Wednesday, June 28, 2006

USC Seeks Volunteers for Spinal Cord Injury Rehabilitation Study

The University of South Carolinas Arnold School of Public Health is seeking volunteers for a study examining the effects of a two-week intensive treatment program on walking, balance, and mobility for individuals with spinal cord injury.

A news release says the study combines two rehabilitation techniques to form a new therapy, known as Intensive Mobility Training. The release states participants will walk, with support, on a treadmill and receive training to help them improve their balance, coordination and mobility.

Participants must be able to stand with or without an assistive device for two minutes, take at least 10 steps with or without assistance, and must have experienced the injury as least six months before entering the treatment program.

The study, funded by the SC Spinal Cord Injury Research Fund, is under the direction of Dr. Stacy Fritz, a faculty member in the physical therapy program in the department of exercise science. For information, contact Fritz at (803) 777-6887 or
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Monday, June 26, 2006

China Stem Cell Study May Help Man to Walk Again

China stem cell study may help Sikeston man to walk again
Terry Cole longs for the day he can throw out his handicap parking plaque.

And now the Sikeston Mississippi resident may finally be getting that chance. Paralyzed at 19, Cole's lived each day of his life in a wheelchair since he suffered a spinal cord injury in a car wreck in 1975.

But it wasn't until a couple months ago Cole discovered he may have an opportunity to walk again through a nerve regeneration study using stem cells this fall in Beijing, China.

"If I waited on the United States to approve stem cell surgeries, I'd be too old to have the surgery," Cole, 50, said.

It was Cole's wife, Cindy, who learned about the study after reading a local news story. The couple then contacted Dr. Huang Hongyun, who is conducting the clinical study to treat chronic complete cervical spinal cord injuries and is also the director of Beijing Xishan Institute for Neuroregeneration and Functional Recovery.

To even be considered for the study, Cole had to meet several requirements. For example, he had to be younger than 60 and have a cervical spinal cord injury ranging in the C4 to C7 level (Cole's level is C6).

An MRI and pre-evaluation were also conducted by Sikeston doctors Jimmy Heath and Steven Douglas; then Cole was approved to be a candidate for the study by Hongyun.

Once approved, Cole had to find a neurotherapist to conduct six months of pre-surgery therapy. He fulfilled that requirement by finding physical therapist Tracy Davied and occupational therapist Brooke Reed of Ozark Therapy in Sikeston.

"Sikeston is real fortunate to have therapists trained in spine and neuro re- education so I don't have to travel to Cape (Girardeau) or St. Louis to have this," Cole said. "And Ozark has been so good about working me into their schedule five days a week."

Cole's in his seventh week of pre-surgery therapy, which consists of three- hour sessions, five days a week. During sessions Cole must ride a special bike, stretch and sit without support.

"We're not so much working on motor function, but more on flexibility, endurance and trunk control," Davied said.
Sessions begin with an hour of Cole riding his ERGYS-2 bike ? a $15,000- custom-built bicycle, which attaches 12 computer-programmed electrodes from the equipment to his body. These electrodes stimulate the nerves; the muscles contract, resulting in movement.

Cole said he learned about the bike after being evaluated by Dr. John McDonald who is credited for helping the late Christopher Reeve regain some movement.

The purpose of the therapy is to help build Cole's aerobic capacity and endurance to help nerve regeneration following his surgery, his therapists said.

In addition to therapy, Cole quit smoking and changed his diet so he could have more energy.

"I changed my eating by 100 percent," Cole said. "I used to eat one meal a day because I didn't want to gain any weight."

Cindy Cole said she's noticed some muscle tone in her husband's legs and increased stamina since he began the daily therapy sessions. "He has a healthier color about him," she said.

Cole is one of only 28 people who will be divided into four groups for the study. Three groups will each receive a different type of stem cells (cells collected from aborted fetuses), and one group will receive no stem cells.

"You won't know which one you will get," Cole said. "You will be in Beijing for 30 days. They will implant the stem cell where the spinal cord nerve is severed. Hopefully, nerve regeneration will take place."

After the 30 days, Cole will return to therapy at Ozark for six months. To optimize results, Reed said therapy should begin as soon as possible following procedure.

"Then you go back and when they conclude the study, if you didn't receive the stem cell determined to be the best for treatment, then you will have the surgery with that stem cell for free," Cole said.

Cole's first visit will be paid for out of his own pocket, which will be several thousand dollars. Cole said insurance will not cover the surgery or therapy because Cole's "quality of life is good."

Cole is expected to undergo surgery in November or December. He knows there's no certainty with the surgery, but it's a risk he's willing to take.

