Purpose. As motor vehicle accidents and violence cause the majority of spinal cord injuries (SCI) sustained in the USA and people with SCI will likely struggle with emotional issues related to the offender, the purpose of this exploratory study was to examine potential salutary effects of forgiveness among people with SCI incurred traumatically. Specifically, we hypothesized that forgiveness would have positive associations with health-related outcomes. Method. A community-based sample of 140 adults (19-82 years of age) with SCI completed a self-report survey regarding dispositional forgiveness of self and others, health behavior, health status, and life satisfaction. Hierarchical multiple regression analyses were employed to examine the relationships in question. Results. After controlling for demographic variables, forgiveness of self was significantly associated with health behavior and life satisfaction (uniquely accounting for 7% and 13% of the variance, respectively) and forgiveness of others was significantly associated with health status (uniquely accounting for 9% of the variance). Conclusion.Results suggest that forgiveness may play a role in the health and life satisfaction of people with traumatic SCI, with the benefit depending on the type of forgiveness offered.

No description available.

No description available.

Injury to the cervical spinal cord is a devastating event that results in a transient to permanent loss of sensory and motor functions following injury. Moderate recovery has been reported to occur in individuals and in animal models after spinal cord injury (SCI). One approach to promote recovery after SCI is rehabilitative training. This thesis examines the relation of reaching training with adaptive changes (i.e. plasticity) and functional recovery following SCI. In my first experiment, I investigated whether plasticity of the corticospinal tract (CST) is the cause for reaching recovery after ablation of the dorsal and lateral CST. Rats that received reaching training were significantly better in reaching than their untrained counterparts. A relesion of the CST revealed that the reaching recovery mainly depended on plasticity of the CST itself. Since it is controversial whether training should be initiated immediately after SCI, I investigated whether a delayed initiation of reaching training after SCI is beneficial. I compared the reaching success of rats that received reaching training on day 4 post SCI with rats that received training on day 12 post SCI. I found that the reaching success in rats that either received reaching training on day 4 or 12 following SCI was similar. Lastly, I investigated whether training efficacy is declined in chronically injured rats. Since it has been shown that the inflammatory response after SCI declines, it is questionable whether there is a relation between the inflammatory response after SCI and training efficacy. In my last experiment I injected chronically injured rats with a substance that induces a systemic inflammation. I found that rehabilitative reaching training in chronic injured rats only resulted in an improved reaching recovery when the training was combined with the administration of the substance that induces inflammation (lipopolysaccharide). Although there are still unanswered questions regarding the underlying mechanism for functional recovery after SCI, the results of this thesis could be used as a basic to improve future rehabilitative training strategies and therefore improve the quality of life in individuals that suffer from SCI.

Neurotrophin-3 (NT-3) and anti-NogoA have shown promise in regenerative strategies after spinal cord injury; however, conventional methods for localized release to the injured spinal cord are either prone to infection or not suitable for sustained release. To address these issues, we have designed a composite drug delivery system that is comprised of poly(lactic-co-glycolic acid) (PLGA) nanoparticles dispersed in an injectable hydrogel of hyaluronan and methyl cellulose (HAMC). Achieving sustained and bioactive protein release from PLGA particles is a known challenge; consequently, we studied the effects of processing parameters and excipient selection on protein release, stability, and bioactivity. We found that embedding PLGA nanoparticles in HAMC results in more linear drug release due to the formation of a diffusion-limiting layer of methyl cellulose on the particle surface. Co-encapsulated MgCO3 was able to significantly improve NT-3 bioactivity, while trehalose + hyaluronan was able to improve anti-NogoA bioactivity and release.

Neurotrophin-3 (NT-3) and anti-NogoA have shown promise in regenerative strategies after spinal cord injury; however, conventional methods for localized release to the injured spinal cord are either prone to infection or not suitable for sustained release. To address these issues, we have designed a composite drug delivery system that is comprised of poly(lactic-co-glycolic acid) (PLGA) nanoparticles dispersed in an injectable hydrogel of hyaluronan and methyl cellulose (HAMC). Achieving sustained and bioactive protein release from PLGA particles is a known challenge; consequently, we studied the effects of processing parameters and excipient selection on protein release, stability, and bioactivity. We found that embedding PLGA nanoparticles in HAMC results in more linear drug release due to the formation of a diffusion-limiting layer of methyl cellulose on the particle surface. Co-encapsulated MgCO3 was able to significantly improve NT-3 bioactivity, while trehalose + hyaluronan was able to improve anti-NogoA bioactivity and release.

