Many exciting developments are occurring in the field of spinal cord injury research.
They include both basic and applied research aimed at finding a cure, as well as ways to improve function and quality of life.
After years of tests and research there have been many positive results.
Listen in as Edelle Field-Fote, PT, Ph.D., discusses spinal cord injury research and the work being done at Shepherd Center to help improve the quality of life for its patients.
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Latest Developments in Spinal Cord Injury Research
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Learn more about Edelle Field-Fote, Ph.D., PT
Edelle Field-Fote, Ph.D., PT
Dr. Field-Fote became the director of spinal cord injury research at Shepherd Center in May 2014. For the past two decades, she was the director of the Neuromotor Rehabilitation Research Laboratory at the Miami Project to Cure Paralysis. She has a bachelor's degree in physical therapy from the University of Miami, a master's degree in environmental health and safety from the University of Miami and a doctorate in movement science from Washington University in St. Louis. Dr. Field-Fote's research has focused on restoring walking and hand function after spinal cord injury by making use of spinal pathways not damaged by injury.Learn more about Edelle Field-Fote, Ph.D., PT
Transcription:
Latest Developments in Spinal Cord Injury Research
Melanie Cole (Host): Many exciting developments are occurring in the field of spinal cord injury research, and many of them are at Shepherd Center. My guest today is Dr. Edelle Field-Fote. She’s Shepherd Center’s director of spinal cord injury research. Welcome to the show, Dr. Field-Fote. Tell us a little bit about spinal cord injury, why someone might have it, and what’s going on in the world of research.
Dr. Edelle Field Fote (Guest): Well, thank you. I’m pleased to be here. We have some really exciting studies that are going on here at the Shepherd Center, and I’ll tell you a little bit about the background in terms of people with spinal cord injury. Spinal cord injury is one of the types of disorders that can occur to anybody at any age. It’s not like something that people are born with. Very often, individuals who have spinal cord injury have had a traumatic injury, but there are also nontraumatic types of disorders that can result in spinal cord injury. When people who don’t know anyone who has a spinal cord injury thinks about this disorder, they very often think that people are totally paralyzed after spinal cord injury, and that’s not true. In fact, these days, with a very good emergency medical care, the people we see at the scene of accidents, the majority of people who have spinal cord injury have what we call incomplete injuries, where they actually have some movement and some feelings below the levels of injury. One of the major goals in my laboratory is to try and determine what is the best approach to improve function in people who have some remaining function after spinal cord injury. We have some new studies that are going on now that are really exciting, and the first one is one that is funded by the National Institute of Health. It addresses questions related to a device that can be used in rehabilitation called whole-body vibration. What we’ve noticed when we look at the literature is we know that when we think about drug studies, we know that many millions of dollars are spent each year trying to determine what’s the best dose of the drug to be used before that drug actually makes it to the marketplace. Interestingly enough, in many cases, it’s actually activity and training and rehabilitation and physical therapy that’s much better than drugs for people with certain types of neurological disorders such as spinal cord injury. And despite that, we know very little about the necessary doses for things like rehabilitation. This is one of the first studies to actually ask the question of what is the best dose of rehabilitation intervention, and in this case, whole-body vibration for improving function in people with spinal cord injury. In this study, we will be assessing different doses of whole-body vibration and looking at the changes that the different doses make in things like spasticity, which is the involuntary muscle spasms that people with spinal cord injury may experience. Looking at the effects on walking function and getting some preliminary data on things like the effects on pain and strength. In our prior studies, what we showed is that whole-body vibration on its own seemed to improve walking function in people with spinal cord injury and also reduced spasticity. Then, in a subsequent study, we showed that if we put vibration on the legs of people with spinal cord injury, we could actually get what we saw as involuntary stepping movement. That made us think perhaps that vibration works by activating circuits in the spinal cord that underlie the generation of walking function. This study will be an attempt to determine which is the best dosage of whole-body vibration to improve walking function and reduce spasticity in people with spinal cord injury.
Melanie: You’re trying to minimize fatigue but leading to improvement. How long do you think that people are going to have to stand on this whole-body vibration device?
Dr. Field-Fote: That’s an interesting question. In regard to your first part of your question, we actually don’t know that it has an impact on fatigue. What we think it impacts is the spinal circuits that underlie walking function and also the spinal circuits that underlie involuntary muscle spasm. Our prior studies suggest that vibration works on these two different types of circuits in very different ways and that the way that it works ends up improving walking function and reducing spasticity. Surprisingly enough, the amount of vibration that is needed to activate the spinal circuit is a very small amount. In our prior studies, we did bouts of short duration, consisted of 45 seconds of vibration followed by a minute rest, followed by another 45 seconds of vibration and a minute rest, so that we had four bouts of 45 seconds with one-minute rest in between. Just that short duration of whole-body vibration seemed to have a powerful impact on the spinal circuit so that the individuals that participated in the study showed improvement in walking function. There are actually other studies in individuals with stroke and elderly individuals that have used similar very short exposures to whole-body vibration and had positive results as well. It may be that not a very long duration or exposure is necessary to be able to get a benefit from whole-body vibration.