"If I sit in that chair the rest of my life, I sit there," Cole said while riding his bike and nodding toward his wheelchair. "I have the opportunity to get out of the chair, and I'm going to take it."

Cole continued: "When you go on vacation, you just go. Right? I don't. I have to check on how wide the bathroom doors at the hotel are and whether there's handicap accessibility."

There's no sound of self-pity in Cole's voice; he's simply telling it like it is. Cole credited his wife of 24 years for continuously giving him her entire support.
"I don't have to sit in that wheelchair. I just have to be behind it," Cindy Cole said.

Cole said he doesn't know what drives him to go through all of this work just for the mere chance he might be able to walk again. "It's just been a dream," Cole said.

Cole, a Christian, is aware of the controversy associated with stem cell use but, he said: "That's between me and the Lord."

By: Leonna Heuring
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Thursday, June 22, 2006

Researchers Stretch Nerve Fibers to New Limits

Blue whales can wiggle their tails. That's far from surprising to almost anyone except a neurobiologist. But the sea mammal's ability to communicate between its brain and its tail ? 75 or more feet away ? has inspired a group of scientists to find a new way to grow nerves in the laboratory.

Such nerves might someday help people with spinal injuries and other conditions, such as certain types of blindness, in which nerves have been severed.

The group's goal, says Douglas Smith, director of the University of Pennsylvania's Center for Brain Injury and Repair, is to span gaps in damaged nerves.

Other scientists have concentrated on growing nerve fibers, or "axons," by increasing the growth rate at their free ends.

How nerves grow
Any nerve starts as a neuron cell that spouts nerve fibers. This axon, in turn, grows from the "growth cone" at its tip until it reaches a particular neuron to complete its circuit.

Most nerve-growth research has concentrated on enhancing the growth cone's effectiveness as axons reach across biological chasms to reach target neurons.
Not only is this process slow, but in the laboratory it hasn't produced nerves that are nearly long enough to span the gaps produced by human spinal cord injuries and many other types of nerve damage.

Scientists have thought that these cellular baby steps were the only ways nerve tissue grows and that the most an axon could grow in a day was less than one-tenth of an inch (1 millimeter), Smith explains.

That's where the whales come in.

Baby blue whales grow about 1.6 inches (4 centimeters) per day. And because at birth a nerve already connects whale brain to whale tail, there is no exposed axon tip, and so no growth cone, to drive this breakneck growth rate.

"In theory all that we've learned about pathfinding with an axon growth cone doesn't apply," Smith said. "Those axons are growing in a completely different way, one that has never been studied."

The likely explanation, he says, is that these nerves, and possibly all nerves, have a second way to grow, one that accelerates the cellular processes.

"The one thing that must be the driving force is mechanical," Smith said.

As a whale ? or any vertebrate ? grows, nerves stretch, but get thinner as well.

If this thinning were to continue until the whale was whale-sized, the nerves would be stretched impossibly thin. But somehow the nerves thicken as the creature matures.

Copy nature
Smith's group is imitating this natural system to make bundles of long nerves, so-called "three-dimensional neural networks," that one day might serve as a bridge across damaged nerves.

The scientists start with rat neurons, which they sprinkle onto two plastic, nutrient-stuffed plates. As any neuron would, these sprout axons, the nerve fiber itself.

Then the scientists place the plates close to each other, coaxing the axons' growth cones on each plate to connect to neurons on the other, resulting in complete, intact nerves that run from plate to plate.

Next computer-controlled micromotors slowly separate the plates (too fast and they'll snap), stretching the nerves like a heretic on a medieval rack.

Currently the nerves can be stretched up to nearly a half-inch (1 centimeter) per day and have been grown up to 4 inches (10 centimeters) long.

Smith's group then processes these elongated nerves to construct a portable neural network. The nerves are removed from the culture environment in which they were grown and are covered with a bed of nutrient-rich collagen, which is then rolled up like a Hostess Ho Ho.

A member of Smith's group, Akira Iwata, has implanted nerve rolls into laboratory rats, bridging cuts in the animals' spinal cords. The imported nerves not only survived for at least a month but also connected with nerves in the rats' spinal cords.

This work was described in the February 2006 issue of the journal Tissue Engineering.

Soon, Smith says, the group plans to test whether the new nerves can actually transmit information.

Just watching the animals to see if they recover isn't enough, since ? fortunately for rats but unfortunately for this experiment ? rats are far better at surviving spinal cord injuries than humans.
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Wednesday, June 21, 2006

Stem-Cell Therapy Restores Movement in Paralyzed Mice

In what experts are describing as a major advance, scientists have used embryonic stem cells to form new, functional nerve cell connections in formerly paralyzed mice that effectively restored the animals' limb movement.