Spinal cord injury occurs at a rate of 11.5 - 53.4 per million in developed countries with great emotional and financial consequences. The damage caused by the initial injury is followed by secondary damage, a complex cascade of mechanisms including ischemia, oxidative stress, inflammation and apoptosis. Although nothing can be done to reverse the initial damage to the spinal cord once it occurs, the secondary damage can be targeted by therapeutics to improve recovery. Following injury, concentrations of the potent antioxidant glutathione (GSH) are decreased in the spinal cord which potentiates mechanisms of secondary damage. In an attempt to maintain the GSH concentrations, the non-essential amino acid glutamine was tested as it was shown to increase GSH concentrations both in vivo and in vitro. Glutamine is being used extensively in clinical research in an expansive number of physiological and pathological conditions including brain trauma. To examine the therapeutic potential of glutamine after spinal cord trauma, two compression injury models, the modified aneurysm clip and the modified forceps, were used to induce an injury in male Wistar rats. We have demonstrated the ability of glutamine treatment (1 mmol/kg), given 1 hour after a 30 g aneurysm clip injury to increase GSH not only in whole blood samples but within the spinal tissue at the site of injury. Increasing GSH in this way also resulted in improved locomotor scores and maintenance of white matter tissue at the injury epicenter. Experiments using the forceps model were then performed to determine if the potency of glutamine treatment would be carried over to a different model and at a variety of severities. Glutamine, again, demonstrated the ability to improve maintenance of whole blood GSH, locomotor scores and tissue histology. In our experiments, glutamine has proven to be a potent therapeutic for spinal cord injury with an effect that is matched by few compounds currently being studied and well exceeding the standard therapeutic, methylprednisolone. Given the breadth of knowledge regarding the effects of glutamine clinically in numerous paradigms and the potency of the therapeutic effect seen in these studies, we believe that glutamine is fit for clinical trial and has a high potential for success.

