We’d Like to Bounce Something Off You…

In 1945, George Nissen, a competitive gymnast, patented the modern trampoline as a “tumbling device. Initially intended as a training tool for acrobats and gymnasts it was subsequently used for military aviator training.

More recently, at least if my neighborhood backyards are anything to go by, the main use of trampolines, is recreational. Driven perhaps, by parents concerns that their kids are becoming more sedentary, along with a family-friendly price tag, it seems there are few family gardens in suburban Northern America that don’t have a trampoline

All this despite the fact that the American Academy of Pediatrics and other lofty medical organizations such as the American Academy of Orthopedic Surgeons, the Canadian Pediatric Society and the Canadian Academy of Sports Medicine have issued guidelines discouraging the use of trampolines in homes and playgrounds..

In fact, with each new set of guidelines comes an increase in the numbers of trampolines in the home setting.

And an increase in injuries…

In 2009, the rate of trampoline-associated injuries was 160 per 100,000 among 5-14 year olds. And approximately 75% of these injuries occurred when more than one person was on the trampoline at the same time.

The most common site of trampoline injury, is the lower leg accounting for 34% – 50% of injuries and >60% involved the ankle,  Upper extremities are injured in 24% – 36% of cases. Most commonly, when people fall off the trampoline. Of these, approximately 60% are fractures.

Head and Neck Injuries account for 10% to 17% of all trampoline-related injuries and 0.5% of these, result in permanent neurologic damage.

And before, you succumb to your precious little angel’s demands, or are tempted by fall yard sale trampoline bargains you may also want to consider the following:

  • The potential for severe and devastating injury is high.
  • Enclosures and padding may provide a false sense of security and do not prevent the large numbers of injuries that occur on the trampoline mat itself.
  • Many injuries occur even with reported adult supervision.
  • Multiple jumpers increase injury risk, particularly to the smallest participants; so trampoline use should be restricted to a single jumper at any given time
  • Individuals 5 years and younger appear to be at increased risk of fractures and dislocations from trampoline-related injuries.
  • Somersaulting, flipping, and falls put jumpers at increased risk of head and cervical spine injury with potentially permanent and devastating consequences. These maneuvers should not be performed in the recreational setting.
  • Active supervision by adults familiar with the above recommendations should occur at all times. Mere presence of an adult is not sufficient.

Have you got a trampoline story to tell? SRxA’s Word on Health is looking forward to hearing from you.

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Diabetes Drug may Repair Injured Brains

Here’s a good brain teaser for a Wednesday.  What do an old diabetes drug, brain injury and Alzheimer’s Disease have in common?

Here’s some clues to help you solve the riddle.

(i)           Metformin is a widely used treatment for type II diabetes

(ii)          An increasing proportion of people with Alzheimer’s Disease also have diabetes

(iii)         Hyperinsulinemia (excess levels of insulin in the blood) may enhance the onset and progression of neurodegeneration

Have you solved it?  If so, congratulations!

If not, the answer, according to data just published in the journal Cell Stem Cell is that the former may hold the clue to treating the latter.

In other words, the study suggests that metformin, an anti-diabetes drug first discovered in the 1920’s, is able to help activate the mechanism that signals stem cells to generate brain cells.

Principal investigator, Freda Miller, a Professor from the Department of Molecular Genetics at the University of Toronto
says “If you could take stem cells that normally reside in our brains and somehow use drugs to recruit them into becoming appropriate neural cell types, then you may be able to promote repair and recovery in at least some of the many brain disorders and injuries for which we currently have no treatment.”

The research involved laboratory experiments using both mouse and human brain stem cells, as well as learning and memory tests performed on live mice given the drug.

Miller and her colleagues started by adding metformin to stem cells from the brains of mice, then repeated the experiment with human brain stem cells generated in the lab. In both cases, the stem cells gave rise to new brain cells.

They then tested the drug in lab mice and found that those given daily doses of metformin for two or three weeks had increased brain cell growth and outperformed rodents not given the drug in learning and memory tasks.

In the key experiment, mice were forced to learn the position of a platform hidden under the surface of a water-filled maze and then asked rapidly to learn a new position.