While success in humans remains a distant goal, the achievement is "proof of principle" that stem-cell grafts such as these might someday be used to treat spinal cord injury, ALS (Lou Gehrig's disease), Parkinson's disease and other crippling neurological conditions, one expert said.

"This is something that we've been looking for for 30 years," said Naomi Kleitman, program director of the Extramural Research Program at the U.S. National Institute of Neurological Disorders and Stroke.

Kleitman was not involved in the study, but her office helped fund the research. She called the finding "exciting, because it proves the principle that with the right combination, we can coax [nerve] cells out, and now we know what to build on."

The findings will be published Monday in the journal Annals of Neurology.

Numerous studies have come out over the past few years showing that embryonic stem cells can form nerve cells in areas of the spinal cord damaged by injury or disease. But getting these motor neurons to make functional connections to muscle has been a frustrating roadblock.

"In the simplest [neuronal] relay, a brain cell talks to the motor neuron in the spinal cord and says, 'Move that muscle,' " Kleitman explained. "Then, the motor neuron reaches out of the spinal cord to the muscle using these long fibers called axons. They communicate with the muscle, send an impulse, and the muscle contracts."

But this seemingly simple network relies on a complex partnership of growth factors and signaling chemicals -- each vital to the process. So, research aimed at deciphering these players and their connections has continued.

"It's like a detective story where if you don't put all the clues in order, you wind up going off in the wrong direction," Kleitman said.

The new study was conducted by a team at Johns Hopkins University School of Medicine, led by Dr. Douglas Kerr. His group concocted a kind of neural "recipe" that satisfied all of the conditions needed for the successful growth and networking of new motor neurons.

Starting in the laboratory, they first used specific growth factors to spur mouse embryonic stem cells to differentiate into motor neurons. Then they added two chemicals -- retinoic acid and sonic hedgehog protein -- to help these new cells feel more at home in the spinal-cord environment.

The next step was to deliver these primed cells into the spinal cords of mice previously paralyzed by a viral infection.

But another roadblock loomed.

"We know that there are proteins in this area that inhibit axons from growing in adult animals," Kleitman explained. The proteins are linked to the protective myelin sheath that coats nerve fibers. "They're part of how we keep our nervous system from going haywire during normal function," she said.

To overcome this resistance, the Hopkins team added two agents -- cyclic AMP (cAMP) and the drug rolipram -- to the mix. According to Kleitman, these molecules "block the 'stop sign,' so that now the axons can grow."

But there was one more hurdle -- it's one thing to allow axons the freedom to grow, but to grow where? "You've got pretty long distances to cover, so one of the things you need is a 'target' that's screaming out like a neon sign, 'Come here!' " Kleitman said.

The Hopkins group created just such a target by applying a powerful neural growth factor, called GDNF, to the remains of nearby, deadened sciatic nerve cells. The GDNF -- derived from fetal mouse neural stem cells -- essentially "called out" to the growing axons, urging them to make the connection.

In the end, this complex biochemical "recipe" worked, the Hopkins team reported.

Of the more than 4,100 new motor neurons created in one mouse's spinal cord, about 200 exited the cord and 120 found their way to skeletal muscle. These new connections looked identical under the microscope to those seen in healthy mice, the researchers said.

What's more, 11 of the 15 treated, previously paralyzed mice began to regain muscle strength and function and were more mobile in their cages.

However, this restoration of function did not occur when the researchers left out even one of the ingredients from the mix.

According to Kerr, his team has simply tried to recreate the environment that directs neural formation early in fetal development.

"As adults, our cells no longer respond to early developmental cues because those cues are usually gone," he explained in a statement. "That's what we believe we have changed [here]. We asked what was there when motor neurons were born, and specifically what let motor neurons extend outward. Then we tried to bring that environment back, in the presence of adaptable, receptive stem cells."

Kleitman called the work "elegant," but stressed that much more research needs to be done before this strategy could be applied to human patients. "To take this to a person you need to work with something larger than a rat leg -- that's only about an inch of [neuronal] growth," she said.

Scientists also need to make sure that certain risks associated with stem-cell therapy -- most notably, increased tumor formation -- can be minimized.

However, Kerr said his group is already engaged in a federally funded study, set to start this summer, that will try and replicate the mouse findings in a larger model -- a pig -- using human embryonic stem cells. If that effort proves successful, FDA-approved human clinical trials might be a few years away, the researcher said.
Kleitman said the new advance has everyone in her field optimistic.

