Atlanta Injury Law Blog

When I was a young lawyer there was a very busy quadriplegic trial lawyer in Atlanta named Stan Nylen.  He made his was from courthouse to courthouse in an "Ironsides" van and driver/attendant. Stan could raise one hand just enough to extend two fingers to shake hands. "Old war horse" lawyers in Atlanta have quite a store of Stan Nylen stories.

One of my former law partners had a young woman lawyer in his firm who became a quadriplegic due to an injury and returned to work in the law firm. I have litigated against a paraplegic insurance defense lawyer who I thought was very effective. Within the past couple of years I have encouraged a paraplegic client to consider going to law school.

Here is an inspirational article from a San Francisco law firm's newsletter about a congenitally quadriplegic attorney and a similarly challenged law student.  The quadriplegic attorney, according to the article,  “love her to death” and “regard her just like any other lawyer—just better than most."

Here is another one of those stories about a spinal cord injury survivor that is both heart breaking and inspirational -- a former high school cheerleader paralyzed in a freak accident who is focused on her physical therapy, hoping for the day that stem cell treatment might help her. She has even gone scuba diving.

As a trial lawyer in Atlanta, Georgia, often representing survivors of  spinal cord injuries,  both paraplegia and quadriplegia, I have dealth  with effects of such injuries about which most people know nothing. Among those are pressure sores, muscle spasticity and autonomic dysreflexia. Of course, this brief post is not medical advice, just an expression of awareness of the types of things that must be conveyed to a judge and jury  to help them understand.

Spinal cord injury survivors are extremely vulnerable to the development of pressure sores -- also known as bed sores or decubitus ulcers -- even with the very best of care. Even Christopher Reeve ("Superman"), who had the very best care money could buy, had a pressure sore that became severely infected, leading to systemic infection, a heart attack, coma and death. We have had a quadriplegic client who died from a pulmonary embolus while in one of the very best hospitals for treatment of a pressure sore.

A paraplegic or quadriplegic may not feel a pressure sore developing, so it is extremely important to change position on regular intervals to allow the blood circulation through pressured areas. A healthy person will feel discomfort in a position that could affected circulation, and shift position.  With a spinal cord injury,  such messages are blocked at the level of injury so that the person not even be aware of the area where potential skin damage could occur.

Damage from a pressure sore may range from slight discoloration of the skin (stage 1) to open sores that go all the way to the bone (severe). The affected area may feel warmer than the surrounding tissue. In light-skinned people, the discoloration may appear as dark purple or red. In darker-skinned people, the discoloration will appear darker than the surrounding tissue.

A "day in the life" video can be extremely effective in explaining the care routine for pressure sores.  Medical illustrations can aid a physician in explaining how and why pressure sores develop.  Simple common sense analogies -- which I will not put on a web site where opposing counsel could read them -- can also aid jury comprehension.

There are many online information resources about spinal cord injury. One of the best sources is Apparelyzed.com.  It is extremely important that anyone with a spinal cord injury go to a specialized rehabilitation center such as the Shepherd Center in Atlanta, which is just down the street from us.

As a trial lawyer in Atlanta, Georiga, representing clients who have  spinal cord injuries,  both paraplegia and quadriplegia, I have  become familiar with effects of such injuries about which most people know nothing. Among those are muscle spasticity and autonomic dysreflexia. Of course, this incomplete and over-simplified post cannot constitute medical advice, only an expression of awareness of the problem and the types of things that must be communicated to a jury at trial to help them understand.

Following a spinal cord injury,  nerve cells below the level of injury become disconnected from the brain at the level of injurdue to scar tissue  in the structure of the damaged area of the spinal cord, blocking messages from below the level of injury reaching the brain. When an injury occurs to the spinal cord, the body goes into spinal shock, and this may last several weeks. During this time changes take place to the nerve cells which control muscle activity.