Mice were injected with either metformin or saline for 38 days. On days 22 through 38, they learned the initial position of the platform, which provided an escape from the water-filled maze.  Then the platform was moved to the opposite side of the maze, and the animals were asked again to learn its position. In both tasks, the mice learned the platform positions with equivalent speed.

But when they were put back in the maze – this time with the platform removed – control mice spent more time searching for it in the original position, while the metformin-treated animals preferentially looked in the new region.

The implication  is that metformin helped the mice form their new memories of the second platform position. Further analysis showed that their enhanced ability was paralleled by an increase in the number of  neurons.

In a separate study researchers have shown that metformin can increase lifespan and delay the onset of cognitive impairment in a mouse model of Huntington’s disease.

Taken together, these findings raise the possibility that metformin’s ability to enhance neurogenesis might have a positive impact in some nervous system disorders.

Miller’s team is already planning a pilot study to test metformin in young patients with acquired brain damage, either as result of treating a childhood brain tumor or from a traumatic head injury.

We will report back to you with results, as they are published.

Botox, Brotox & Bladders

When someone mentions Botox injections, you probably think of Hollywood actresses with too perfect faces or wealthy housewives desperately trying to turn back time. Yes, we know it’s becoming more main stream, so maybe you’re also thinking about your own appointment for “shots” or maybe even “BroTox”. What we’re pretty sure you’re not thinking about is – incontinence. However, that’s exactly its newest use. Recently, the FDA approved using the injections to help patients with neurological conditions (such as multiple sclerosis or spinal cord injury) who suffer from either incontinence, or an overactive bladder. Neurologic conditions can cause miscommunication between the bladder and the brain.  As a result, the bladder muscle can become overactive, increasing the pressure in the bladder and decreasing the volume of urine the bladder can hold. This can lead to frequent, unexpected urine leakage, or urinary incontinence. Botox works by paralyzing bladder muscles, thus preventing the contractions that cause urgency or leakage. Although medications and behavioral modifications are treatment options, many patients, especially the elderly, do not respond to these methods and need a more aggressive approach. “About 80 percent of patients with neurological conditions, such as spinal cord injuries, Parkinson’s disease and multiple sclerosis, see improvement after about a week, and the results can last four to nine months,” says Charles Nager, MD, co-director of the UC San Diego Women’s Pelvic Medicine Center at UC San Diego Health System. Incontinence is the seventh condition, including chronic migraines, upper limb spasticity and underarm sweating, that Botox has been approved to treat since it first arrived on the market in 2002. The outpatient procedure uses a local numbing gel, followed by 15 -20 injections in different areas of the bladder muscle. “It can really be life changing for someone with severe incontinence issues,” said Nager. Want to share your Botox stories with SRxA’s Word on Health?  We’d love to hear from you.

Spinal Cord Injury therapy – one small step closer

Back in August 2010, Word on Health brought you news that the FDA had given the green light for a stem cell therapy trial.

Given the enormous ethical and regulatory hurdles surrounding this controversial topic, we take our hats off to Geron Corporation who, on Monday, announced the enrolment of the first patient.

The primary objective of the Phase I study is to assess the safety and tolerability of the stem-cell therapy GRNOPC1 in patients with recent thoracic spinal cord injuries. The therapy is injected directly into the injured area and is hoped to restore spinal-cord function by triggering the production of myelin-producing cells, potentially allowing for new movement.

Spinal Cord Injury is caused by trauma to the spinal cord that results in loss of functions such as movement, sensation and bowel or bladder control. Every year approximately 12,000 people in the U.S. sustain spinal cord injuries. The most common causes are automobile accidents, falls, gunshot wounds and sports injuries.

The initiation of this Phase I study is thought to represent the first publicly known use of embryonic stem cells in humans.

According to Geron’s President and CEO, Thomas B. Okarma, Ph.D., M.D. “Initiating the GRNOPC1 clinical trial is a milestone for the field of human embryonic stem cell-based therapies. When we started working on this in 1999, many predicted that it would be a number of decades before a cell therapy would be approved for human clinical trials.”

In order to participate in the study, patients must be newly injured and receive the therapy within 14 days of the injury. The company has said it plans to enroll between eight and 10 patients in the US.

