This study is open for enrollment until December 1, 2009. The information below can be printed or call the numbers listed.
If you have a Spinal Cord Injury
or Multiple Sclerosis
You may be eligible for a research study
Care Call is a phone-based intervention that aims to reduce health problems and improve quality of life for people with SCI or MS.
You may be able to take part if you:
are an English-speaking adult who has SCI or MS
normally use a wheelchair during the day for 6 or more hours
do not currently have a deep wound
have access to a telephone for the next 6+ months
You will not need to travel to take part in this study; you may stay in your home.
You will receive $100 for your participation and completion of the study.
For more information and to be screened for eligibility
please call Kelsey Dicker
866-785-7040 (toll-free)
You are welcome to share this form with others who might be eligible and interested to learn more about Care Call.
Care Call is conducted by the New England Regional Spinal Cord Injury Center in Boston, MA
and is funded by the Centers for Disease Control and Prevention (CDC) Award #R01/DD000155-01
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Do you have a Spinal Cord Injury
or Multiple Sclerosis?If so, you may be eligible for a research study!
Am I eligible to participate?
You may be able to take part if…
You are an English-speaking adult who has SCI or MS and lives at home
You normally use a wheelchair during the day for 6 or more hours
You do not currently have a deep wound
You will have access to a telephone for the next 6+ months
What is the study? How does the study work?
• Care Call, a phone-based intervention, aims to reduce health problems and improve quality of life for people with SCI or MS.
• You will not need to travel to take part in this study; you may stay in your home.
• If you choose to take part and are eligible for the study, you will be randomly assigned to either Group 1 or 2. Both groups will receive an in-home assessment at the beginning and end of the study, as well as a community resource book. Only Group 1 will receive weekly phone calls from the Care Call system.
• You will receive $100 for your participation and completion of the study.
I’m interested in participating! Who do I contact?
Please call Kelsey Dicker at (617) 638-1996 or toll-free at (866) 785-7040
to receive further information and to be screened for eligibility.
We look forward to hearing from you!
You are welcome to share this flyer with others who might be eligible and interested to learn more about Care Call.
Care Call is run by Steve Williams, MD, at the New England Regional Spinal Cord Injury Center in Boston, MA. The study is funded by the Centers for Disease Control and Prevention (CDC), Award ##R01/DD000155-01. This study is completely voluntary and will not affect any medical care you now receive.
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Fampridine-SR is a sustained-release tablet formulation of the investigational drug fampridine (4-aminopyridine, or 4-AP). Data collected in laboratory studies found that fampridine can improve the communication between damaged nerves, which may result in increased neurological function. Positive vote by FDA advisory committee for Fampridine-SR Acorda Therapeutics, Inc. has announced the U.S. Food and Drug Administration (FDA) Peripheral and Central Nervous System Drugs (PCNSD) Advisory Committee voted 12 to 1 that clinical data on Fampridine-SR 10 mg twice daily demonstrated substantial evidence of effectiveness as a treatment to improve walking in people with multiple sclerosis (MS) and voted 10 to 2 (1 abstention) that it is clinically meaningful and can be safe for use. "We are pleased with the outcome of today`s Advisory Committee meeting. People with MS have an urgent need for therapies to improve their walking, which is essential to conducting their activities of daily life. If approved, Fampridine-SR would be the first medicine to improve walking in people with MS," said Ron Cohen, M.D., Acorda Therapeutics President and CEO. "This Advisory Committee meeting is an important milestone in the development of Fampridine-SR, and we look forward to working with the FDA as it completes its review of Acorda`s New Drug Application." The Committee also recommended by a vote of 12 to 1 that Acorda be required to evaluate the effects of doses lower than 10 mg twice daily, but by a 10 to 2 vote (1 abstention) that these studies not be required prior to approval. At the request of the FDA, the Committee discussed possible conditions for use, including for patients with renal impairment or history of seizure. Acorda has proposed a Risk Evaluation and Mitigation Strategy (REMS) program, which could include healthcare professional and patient education around appropriate use of Fampridine-SR. The FDA seeks the advice of an advisory committee such as the PCNSD when evaluating a potential new treatment, but is not required to follow its recommendation. The current Fampridine-SR Prescription Drug User Fee Act (PDUFA) date set by the FDA is October 22, 2009; the PDUFA date is the target date for the FDA to complete its review of Fampridine-SR.