Background: Persons who sustain a spinal cord injury (SCI) experience a dramatic loss of muscle and bone, and a dramatic increase in adipose tissue. It has been suggested that the muscle atrophy, obesity, and sublesional osteoporosis (SLOP) that occurs after SCI is due in part to the loss of voluntary control of the skeletal muscles in the lower extremities, impaired energy metabolism below the level of the lesion, and cessation of sufficient mechanical strain on bone. The prevalence of obesity and SLOP after SCI leads to increased cardiovascular disease and fracture risk, respectively. Current body composition screening procedures for the general population fail to identify individuals with SCI who are obese or have SLOP. Muscle contractions provide physiological loads on bone; thereby a muscle-bone relationship is proposed with proportional declines in muscle and bone after SCI. In addition, both positive and negative relationships have been proposed between adipose tissue and bone; increased skeletal load bearing from excess adipose tissue mass may account for the positive associations reported to date. Due to a lack of load bearing activity after SCI, there should be a negative association between adipose tissue and bone. Objectives: The primary objective is to characterize body composition among adults with chronic SCI using valid, reliable, and interpretable measures, and to suggest screening procedures for the detection of obesity and SLOP in this population. The secondary objectives are to explore the associations between: 1) muscle and bone, and 2) adipose tissue and bone. Design and Setting: Cross sectional observational. Population: A sample of 16 individuals (13 men, 3 women) with chronic SCI participated in this study. The neurological level of lesion ranged from C3-T12, with 9 motor complete and 7 incomplete SCI. Average±standard deviation for age was 51.12±12.37 years, and duration of injury 16.5±7.87 years. An additional 29 individuals with chronic SCI were included when exploring the relationship between muscle and bone. Forty-one individuals (31 men, 9 women) were included in this analysis; the neurological level of lesion ranged from C2-T12, with 13 motor complete and 28 incomplete SCI. Average±standard deviation for age was 48.7±13.36 years, and duration of injury 114.22±10.4 years. Methods: Lean tissue, adipose tissue, and bone tissue were measured via surrogates of body adiposity, as well as two different scanning technologies. Lean tissue was assessed via muscle cross sectional area (CSA) (mm2) and muscle density (mg/cm3), and measured using peripheral quantitative computed tomography (pQCT). Adipose tissue was assessed via body mass index (BMI) (kg/m2), waist circumference (WC) (cm), and % body fat, and measured using a floor scale, tape measure, and dual energy x-ray absorptiometry (DXA), respectively. Bone tissue was assessed via hip, distal femur, and proximal tibia areal bone mineral density (aBMD) (g/cm2) using DXA, as well as cortical thickness (mm) and total volumetric bone mineral density (vBMD) (mg/cm3) at the 1/3 proximal tibia, and trabecular vBMD (mg/cm3) and total vBMD (mg/cm3) at the distal tibia using pQCT. The relationships between muscle and bone, and adipose tissue and bone, were determined by correlating muscle CSA with indices of bone strength, and indices of obesity with indices of SLOP, respectively. Results: The majority of participants had lean tissue values below able-bodied norms (67-100%). When using the able-bodied definition of BMI >30 kg/m2, 19% of individuals were obese, whereas 63% and 81% were obese when using SCI-specific definitions of BMI >25 kg/m2 or >22 kg/m2, respectively. One hundred percent of individuals had SLOP using distal femur Z-score, and over 50% were at risk of fracture using distal femur fracture threshold of <0.78 g/cm2. Weak (r=0.42) to moderate (r=0.57) correlations were found between muscle CSA and indices of bone strength, supporting the theory of a muscle-bone unit. No correlations were found between adipose tissue and bone. Conclusions: Based on the cohort data, we propose that individuals with ≥2 risk factors (female, ≥60 years of age, duration of injury (DOI) ≥10, tetraplegia, motor complete) should be screened for obesity using % body fat from DXA as well as a combination of carefully interpreted SCI-specific BMI and WC. In addition, these same individuals should be screened for SLOP using a distal femur Z-score and fracture threshold from DXA. It is clear that due to the prevalence of obesity and SLOP in this population, intervention for prevention or treatment is essential. The presence of a muscle-bone unit indicates that muscle atrophy contributes to a reduction in bone strength; this is clinically important, as muscle strength is potentially amenable to rehabilitation intervention. No correlation was found between adipose tissue and bone. Future work should continue to explore these relationships using appropriate technology.

