NSW Minister Hazzard and Treasurer Perrottet announce the successful applications for the NSW Government’s $15m investment in SCI research.

NSW Minister Hazzard and Treasurer Perrottet announce the successful applications for the NSW Government’s $15m investment in SCI research.

Minister Hazzard and Treasurer Perrottet at NeuRA
Back L to R: Minister for Health Brad Hazzard; Prof Peter Schofield, Director, NeuRA; Treasurer Dominic Perrottet; Prof Simon Gandevia; Dr Euan McCaughey. Seated: Duncan Wallace, CEO SpinalCure.

SpinalCure was pleased to initiate and work with the NSW Government to establish this $15million grant round. Fifteen applications were received by the NSW Office of Health and Medical Research and assessed by an international panel of SCI researchers. The projects selected for funding by this panel were announced today by the Minister for Health, Brad Hazzard and NSW Treasurer, Dominic Perrottet at a media event in the new Spinal Cord Injury Research Centre at NeuRA in Sydney.

After being welcomed to the Centre by Prof Peter Schofield, Director of NeuRA, the Treasurer and Minister spoke to full house of TV and press reporters about spinal cord injury and their hopes for the funding. Minister Hazzard brought SpinalCure CEO Duncan Wallace up to the microphones for an impromptu speech, giving him the opportunity to speak of the value of investing in cure-related research to address the enormous human and economic cost of SCI.

Dr Euan McCaughey, assisted by Steven Ralph who lives with C5 quadriplegia, then demonstrated the use of functional electrical stimulation — the technology utilised in Dr McCaughey’s clinical project which aims to improve respiratory function in quadriplegics.

We are pleased that three projects which focus on restoring function have been funded. These seek to improve outcomes by using the spinal cord’s innate ability to rewire itself (a process known as neuroplasticity) to re-establish communication between brain and body. Professor Lisa Harvey’s clinical trial will quantify the effects of intensive exercise soon after injury while Prof Sylvia Gustin at UNSW/NeuRA hopes to restore the sensation of touch to incomplete paraplegics by using virtual reality treatments to stimulate neuroplasticity. The third project is an intriguing clinical study headed by NeuRA’s Prof Jane Butler, exploring the ability of intermittent hypoxia (i.e. periods of low oxygen levels) to improve outcomes in both newly injured people and those with chronic (long term) injuries.

Treasurer Perrottet at NeuRA
NSW Treasurer Dominic Perrottet speaks on his hopes for the $15m NSW SCI research grants.

The remaining four successful applications aim to improve treatments for common issues that make living with a spinal cord injury so unrelenting. These include a study hoping to develop an ‘early warning system’ for the urinary tract infections that plague catheter users and an analysis of the effectiveness of CBD oil to lessen the constant neuropathic pain experienced by so many spinal injured people. NeuRA’s Dr Euan McCaughey will receive funding to develop a treatment that improves breathing and bowel function in quadriplegics through “Abdominal Functional Electrical Stimulation”. We hope these research studies will result in improved health and quality of life for people living with a spinal cord injury while further steps are taken towards a cure.

SpinalCure continues to believe that the focus of funding should shift to cure-related projects—research that seeks to repair the damaged cord and restore communication between brain and body. Emerging treatments like neurostimulation show that spinal cord injuries can be repaired— that it’s only a matter of time before a cure is found. Even partial return of body control and autonomic function offers enormous improvements in a patient’s health, independence and quality-of-life, mitigating the need for stop-gap research which seeks to address only the secondary ramifications of a damaged spinal cord. Further, restoration of function promises to reduce the huge $2.5bn annual cost of SCI to the Australian economy.

As part of our firm commitment to find a cure for paralysis, SpinalCure is proud to have helped establish the new SCI Research Centre at NeuRA. We are delighted to see much of the funded research being based there. Two of the projects are led by members of the team conducting the neurostimulation clinical trial which SpinalCure and NeuRA have collaboratively established.

This $15million investment in spinal cord injury research by the NSW Government has been a valuable step in addressing the enormous human and financial costs of spinal cord injury. SpinalCure will continue to work with State and Federal Governments to highlight the practicality of cure-related research like NeuRA’s neurostimulation trial. SpinalCure and its NZ partners CatWalk will continue to raise funds to support this groundbreaking work.

We are overwhelmed at all the press coverage following yesterday’s $15M grant announcement. We are pleased that so many major outlets have picked up this story and presented to their audiences. However some of the media reports have confused two technologies:

At the event Dr Euan McCaughey demonstrated how surface electrodes can be used to activate muscles causing Steven Ralph’s hand to close. Dr McCaughey has received a grant to develop a treatment using this simple technology to improve breathing, coughing and bowel function in quadriplegics like Steven.