Once spinal shock wears off,  natural reflexes reappear. In an abled boded person, a stimulus to the skin is sensed, and a  signal is sent to the brain through the spinal cord. If the stimulus is perceived not to be dangerous, an inhibitory signal is set down the spinal cord, and cancels the reflex from moving the muscle.

In a person with a spinal cord injury this inhibitory signal is blocked by the damage to the cord, and the reflex continues with a contraction of the muscle.

Muscle spasms can occur any time the body is stimulated below the level of the spinal cord  injury. When a muscle is stretched, or there is a painful stimulus below the level of injury, the sensations can produce the reflex causing the muscle to contract or spasm.

Many stimuli can trigger spasticity, but some are more common.  A bladder or kidney infection,  skin breakdown, and lack of  regular range of motion exercises can increase  spasticity.

The best way to manage or reduce  spasms is to perform a daily range of motion exercise program, and avoid bladder infections, skin breakdowns, or injuries to the feet and legs. There are three primary medications used to treat spasticity, baclofen, Valium, and Dantrium. All have some side effects and do not completely eliminate spasticity.

Spasticity is not all bad, however. It can be a warning sign to identify pain or problems in areas where there is no sensation. For example, sometimes people know when a urinary tract infection is coming on by the increase in muscle spasms. Ironically, it may also help to maintain muscle size and bone strength and blood circulation in the legs.

A surgical procedure called a radiofrequency rhizotomy is sometimes indicated in the treatment of severe spasticity. Another treatment of severe spacticty is the implantation of a Baclofen Pump.

As I mentioned above, none of this is medical advice. But if you are going to trial to recover damages sufficient to fund a life care plan for a spinal cord injury, it is important to have a lawyer to understands  the multiple effects of spinal cord injury well enough to communicate it effectively to a judge and jurors who never heard of muscle spasticity.

As a trial lawyer in Atlanta, Georiga, working with clients who have suffered spinal cord injuries, including both paraplegia and quadriplegia, I have  found a wide array of effects of such injury about which most people know nothing. One of those is autonomic dysreflexia. Of course, this incomplete and over-simplified post cannot constitute medical advice, only an expression of awareness of the problem and the types of things that must be communicated to a jury at trial to help them understand.

On one occasion, a very independent young client who became paraplegic due to an injury was stopped speeding in a small town in New Mexico  en route to California. The client had a tough time explaining to an officer why, due to autonomic dysreflexia, it was a matter of life and death to a handicapped equipped restroom as quickly as possible.  It took  letter from a physician at Shepherd Spinal Center explaining the condition to get the ticket dropped without the client having to return to New Mexico.

Autonomic dysreflexia is a problem for which spinal cord injury victims are very susceptible, especially if the injury is at or above the T-5 level. People with spinal cord injuries at T6 - T10 may also be susceptible. It is unusual with injuries at T-10 and below.  The older the injury the less likely the person will experience autonomic dysreflexia.

Autonomic dysreflexia can develop suddenly, and is a possible emergency situation. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.

Autonomic dysreflexia means an over-activity of the Autonomic Nervous System. It can occur when an irritating stimulus is introduced to the body below the level of spinal cord injury, such as an overfull bladder. The stimulus sends nerve impulses to the spinal cord, where they travel upward until they are blocked by the lesion at the level of injury. Since the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of autonomic nervous system. This results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure. Nerve receptors in the heart and blood vessels detect this rise in blood pressure and send a message to the brain. The brain sends a message to the heart, causing the heartbeat to slow down and the blood vessels above the level of injury to dilate. However, the brain cannot send messages below the level of injury, due to the spinal cord lesion, and therefore the blood pressure cannot be regulated.

Symptoms of autonomic dysreflexia include pounding headache (caused by the elevation in blood pressure), goose pimples, sweating above the level of injury, nasal congestion, slow pulse, blotching of the skin and restlessness.