Melanie: Tell us about some of the other research and very exciting projects you are doing there at Shepherd Center.
Dr. Field-Fote: I’m glad you asked. The studies that I just described in terms of whole-body vibration is directed to individuals for whom there is deficits of walking function. We also have studies that we will be starting up soon that are directed at individuals who have impaired hand and arm function. In our prior studies, we have had a long history of looking at the effects of training on hand function and people who have what we call tetraplegia after a cervical or spinal cord injury that affects the neck. Interestingly enough, immediately after a spinal cord injury, as one might expect, movement is very, very difficult even for people who have some remaining motor function or movement function. And what we find is, as would be the case with anyone, if you don’t try to move and you don’t try to be active, the less you try, the less active you are. This is a phenomenon called learned non-use, where people early after injury experience inability to move and therefore decrease their trying, their attempts to move. And what we found is if you allow people to be immersed in an environment where they are encouraged to move as much as possible, they can actually improve their function and the function of their hands. They can make a really important difference to their quality of life because so many things that we do in our daily life—eating, dressing, even scratching an itch—involve hand function. The newer studies that we’ll have starting up actually combine what we’ve learned about the role of practice by combining practice with brain stimulation. There are noninvasive forms of brain stimulation that can be used to activate the brain. Our thoughts are that by combining brain stimulation with practice, we can actually make the brain better at pushing information down to the remaining parts of the spinal cord that are carrying information. If you think of a garden hose, for example, that just has a trickle of water coming through it, if you turn the faucet on higher, even if that garden hose has a kink in it, you can actually get more of the water through. We think that if we can derive information through those spinal cord pathways at a higher rate and a higher volume, that we’ll actually improve hand function in people who have tetraplegia.
Melanie: Tell us a little bit about the cell transplantation research that you’re doing that are in clinical trial right now. It’s fascinating and very exciting.
Dr. Field-Fote: Well, the studies that we will be beginning is the Asterios study, and these are for individuals who are in the very, very early stages of spinal cord injury. They have to be within the first 14 days of spinal cord injury to be considered for participation in this study. This study is actually a carry-on study from a prior study called the Geron study, where individuals who participated in the study received a certain type of cell. And the cell type is called oligodendrocyte progenitor cells or OPC cells. These cells are the type of cells that have the potential to myelinate or insulate the spinal nerve cells that are traveling within the spinal column. Very often, after spinal cord injury, what happens is there is damage to the spinal cord. And in addition to the damage to the nerve fibers themselves, there’s damage to the cells that insulate the spinal cord. It’s like a wire, basically, that’s lost its insulation. Even if information is trying to get down through that wire, without insulation, the electricity basically just leaks out of the wire and doesn’t get to the target at the lower levels of the spinal cord to activate the neuron that would activate the muscles. These cells are intended to increase the myelination or insulation around the spinal cells and allow them to transmit information better. Unlike the studies that are going on in my laboratory, this is a study that is geared for people with very early spinal cord injury, and this study is being directed by our clinical trials office that’s headed up by Ms. IsmaraCleffen and so she’d be a very good person to contact for individuals who might be interested in this study. But as I said, it’s for people in the very early stages after spinal cord injury.
Melanie: In just the last minute, if you would, Dr. Field-Fote, please tell us why people should choose Shepherd Center for their spinal cord injury rehab.
Dr. Field-Fote: I will tell you a little bit about why I chose Shepherd Center. I am a physical therapist by training with a clinical background in physical therapy, and Shepherd Center has always been one of the biggest names that comes to mind when someone thinks of spinal cord injury rehabilitation. For the past 14 years, before joining Shepherd Center, I was the director of a research laboratory at a Miami project to cure paralysis. That’s the University of Miami Miller School of Medicine. The University of Miami does not itself have a rehabilitation center at this time. Whenever someone would call me and ask me for my advice as a spinal cord injury researcher and a physical therapist about where they should go or where they should take their son or daughter after spinal cord injury, I always recommended Shepherd Center. There are excellent clinicians here, both in the medical field and in the therapy field, excellent physical therapists, occupational therapists, recreational therapists, speech therapists. They have all of the different professionals that are available to help people with spinal cord injury. Because there is such a large volume of people here with spinal cord injury who come to Shepherd Center, there’s also very good peer support. In addition to that, there is just beautiful physical surroundings, which I think always is valuable for improving people’s morale when they can be among beautiful gardens and among beautiful physical facilities as part of their rehabilitation care.
