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Thread: When there is true regeneration will rehab be necessary to detect initial recovery?

  1. #1

    When there is true regeneration will rehab be necessary to detect initial recovery?

    To any of the scientists or more informed members than me (most): I was wondering why, when true regeneration occurs, would rehab be needed to detect (at least initial) functional recovery? Don't get me wrong, for strengthening the connections, for improving the extent of recovery, for developing more complex functions like walking or other coordinated movements, I can see why rehab would be important. But (for example in the case of a complete injury) why wouldn't the individual be able to detect the new sensation, why wouldn't autonomic functions begin to work, why wouldn't at least basic movement be possible almost immediately (that is when axons have actually been regenerated)? Admittedly, my thinking here is simplistic but I think of a newborn.... No matter how crudely, he/she can move his/her arms and legs immediately. Those nerve fibers are new, like truly regenerated ones would be.
    Like most of my posts here I imagine I'll get a swift response with some misunderstanding so please note the word detect here. I'm not saying to improve recovery rehab won't be necessary. I just question the necessity of having a huge rehab component as a part of a trial and saying "lets wait, more rehab could be necessary". A true biological cure that induces regeneration, it seems to me, wouldn't require this to detect at least some functional outcomes. If I'm way off here I would welcome an explanation...

  2. #2
    And if its as simple as the damage in the wound environment and the (likely) minimal amount of true regeneration we will initially be able to induce completely changes the game relevative to the developmental stage of a newborn baby, fair enough...

  3. #3
    Sensation should be automatic. Bowel/bladder may be affected by learned non-use. Basic movement may be tough because you have no muscle left. How hard will it be to rebuild that muscle? Something that will be critical for us chronics is range of motion (ROM). If you have lost ROM in your hips, legs, ankles, feet and toes it will be much harder to walk.

  4. #4

    jim

    Quote Originally Posted by Jim View Post
    Sensation should be automatic. Bowel/bladder may be affected by learned non-use. Basic movement may be tough because you have no muscle left. How hard will it be to rebuild that muscle? Something that will be critical for us chronics is range of motion (ROM). If you have lost ROM in your hips, legs, ankles, feet and toes it will be much harder to walk.
    You could be right Jim But did you every think if they can give you some thing to make you spinal cord grow ? .Why not give us a drug that would help to strengthen are muscles I am sure there is a drug out there . i do think a cure will come but i say this with a heavy heart none of us will benefit from it for a while . For the way things is going .Yes it all comes down to money i do wonder how much more is need i am afraid to ask for i know it be a other 5 years
    ps dont shoot the messenger
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  5. #5
    Quote Originally Posted by ay2012 View Post
    To any of the scientists or more informed members than me (most): I was wondering why, when true regeneration occurs, would rehab be needed to detect (at least initial) functional recovery? Don't get me wrong, for strengthening the connections, for improving the extent of recovery, for developing more complex functions like walking or other coordinated movements, I can see why rehab would be important. But (for example in the case of a complete injury) why wouldn't the individual be able to detect the new sensation, why wouldn't autonomic functions begin to work, why wouldn't at least basic movement be possible almost immediately (that is when axons have actually been regenerated)? Admittedly, my thinking here is simplistic but I think of a newborn.... No matter how crudely, he/she can move his/her arms and legs immediately. Those nerve fibers are new, like truly regenerated ones would be.
    Like most of my posts here I imagine I'll get a swift response with some misunderstanding so please note the word detect here. I'm not saying to improve recovery rehab won't be necessary. I just question the necessity of having a huge rehab component as a part of a trial and saying "lets wait, more rehab could be necessary". A true biological cure that induces regeneration, it seems to me, wouldn't require this to detect at least some functional outcomes. If I'm way off here I would welcome an explanation...
    I think your question is, can appropriate synapses be formed and understood by the conscious mind without the rehabilitation modalities after axons have regenerated?

    The expert consensus as it stands will probably be "No". However, I don't think it's as black and white as that. Spurious synaptic connections can be formed without exhaustive rehabilitation in theory - pretty obvious. But then that is hard to prove as our brain is always executing stuff - whether we're conscious or not.

    I'm not sure if you're incomplete or complete but if you talk to some of the incompletes on here they will often tell you that it can be a common scenario whereby it can take months of trial and error (f*****g about with your body) to figure out how the hell you made that big toe move. It can often be as ridiculous as your left big toe moving even though you're trying to contract your right quadricep. It's just that spurious. Techniques such as biofeedback coupled with quality neuro rehabilitation will definitely be needed to educate your nervous system. However, that doesn't mean that there wont be better, more efficient and pragmatic techniques in the future.