The most common stimuli causing an episode of autonomic dysreflexia are an overfull bladder a bowel full of excrement or gas.  As spinal cord injury victims and their loved ones are painfully aware, these toileting issues are a major -- and often humilitating -- problem for people with spinal cord injuries. Any stimulus to the rectum, such as digital stimulation, can trigger a reaction, leading to autonomic dysreflexia.  Other causes include skin irritations, wounds, pressure sores, burns, broken bones, pregnancy, ingrown toenails, appendicitis, and other medical complications.

 Treatment of autonomic dysreflexia must be initiated quickly to prevent complications.  Since a full bladder is the most common cause, the first thing to do is check the urinary drainage system. If a Foley or suprapubic catheter is used, check to see if the bag is full or elevated, the tube kinked, or the catheter plugged.  If those obvious things do not solve the problem, change the catheter immediately. If that doesn't work, digital stimulation to evacuate the bowel is probably the next step.  If neither bladder nor bowel is stimulating autonomic dysreflexia, check for a pressure sore, ingrown toenail or fractured bone. If all those causes have been elimiated, get to the emergency room ASAP. Spinal cord injury patients should carry a card explaining autonomic dysreflexia and the treatments required.

As with most things, an ounce of prevention is worth a pound of cure. Some precautions that a spinal cord injury patient can take include:

• If using an indwelling catheter, keep the tubing free of kinks, the drainage bags empty, check daily for grits (deposits) inside of the catheter, and .catheterize yourself as often as necessary to prevent overfilling.
• If you have spontaneous voiding, make sure you have an adequate output.
• Carry spare clothes and an intermittent catheter kit when you are away from home.
• Maintain a regular bowel program.
• Perform routine skin assessments.
• Have a yearly re-evaluation.

There are many online information resources about spinal cord injury and autonomic dysreflexia  It is extremely important that anyone with a spinal cord injury go to a specialized rehabitation center such as the Shepherd Center in Atlanta, which is just a mile or so down the street from us.

As I mentioned above, none of this is medical advice. But if you are going to trial to recover damages sufficient to fund a life care plan for a spinal cord injury, it is important to have a lawyer to understands this stuff well enough to communicate it effectively to a judge and jurors who never heard of autonomic dysreflexia.

Medical research in Portugal is exploring the possibility that olfactory nerve stem cells from a spinal cord injury patient may be used to repair the spinal cord injury.  The idea behind the procedure is that the nasal tissue has nerve cells that can regenerate.

Research on rats with crushed spinal cords suggests potential for a new treatment protocol soon after injury combining radiation therapy to destroy harmful cells and microsurgery to drain excess fluids significantly increases the body's ability to repair the injured cord leading to permanent recovery from injury.   When a midline incision was performed on the spinal cord one hour after injury, followed by localized radiation therapy given for ten days starting on day ten after injury, there was nearly a two-fold improvement in the body's ability to heal the injured cord compared with untreated rats.

A report this week raises the hopes of people searching for stem cell therapies for victims of brain injury, spinal cord injury and other ailments. Ethical concerns have curbed development of therapies using embryonic stem cells. However, according to the report published this week in Nature Bioitechnology, stem cells with therapeutic value can be harvested from amniotic fluid and placentas.

According to the report, the amniotic cells can mature into all of the major types of cells, dividing once every 36 hours yet never showing signs of aging and never becoming tumors -- even after living for more than two years in the lab.  Researchers at Wake Forest and at Children's Hospital in Boston coaxed the cells to become brain cells and injected them into the skulls of mice with diseased brains, where new cells filled in diseased areas and appeared to make new connections with nearby healthy neurons. When coaxed to become bone cells and seeded onto a gelatin scaffold that was then implanted in a mouse, the cells calcified and turned into dense, healthy bone.

The study leader, Anthony Atala, director of the Institute for Regenerative Medicine at Wake Forest University School of Medicine, estimates that if 100,000 women donated their amniotic cells to a bank, that would provide enough cells of sufficient genetic diversity to provide immunologically compatible tissue for virtually the entire US popularion.