Melanie: Thank you so much, Dr. Edelle Field-Fote. For more information, you can go to shepherd.org. That’s shepherd.org. You’re listening to Shepherd Center Radio. I’m Melanie Cole. Thanks so much for listening, and have a great day.
Latest Developments in Spinal Cord Injury Research
Melanie Cole (Host): Many exciting developments are occurring in the field of spinal cord injury research, and many of them are at Shepherd Center. My guest today is Dr. Edelle Field-Fote. She’s Shepherd Center’s director of spinal cord injury research. Welcome to the show, Dr. Field-Fote. Tell us a little bit about spinal cord injury, why someone might have it, and what’s going on in the world of research.
Dr. Edelle Field Fote (Guest): Well, thank you. I’m pleased to be here. We have some really exciting studies that are going on here at the Shepherd Center, and I’ll tell you a little bit about the background in terms of people with spinal cord injury. Spinal cord injury is one of the types of disorders that can occur to anybody at any age. It’s not like something that people are born with. Very often, individuals who have spinal cord injury have had a traumatic injury, but there are also nontraumatic types of disorders that can result in spinal cord injury. When people who don’t know anyone who has a spinal cord injury thinks about this disorder, they very often think that people are totally paralyzed after spinal cord injury, and that’s not true. In fact, these days, with a very good emergency medical care, the people we see at the scene of accidents, the majority of people who have spinal cord injury have what we call incomplete injuries, where they actually have some movement and some feelings below the levels of injury. One of the major goals in my laboratory is to try and determine what is the best approach to improve function in people who have some remaining function after spinal cord injury. We have some new studies that are going on now that are really exciting, and the first one is one that is funded by the National Institute of Health. It addresses questions related to a device that can be used in rehabilitation called whole-body vibration. What we’ve noticed when we look at the literature is we know that when we think about drug studies, we know that many millions of dollars are spent each year trying to determine what’s the best dose of the drug to be used before that drug actually makes it to the marketplace. Interestingly enough, in many cases, it’s actually activity and training and rehabilitation and physical therapy that’s much better than drugs for people with certain types of neurological disorders such as spinal cord injury. And despite that, we know very little about the necessary doses for things like rehabilitation. This is one of the first studies to actually ask the question of what is the best dose of rehabilitation intervention, and in this case, whole-body vibration for improving function in people with spinal cord injury. In this study, we will be assessing different doses of whole-body vibration and looking at the changes that the different doses make in things like spasticity, which is the involuntary muscle spasms that people with spinal cord injury may experience. Looking at the effects on walking function and getting some preliminary data on things like the effects on pain and strength. In our prior studies, what we showed is that whole-body vibration on its own seemed to improve walking function in people with spinal cord injury and also reduced spasticity. Then, in a subsequent study, we showed that if we put vibration on the legs of people with spinal cord injury, we could actually get what we saw as involuntary stepping movement. That made us think perhaps that vibration works by activating circuits in the spinal cord that underlie the generation of walking function. This study will be an attempt to determine which is the best dosage of whole-body vibration to improve walking function and reduce spasticity in people with spinal cord injury.
Melanie: You’re trying to minimize fatigue but leading to improvement. How long do you think that people are going to have to stand on this whole-body vibration device?
Dr. Field-Fote: That’s an interesting question. In regard to your first part of your question, we actually don’t know that it has an impact on fatigue. What we think it impacts is the spinal circuits that underlie walking function and also the spinal circuits that underlie involuntary muscle spasm. Our prior studies suggest that vibration works on these two different types of circuits in very different ways and that the way that it works ends up improving walking function and reducing spasticity. Surprisingly enough, the amount of vibration that is needed to activate the spinal circuit is a very small amount. In our prior studies, we did bouts of short duration, consisted of 45 seconds of vibration followed by a minute rest, followed by another 45 seconds of vibration and a minute rest, so that we had four bouts of 45 seconds with one-minute rest in between. Just that short duration of whole-body vibration seemed to have a powerful impact on the spinal circuit so that the individuals that participated in the study showed improvement in walking function. There are actually other studies in individuals with stroke and elderly individuals that have used similar very short exposures to whole-body vibration and had positive results as well. It may be that not a very long duration or exposure is necessary to be able to get a benefit from whole-body vibration.
Melanie: Tell us about some of the other research and very exciting projects you are doing there at Shepherd Center.
