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Clinical Neuroengineering
Spinal Cord Injury Assessment
 Abstract
There are roughly 14,000 new incidences of spinal cord injury (SCI) every year in the United States, and around 300,000 Americans are currently living with the devastating effects of SCI's. This number is rising because of the steady improvements in life expectancy without the analogous improvement in the quality of life. According to the NIH, among neurological disorders, SCI's cost to society ranks second after mental retardation.

Acute spinal cord injuries can be 'anatomically incomplete' with spared demyelinated axons showing physiological continuity across the lesion. Even a small number of spared fibers after SCI can greatly improve patients' quality of life, and if some sensory-motor function is preserved the odds of walking again are greater than 50%. Detailed knowledge about the integrity of the conducting spare fibers can help physicians plan strategic treatments and limit progression of the injury into the secondary phase. In addition, although stem cell research and gene therapies have been capable of producing therapeutically-induced functional recovery in animal models, existing methods lack the ability to quantitatively measure in vivo the resulting regeneration and recovery of neurophysiology.

This motivates us to develop quantitative assessment methods via event-related neurological monitoring and advanced image analysis. Our group focuses on developing novel signal processing techniques and acquisition setups for electrophysiological monitoring of:
Somatosensory Evoked Potentials (SEP)
Motor Evoked Potentials (MEP)
 
SEP for a: baseline, b: day1, c: week1 and d: week2 following a 50mm impact contusion injury. Prior to injury, the characteristic peaks of SEP are present for each limb. Immediately following injury, day1 recordings show a significant reduction in peak amplitude for the hindlimbs, but forelimb signals remain unaffected. This trend continues through the first two weeks following SCI.

And novel image processing techniques and acquisition setups for structural analyses of injury using:
High Resolution Diffusion Tensor (DT)
Magnetic Resonance Imaging (MRI)
 
Diffusion tensor images of an injured spinal cord. a) white = white matter, green = gray matter, red = injury-induced vacuoles; b) orange = vacuoles, gray = injured spinal cord; c) a bundle of survivable fibers; d) a bundle of normal fibers
 
Researchers
Angelo H. All, MD, MBA
Gracee Agrawal
Chris Lee
 
Collaborators
Richard Skolasky, PhD - Johns Hopkins School of Medicine (Orthopedic Surgery/Statistics)
Piotr Walczak, MD - Johns Hopkins School of Medicine (Radiology)
 
Funding
Maryland Stem Cell Research Fund (TEDCO)
Johns Hopkins RESTORE Fund
 
Publications
Agrawal G, Thakor NV, All AH, Evoked potential versus behavior to detect minor insult to spinal cord in rat model, J Clinc Neurosci, in press, 2008

Agrawal G, Sherman D, Thakor N, All A, A Novel Shape Analysis Technique for Somatosensory Evoked Potentials, Conf Proc IEEE Eng Med Biol Soc, 1:4688-91, 2008

Aggarwal V, All AH, Somatosensory evoked potential monitoring of spinal cord in noisy environments, Intl J of Medical Implants and Devices, 2(3):139-149, 2007

Fatoo N, Mirza N, Ahmad R, Al-Nashash H, Naeini H, Thakor NV, Detection and assessment of spinal cord injury using spectral coherence, Conf Proc IEEE Eng Med Biol Soc, 1:1426-9, 2007
 
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