Meanwhile, pediatric surgeon Dario Fauza at Children's Hospital in Boston has been pursuing a parallel line of research, growing amniotic stem cells into cartilage and diaphragms to repair defects in newborn sheep.  His goal, of course, is to be able to use amniotic stem cells to repair defects in newborn humans.

Whether any of this will become clinically available in time to help today's victims of brain and spinal cord injury, as well as other conditions, is an open question, but for those of us searching for hope for our loved ones, it is a matter of great interest.

The current issue of Forbes carries an interesting article on driver rehabilitation after a serious injury or illness. Many people with newfound disabilities, including neurological conditions, heart disease and stroke, are overcoming great obstacles to find ways to get back to driving on the highway.  For the impaired person, the ability to drive symbolizes independence and freedom.  I saw that in my daughter after she lost her hearing due to an illness.  The weeks between discharge from the hospital and clearance to drive again were absolutely maddening for her, and for everyone around her.

Here in the Atlanta area, DeKalb Medical Center Rehabilitation Services has a Driving Solutions Program which provides driver assessment, training and adaptive equipment recommendations for vehicle operation. The assessment process includes tests of vision, visual perception and reaction time, as well as assessment of cognitive and physician functioning. Driver training is available to new and experienced drivers to promote safety and competency behind the wheel. Training in the use of adaptive equipment is available. I took my daughter over there for an assessment that cleared her to drive again, restoring freedom and a modicum of normalcy after a traumatic, life changing loss.

A quadriplegic  in Massachusetts with a small sensor implanted in his brain has demonstrated ability to control a computer, a television set and a robot using only his thoughts. In a variety of experiments, Matthew Nagle moved a cursor, opened e-mail, played a simple video game called Pong and drew a crude circle on the screen. He could change the channel or volume on a television set, move a robot arm somewhat, and open and close a prosthetic hand.  Although his cursor control was sometimes wobbly, the basic movements were not hard to learn.

A sensor measuring 4 millimeters by 4 millimeters — less than a fifth of an inch long and wide — and containing 100 tiny electrodes was implanted in the area of Mr. Nagle’s motor cortex responsible for arm movement and was connected to a pedestal that protruded from the top of his skull. Technicians plugged a cable connected to a computer into the pedestal, so Mr. Nagle was directly wired to a computer,   Mr. Nagle would then imagine moving his arm to hit various targets. The implanted sensor eavesdropped on the electrical signals emitted by neurons in his motor cortex as they controlled the imaginary arm movement.  In the future, scientists would like to develop an implant that would transmit signals wirelessly out of the brain, doing away with the permanent hole in the head and the accompanying risk of infection.

The implant system, known as the BrainGate, is being developed by Cyberkinetics Neurotechnology Systems Inc. of Foxborough, Mass. The company is now testing the system in three other people, who remain anonymous: one with a spinal cord injury, one with Lou Gehrig’s disease and one who had a brain stem stroke.

German researchers announced today that they have isolated stem cells in adult mouse testicles that have properties similar to those of embryonic stem cells. When injected into early mouse embryos, the cells contributed to the growth of various mouse organs, including heart, brain, and lungs. If the method works in humans, it could provide an alternative source for stem cells, avoiding the ethical controversy of generating stem cells from human embryos. Like embryonic stem cells, these testicle-derived cells can contribute to the development of multiple organs when injected into embryos, the researchers said.

Every advance in stem cell research is another glimmer of hope that someday there may be more effective treatments for spinal cord injuries and brain injuries.

I occasionally write in this blog of advances in stem cell research that may someday aid in spinal cord and brain injury treatment. I'm excited about the potential for development of non-embryonic stem cells from cord blood, adult olfactory nerves, etc. On the face of it, I tend to favor laws that restrict any form of human cloning, even for therapeutic purposes. However, a bill pending in the Georgia legislature that would make therapeutic cloning a felony may be a classic example of the law of unintended consequences.