"We get really excited when good science leads to more good science, that then leads in a direction that can really help people," she said.
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Tuesday, June 20, 2006

Volunteers Needed to Complete a Computer Security - Accessibility Survey


Two researchers from the Department of Computer & Information Sciences at Towson University are seeking individuals with upper-body motor impairments to participate in a survey. The survey should take approximately 10 minutes to complete and all responses will remain completely confidential and anonymous.

The purpose of the survey is to gain insight into the computing behaviors of individuals with upper-body motor impairments. We expect that the results will help researchers and system developers create more effective access control techniques to meet the special needs of this user population. The results should also assist employers in providing improved technical and procedural support to computer users that have difficulties using standard input devices.

If you would like to take the online survey, please go to the following link:

If you prefer a paper version of the survey, please send us an e-mail that contains your mailing address and we will send the survey to you.

Contact information:
John D'Arcy, Ph.D.
Jinjuan Feng, Ph.D.
Department of Computer & Information Sciences
Towson University
7800 York Road
Towson, MD 21252 U.S.A.

About the Researchers:
Dr. John D'Arcy teaches and conducts research in the area of information assurance and security, with particular emphasis on end user security-related behaviors. His research is acknowledged in academic journals such as Communications of the ACM and Computers & Security, as well as in numerous refereed conference proceedings. For more information on Dr. D'Arcy, please go to:

Dr. Jinjuan Feng conducts research in the area of universal accessibility with specific focus on improving input devices for computer users with spinal cord injuries. She has published numerous papers in academic journals. She is currently leading a research project to develop a hands-free speech-based system for users with spinal cord injuries. This project is funded by the U.S. Department of Education's National Institute on Disability and Rehabilitation Research. For more information on Dr. Feng, please go to:
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Monday, June 19, 2006

Chinese Surgeon's Claims about Cell Implants Disputed

By Gareth Cook, Boston Globe

For many patients with spinal cord injuries and other incurable maladies, Dr. Hongyun Huang has been the great hope.

Hundreds of patients from across the United States and around the world have flocked to his Beijing surgery practice, where Huang implants cells with what he says are amazing healing powers. Huang's fees can reach into the tens of thousands of dollars, but, he has said, these cells can help patients who cannot be helped with any other modern medicine. Patients have come forward to say that Huang has helped them, inspiring stories in American and British newspapers about a Chinese doctor who has maybe, just maybe, stumbled upon a modern scientific miracle.

Now a team of doctors has finished the first independent, scientifically rigorous assessment of Huang's work. The results, published in the journal Neurorehabilitation and Neural Repair , are not just disappointing, they are disturbing, say scientists who have read the paper.

Of seven spinal cord injury patients the doctors followed, none experienced significant improvements, and five suffered potentially dangerous complications. One man who went to Beijing with damage to his spinal cord returned with holes drilled in his head -- apparently Huang had placed cells in the man's brain, not his spinal cord.

"This is extremely damning of Dr. Huang's work," said Dr. Kevin C. O'Connor , medical director of the spinal cord injury program at the Spaulding Rehabilitation Hospital, who was not involved in the study. "It is pretty scary stuff."

In an e-mail exchange, Huang refused to answer direct questions, but he accused the study's three authors, all leading spinal injury doctors, of being liars.

Huang's treatments are part of a seismic shift in alternative therapies. There have always been clinics that cater to desperate patients, offering them unproven, often expensive, treatments, from shark cartilage to vitamin supplements. But the boom in stem cell science and the hype surrounding it have brought an explosion of clinics around the world that offer therapies based on living cells. Huang's therapy, though not based on stem cells, uses cells from aborted fetuses that he says have regenerative power, the way stem cells do.

For years, scientists and doctors have been trying to make sense of Huang's work. Huang is a neurosurgeon, and he did research on the biology of fetal cells at Rutgers University and New York University before returning to China. Until now, however, there has never been a rigorous study of his treatments, with outside doctors carefully examining patients before and after -- considered a crucial test of any medical procedure.

In 2004, Huang was invited to explain his work to a group of Boston doctors, but it was impossible to draw any conclusions from his presentation because he had not gathered enough data, according to Lucie Bruijn , who was at the meeting and is the science director and vice president of the ALS Association , which funds research into the fatal, neurodegenerative illness also known as Lou Gehrig's disease. Huang has treated patients with ALS as well as patients with spinal cord injury.

Huang says he injects his patients with "olfactory ensheathing cells." These cells are thought to help nerves repair themselves by releasing growth factors. The cells have been shown to repair nerves in animals, but there is no evidence they help people.