In contrast the neurostimulation work at NeuRA involves applying electrical currents to the spinal cord to give a person back voluntary control of muscles and restore autonomic functions.

Funding permitting we hope to have initial spinal neurostimulation treatments available in as little as five years which will likely make a profound difference in people’s lives. A comprehensive cure is on the horizon, but will likely take longer and be subject to further cure-related research funding.

Media articles

Securing this funding was a huge team effort led by our COO, Kathryn Borkovic and would not have been possible without the help of key SpinalCure supporters. In particular we’d like to thank Kerri-Anne Kennerley and our Patron Sandra Sully for their invaluable assistance and the Neilson Foundation for their vision and support.

The complete list of projects funded by the NSW Government $15m investment follows:

Professor Luke Henderson
University of Sydney

Mechanisms underlying chronic pain following spinal cord injury

Approximately half of all spinal cord injury patients develop chronic pain. Current treatments for this pain have proven to be largely ineffective and many have signficant side-effects.

The aim of this study is to extend the current understanding of the causes of spinal cord injury pain with a focus on changes in the functioning of specialised brain cells (astrocytes) in causing the pain. The investigators will use modern brain imaging techniques to determine the underlying brain changes responsible for spinal cord injury pain and to examine whether a novel non-intoxicating component on the cannabis plant called cannabidiol (CBD) can normalise brain function leading to reduced pain. In addition, they hope to identify a biomarker in brain activity that will predict whether an individual will respond to CBD treatment, easing suffering, saving time and reducing cost.

In the short term, the study will determine the efficacy of a CBD on pain in individuals with spinal cord injury pain, which will directly affect healthcare delivery. In the medium term the study aims to determine the mechanisms responsible for neuropathic pain which will underpin the development of treatments to cure spinal cord injury pain and potentially many other chronic pain conditions. The ultimate goal of the research is to find an effective cure for chronic pain amongst SCI patients.

Professor Ashley Craig
University of Sydney, Kolling Institute, RNSH

A novel neuro-cardiac self-regulation therapy to improve autonomic and neural function after SCI: Clinical trials and translation to implementation

Spinal cord injury (SCI) is a devastating injury that results in paralysis to the spinal cord and very signficiant problems such as highly unstable blood pressure and alterned nervous system control. This can be life threatening, reducing the person’s quality of life and life expectancy. While there has been an important focus on trying to restore voluntary physical function, such as mobility, little attention has been given to the control of vital involuntary or automatic functions of the body, such as blood pressure, heart rate and breathing. This research project will focus on an approach that trains the person to restore physical function by learning how to self-regulate their autonomic nervous system activity which is central for a healthy life.

This research project will conduct clinical trials to determine how effective self-regulation therapy is. It works by teaching the participant the connections between the way they breathe and how their nervous system operates. The participant also learns to control their breathing rate and nervous system activity by observing feedback on a computer screen. This therapy has been called biofeedback. For example, life-threatening unstable blood pressure will potentially become more stable as the participant learns control, and this will result in increased life expectancy and quality of life as their autonomic nervous system function improves. The project will also determine the most effective ways of making this self-regulation therapy available to people with SCI living in the community including the barriers and enablers to accessing this therapy.

Professor Lisa Harvey
The Royal North Shore Hospital, Sydney

Early and intensive motor training (or usual care) to enhance neurological recovery and function in people with spinal cord injury: The Early & Intensive SCI-MT Trial

Paralysis is the most obvious effect of spinal cord injury and affects the ability to walk, carry out self-care, live independently, and participate in work and leisure. There is no cure for paralysis yet. Early and intensive motor training directed at recovery below the level of the spinal cord injury has the potential to promote neurological recovery and make a lasting difference to the lives of people with spinal cord injury.

The aim of the Early and Intensive SCI-MT Trial is to determine the effectiveness of early and intensive motor training on neurological recovery and function in people with spinal cord injury. People who have experienced a spinal cord injury will be randomised soon after injury to receive either usual care or a 10-week program of intensive motor training designed to maximise neurological recovery, reduce paralysis and increase function. This intervention exploits the early plasticity of the spinal cord. The trial will provide evidence of the effectiveness of an intervention that has the potential to make an immediate and life-long difference to people with a spinal cord injury. The project will be a collaboration with all NSW Health spinal injury units and could feasibly be rolled out on a large-scale.

