HEQ explores innovation in the treatment of spinal cord injury.

Injuries to the spinal cord, whether they are caused by an acute trauma such as a car crash or disease or degeneration, can be both physically and psychologically debilitating. The World Health Organization (WHO) reports that between 250,000 and 500,000 people around the world will incur some type of spinal cord injury every year; with the majority of these injuries occurring as a result of preventable causes, including traffic collisions, accidental falls, or violence: of the 40 to 80 cases of spinal cord injury per million population estimated by the WHO, around 90% are attributed to traumatic causes.

Long term physical issues

The risk of mortality associated with spinal cord injury is correlated with the severity of the injury itself, as well as the availability of prompt treatment, with the methods used to transport an injured patient and the time which elapses between the onset of the injury and treatment also cited as factors. Overall, while the mortality risk of spinal injury drops after the first year, it remains higher than the average; with spinal cord injury patients between two and five times more likely to die prematurely than the general, uninjured population.

In addition to the aftereffects of the injury itself, patients may face heightened risk of secondary conditions, including:

• Chronic pain;
• Deep vein thrombosis;
• Muscle spasms;
• Pressure ulcers;
• Osteoporosis; and
• Respiratory complications.

These conditions may further incapacitate the patient and some may even increase the risk of premature death. In particular, as the global pandemic continues, the respiratory issues which may arise from spinal cord injury could render the patient vulnerable to the more severe effects of COVID-19.

Mental and psychological challenges

Many patients who experience an injury to the spinal cord find their physical range of mobility becomes limited to a greater or lesser degree, with more severe injuries necessitating the adoption of assistive technology, changes to a patient’s home layout and lifestyle, and potentially the need to employ a caregiver.

These limitations – and, depending on the range of external support available in the patient’s home country, the extensive costs they may incur – can exacerbate the psychological distress which frequently accompanies any life-altering injury. Between 20% and 30% of spinal cord injury patients exhibit clinically significant symptoms of depression; and this in turn can inhibit the rate at which a patient’s health improves. The mental health of patients may be further affected by a relatively high rate of social and economic exclusion: young children who suffer a spinal cord injury are less likely to start school than their peers, and those who do attend school are less likely to advance academically; while more than 60% of adults worldwide with a spinal cord injury are unemployed.

Innovation in spinal cord injury treatment

As the role of digital and technological innovation in healthcare becomes more and more prominent, researchers are investigating the potential of an array of solutions which may aid the support and care of spinal cord injury patients. The South East Coast Ambulance Service NHS Foundation Trust in Sussex, UK, is trialling new protocols for the transport of spinal cord injury patients, in response to a growing body of evidence which appears to indicate that the traditional use of neck braces or collars may be more likely to cause additional harm to injured patients than previously thought. In addition to adopting manual in-line stabilisation and scoop stretcher transport for ‘standard’ patients and a distinct ‘comfort’ approach for ‘non-standard’ patients – that is, those who may be otherwise vulnerable, such as young children, pregnant women and the elderly – paramedics will also equip non-standard patients with a lanyard designed to inform the hospital of their status.

Artificial Intelligence in prosthetic technology

Researchers at North Carolina State University (NCSU) have developed a software program based on Artificial Intelligence (AI) algorithms, which can be integrated into existing prosthetic limbs and which deploys computer vision and AI to respond to changes in terrain. The program is capable of recognising six key terrain types which may necessitate adjustment of the prosthetic’s movement protocols:

• Brick;
• Concrete;
• Glass;
• Tile;
• ‘Upstairs’; and
• ‘Downstairs’.

Associate Professor of electrical and computer engineering at NCSU Edgar Lobaton, a co-author on the study, said: “Lower-limb robotic prosthetics need to execute different behaviours based on the terrain users are walking on. The framework we’ve created allows the AI in robotic prostheses to predict the type of terrain users will be stepping on, quantify the uncertainties associated with that prediction, and then incorporate that uncertainty into its decision making. We came up with a better way to teach deep learning systems how to evaluate and quantify uncertainty in a way that allows the system to incorporate uncertainty into its decision making: this is certainly relevant for robotic prosthetics, but our work here could be applied to any type of deep learning system.”

Machine learning in gene therapy for gait recovery

An ongoing study based at the École Polytechnique Fédérale de Lausanne in Switzerland has shown promising results in the use of AI and machine learning to identify the neurons which play a key role in the process of gait reacquisition. By singling out the specific neurons which are significant to recovery from spinal cord injury, the researchers have been able to prioritise these neurons for additional stimulation, enhancing the effectiveness of mobility treatments. Early stages of the trial, which saw paralysed mice subjected to spinal cord stimulation, were successful in restoring mobility to the rodents; while later tests on human patients at Lausanne University Hospital were similarly effective in accelerating the recovery process.

Virtual reality and paraplegia

Up to 50% of patients with paraplegia may still have functional nerve fibres capable of sending faint sensation messages from the lower body to the brain, recent research from Neuroscience Research Australia (NeuRA) revealed. Associate Professor Sylvia Gustin, who led the study, has launched a new project which aims to deploy virtual reality (VR) technology to enhance and amplify those neural signals, in order to restore lower limb sensation. The programme, titled RESTORE, has received an AUS$2.5m grant from the New South Wales Ministry of Health; and seeks to combine physical lower extremity stimulus with virtual reality simulations, with the aim of ‘retraining’ the brain to recognise the corresponding signals from the nerve fibres.

Gustin said: “It’s very exciting that we can explore how virtual reality can be used to help people regain feeling in their limbs. The outcomes of our research could lead to a cultural and scientific shift in terms of how we treat people with spinal cord injuries; and what they can expect from life after experiencing such a devastating injury.”

This article is from issue 14 of Health Europa. Click here to get your free subscription today.