The Effect of Spinal Cord Injury Edema on Potential Functional - - PowerPoint PPT Presentation

Residual Ruins: The Effect of Spinal Cord Injury Edema on Potential Functional Recovery

Alondra Medina

The University of Texas Rio Grande Valley

• Spinal cord injuries affect ~300,000 in the US
• SCI cause varying degrees of motor and sensory

impairment

• Tetraplegia remains the most common SCI (>58%)
• Currently over 9 months of rehabilitation are often

required to achieve meaningful improvements in function in SCI

Spinal Cord Injury

Duration of Therapy / Rehabilitation Training Functional Recovery

36 38 40 42 44 46 48 50 52 Baseline 3 months 6 months 9 months Muscle Strength of Chest (kg) Hicks, 2003

• Spinal cord injuries affect ~300,000 in the US
• SCI cause varying degrees of motor and sensory

impairment

• Tetraplegia remains the most common SCI (>58%)
• Currently over 9 months of rehabilitation are often

required to achieve meaningful improvements in function in SCI

Spinal Cord Injury

Duration of Therapy / Rehabilitation Training Functional Recovery

36 38 40 42 44 46 48 50 52 Baseline 3 months 6 months 9 months Muscle Strength of Chest (kg) Hicks, 2003

Can a neuroimaging biomarker assist in determining what is causing limited efficacy in rehabilitation?

• Following SCI, a series of scarring events occur around the zone of original damage
• A cyst forms around the site of injury and becomes encapsulated by a glial scar

Spinal Cord Edema as a Biomarker

• T2-weighted MRI imaging can be used to view the development of the edema
• Over time, the edema compacts and stabilizes in size and shape

Spinal Cord Edema as a Biomarker

Huber, 2017

• The objective of our project was to determine if the properties of the

residual edema in the spinal cord after SCI influenced functional recovery.

• We hypothesized that subjects with a larger spinal edema would

demonstrate limited recovery and reduced baseline function.

Objective

Neu euroimagin ing

T2-weighted MRI of the spinal cord

Reh ehabil ilit itatio ion

• Subjects underwent 10 sessions

(2 hours each)

• Intense upper limb rehabilitation
• Upper limb function was assessed

before and after therapy

• Manual muscle strength testing

and dexterity tests (nine hole peg test)

Methods

Edem ema Im Image Processing

• Image processing of edema and

tissue bridges was performed in FSL

• The spinal cord edema was first

isolated as a separated region of interest (ROI)

• Regions ventral and dorsal of

the edema were also quantified (termed tissue bridges)

• An example of the regions

identified as tissue bridges are shown in yellow.

Methods

Pati atient ID Gend nder Age Han andedn dness Month ths Post Inju njury Le Level of Inju njury AIS Grad ade Etiology UE UEMS K001 F 28 R 47 C5 B T 10 K002 M 68 R 135 C3 D T 38 K049 M 47 R 164 C4 D T 44 K092 F 67 R 417 C4 B T 23 K14 K146 M 57 R 30 C4 C T 25 K15 K153 F 32 R 79 C5 B T 22 K160 M 58 R 368 C6 D T 23 K207 M 56 R 60 C5 D T 33

• Patients were chronic SCI (over 18 months post injury)
• All patients were incomplete tetraplegic (AIS Grade B,C, and D)

Methods

Edema Volume is Not Related to Baseline AIS grade

500 1000 1500 2000 2500 3000 3500

1 2 3

Spinal Cord Edema Volume (mm3)

AIS B AIS C AIS

AIS B AIS C AIS D

• We observed that subjects with varying

baseline function had similar sized edemas regardless

• f

baseline AIS grade.

• This suggested that spinal cord edemas

were not related to baseline function.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 1000 2000 3000 4000

Change in Total Strength Edema Volume

r = .297

• 20%
• 10%

0% 10% 20% 30% 40% 50% 60% 70% 80% 1000 2000 3000 4000

Change in Distal Strength Edema Volume r = .542

• We found that total spinal cord edema volume did not correlate with recovery following

two-weeks of rehabilitation.

Edema Volume is not related to Recovery Potential

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 1000 2000 3000 4000

Change in Total Strength Edema Volume

r = .297

• 20%
• 10%

0% 10% 20% 30% 40% 50% 60% 70% 80% 1000 2000 3000 4000

Change in Distal Strength Edema Volume r = .542

• We found that total spinal cord edema volume did not correlate with recovery following

two-weeks of rehabilitation.

Edema Volume is not related to Recovery Potential

Edema volu lume was not t related to to baseline fu function

• r

r fun functional recovery

0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 AIS B AIS C AIS D

Tissue Bridge Ratio Ventral Dorsal

AIS D AIS B AIS C

• Sparing of the dorsal and ventral tissue bridges was

directly related to AIS grade.

• Our results validate clinical testing by demonstrating that

individuals with AIS D showed the most sparing of both the ventral and dorsal tissue bridges.

Tissue Bridge Volume is Dependent on AIS grade

Ventral Tissue Bridge Volume is Related to Recovery Potential

0% 10% 20% 30% 40% 50% 1 2 3

Change in Total Strength Tissue Bridge Ratio: Ventral

0% 20% 40% 60% 80% 1 2 3

Change in Distal Strength Tissue Bridge Ratio: Ventral

r = .930 p = .007 r = .952 p = .003

0% 10% 20% 30% 40% 50% 2 4 6

Change in Total Strength Tissue Bridge Ratio: Dorsal

0% 20% 40% 60% 80% 100% 2 4 6

Change in Distal Strength Tissue Bridge Ratio: Dorsal

r = .794 p = .059 r = .770 p = .073

• Patients that demonstrated

a larger ventral tissue bridge benefited more from rehabilitation.

• Dorsal tissue bridge sparing

had a trending relationship with recovery.

Ventral Tissue Bridge Volume is Related to Recovery Potential

0% 10% 20% 30% 40% 50% 1 2 3

Change in Total Strength Tissue Bridge Ratio: Ventral

0% 20% 40% 60% 80% 1 2 3

Change in Distal Strength Tissue Bridge Ratio: Ventral

r = .930 p = .007 r = .952 p = .003

0% 10% 20% 30% 40% 50% 2 4 6

Change in Total Strength Tissue Bridge Ratio: Dorsal

0% 20% 40% 60% 80% 100% 2 4 6

Change in Distal Strength Tissue Bridge Ratio: Dorsal

r = .794 p = .059 r = .770 p = .073

Patie tients ts with ith a lar larger ve ventr tral tis tissue ue bri bridge demonstr trate ted mor

• re

fu functional be benefit fol

• llowing rehabilitati

tion

Final Thoughts

Can a neuroimaging biomarker assist in determining what is causing limited efficacy in rehabilitation? Ventral tissue bridges appear to provide the most feedback regarding rehabilitation efficacy

Future Research

• Wider range of patients
• Use MRI images from hospital and

analyze more patients

• Look at patients with AIS grade A
• Find ways to enhance the survival of the ventral tissue bridge
• Different stimulation techniques
• Stem cells

Research team:

• Dr. Kelsey Baker (Mentor), Juan Torres, Aaron Carrillo, Luis

Trevino, Gisselle Montemayor, Rogelio Meza, Ileana Mendoza, Maria Martin, Carlos Arroyo, Claudia De Leon, Leslie Cardenas, and Nicole Alonzo Research partner: Alyssa Canales

Ela Plow PhD, PT Kevin Kilgore, PhD Frederick Frost, MD Kyle O’Laughlin, MS

Cleveland veland Collab llaborator

• rators

Work Presented is in part of an active Clinical Trial: NCT01539109

Acknowledgements