Dr. Field-Fote: I’m glad you asked. The studies that I just described in terms of whole-body vibration is directed to individuals for whom there is deficits of walking function. We also have studies that we will be starting up soon that are directed at individuals who have impaired hand and arm function. In our prior studies, we have had a long history of looking at the effects of training on hand function and people who have what we call tetraplegia after a cervical or spinal cord injury that affects the neck. Interestingly enough, immediately after a spinal cord injury, as one might expect, movement is very, very difficult even for people who have some remaining motor function or movement function. And what we find is, as would be the case with anyone, if you don’t try to move and you don’t try to be active, the less you try, the less active you are. This is a phenomenon called learned non-use, where people early after injury experience inability to move and therefore decrease their trying, their attempts to move. And what we found is if you allow people to be immersed in an environment where they are encouraged to move as much as possible, they can actually improve their function and the function of their hands. They can make a really important difference to their quality of life because so many things that we do in our daily life—eating, dressing, even scratching an itch—involve hand function. The newer studies that we’ll have starting up actually combine what we’ve learned about the role of practice by combining practice with brain stimulation. There are noninvasive forms of brain stimulation that can be used to activate the brain. Our thoughts are that by combining brain stimulation with practice, we can actually make the brain better at pushing information down to the remaining parts of the spinal cord that are carrying information. If you think of a garden hose, for example, that just has a trickle of water coming through it, if you turn the faucet on higher, even if that garden hose has a kink in it, you can actually get more of the water through. We think that if we can derive information through those spinal cord pathways at a higher rate and a higher volume, that we’ll actually improve hand function in people who have tetraplegia.
Melanie: Tell us a little bit about the cell transplantation research that you’re doing that are in clinical trial right now. It’s fascinating and very exciting.
Dr. Field-Fote: Well, the studies that we will be beginning is the Asterios study, and these are for individuals who are in the very, very early stages of spinal cord injury. They have to be within the first 14 days of spinal cord injury to be considered for participation in this study. This study is actually a carry-on study from a prior study called the Geron study, where individuals who participated in the study received a certain type of cell. And the cell type is called oligodendrocyte progenitor cells or OPC cells. These cells are the type of cells that have the potential to myelinate or insulate the spinal nerve cells that are traveling within the spinal column. Very often, after spinal cord injury, what happens is there is damage to the spinal cord. And in addition to the damage to the nerve fibers themselves, there’s damage to the cells that insulate the spinal cord. It’s like a wire, basically, that’s lost its insulation. Even if information is trying to get down through that wire, without insulation, the electricity basically just leaks out of the wire and doesn’t get to the target at the lower levels of the spinal cord to activate the neuron that would activate the muscles. These cells are intended to increase the myelination or insulation around the spinal cells and allow them to transmit information better. Unlike the studies that are going on in my laboratory, this is a study that is geared for people with very early spinal cord injury, and this study is being directed by our clinical trials office that’s headed up by Ms. IsmaraCleffen and so she’d be a very good person to contact for individuals who might be interested in this study. But as I said, it’s for people in the very early stages after spinal cord injury.
Melanie: In just the last minute, if you would, Dr. Field-Fote, please tell us why people should choose Shepherd Center for their spinal cord injury rehab.
Dr. Field-Fote: I will tell you a little bit about why I chose Shepherd Center. I am a physical therapist by training with a clinical background in physical therapy, and Shepherd Center has always been one of the biggest names that comes to mind when someone thinks of spinal cord injury rehabilitation. For the past 14 years, before joining Shepherd Center, I was the director of a research laboratory at a Miami project to cure paralysis. That’s the University of Miami Miller School of Medicine. The University of Miami does not itself have a rehabilitation center at this time. Whenever someone would call me and ask me for my advice as a spinal cord injury researcher and a physical therapist about where they should go or where they should take their son or daughter after spinal cord injury, I always recommended Shepherd Center. There are excellent clinicians here, both in the medical field and in the therapy field, excellent physical therapists, occupational therapists, recreational therapists, speech therapists. They have all of the different professionals that are available to help people with spinal cord injury. Because there is such a large volume of people here with spinal cord injury who come to Shepherd Center, there’s also very good peer support. In addition to that, there is just beautiful physical surroundings, which I think always is valuable for improving people’s morale when they can be among beautiful gardens and among beautiful physical facilities as part of their rehabilitation care.
Melanie: Thank you so much, Dr. Edelle Field-Fote. For more information, you can go to shepherd.org. That’s shepherd.org. You’re listening to Shepherd Center Radio. I’m Melanie Cole. Thanks so much for listening, and have a great day.