The role of rehabilitation and methodological problems in spinal cord repair therapies.

Despite the rapid development of studies of spinal cord repair therapies (SCRT), there is still a dearth of reliable reports on their clinical usefulness. Basing on a review of current literature, this article emphasises the role and special character of comprehensive rehabilitation based on the modulation of central nervous system plasticity in the treatment of spinal cord injuries with the use of SCRT. Basing on guidelines by the International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP), this article also discusses ethical and methodological issues of SCRT studies. Comprehensive motor rehabilitation exerts an effect that potentially modifies spinal cord plasticity and may significantly supplement SCRT, leading to expected functional effects. Encouraging results of animal studies cannot be directly translated into expectations regarding SCRT utility people. Ensuring a high quality of studies on SCRT efficacy and safety necessitates compliance with rigorous methodological requirements. Functional ability of the patient needs to be a significant end-point of SCRT studies.

Repair therapies in spinal cord injuries.

Spinal cord repair therapies (SCRT) are experimental treatments which are attracting a growing interest among both spinal cord injury sufferers and their families as well as physicians and physiotherapists. Basing on current professional literature, this article presents the most important SCRT strategies. The majority of currently developed SCRTs are at the stage of experimental in vitro or animal studies. Few of these studies are in the early clinical trial stage or are being offered as non-standard commercial health care services. Basing on a review of the literature, it can be stated that currently there are few studies which meet the criterion of reliability, and their results make possible an objective assessment of the safety and efficacy of SCRT. Available study results are insufficient to confirm the advisability of widespread application of these methods.

Strategies for neuroprotection following spinal cord injury.

Progress in neuropathology has made possible the description of local responses of neural tissue in early stages after traumatic spinal cord injury (SCI). The recent identification of multiple factors responsible for secondary spinal cord damage and for potential regenerative abilities has not resulted in the development of a standard for neuroprotective therapy in SCI patients. The paper reviews current knowledge concerning the sequence of biochemical events in the injured spinal cord and gives an overview of therapeutic possibilities for preventing the spread of secondary injury. The literature survey has led to the following conclusions: 1. The primary zone of traumatic damage enlarges due to local vascular disturbances, hypoxia, and the resulting inflammation. 2. Inflammation in the region of secondary injury, apart from having a destructive impact, is the source of substances which may induce neural tissue repair. 3. The administration of methylprednisolone and surgical decompression of the spinal cord within several hours after SCI improves functional and neurological outcomes in patients with incomplete neurological deficits. Currently there is no sufficient scientific evidence to support the safety and efficacy of other neuroprotective methods in humans.