.Spinal
Cord Injury: IOM Strategies in Search for a Cure
Study Background and Goals
Approximately 10,000 spinal cord injuries
occur in the United States each year. At any given time, over 300,000
individuals in the United States suffer from spinal cord injury - associated
maladies including: paralysis, bowel and bladder dysfunction, sexual
dysfunction, respiratory impairment, temperature regulation problems,
and chronic pain.
Prior to the 1980s there was little optimism regarding the possibility
of restorative therapies for individuals with severely damaged spinal
cords. But since that time, long-standing beliefs about the inability
of the adult nervous system to heal have been eroded by the flood of
new information from research in the neuroscience.
The challenge of restoring function in
the wake of spinal cord injuries remains extremely complex, and there
are still no cures. After an injury, neurons are susceptible to further
degeneration and to attack from the body's immune system. Moreover,
even when injured neurons are encouraged to regenerate, or are replaced
by transplanted cells, new projections must be guided to the correct
organs and muscles so that they ultimately transmit appropriate movement
control and sensory information to and and from the brain. Errant nerve
regeneration in the spinal cord may be completely or predominantly dysfunctional,
or worse, it may introduce spinal tumors, and/or chronic and severe
pain.
Public awareness of, and funding for, spinal
cord injury research has expanded in the past 10 years, aided greatly
by the efforts of patient advocates, scientists, and clinicians. Beginning
in 1994 with legislation passed in Kentucky, over a dozen states have
established funds that, together, support more than $25 million dollars
annually to develop cures for spinal cord injuries. The state funding
provides a substantial boost to the annual $85 million that the National
Institutes of Health invests in spinal cord injury research.
Attention to spinal cord injury and other
biomedical research has been further enhanced by the work of actor Christopher
Reeve who was paralyzed after a 1995 horseback riding accident and has
gone on to lead what was then known as the Paralysis Foundation - an
organization which now bears his name and contributes approximately
$8 million annually to support spinal cord injury research.
In 1998, New York State joined the ranks
of states that have earmarked funds for spinal cord injury research,
and specifically for research aimed at curing such injuries. The New
York Spinal Cord Injury Trust Fund is administered through the state's
Department of Health and the fund provides up to $8,5 million per year
for spinal cord injury research, making in the largest state program
of its kind. The New York Department of Health has asked the Institute
of Medicine of the National Academy of Sciences to convince an expert
committee that will :
1. Review the state of the science surrounding
therapies to restore lost function related to spinal cord injuries.
2. Identify and prioritize gaps in existing
knowledge in spinal cord injury clinical research.
3. Recommend short - and long-term, and
low - and high-risk, strategies to bridge those gaps.
4. Recommend how New York State and other
funders can best support research aimed at curing spinal cord injuries.
In making their recommendations on ways
to accelerate the development of cures for spinal cord injuries, the
committee will consider strategies to advance the field as a whole,
as well as the unique contributions that can be made by the New York
Spinal Cord Injury Trust Fund.
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