This review provides a concise outline of the advances made in the care of patients and to the quality of life after a traumatic spinal cord injury (SCI) over the last century. Despite these improvements reversal of the neurological injury is not yet possible. Instead, current treatment is limited to providing symptomatic relief, avoiding secondary insults and preventing additional sequelae. However, with an ever-advancing technology and deeper understanding of the damaged spinal cord, this appears increasingly conceivable. A brief synopsis of the most prominent challenges facing both clinicians and research scientists in developing functional treatments for a progressively complex injury are presented. Moreover, the multiple mechanisms by which damage propagates many months after the original injury requires a multifaceted approach to ameliorate the human spinal cord. We discuss potential methods to protect the spinal cord from damage, and to manipulate the inherent inhibition of the spinal cord to regeneration and repair. Although acute and chronic SCI share common final pathways resulting in cell death and neurological deficits, the underlying putative mechanisms of chronic SCI and the treatments are not covered in this review.

Modern athletes are constantly susceptible to performance-threatening injury as they push their bodies to greater limits and endure higher physical stresses. Loss of performance and training time can adversely and permanently affect a sportsperson’s career. Now more than ever with advancing medical technology the answer may lie in biologic therapy. We have been using peripheral blood stem cells (PBSC) clinically and have been able to demonstrate that stem cells differentiate into target cells to enable regenerative repair. The potential of this technique as a regenerative agent can be seen in three broad applications: 1) articular cartilage, 2) bone and 3) soft tissue. This article highlights the successful cases, among many, in all three of these applications.

Introduction. In the US over half a million people are prescribed crutches each year. More than 750,000 wheelchair users exist in the UK and wheelchair and crutch users commonly develop shoulder pathology. The purpose of this study was to determine the influence of complex topographies on heart rate (HR) and thus energy expenditure, using a wheelchair and differing crutch designs on the exertional body stress. Method. Two Paralympics Athletes from the GB amputee football squad were assessed in a Lomax Active wheelchair and 5 different types of crutches in a randomly allocated order over a course representing everyday complex terrains at the Pedestrian Accessibility and Movement Environment Laboratory (PAMELA), University College London. In addition results were compared over the same course with the athletes using their own personal pair of crutches. The PAMELA course consisted of a mixture of 4% and 2.5% cross falls (transverse) and a simulated road crossing, sprint, slalom and a slow straight. Results. Initial findings show both athletes needed to work harder, thus spend more energy (13% more) to cope with the wheelchair tasks (2.6) than with the crutches(2.3). The Total Heart Beat Index (THBI) revealed that trying to ambulate with the crutches was more difficult in 4% cross fall (3.3) than on the longitudinal slopes (3.2), followed by 2.5% cross fall (2.85), slalom (2.1) and sprint (1.8). For the same tasks executed using a wheelchair the 2.5% gradient was shown to be the higher energy demanding (3.8), followed by the 4% (3.5), slopes (2.9), slalom (2.2) and sprint (2.1). Both participants reached a lower THBI (2.2) during the same task when using their own crutches. Conclusion. The results of this study imply that ambulation with crutches puts less burden than wheelchair. This might be due to the time these athletes spend with crutches, either in training or activities of daily living. Furthermore, the physical strain which they underwent during the complex terrains was clearly reflected on their heart rate. The setting of longer distances to collect more consistent HR data should be the focus of further research. The comparison in performance between athletes and the general population should also be investigated