For the past several years Georgia has been trying to situate itself as a center for biomedical research and an incubator for new businesses in the biomedical industry. Now, however, a bill pending in the legislature would make felons of scientists who do anything considered "therapeutic cloning." Penalties would incuded up to 10 years in prison and up to $100,000 in fines.

According to the research scientists quoted in the AJC, the definitions in the bill are far from a model of clarity as to just what research is criminalized. Too often we see legislation sail through the legislature looking as if it were drafted with a crayon. Last year's tort reform bill was a prime example.

If you were a super brilliant biomedical researcher working at the cutting edge of stem cell science, and you had otherwise equally attractive job offers, one in a state that encourages stem cell research and one in a state that threatens to put you in prison for ten years if your research crosses a vaguely defnined line, which job would you take? If you were looking for a location for a cutting-edge biomedical business to which you need to attract the hottest scientific talent, would you choose to locate in a state that encourages and supports research, or in a state where grand-standing politicians may impose severe criminal sanctions for research?

While I applaud the intent of the bill's author, to encourage non-embryonic stem cell research and discourage human cloning for any purpose, the legislators need to carefully consider whether ill-considered action may destroy Georgia's future role in the biomedical industry of the 21st century.

Researchers at the University of Pennsylvania Medical School have developed a technique for stretching axonal connections between neurons, forming an elongated nerve network that may be implanted to bridge damaged nerve tissue. While the study is a very early effort with lab rats, the researchers hope it will lead to treatment for human spinal cord injury.

A team led by Dr. Geoffrey Raisman at the Institute of Neurology in London plans to begin within a year human clinical trials with patients' own olfactory nerve stem cells to treat nerve and spinal cord injury. Use of the stem cells from the patient's own nose avoids the ethical concerns about use of embryonic stem cells. Those of us who have spent years working with spinal cord injury victims have been holding on to hope for a long time. Pray that this approach turns out to be effective.

I never cease to be amazed and inspired by the resilient spirit of clients with spinal cord injuries. We have one paraplegic client who braved Third World travel conditions to participate in a church mission trip to Nicarauga. She ministered to women and children in the community, taught music classes at a school for the blind and helped at an orphanage for children with disabilities. There was also our quadriplegic client -- paralyzed in an SUV rollover -- who was determined to write books and return to college teaching, and a mute quadriplegic client who couldn't do much but was always the most optimistic and cheerful person in the room. All of these remarkable people were patients of the Shepherd Spinal Center in Atlanta, which is just about ten minutes from our office.

An Indiana man who has been a paraplegic for 23 years is going to China for an olfactory nerve stem cell implantation in his spinal cord. An American researcher has characterized the operation as "highly controversial" as China does not have the safeguards on medical experimentation that we have in the U.S. However, for a person with a terribly disabling condition, the idea of waiting indefinitely for the FDA to approve a procedure that appears to offer hope of a better life may be unacceptable, as he feels he has nothing to lose in his "only chance to walk again."

LONDON, England, 12/1/05

British surgeons hope a new procedure using stem cells from the lining of the nose will help mend severed nerves of paralyzed patients and may one day allow them to walk again. Neuroscientist Geoffrey Raisman discovered 20 years ago that the cells responsible for sense of smell are good at renewing themselves. When these cells were injected into the spines of rats they appeared to help cure damage to the nervous system.

Now Raisman hopes to transfer that technology to humans, and will begin clinical trials early next year. He will begin trials with 10 patients who have suffered a type of injury most often seen in motorcycle accidents where nerves in the arm are pulled out of the spinal cord.

Since the cells come from the patients themselves, there is no risk of them being rejected by the immune system. The procedure involves taking stem cells from the lining of the nose and using them to create a "bridge" between the severed ends of the nerves. Raisman said that until now it had not been possible to repair the major nerves running through the spinal cord or branching off from it.

