Spinal Cord Injury

Spinal cord injuries (S.C.I.) give palsies of all the nerve functions depending on the motor neurons which lie below the site of the injury. If the lesion is in the cervical region it results in quadriplegia; if the injury is lower it is a matter of paraplegia. These palsies have no possibility of healing. Sketch of the transfer to lower limbs of the ulnar nerves. Public opinion nowadays is so used to hearing about miracle operations like heart transplants or re-implantation of amputated limbs that it can hardly understand why nothing can be done to cure paraplegia. Numberless associations and foundations try to help the patients by means of F.K.T. and social assistance, psychological and economical aids but they cannot do more. Only scientific research, in the various fields of neuroscience (which is extremely difficult in spinal cord due to various factors among which the insufficient knowledge of many biochemical and physiopathological mechanisms of the spinal cord) can hope to find a cure for these palsies. A car, sport or work accident can provoke an irreversible palsy which tragically sets in perfectly healthy young people. Notwithstanding the miracles obtained by medicine and surgery in other fields, spinal cord injury cannot be cured.
Spinal cord injuries are very severe lesions, often lethal. Out of the surviving patients 75% become paraplegic, 25% tetraplegics. Para and tetraplegia mainly affects young people below 30. From a statistics made by our foundation in collaboration with the most important European rehabilitation centres it emerged that 40% of patients are 20 to 30 years old and 35% are under 20 years of age. These lesions are due, for 50%, to street accidents and for the remaining 50% to sport, work or game events. The most alarming fact is the incidence of tetra and paraplegia: in Italy we estimate that there are 90.000 plegics and that every year 32 more plegics per million people are added: more or less 1.800 new cases. These data are in conformity with those of other countries of the European Community.
The knowledge of functional anatomy, physiology and reaction capacity of the spinal cord to various damages as well as the possibility of regeneration is still fragmentary and insufficient. Orthopaedic treatments can stabilise the spine by various means of fixation and bone grafts obtaining bone fusion and allowing a good position in the wheelchair, often also removing the pain symptoms. But it cannot cure palsy. Paraplegics who are able to return to an active life, in a wheelchair, are more and more numerous, gaining an acceptable quality of life but with enormous economical, personal and social burden. Recently electrical stimulation systems have been calibrated to stimulate various muscle groups and they can give muscular function through computerised mechanisms. Some of these systems are used to control the bladder by stimulating the sacral nerve roots. In tetraplegics an implanted electrodes system of stimulation (free-hand, Cleveland) has been built which can restore some active, voluntary, elementary movements of one hand.
The European S.U.A.W. programme (in which the Foundation for the Research on Spinal Cord Lesions took part with Prof. Brunelli) has prepared and implanted in two patients a sophisticated apparatus which stimulated various muscles of the lower limbs by a software transmitted through an antenna to a receiver implanted subcutaneously in the abdomen. The result is a rudimentary artificial walking requiring both a walker and a trolley carrying batteries and a computer. This research had to be abandoned due to the high costs and low economical return. At present some expectancies seem to be promising by means of the use of B.C.I. (brain-computer interfaces ) which throughout sophisticated electronic apparatus can transmit to muscles the commands derived by the brain cortex.


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