Improving care for spinal cord compression

In the latest round of CIHR Project Grant funding announced in January, Dr. Neil Duggal from the Department of Clinical Neurological Sciences and Robert Bartha, PhD, a Robarts Scientist and Professor in Medical Biophysics, were awarded funding for their project entitled, “The Role of Neural Plasticity in Rehabilitation for Reversible Spinal Cord Compression in Elderly Patients.”

We spoke to Dr. Duggal about spinal cord compression and how a home-based rehabilitation program may help future patients improve their symptoms more quickly.

How common is spinal cord compression in older adults and why does it occur?

More than half of middle-aged adults show evidence of degenerative changes in the neck (the cervical spine) related to the general wear and tear that comes with age. Estimates suggest as many as one in 10 people will have evidence of spinal problems related to degeneration. In more advanced cases, these changes can compress and injure the spinal cord, causing a condition called cervical myelopathy. A person with cervical myelopathy will show a variety of symptoms, but it is the loss of hand dexterity, which can range from mild to very severe, that has the most significant impact on a patient’s quality of life.

Degenerative spinal cord compression is an overlooked, progressive spinal affliction that is the most common cause of spinal cord injury in adults, worldwide. With the aging of the global population, new cost-effective solutions are required to improve clinical outcomes for an increasing number of patients with varying stages of disability.

What are you investigating about spinal cord compression in this current research project?

Cervical myelopathy is treated using surgery that decompresses the spine, with the goal of preventing the patient’s symptoms from getting worse. While some patients will show improvements, many do not. Thousands of Canadians undergo spinal decompression surgery each year, and the majority only experience partial recovery of hand dexterity and are left with long-term disabilities. But surprisingly, there are currently no therapeutic strategies available to aid recovery of hand function post-surgery.

This research project is seeking to fill this gap in clinical care by investigating a home-based rehabilitation program that focuses on improving hand dexterity. The rehabilitation program will use a dexterity kit specially designed by our research group for patients with cervical myelopathy. The patient will be able to take the kit home and go through the required activities without having to make extra trips to the hospital. We hope to show that simple dexterity rehabilitation following surgery can accelerate recovery. Alongside this therapeutic intervention, we are also mapping the brains of participants who receive the focussed hand rehabilitation in order to understand the role of brain plasticity in recovery and rehabilitation.

Why are clinical and basic science collaborations so important?

Innovation is possible when clinicians and scientists team up to answer these important questions. I have been fortunate to have had a great collaboration with Dr. Bartha for over a decade. I came to him with a clinical problem after realizing that clinicians were only looking at the spinal cord when evaluating spinal compression. Dr. Bartha and I hypothesized that through advanced imaging, we could also look at the brain to better understand symptoms, recovery and rehabilitation.

None of this would have been possible without this collaboration. I really believe that innovation happens at the intersection of clinical and basic science, when you have the right team and can rethink a problem in a different way.

What do you hope the outcomes of this project might mean for patient care in the future?

The overall goal of our project is to test a novel, low-cost, take-home rehabilitation program specifically designed to increase manual dexterity in patients with spinal cord compression.

Enhancing recovery of hand function post-surgery continues to be a major unmet clinical need, and we hope the results from this project will help to establish a standardized rehabilitation guideline for patients. In addition, because this project is investigating a home-based rehabilitation program, it has the potential to significantly improve access to care for those who, due to lack of health insurance or an inability to afford private care, rely on the public system for rehabilitation services, where wait times continue to be an issue.

Why is funding for clinical research like this so important?

Clinical research helps to advance patient care by exploring novel treatment options. Projects of this size would not be possible without funding from organizations like CIHR. Funding clinical research is critical to improving the health and quality of life of individuals. The development of innovative solutions, for common clinical problems, requires years of research and funding to bring a change treatment paradigms.