"The injury occurs when a blow to the shoulder pulls nerve fibres out of the spinal cord -- it's like pulling a plug out of a socket. We're trying to make the nerve fibres grow back in," Britain's Press Association reported him as saying.

"It's never been done before. If successful it will open the door to treating all kinds of connective nerve fibre conditions, including spinal injuries, the most severe kinds of stroke, and blindness and deafness caused by nerve fibre injury."

Raisman said the success of the first trial is crucial because harvesting stem cells is such a difficult task.

At present only small numbers can be retrieved, limiting the kinds of injury that can be treated. The new trial is seen as a first step to demonstrating that the technique works in humans.

"If it succeeds it will show that these cells are effective at restoring nerve fibre connections," PA reported Raisman as saying.

If successful, the procedure could also help restore sight to the blind.

See also: Nasal stem cell transplants 'show promise', Couple seeks medical miracle in Portugal, Chinese surgeon gives hope to the paralysed, Spinal cord cells to be repaired by using nose cells, Nose cells could reverse paralysis, Surgeons attempt spinal repairs using nose cells, MGH study finds first function for, promising flexibility in adult-born nerve cells, Neurons Generated In The Adult Brain Learn To Respond To Novel Stimuli, Turning to stem cells.

Dallas, TX, 11/30/05.

People who have suffered partial paralysis from spinal-cord injury show increased activity in the part of the brain responsible for muscle movement and motor learning after 12 weeks of training on a robotic treadmill, according to a report recently published by UT Southwestern Medical Center physical therapists led by Dr. Patricia Winchester.

Their study, will be published in the December issue of the journal Neurorehabilitation and Neural Repair, is the first to demonstrate that locomotor training can promote activation in the parts of the brain involved in walking in spinal-cord injury patients.

The results suggest that rehabilitation strategies could be designed based in part upon whether or not they engage the areas of the brain necessary for walking.

Locomotor training can promote activation in the parts of the brain involved in walking in spinal-cord injury patients. Additionally, the findings suggest that a diagnostic technique called functional magnetic resonance imaging (fMRI), used by the researchers to measure the activation of these brain areas, may be useful in predicting which individuals will benefit from a particular intervention after spinal-cord injury.

FOXBOROUGH, Mass.--Dec. 2, 2005

Remember "The Six Million Dollar Man" and "The Bionic Woman" TV shows in the 1970's? Those science fiction concepts are just a little closer to reality today.

On a Today Show feature titled "Mind-moving Machines to Help the Disabled." Katie Couric presented the story of Matthew Nagle, the first participant in Cyberkinetics' ongoing clinical trial of its BrainGate( TM ) Neural Interface System. Nagle demonstrated his ability to use his own thoughts to control a computer and command the prosthetic hand on a table beside him to open and close. Mr. Nagle is currently paralyzed from the neck down due to an injury four years ago that severed his spinal cord.

The BrainGate Neural Interface System is a proprietary, investigational brain-computer interface that consists of an internal sensor to detect brain cell activity and external processors that convert these brain signals into a computer-mediated output under the person's own control. The sensor is a tiny silicon chip about the size of a baby aspirin with one hundred electrodes, each thinner than a human hair, that can detect the electrical activity of neurons. The sensor is implanted on the surface of the area of the brain responsible for movement, the motor cortex. A small wire connects the sensor to a pedestal that is placed on the skull, extending through the scalp. An external cable connects the pedestal to a cart containing computers, signal processors and monitors that enable the study operators to determine how well study participants can control devices driven by their neural output - that is, by thought alone. The ultimate goal of the BrainGate System development program is to create a safe, effective and unobtrusive universal operating system that will enable those with motor impairments resulting from a variety of causes to quickly and reliably control a wide range of devices, including computers, assistive technologies and medical devices, simply by using their thoughts.

