Spinal cord injury (SCI) results in a complex spectrum of impairments in the central, peripheral, and autonomic nervous system. Concurrent with SCI onset, there are declines in lean mass and bone mass that are associated with an increase in visceral and intramuscular fat mass. Consequently, the observed changes in body composition combine to have devastating effects on the individual’s health, resulting in an increase in the frequency and severity of a variety of secondary health conditions, including: fracture, diabetes and heart disease which in turn, adversely impacts their psychological well-being, community participation, morbidity and mortality. Historically, SCI research has been done in silos with scientists frequently having extensive experience in evaluating a single organ system, a single secondary health conditions and applying this expertise to a single portion of the care continuum of care (i.e. injury onset, prehospital care, transfer to a level I trauma center for definitive operative intervention, transfer and admission for tertiary inpatient rehabilitation, transition to outpatient rehabilitation services and living in a community setting).
The SCI Rehabilitation Translational Continuum Team (ReCon Team) was formed to address 1) the major gaps between clinical application of research conducted in a animal or human laboratory setting; and, 2) the lack of consensus on methodologies and outcomes to studies the interactions between muscle, bone, fat and the central and peripheral nervous system in SCI rehabilitation research. The ReCon team is a unique inter-provincial and international team committed to addressing the need for knowledge exchange across the translational spectrum and the joint understanding of how bone, muscle and the nervous system interact to influence rehabilitation outcomes and inform future service delivery models for individuals with SCI over the course of their lifetime.
Systematic Reviews
Through a series of in-person and online meetings, the ReCon team has identified three important gaps in our knowledge with respect to how and when to: use bone biomarkers, assess of muscle health and understand changes in the peripheral nervous system that are distinct from the central nervous system a after SCI. Three themes related to SCI rehabilitation were identified: biomarkers for bone health, muscle imaging modalities, and the clinometric properties of neurophysiological outcomes, all three working groups chose to evaluate the proposed questions jointly in animal and human models after SCI, using systematic reviews with scoping synthesis methodology. Three methodological team leads were identified for each systematic systematic search and scoping synthesis. The working group leads were responsible for organizing their team’s activities and selecting the primary question which was the focus for each systematic review/scoping synthesis papers.
White Paper
The first ReCon white paper is intended for funding agencies (funding opportunities), clinicians (multi-system interactions and government (economic costs) to increase their awareness regarding the need to support translational research initiatives. During the ReCon August 2018 meeting, the team have identified several issues that will need to be addressed in the reconceptualized model of SCI to promote the translational success of pre-clinical research findings.
The ReCon team is moving towards multi-center research efforts designed to tackle important questions that will directly challenge and change the standard of care for individuals with acute and chronic SCI. Further, the team now recognizes that the funding options for these endeavours are extremely limited and that research focused on musculoskeletal-central nervous system interactions during rehabilitation are potentially under-represented relative to its importance to individuals with SCI, their caregivers and health care providers.