplasticity. These rehabilitation and neuromodulation techniques accelerate the release of some neurotrophic factors to enhance neuroplasticity and functional sensorimotor recovery.

This narrative review emphasizes the importance and capability of neuroplasticity in improving functional recovery and quality of life of the people following SCI. It identifies that different physical rehabilitation and neuromodulation strategies induce significant improvements in sensorimotor recovery and underlines that the combination of rehabilitation and neuromodulation techniques provides greater functional outcomes. There is a need for further investigation using preclinical and clinical studies in the future that should concentrate on the basic molecular and cellular processes of neuroplasticity and investment in enhancing the rehabilitation and neuromodulation techniques and finding new techniques.

Spinal cord injury (SCI) is characterized by serious both motor and sensory disability of the limbs below the injured segment. It is the most traumatic disorder among central nervous system (CNS) conditions which not only leads to psychological and physical harm to patients but also results in a dramatic loss in the life quality. Many efforts have been developed to find a therapeutic approach for SCI; however, an effective treatment has not yet been found. The lack of effective treatment approach and rehabilitation of SCI underscores the need to identify novel approaches. Tissue engineering associated with stem cells has been recently introduced as an effective treatment approaches for traumatic SCI. Although, low survival rates, immune rejection, cell dedifferentiation, and tumorigenicity have been addressed for tissue engineering. Regenerative medicine is an interdisciplinary field developing and applying tissue engineering, stem cell (SC) therapy, and SC-derived extracellular vesicle therapy that aims to provide reliable and safe ways to replace injured tissues and organs. The application of mesenchymal stem cells-derived extracellular vesicles (MSC-EVs) has recently attracted attention to improve central nervous system dysfunction such as SCI, mainly by promoting neurogenesis and angiogenesis.

In this review article the latest information of SCI improvement using stem cell-derived extracellular vesicles published data in the Web of Science, Scopus, Science Direct and Pub Med databases were collected. 

The data collected show that MSC-EVs, including exosomes, alone or in combination with scaffolds can can regenerate the injured nerve in SCI.

This study summarizes the efficacy of MSC-EVs, including exosomes, alone or in combination with scaffolds in the treatment of SCI and then discusses the therapeutic outcomes observed in SCI experimental models following treatment with MSC-EVs alone or loaded on scaffolds in particular collagen-based scaffolds.

Spinal Cord Injury (SCI) increases the frequency and severity of bowel problems, especially for those who age with this injury. The present study aimed to investigate the effectiveness of a bowel management training program in patients aged with SCI. 

A multiple-baseline single-case design of concurrent type was employed. Three male married patients with SCI whose ages ranged between 48 and 53, with a mean duration of 32 years after the injury, were recruited for this study from a rehabilitation center in Isfahan City, Iran, in 2020. An individualized 8-week bowel management training program was conducted. The patients’ bowel dysfunction was evaluated by Neurogenic Bowel Dysfunction (NBD) score. 

The results were provided by the six features of single-case designs, namely immediacy of the effect, overlap, variability consistency of data patterns across similar phases, trend, and level, revealed the efficacy of the program in decreasing bowel dysfunction problems in men aging with SCI.

Health care providers should know about the changes that might happen as an individual gets old with SCI to take preventive measures and reduce the harmful effects of aging, especially bowel dysfunction.

Damage to the spinal cord is a central nervous system disorder that results in direct damage to neural cells (axons, cell bodies) and glia, followed by autonomic, motor and sensory impairments. Inflammatory response after this injury can contribute to secondary tissue damage that leads to further behavioral and functional disorders. Inflammation is a complex process, which occurs after an injury. If this progressive process is not well controlled can lead to additional damage to the spinal cord which is preventing neural improvement and regeneration and, which ultimately will not provide good clinical consequences. Inflammation in the injured spinal cord is a physiological response that causes the death of glial and neuronal cells. The reduction of the initial inflammatory process after damage to the spinal cord is one of the important therapeutic strategies. It has been proposed that low-level laser (LLL) therapy, as a noninvasive manner, can modulate inflammatory processes, which leads to a significant improvement in neurological symptoms after spinal cord injury (SCI).

A comprehensive review was performed on SCI, the etiologies, and treatment methods using the keywords spinal cord injury, low-level laser, and inflammation in valid medical databases such as Google Scholar, PubMed, and Elsevier (76 articles). Among the collected papers, articles that were most relevant to the purposes of the study were selected and studied.

LLL therapy was able to reduce inflammation and also attenuate neuronal damage after spinal cord damage.

The present study illustrates that LLL therapy has positive effects on improving functional recovery and regulating the inflammatory function in the SCI