If you've ever spent time with a quadriplegic you know what a big deal it is to be able to just control a computer and have use of one hand. This system is still in early clinical trials, but if it works out it could dramatically improve the quality of life of many quadriplegics.

Researchers at Geron Corporationof Menlo Park, California, want to begin the first testing embryonic stem cell therapy in humans with damaged spinal cords. If the U.S. Food and Drug Administration gives its OK and the injections help, it could bring hope to many of the more than 250,000 people in this country with spinal disabilities.

Geron has been working with researchers at the University of California-Irvine, who reported lastyear that paralyzed rats could walk nine weeks after being injected with oligodendrocyte progenitor cells derived from human embryonic stem cells.

The move is controversial. Some researchers say Geron is moving too fast, and that more animal testing should be done first. Some point out that treatments that work with lab animals sometimes don't work on humans. Some worry that the stem cells could turn cancerous. Others object to all embryonic stem cell research on moral or theological grounds.

Spinal cord injuries frequently damage one part of nerve cells called axons, the long wire-like extensions of the nerve cells. That damage disrupts the axon's ability to transmit information, resulting in paralysis. For its test, Geron proposes to turn human embryonic stem cells into the precursors for specialized nerve cells, called oligodendrocyte progenitor cells. Surgeons then would inject the cells into the spinal injury with the help of a special stabilizing frame the company has developed. If everything goes as planned, the progenitor cells would help form new axons and also turn into oligodendrocytes, which help form an insulating sheath for the axons, called myelin.

The study would involve just a few dozen patients with irreversible spinal cord injuries, with the initial focus on just determining if the stem cell injections are safe.

If you have ever spent time with quadriplegics, and know what they endure, all the reservations about research seem trivial. If it were me or a member of my family sitting in the sip-and-puff power wheelchair, I would say, "bring on the stem cells, NOW!"

Purdue University researchers may have isolated the substance most responsible for the tissue damage that follows initial spinal cord injury, a discovery that could also improve treatments for a host of other neurodegenerative conditions.

A research team led by Riyi Shi (REE-yee SHEE) has found that a chemical called acrolein, a known carcinogen, is present at high levels in spinal tissue for several days after a traumatic injury. Although acrolein is produced by the body and is non-toxic at normally occurring low levels, it becomes hazardous when its concentration increases. See article.

Purdue University scientists have identified acrolein as a toxin that appears in spinal tissue after spinal cord trauma, and may play a role in causing paralysis. They hope that further research will lead to methods for detoxifying acrolein after SCI, and thereby preventing or lessening the resulting paralysis. See news release below.

Insurance executives and corporate risk managers know that family caregivers, caring for catastrophically injured loved ones, eventually will be ground down to exhaustion. And they know a wrongful death claim has far less value and jury appeal than a catastrophic injury claim, so if they can delay long enough they may save millions.

Therefore, in representing spinal cord and brain injury victims in claims for their catastrophic injuries, we have learned that the defense will generally follow a strategy of purposeful delay, knowing that the longer a quadriplegic goes without the full array of support services and equipment, the more likely he or she is to die before trial.

Future repairs of injured spinal cord and other nerves could be accomplished with the aid of stem cells grown in self-assembling three-dimensional biodegradable scaffolds of nanofibers.
The fibers, delivered in liquid form, self-assemble into a scaffold within seconds of making contact with the electrically charged ions surrounding cells. An amino acid in the fibers helps promote the growth of neurites -- branches extending from nerves that help the cells communicate. The scaffolds then dissolve as cells grow into place. Preliminary work on repairing spinal-cord damage in mice and rats with neural-progenitor cells has been promising. However, this has not yet produced a treatment for spinal-cord injury in humans. See article.