Working at Chaoyang and West Hills (Xishan) hospitals, Huang's team extracts these cells from aborted fetuses and then opens up a hole in the patient's brain or spinal cord, injecting the cells. In presentations at scientific conferences, he has said he has helped many patients and has seen no serious side effects.

Dr. Bruce H. Dobkin , one of the authors of the study, said that he approached Huang after hearing a presentation at a Vancouver scientific conference. Huang began referring patients to Dobkin, who is medical director of the Neurologic Rehabilitation and Research Program at the University of California, Los Angeles, so that he could conduct extensive evaluations of the patients before and after the Beijing procedure. Two other doctors did the same thing: Dr. James Guest , of the Miami Project to Cure Paralysis and the University of Miami Miller School of Medicine , and Dr. Armin Curt , of Balgrist University Hospital in Zurich and the University of British Columbia in Canada.

For the evaluations of patients' before-and-after treatment, the team used a standardized test, known as ASIA , which scores patients' ability to move and feel. Patients and their caretakers noted minor ways in which they thought the patients had improved, but the scoring showed that there were no meaningful improvements in any of the patients after the surgery. The ASIA test is widely used and is accurate, according to O'Connor.

Dobkin, who is also editor in chief of the journal that published the results, said that he attributes the improvements the patients noted to the power of the placebo effect, compounded by the pressure they feel to improve, having just spent what is reported to be more than $20,000 on the surgery.

Patients with spinal cord injuries or ALS, Dobkin said, are in a difficult position because modern medicine cannot cure them. But he said he fears that patients are not properly considering the risks that the procedure will worsen their condition. One patient, Dobkin said, was able to walk but wanted help with a bladder problem, and Huang drilled a hole near her neck, exposing the spinal cord for an injection of cells.

"It is just nonsense," Dobkin said. "That he would even agree to do this is really frightening to me."

Dobkin said the patients suffered side effects that included meningitis, which is a dangerous inflammation of the tissue around the spinal cord or brain, as well pneumonia and gastrointestinal bleeding. Such side effects in a patient who is already quite sick can set off a cascade of medical problems, Dobkin said.

Huang's website includes profiles of patients he has treated for a wide variety of conditions. The conditions have different causes and different symptoms, yet Huang treats them all with the same cells.

Without independent, long-term evaluations of his patients, it is impossible to know how they are faring, or what difference -- for better or ill -- the treatments make. Without this information, there is no way that patients can balance the true risks and potential benefits. And, Dobkin and others said, there is no way to learn anything from what Huang is doing with his human guinea pigs.
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Tuesday, June 13, 2006

Could the paralysed walk again?

The paralysed may one day walk again thanks to groundbreaking research by scientists at UCL's Spinal Repair Unit. Professor Geoffrey Raisman?s team can already cure rats with spinal cord injuries, restoring their ability to climb, and this autumn they are going to test their treatment on patients for the first time.

Their 'cure' relies on cells extracted from the nose, which are then transplanted to the site of the injury in the spinal cord to help the damaged nerves to regenerate. The nasal lining is unique in being the only place in the body where nerve fibres grow throughout our lives, and the transplanted cells appear to confer this ability on the neurons in the spinal cord. The transplanted cells form a bridge across the gap between the two ends of the damaged nerve fibres, creating a pathway the injured nerves can grow along until they reconnect with each other. This restores the original nerve pathway, and allows it to work again.

The team have used this method to repair several different types of spinal cord problems in rats. Rats with spinal cord injuries that prevented them using one of their front paws were soon back to normal after treatment and happily climbing all over the place. The scientists were even able to restore rats? ability to breathe. Rats with an injury to the nerves that control one side of the diaphragm could no longer breathe properly. But after treatment, the rats were able to breathe with the injured side again.

Raisman is confident the technique will work just as well on humans, and he plans to start testing it out soon, with the first operations set for October. Professor Tom Carlstedt of the National Hospital for Neurology and Neurosurgery, who has years of experience operating on spinal cords, will be the operating surgeon. The first patients will be motorcycle accident victims whose arms are paralysed - a common consequence of such accidents, as the nerves controlling the arms are often wrenched from the spinal cord during the crash.

Raisman says that beyond the risks normally associated with surgery, there is no risk in transplanting the nasal cells to the spinal cord. As the cells come from the patient's own body, there is no danger of the transplant being rejected.

Thousands of paralysis victims will be watching UCL this autumn to see if their prayers have finally been answered. But it will be no miracle if the treatment succeeds - it comes after more than 20 years of painstaking research by Raisman and his team.

By Davina Bristow
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