A/Prof Diane McDougald
The ithree institute, The University of Technology Sydney (UTS)

Metagenomics based diagnostics for control urinary tract infections

Spinal cord injury patients are at high risk of catheter associated urinary tract infections (CAUTI), including infection by multi-drug resistant organisms. This can spread throughout hospitals causing significant cost to hospitals.

Researchers can determine when a patient may be under threat of infection by monitoring the group of bacteria that colonise their catheter, the microbiome. Changes in that microbiome, that are shown to correlate with changes in health status, can be observed well before the patients present as sick. This project aims to develop a diagnostic tool to predict UTIs by monitoring the microbiome as proxy. The diagnostic would use the patients’ catheter for sampling during routine changes, hence taking advantage of a material that would otherwise be discarded.

By having an early warning system, physicians can draw on a range of alternative management approaches, such as more frequent catheter changes or more expensive single use catheters. These approaches will reduce the number of UTI episodes for patients improving quality of life, reducing mortality and reducing hospital costs associated with UTIs and drug resistant UTIs.

Associate Professor Sylvia Gustin
NeuRA, University of New South Wales

RESTORE: Immersive Virtual Reality Treatment for Restoring in People with Discomplete Paraplegia

Complete spinal cord injury (SCI) is associated with a complete loss of function such as mobility or sensation. An earlier study, by these researchers, showed that 50% of spinal cord injured patients tested had surviving somatosensory pathways at the level of the spine. This means the brain is still receiving messages. This is called “discomplete SCI” – a SCI person who cannot feel touch, but touch information is still forwarded from the place of touch to the brain.

Currently there are no effective intervention to promote or restore touch perception among those with discomplete SCI. The proposed study will address this need by developing and testing a novel intervention that can provide touch restoration. Immersive virtual reality is being used to re-train the brain to identify the distorted signals from toe to brain as sensation (touch). The immersive virtual reality interface will be developed to be distributed to people’s homes, providing affordable self-directed means of rehabilitative therapy. This project offers new, exciting diagnostic and therapeutic avenues in SCI practice.

Dr Euan McCaughey
Neuroscience Research Australia, UNSW

Abdominal Stimulation to improve clinical outcomes after spinal cord injury: translation into worldwide clinical practice

Sixty percent of new SCI cases are caused by an injury to the neck area of the spinal cord. This is the most severe form of spinal cord injury and leads to a condition known as tetraplegia.

Tetraplegia paralyses all four limbs and affects the major breathing muscles, namely the diaphragm, abdominal and intercostal muscles. This impacts breathing and leads to the development of respiratory complications, the leading cause of illness and death in the first year of tetraplegia. Poor breathing function also means that around 40% of people with tetraplegia require a mechanical ventilator. While a life-saving machine, using a mechanical ventilator increases the chances of further illness and death, increases readmissions to hospital, decreases quality of life, and costs an extra $2,000 per patient per day. As the abdominal muscles are also an important muscle to help empty the bowel, a spinal cord injury can also result in poor bowel function and bowel complications.

Electrical stimulation, the application of electrical pulses to a nerve, can make muscles contract, even when paralysed. This researcher has shown that surface electrical stimulation of the abdominal muscles, termed Abdominal Stimulation, improves the breathing of people with tetraplegia. This research project will investigate whether Abdominal Functional Electrical Stimulation (FES) reduces respiratory complications and reduces mechanical ventilation duration for people with acute tetraplegia, and improves bowel function for people with a chronic spinal cord injury. A standard Abdominal FES treatment program will be developed to support the translation of this research into clinical practice. This research has the potential to improve quality of life for SCI patients and reduce costs for the NSW health system.

Professor Jane Butler
Neuroscience Research Australia, The University of New South Wales

Therapeutic acute intermittent hypoxia: developing a novel treatment to restore voluntary function after spinal cord injury

Therapeutic acute intermittent hypoxia has potential to restore function to muscles paralysed after spinal cord injury through ‘neuroplasticity’. This means the therapy changes the way the brain and spinal cord connect to improve muscle function. Treatment with acute intermittent hypoxia involves breathing air with an oxygen content equivalent to standing on top of a 6000 m (20,000 ft) mountain. Low oxygen air is alternated with normal air for a total of 30 minutes. In previous studies in animals and humans with spinal cord injury, it has been shown that just one 30-minute session of therapeutic acute intermittent hypoxia can boost the function of previously paralysed and partially paralysed muscles for more than an hour. However the mechanisms of these improvements in motor output are not well understood.

This proposed study will examine the mechanisms of action, how to optimise the response in people with spinal cord injury and why some individuals with spinal cord injury do not respond to this treatment. It will also identify the best way to target, tailor and apply this treatment clinically for people with both acute and chronic spinal cord injury.