Background: Persons who sustain a spinal cord injury (SCI) experience a dramatic loss of muscle and bone, and a dramatic increase in adipose tissue. It has been suggested that the muscle atrophy, obesity, and sublesional osteoporosis (SLOP) that occurs after SCI is due in part to the loss of voluntary control of the skeletal muscles in the lower extremities, impaired energy metabolism below the level of the lesion, and cessation of sufficient mechanical strain on bone. The prevalence of obesity and SLOP after SCI leads to increased cardiovascular disease and fracture risk, respectively. Current body composition screening procedures for the general population fail to identify individuals with SCI who are obese or have SLOP. Muscle contractions provide physiological loads on bone; thereby a muscle-bone relationship is proposed with proportional declines in muscle and bone after SCI. In addition, both positive and negative relationships have been proposed between adipose tissue and bone; increased skeletal load bearing from excess adipose tissue mass may account for the positive associations reported to date. Due to a lack of load bearing activity after SCI, there should be a negative association between adipose tissue and bone. Objectives: The primary objective is to characterize body composition among adults with chronic SCI using valid, reliable, and interpretable measures, and to suggest screening procedures for the detection of obesity and SLOP in this population. The secondary objectives are to explore the associations between: 1) muscle and bone, and 2) adipose tissue and bone. Design and Setting: Cross sectional observational. Population: A sample of 16 individuals (13 men, 3 women) with chronic SCI participated in this study. The neurological level of lesion ranged from C3-T12, with 9 motor complete and 7 incomplete SCI. Average±standard deviation for age was 51.12±12.37 years, and duration of injury 16.5±7.87 years. An additional 29 individuals with chronic SCI were included when exploring the relationship between muscle and bone. Forty-one individuals (31 men, 9 women) were included in this analysis; the neurological level of lesion ranged from C2-T12, with 13 motor complete and 28 incomplete SCI. Average±standard deviation for age was 48.7±13.36 years, and duration of injury 114.22±10.4 years. Methods: Lean tissue, adipose tissue, and bone tissue were measured via surrogates of body adiposity, as well as two different scanning technologies. Lean tissue was assessed via muscle cross sectional area (CSA) (mm2) and muscle density (mg/cm3), and measured using peripheral quantitative computed tomography (pQCT). Adipose tissue was assessed via body mass index (BMI) (kg/m2), waist circumference (WC) (cm), and % body fat, and measured using a floor scale, tape measure, and dual energy x-ray absorptiometry (DXA), respectively. Bone tissue was assessed via hip, distal femur, and proximal tibia areal bone mineral density (aBMD) (g/cm2) using DXA, as well as cortical thickness (mm) and total volumetric bone mineral density (vBMD) (mg/cm3) at the 1/3 proximal tibia, and trabecular vBMD (mg/cm3) and total vBMD (mg/cm3) at the distal tibia using pQCT. The relationships between muscle and bone, and adipose tissue and bone, were determined by correlating muscle CSA with indices of bone strength, and indices of obesity with indices of SLOP, respectively. Results: The majority of participants had lean tissue values below able-bodied norms (67-100%). When using the able-bodied definition of BMI >30 kg/m2, 19% of individuals were obese, whereas 63% and 81% were obese when using SCI-specific definitions of BMI >25 kg/m2 or >22 kg/m2, respectively. One hundred percent of individuals had SLOP using distal femur Z-score, and over 50% were at risk of fracture using distal femur fracture threshold of <0.78 g/cm2. Weak (r=0.42) to moderate (r=0.57) correlations were found between muscle CSA and indices of bone strength, supporting the theory of a muscle-bone unit. No correlations were found between adipose tissue and bone. Conclusions: Based on the cohort data, we propose that individuals with ≥2 risk factors (female, ≥60 years of age, duration of injury (DOI) ≥10, tetraplegia, motor complete) should be screened for obesity using % body fat from DXA as well as a combination of carefully interpreted SCI-specific BMI and WC. In addition, these same individuals should be screened for SLOP using a distal femur Z-score and fracture threshold from DXA. It is clear that due to the prevalence of obesity and SLOP in this population, intervention for prevention or treatment is essential. The presence of a muscle-bone unit indicates that muscle atrophy contributes to a reduction in bone strength; this is clinically important, as muscle strength is potentially amenable to rehabilitation intervention. No correlation was found between adipose tissue and bone. Future work should continue to explore these relationships using appropriate technology.

Spinal cord injury occurs at a rate of 11.5 - 53.4 per million in developed countries with great emotional and financial consequences. The damage caused by the initial injury is followed by secondary damage, a complex cascade of mechanisms including ischemia, oxidative stress, inflammation and apoptosis. Although nothing can be done to reverse the initial damage to the spinal cord once it occurs, the secondary damage can be targeted by therapeutics to improve recovery. Following injury, concentrations of the potent antioxidant glutathione (GSH) are decreased in the spinal cord which potentiates mechanisms of secondary damage. In an attempt to maintain the GSH concentrations, the non-essential amino acid glutamine was tested as it was shown to increase GSH concentrations both in vivo and in vitro. Glutamine is being used extensively in clinical research in an expansive number of physiological and pathological conditions including brain trauma. To examine the therapeutic potential of glutamine after spinal cord trauma, two compression injury models, the modified aneurysm clip and the modified forceps, were used to induce an injury in male Wistar rats. We have demonstrated the ability of glutamine treatment (1 mmol/kg), given 1 hour after a 30 g aneurysm clip injury to increase GSH not only in whole blood samples but within the spinal tissue at the site of injury. Increasing GSH in this way also resulted in improved locomotor scores and maintenance of white matter tissue at the injury epicenter. Experiments using the forceps model were then performed to determine if the potency of glutamine treatment would be carried over to a different model and at a variety of severities. Glutamine, again, demonstrated the ability to improve maintenance of whole blood GSH, locomotor scores and tissue histology. In our experiments, glutamine has proven to be a potent therapeutic for spinal cord injury with an effect that is matched by few compounds currently being studied and well exceeding the standard therapeutic, methylprednisolone. Given the breadth of knowledge regarding the effects of glutamine clinically in numerous paradigms and the potency of the therapeutic effect seen in these studies, we believe that glutamine is fit for clinical trial and has a high potential for success.