    Disclaimer 1: I could also be talking complete nonsense as I am not an expert in neuro rehabilitation and how synapses form

    Disclaimer 2: At no point have I talked about autonomic function or pattern generators. Different topic.

  6. #6
    Regenerated axons will be making many connections, some appropriate and many inappropriate. "Activity-induced plasticity" strengthens those synapses that are being used and weakens synapses that are inactive. In other words, exercise "sculpts" movements in your CNS, making it easier for brain activity to activate patterns of activity that you use faster and easier while suppressing activities that interfere or you don't want.

    The regenerated spinal cord is a new spinal cord, different from the previous one, which was sculpted when you were a baby and learned to walk. Because most of the old connections are gone and have been replaced by new connections, you really have to learn to walk again, as a baby learns to walk again. If our experience in Hong Kong and Kunming is any indication, 75% of the patients in Kunming are walking with minimal assistance while none of the patients in Hong Kong are walking.

    The questions that we are considering now is whether intensive walking exercise now at 1-2 years after the cell transplant will restore walking function. I suspect that it may but we would have to try it to see. The other question is when rehabilitation should start. Should we be doing the training beginning shortly after the regenerative treatment is applied or should we be waiting until the axons have reached more of their targets. These are very significant and important questions that need to be studied in large scale trials.

    Wise.

  7. #7
    Quote Originally Posted by Wise Young View Post
    Regenerated axons will be making many connections, some appropriate and many inappropriate. "Activity-induced plasticity" strengthens those synapses that are being used and weakens synapses that are inactive. In other words, exercise "sculpts" movements in your CNS, making it easier for brain activity to activate patterns of activity that you use faster and easier while suppressing activities that interfere or you don't want.

    The regenerated spinal cord is a new spinal cord, different from the previous one, which was sculpted when you were a baby and learned to walk. Because most of the old connections are gone and have been replaced by new connections, you really have to learn to walk again, as a baby learns to walk again. If our experience in Hong Kong and Kunming is any indication, 75% of the patients in Kunming are walking with minimal assistance while none of the patients in Hong Kong are walking.

    The questions that we are considering now is whether intensive walking exercise now at 1-2 years after the cell transplant will restore walking function. I suspect that it may but we would have to try it to see. The other question is when rehabilitation should start. Should we be doing the training beginning shortly after the regenerative treatment is applied or should we be waiting until the axons have reached more of their targets. These are very significant and important questions that need to be studied in large scale trials.

    Wise.
    What about animals, such as rats, that don't receive intensive training? How would/do they recover from a regenerative therapy?

  8. #8
    First, thank you all for the responses, especially Dr. Young as it has helped clear up the issue a bit in my mind
    Quote Originally Posted by NowhereMan View Post
    What about animals, such as rats, that don't receive intensive training? How would/do they recover from a regenerative therapy?
    That's a good question, and I think I see where you're going: previous successful results in animals haven't demonstrated success in appropriate models (chronic, severe injury). If all these therapies are working in animals without intensive rehab it must be that:
    a) intensive rehab doesn't matter.
    If we insist intensive rehab does matter because of the severity of our injuries (requiring plasticity among the few remaining axons) or because they are chronic (learned non-use) then animal success without rehab would suggest that:
    b) animal models have not been with severe enough injuries and the recovery is largely spontaneous (the injury is such that they would have some form of walking recovered and the gains from the therapy therefore don't require intense rehab to initiate movement). This would be irrelevant for a lot of us. OR
    c) animal models have largely targeted axonal sparing i.e. acute, not chronic, stages and hence the learned non-use argument goes out the window. This would be irrelevant to all of us.

    So. If one wants to make the argument that there has been a lot of success in animal models that justify us going to clinical trial (which would require that success has been demonstrated in severe injuries, chronic time frames) it must be that rehab doesn't matter. In which case we could save a lot of money by scrapping the 6-6-6 walking component of the trial.
    If, we insist that rehab does matter then there must be something different amongst these successful therapeutic interventions in animals (like inappropriate injury models) that would make using them as a justification for human clinical trials misplaced.
    I'd appreciate anybody's thoughts on that line of thinking and whether or not I'm missing something here, in particular Dr. Young's thoughts (if you'll be kind enough to read that long post!)

  9. #9
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  10. #10
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    Was going to mention strength. The amount of muscle strength lost is extremely critical. You have an adult body. An adult neurological system. And the strength of a baby or even less. To rebuild that strength you need critical coordination of all of those things. I believe you somehow need to retrain the neurological system to now work with the uncoordinated system and put that back together slowly. Basically, be a baby, however, with adult pieces.

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