As anyone familiar with the care of quadriplegics can readily attest, bedsores (decubitus ulcers) are a common complication of paralysis. A study conducted by NYU School of Medicine researchers, in collaboration with the Wound Healing Program at Columbia University, sheds new light on the molecular mechanisms underlying the development of chronic wounds, including bedsores.

Published in the July 1 issue of the American Journal of Pathology, the study states that skin cells get stuck in the middle of the normal healing process and cannot migrate to the wound site, due to an overabundance of a molecule called c-myc ( a product of the ubiquitous myc gene, which has been implicated in many human cancers ). This molecule is known to suppress cell migration and to cause the skin to thicken, obstructing reparative cells from reaching the edge of the wound. The cause of c-myc overproduction was found to be beta-catenin, a critical regulator of cell behavior. According to the researchers, beta-catenin activates the production of c-myc as well as other pathways that affect the migration, growth, and regulation of skin cells. Continue below

Brooke Ellison was only eleven when a car hit her, leaving her a vent-dependent quadriplegic. In a tremendous demonstration of grit and determination, she went on to graduate from Harvard with honors. Now the story of her life has been made into a move, directed by the late Christopher Reeve, The Brooke Ellison Story, is available from Sony on DVD.
See movie trailer online: 1 2 3 4 .

Most spinal cord injuries begin with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Most injuries to the spinal cord do not completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons.

Some injuries will allow almost complete recovery. We have been pleased to see some of our clients make wonderful recoveries, and walk again. Others will result in complete paralysis. We have spent many hours in the homes and hospital rooms of permanetly quadriplegic or paraplegic clients, observing and documenting the reality of their daily lives.

Improved emergency care for people with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the nervous system and even restore limited abilities. Respiratory complications are often an indication of the severity of spinal cord injury About one-third of those with injury to the neck area will need help with breathing and require respiratory support. The steroid drug methylprednisolone appears to reduce the damage to nerve cells if it is given within the first 8 hours after injury. Rehabilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support.

Spinal cord injuries are classified as either complete or incomplete. An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete injuries retain some motor or sensory function below the injury. A complete injury is indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Successful recovery depends upon how well these chronic conditions are handled day to day.

The National Institute of Neurological Disorders and Stroke (NINDS) conducts spinal cord research in its laboratories at the National Institutes of Health (NIH) and also supports additional research through grants to major medical institutions across the country. Advances in research are giving doctors and patients hope that repairing injured spinal cords is a reachable goal. Advances in basic research are also being matched by progress in clinical research, especially in understanding the kinds of physical rehabilitation that work best to restore function. Some of the more promising rehabilitation techniques are helping spinal cord injury patients become more mobile.

Shepherd Center in Atlanta is a treatment site for Proneuron's Phase II trial of ProCord, involving implantation of an autologous spinal cellular product. See press release below.

Shepherd Center in Atlanta is one of the nation's leading catastrophic care hospitals, treating people with spinal cord injuries, acquired brain injuries, and related conditions. We have worked extensively with Shepherd patients in liability claims to obtain the funds required to provide for their ongoing care and enhance the quality of their lives.

U.S. News & World Report, in its annual ranking of hospitals, ranks Shepherd Center #16 in the nation among all rehabilitation hospitals, the highest ranking of any rehab hospital in the Southeast.

This blog topic will highlight points of common interest and recent developments in care and treatment of spinal cord injuries.

A new study from Georgetown University Medical Center may offer hope of drug treatment to prevent formation of scar tissue and thereby prevent worsening effects of traumatic central nervous system injury. Based on studies with rats, the hope is that injection of flavopiridol through nasal passages within thirty minutes after trauma may limit the formation of scar tissue and inflammatory response. See news release and the full study.

Much study with human subjects will be required before flavopiridol becomes a standard medical supply on every ambulance, routinely administered by EMT's at accident scenes. If that day ever comes, it will be too late for today's victims. For those of us who have spent years working with victims of catastrophic brain and spinal cord injuries, it sounds like hopeful news.