VA clinical studies [Archive]

jb3822

01-07-2010, 04:18 PM

Quadvet sent me this way. I wanted to get input from the group here. Im a doc and have been pushing for some time to get some clinical studies off the ground for chronic SCI patients that I believe have promise. I recently met with the SCI director of our local VA and am very impressed. They are much more interested in progress than many of the folks in the private setting and they are very interested in anything that may help their patients. That medical record system is also excellent and allows us to track every nuance of progress. Two projects were proposed and well received which involve nerve rerouting.

The first is the Xiao procedure for continence. There are a number of threads on this site about that so I assume you all have your opinions. We had him come to town and share his results and he is excited to see this get off the ground.

The second is utilizing nerve transfers for restoring hand function - both motor and sensory. Any patient with at least elbow flexion would be a potential candidate. The benefit of this approach over tendon transfers is 1) many more options 2) minimal immobilization 3) more natural function after the procedure. Downside is that there is a chance of failure.

That is where we are heading. I am interested in toughts from you all as I have noticed that folks appear to be much more interested in stem cell therapies than targeting specific functions.

skippy13

01-07-2010, 08:09 PM

Where would these studies take place?

jb3822

01-08-2010, 12:22 AM

Where would these studies take place?

St. Louis

conrad

01-08-2010, 03:29 AM

A bit outta my range, I'm in the Pacific NW with Quadvet. But I do have a question... with the nerve re-routing, what functions are you planning to re-route for hand function? is it trading something else above your injury level to recover hand function? For me (c6 asia c) I have some function below my injury (party tricks only, nothing useful) but I'm probably not considered chronic, am I? I go to Seattle VA, but would it be available if I came down there? I am totally willing to trade something for my hands, but what is the plan for implementing this? time frames?
I know I said A question, but I ran on a tangent sorry.

lynnifer

01-08-2010, 03:41 AM

I am not a vet, nor American ... but I've been wishing someone would go this route for a long time! It's something that can be done 'now' ... instead of waiting for a treatment that may never come.

jb3822

01-08-2010, 03:31 PM

A bit outta my range, I'm in the Pacific NW with Quadvet. But I do have a question... with the nerve re-routing, what functions are you planning to re-route for hand function? is it trading something else above your injury level to recover hand function? For me (c6 asia c) I have some function below my injury (party tricks only, nothing useful) but I'm probably not considered chronic, am I? I go to Seattle VA, but would it be available if I came down there? I am totally willing to trade something for my hands, but what is the plan for implementing this? time frames?
I know I said A question, but I ran on a tangent sorry.

If you are more than a year from injury and your recovery has plateaued you are chronic. Tradeoffs ate designed to be minimal. For example if someone has strong elbow flexion and both the biceps and brachialis muscles are working well (both of which flex the elbow) we would take from one of these muscles only. Strength may be mildly decreased but should not be dramatic

SCI-Nurse

01-08-2010, 07:17 PM

Have these studies been approved the the Human Subjects committees at the VA in question? Have they approved the recruitment of subjects via the internet?

(KLD)

jb3822

01-08-2010, 10:13 PM

Have these studies been approved the the Human Subjects committees at the VA in question? Have they approved the recruitment of subjects via the internet?

(KLD)

IRB is in process. The subjects would be recruited by the SCI director at the hospital - their current population of patients. Initially with very specific indications and strict exclusion criteria. It would probably be a small set of 10-20 then 2 years of followup before it was opened up to a broader population. There is no shortage of potential patients for such a study. I don't believe that there will be any need to recruit on the internet. As we start down the road to make that happen I was interested in the perception of these studies by the folks in this community. If such a discussion is considered inappropriate feel free to delete this thead.

SCI-Nurse

01-09-2010, 01:19 AM

You should have clarified this when posting. Our IRB would look askance at such as post as it appears you were soliciting subjects, and they are very strict about ethical practices within the VA research mission.

I will leave this here for now, but would recommend that any veteran who is interested in any research study never do so without checking that the study and method of subject recruitment meets the appropriate IRB requirements.

(KLD)

conrad

01-09-2010, 02:59 AM

Thank you KLD for lookin out for us.:applaud:
I was more interested in information, not signing up for something I haven't had time to research yet. And I've been in the system for long enough to know there are protocols that have to be followed. Mostly I wanted to know how far out this could be? any ideas? and I'm with Lynnifer, something now may be better than waiting 'til the end!

quadvet

01-09-2010, 06:27 AM

I am interested in toughts from you all as I have noticed that folks appear to be much more interested in stem cell therapies than targeting specific functions. I don't see how VA could frown on that, thanks for your interest. I think many here are interested in this approach as stem cell research debate drags on.

Howdy Conrad, long time! :waving:

Semper Fi

01-09-2010, 11:53 AM

I assume doc you are refering to Jefferson Barracks SCI unit blg 52. Dr. Parks and he staff are very proffesioinal and are not the run of the mill VA quacks. They would never allow their VA SCI people to be put in a bad position.
I will copy this input and send it to the SCI unit and the Gateway chapter of PVA for their opinion and review then let you know their thoughts.
Semper fi

jb3822

01-15-2010, 08:50 PM

I assume doc you are refering to Jefferson Barracks SCI unit blg 52. Dr. Parks and he staff are very proffesioinal and are not the run of the mill VA quacks. They would never allow their VA SCI people to be put in a bad position.
I will copy this input and send it to the SCI unit and the Gateway chapter of PVA for their opinion and review then let you know their thoughts.
Semper fi

Sounds great. Keep me posted.