Neurotech Researchers and Clinicians Tackle Paralysis at SCI2020 Meeting at NIH

by Jennifer French, senior editor

SCI2020, Launching a Decade of disruption in Spinal Cord Injury Research was held earlier this month on the NIH campus in Bethesda, MD. The event was sponsored by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research.

Lyn Jakeman, director of the division of neuroscience at NINDS, kicked off the charge for the audience to “break down silos” and encouraged participants to work collaboratively across disciplines. Jakeman also advised attendees that the spinal cord is now included in the Brain Initiative program. NINDS director Walter Koroshetz also addressed the audience, highlighting the various NIH programs to move innovation from the lab to the bedside. Registrants for the event consisted mainly of scientific researchers, and academics, along with some clinicians and consumer advocates. The intent of the meeting was to set the course for SCI research from 2020 through 2030.

There were two keynote presentations. Michael Boninger of the University of Pittsburgh provided a look into the future of what the treatments for spinal cord injury might look like in 2040. He told the fictional but predictive story of him getting an injury and the innovative treatments to follow which included emergency care, cellular treatments, neuromodulation implants, and rehabilitation. He also shared the current viewpoint of people living with injuries today provided by Jim Krause from the Medical University of South Carolina and this editor, both living with tetraplegia. The second keynote was provided by Rob Wudlick from Get Up Stand Up to Cure Paralysis. He told his personal story of becoming a quadriplegic after an accident in the Grand Canyon.

The two-day meeting was organized into six sessions. Each session had a moderator, panelists, and facilitators. The session moderator along with the panelist provided short presentations on the state of science and their view of the trends in the given topic while the facilitators sparked audience participation with provocative questions and discussion. With the exception of one, the sessions highlighted various progressions of spinal cord injury or key areas of interest.

The first session focused on the acute phase within a few hours of the injury. Among other presentations, William Whetstone from the University of California San Francisco highlighted the emergency room triage protocols developed for stroke patients. This was developed to quickly diagnose and route the patient to the applicable treatment as quickly as possible. They also highlighted the need to develop an infrastructure for SCI centers of excellence and the need to build awareness among the communities on standard care for SCI.

The second session focused on the subacute phase and strategies for repair, plasticity, and regeneration following injury. The discussion centered around progress on cellular therapies, biomarkers, and the need for data sharing. Another session focused on long-term wellness and secondary health effects of SCI. Richard Shields from the University of Iowa led this session. SCI is typically viewed as a stable condition following 12 months post-injury. As the demonstrated research shows, SCI is a systematic disease with the deterioration of muscle and bone impacting the overall health of the body including autonomic functions.

Two sessions had a main focus on technology; one highlighting neuromodulation strategies and the other focusing on prosthetics and robotics. The former was moderated by Edelle Field-Fote of the Shepherd Center and Emory University. The session's discussion circled around the use of neurostimulation for rehabilitation recovery post injury. Stimulation methods coupled with rehabilitation also dominated the discussion to induce plasticity and other health outcomes. However, it was still unclear how to differentiate the effects of rehabilitation from the effects of technology. Some argue that is does not matter as long as there is a functional outcome. The other technology session highlighted developments in exoskeletons, brain-computer interfaces, and epidural stimulation. For all of the various strategies it was clear there is a need for modularity and personalized custom features for individual users. Neurotechnologies were a center of discussion in these sessions.

One of the largest impacts during this meeting was the session titled “With Us, Not for Us,” led by the members of the North American Spinal Cord Injury Consortium. “We want to be disruptive but productive,” said Kim Anderson-Erisman, president of the consortium. The panelists each presented data from a community survey which gathered opinions of 1800 respondents from the SCI community within 37 days. The data showed frustration with the lack of translation and how the quality of treatment for SCI has declined, while costs and mortality rates have both increased over the past decade.

The survey respondents relayed their discontent with media hype of curing SCI and their desire to be part of the integrated knowledge transfer as participants in the research process. Their overall message for the future is that people living with SCI want to be engaged in the research process. Funded research portfolios should reflect the needs of the people living with the condition and these investments should yield tangible impacts. With this future in mind, we shall see what unfolds in the next decade.

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