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CHAPTER 1 2010). This inconsistency is likely due to an incomplete understanding of the cellular mechanism and variability in injured individuals in terms of injury severity and complications. 1.1.2.2 Pharmaceutical interventions A cocktail of different pharmaceutics is typically prescribed due to the complexity of spinal cord injury. These drugs address autonomic dysfunction, spasticity, pain, and depression. In patients with cervical or higher thoracic injuries, drugs controlling the heart rate and blood pressure are often used to treat any dysfunction in the autonomic nervous system. Muscle relaxant and anti-spastic drugs might be given to patients suffering from muscle spasms. Patients who experience pain are often given NSAIDS, narcotics, anti-depressants, and gabapentin. While medications for autonomic dysreflexia, spasticity, and depression are rather effective, pain-related drugs lack efficacy, especially in the case of neuropathic pain. To date, there is only one drug being prescribed in clinical practice to provide neuroprotection and improve functional recovery (Ahuja and Fehlings, 2016); this synthetic glucocorticoid, called methylprednisolone (MP), was first used in the 1970s but still attracts controversy. MP was found to reduce lipid peroxidation and enhance neuronal survival (Fehlings et al., 2014). The first multicentre, double-blind, randomised clinical trial, carried out almost four decades ago, showed no significance difference between MP and control groups in motor and sensory function at 6 weeks and 6 months post-injury (Bracken et al., 1984). It was later suggested that the dose of MP administered in the study was not high enough, which led to a second clinical trial. The same group then reported, 6 years after the first trial, that patients who had received MP within 8 hours had significantly better motor function than the control group (Bracken et al., 1990). This trial, together with the third trial, made MP to be the most commonly prescribed medicine despite its consistent adverse effects, such as increased wound infection and gastrointestinal bleeding (Chappell, 2002). However, in 2013, the use of MP began to be discouraged as new investigations began into its therapeutic and adverse effects (Hurlbert et al., 2013). Currently, other drugs that act on some of the cellular changes are in preclinical and clinical trials, which will be addressed under ‘Molecular therapy’ in Section 1.1.2.4. 1.1.2.3 Rehabilitation Since there is no ‘cure’ for spinal cord injury, the main purpose of rehabilitation is to regain muscle strength and promote neuromuscular plasticity. Physical therapy includes a variety of activities which commences days or weeks following the injury (reviewed in Harvey, 2016). The main purpose of physical therapy is to strengthen muscles that are still innervated and maximise independence with tasks such as bed mobility, wheelchair, and transfers (Taylor-Schroeder et al., 2011). Locomotor training, mainly on a treadmill, could be assisted with braces, robotics, and functional electrical stimulations of certain muscles (Mehrholz et al., 2012). Both physical training and functional electrical stimulation have been shown to partially restore motor function 14PDF Image | Effects of Red Light Treatment on Spinal Cord Injury
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