The doctors and researchers of the University Clinic of Neurology are engaged in the following activities at the Spinal Cord Injury and Tissue Regeneration Center:
Early neurorehabilitation in paraplegia
Paraplegia is the consequence of a spinal cord injury. It is frequently caused by an accident, but also by tumors, inflammations, circulatory disorders, or other diseases. The loss of motor, sensory, and autonomic functions is usually accompanied by other disorders that require concomitant treatment.
The acute phase of a spinal injury (spinal shock) lasts several weeks or months. This is the decisive period for determining which options are available for regenerating the initially lost functions.
At the University Clinic of Neurology, we treat SCI patients during this initial period, after they have been transferred from the respective specialty or intensive care division to the Early Neurorehabilitation Division for acute aftercare. The treatment during the acute phase demands a precise coordination among various specialists such as doctors, nurses, physio- and ergo-therapists, speech therapists, psychologists, and dieticians. The outcome of early rehabilitation forms the foundation for further rehabilitation in specialty clinics.
The care process
The nursing staff is in many respects the first point of contact for all patient concerns. For example, the psychological counseling always offered to patients and their families is usually refused, although psychological processing is an essential component of care. Thanks to the "Care Process for Paraplegic Patients" project, the nursing team of the Early Neurorehabilitation Division is prepared to provide optimum, state of the art nursing care. The psychosocial aspects and signs of the different processing stages are recognized and appropriate interventions are then implemented. One of the outcomes of the project work is a code of practice for the care of paraplegic patients. This code of practice ensures a harmonized approach and coordinates the interdisciplinary collaboration of all professional groups involved.
Neuroplasticity: Requirements for neurorehabilitation
A spinal injury has a serious impact on the patient’s life. Nerve pathways in the spinal column are wholly or partially severed, usually as the result of an accident. Depending on the extent of the damage, the limbs below the spinal injury (i.e., arms and legs or just the legs) are partially or even completely paralyzed. However, the flow of information from the limbs to the brain is also impaired. For instance, in addition to impaired touch, heat, and cold perception, there is no sensory feedback from the limbs regarding their spatial position. The brain also reacts to the lacking information flow. The synapses (connections between the neurons) degenerate in those regions of the brain that formerly controlled feeling and movement in the limbs affected. The neurons themselves are no longer under the usual tension, as they are no longer being sufficiently stimulated. "Neuroplasticity" is the collective term for all of these changes (the conversion and breakdown processes induced by the loss of information flow to and from the paralyzed limbs).
We at the University Clinic of Neurology are dedicated to the in-depth study of these reorganization processes. To this end, we employ various methods such as high-resolution electroencephalography (EEG), in which the brain’s electric signals are measured on the surface of the head. We also use functional magnetic resonance imaging (fMRI) to study the activation of different brain regions while performing certain tasks. The findings thus obtained serve as the basis for further research on modifying the aforementioned neuroplastic changes. One of the techniques we use is transcranial magnetic stimulation (TMS), in which strong magnetic impulses are applied to the surface of the head. With TMS, the electrical activity in the brain can be influenced briefly (a few seconds). The objective is to determine whether it is possible to achieve long-term positive effects in this manner.
