Investigating Spinal Atrophy in Patients With Spinal Injury Clinical Trial
We aim to investigate the effect of motor skill training of the upper and lower limbs on the function and structure of the CNS as measured by neuroimaging parameters sensitive to changes in tissue volume and density and the properties of myelin.
Functional recovery following human spinal cord injury (SCI) remains frustratingly limited
and the majority of patients are left with severe impairments. While rehabilitative training
has been shown to improve clinical outcome following SCI and has a major effect on patients'
quality of life, the neuronal mechanisms underpinning neurological and functional recovery
are not well understood.
Until recently, degenerative changes in components of the CNS remote to a SCI were thought to
occur slowly (over years) and correlate with the degree of disability. Using longitudinal MRI
protocols we have shown that these structural changes in fact occur early and progress both
at the cord and brain level according to a specific spatial and temporal pattern (Freund et
al 2013). It is thought that these trauma-induced structural changes progress retrogradely
along central motor nerve fibres of the myelinated corticospinal tract (CST) and this is
accompanied over time by shrinkage of corticospinal projecting neuronal bodies. Crucially,
patients with less atrophy throughout the CST were those with better clinical recovery at
twelve months. Despite this significant recovery advantage in some patients, all participants
showed irreversible tissue loss, potentially hindering further recovery. Using the
neuroimaging biomarkers established in the previous study cited above, we now aim to assess
whether specific and intensive motor learning through tasks for the upper and lower limb
might slow or reverse the atrophy seen in the sensorimotor system.
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