The trial is expected to take about two years to complete. Word on Health will be watching closely and will bring you further news as it breaks.  In the meantime we’d love to hear from you about your thoughts on this.

A giant step for mankind?

SRxA’s Word on Health was excited to learn that the FDA has finally given the all-clear to test embryonic stem cells as a potential treatment for spinal cord injury.

Geron Corp. who has invested 15 years of research and over $150 million to develop the treatment, finally hopes to start human testing by year-end.   The stem cell therapy known as GRNOPC1 contains cells called oligodendrocyte progenitor cells. Those progenitor cells turn into oligodendrocytes, a type of cell that produces myelin, a coating that allows impulses to move along nerves. When those cells are lost due to injury, paralysis can follow. If GRNOPC1 works, the progenitor cells will produce new oligodendrocytes in the injured area of the patient’s spine, potentially allowing for new movement.

The therapy will be injected into the patient’s spine 1-2 weeks after the patients suffer an injury between their third and tenth thoracic vertebrae, or roughly the middle to upper back. The company plans to enroll 8-10 patients across the U.S.  Each patient will be studied for one year and monitored for a further 15 years. A successful outcome would lead to larger and longer studies of GRNOPC1. Later trials would include patients with less severe spinal injuries and damage to other parts of the spine

Doctors are euphoric. Professor Richard Fessler,  MD, a neurological surgeon at Northwestern University says it may be possible to completely restore a patient’s motor functions.    “It would be revolutionary. The therapy would provide a viable treatment option for thousands of patients who suffer severe spinal cord injuries each year.”

While this study may come too late for many high profile campaigners, including “Superman” and a former first lady, it has the promise of being a step in the right direction.

In the words of Nancy Reagan, “Countless people suffering from many different diseases, stand to benefit from the answers stem cell research can provide. As I’ve said before, time is short and life is precious.”

Right or wrong?  Word on Health looks forward to hearing from you.

Recovery from Spinal Cord Injury – one small step for rats.

Once damaged, nerves in the spinal cord normally cannot grow back, so, as we all know, the patient becomes paralyzed below the area of injury and long-term morbidity results.

Word on Health was therefore cautiously optimistic after reading a new  study published last week in the Early Edition of the Proceedings of the National Academy of Sciences. The pre-clinical data showed that treating injured rat spinal cords with the enzyme – sialidase, improved nerve regrowth, motor recovery and nervous system function.

Sialidase is a bacterial enzyme that removes specific chemical groups found on the surface of nerve cells. The chemical groups normally function to stabilize the cells, but also act to prevent nerve regeneration.

The research team from Johns Hopkins treated rats with lower-back impact injury — severe enough to lose hind-limb function. The rats were injected with sialidase directly over the spinal cord immediately following injury. The researchers then implanted a small intrathecal pump that delivered a steady stream of sialidase directly to the injury over the course of two weeks.  Their hope was that bathing the injured nerves in the enzyme would help their recovery and promote regrowth. They then let the rats recover for another three weeks before assessing the degree of recovery.

Using a well-established, 21-point scale where zero represents paralysis and 21 is normal function, the team of researchers assessed both treated and untreated rats for a range of functions including whether they could lift their feet off the ground and whether they had coordinated leg movements.

The initial injury rendered all rats to score below four, and all rats, treated or not, recovered somewhat by the end of two weeks. By the end of five weeks after injury most untreated rats scored 12 or less, while most treated rats scored better than 15. According to Ronald Schnaar a professor of pharmacology and molecular sciences at Johns Hopkins,  “The difference in coordination control was most remarkable.”

In addition to motor control, spinal cord injury can cause other nervous system problems, including losing the ability to control blood pressure and heart rate. Researchers found that treated animals improved blood pressure control, something they interpreted as improved communication in the spinal cord.  Finally, the team looked at the nerve ends under a microscope and found that treated nerves showed an increased number of “sprouted” nerve ends.

While the data appears promising, as always, we caution that efficacy in animals also doesn’t necessarily translate to humans. Furthermore, it will be a long road to using this as a drug in people. Nevertheless it is a step in the right direction.