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Release: Dec. 15, 2000

UI physical therapy researcher receives $529,000 NIH grant

IOWA CITY, Iowa -- A spinal cord injury causes dramatic changes in the bones, muscles and nervous system below the point of injury. The weight bearing bones in the leg become osteoporotic (less dense and more brittle) and the muscles undergo a mass transformation into "fast-twitch" muscles, which means they fatigue easily. The nervous system, denied its normal input from the brain, undergoes reorganization leading to spasms from overactive spinal reflexes.

University of Iowa Health Care researcher Richard K. Shields, Ph.D., associate professor in the UI Graduate Program in Physical Therapy, has received a four-year, $529,000 grant from the National Institutes of Health to investigate ways of preventing these damaging changes to the neuromusculoskeletal system after spinal cord injury.

"This research emanates from the understanding that even if there were a cure for spinal cord injury today, most individuals in wheelchairs would not be able to take advantage of the cure," Shields said. "The substantial changes to their bones, muscles and spinal reflexes would make them very poor candidates to take advantage of any future advances."

In addition to being very difficult to reverse, bone and muscle degeneration after spinal cord injury is very rapid. In the course of a year, the bones become highly osteoporotic and the muscles have transformed. Preliminary results from Shields' work suggest that early rehabilitation techniques after the injury can maintain the normal properties of the muscles, bones, and spinal reflexes.

The protocol developed by Shields involves electrically stimulating the muscles and exerting load through the skeletal system, which mimics normal weight bearing actions.

"Our protocol starts shortly after the injury, and may represent a paradigm shift in rehabilitation," Shields said. "Instead of focusing only on the non-paralyzed extremities, perhaps rehabilitation in the 21st century will embark on also sustaining the muscle, bone, and reflex systems of the paralyzed extremities as well."

"This will be an increasingly important approach as it appears that other scientists may be moving toward possible ways to cure the damaged spinal cord," he added.

However, even if a cure for spinal cord injuries is not developed in the near future, Shields hopes to show that his methods to sustain the overall health of the paralyzed extremities in these patients will improve their quality of life today.

"For patients who develop osteoporosis after a spinal cord injury, something as simple as putting on a shoe creates a risk of fracturing a bone. But if bone health is maintained, the risk of these pathological fractures is reduced," Shields said. "Also, by maintaining normal spinal reflexes and healthy musculature, the incidence and severity of muscle spasms may be reduced."

Shields' work may also have implications for the space program. The damage to the bones and muscles caused by spinal cord injury mimics the changes that occur in bones and muscles due to weightlessness in space.

"The results of our work could potentially be of use in combating the problems of osteoporosis and muscle transformation associated with long-term space living," Shields said.

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