For a more detailed discussion of stem cells, see the NIH's Stem Cell Reports. Check the Frequently Asked Questions page for quick answers to specific queries. The navigation table at right can connect you to the information you need. The following websites, which are not part of the NIH Stem Cell Information site, also contain information about stem cells. The NIH is not responsible for the content of these sites. http://www.isscr.org/public Stem cell information for the public from the International Society for Stem Cell Research (ISSCR). http://www.nlm.nih.gov/medlineplus/stemcells.html Medline Plus is a consumer health database that includes news, health resources, clinical trials, and more http://www.explorestemcells.co.uk A United Kingdom-based resource for the general public that discusses the use of stem cells in medical treatments and therapies. http://www.stemcellresearchnews.com A commercial, online newsletter that features stories about stem cells of all types.
There are many ways in which human stem cells can be used in research and the clinic. Studies of human embryonic stem cells will yield information about the complex events that occur during human development. A primary goal of this work is to identify how undifferentiated stem cells become the differentiated cells that form the tissues and organs. Scientists know that turning genes on and off is central to this process. Some of the most serious medical conditions, such as cancer and birth defects, are due to abnormal cell division and differentiation. A more complete understanding of the genetic and molecular controls of these processes may yield information about how such diseases arise and suggest new strategies for therapy. Predictably controlling cell proliferation and differentiation requires additional basic research on the molecular and genetic signals that regulate cell division and specialization. While recent developments with iPS cells suggest some of the specific factors that may be involved, techniques must be devised to introduce these factors safely into the cells and control the processes that are induced by these factors. Human stem cells could also be used to test new drugs. For example, new medications could be tested for safety on differentiated cells generated from human pluripotent cell lines. Other kinds of cell lines are already used in this way. Cancer cell lines, for example, are used to screen potential anti-tumor drugs. The availability of pluripotent stem cells would allow drug testing in a wider range of cell types. However, to screen drugs effectively, the conditions must be identical when comparing different drugs. Therefore, scientists will have to be able to precisely control the differentiation of stem cells into the specific cell type on which drugs will be tested. Current knowledge of the signals controlling differentiation falls short of being able to mimic these conditions precisely to generate pure populations of differentiated cells for each drug being tested. Perhaps the most important potential application of human stem cells is the generation of cells and tissues that could be used for cell-based therapies. Today, donated organs and tissues are often used to replace ailing or destroyed tissue, but the need for transplantable tissues and organs far outweighs the available supply. Stem cells, directed to differentiate into specific cell types, offer the possibility of a renewable source of replacement cells and tissues to treat diseases including Alzheimer's diseases, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis.
 Induced pluripotent stem cells (iPSCs) are adult cells that have been genetically reprogrammed to an embryonic stem cell–like state by being forced to express genes and factors important for maintaining the defining properties of embryonic stem cells. Although these cells meet the defining criteria for pluripotent stem cells, it is not known if iPSCs and embryonic stem cells differ in clinically significant ways. Mouse iPSCs were first reported in 2006, and human iPSCs were first reported in late 2007. Mouse iPSCs demonstrate important characteristics of pluripotent stem cells, including expressing stem cell markers, forming tumors containing cells from all three germ layers, and being able to contribute to many different tissues when injected into mouse embryos at a very early stage in development. Human iPSCs also express stem cell markers and are capable of generating cells characteristic of all three germ layers. Although additional research is needed, iPSCs are already useful tools for drug development and modeling of diseases, and scientists hope to use them in transplantation medicine. Viruses are currently used to introduce the reprogramming factors into adult cells, and this process must be carefully controlled and tested before the technique can lead to useful treatments for humans. In animal studies, the virus used to introduce the stem cell factors sometimes causes cancers. Researchers are currently investigating non-viral delivery strategies. In any case, this breakthrough discovery has created a powerful new way to "de-differentiate" cells whose developmental fates had been previously assumed to be determined. In addition, tissues derived from iPSCs will be a nearly identical match to the cell donor and thus probably avoid rejection by the immune system. The iPSC strategy creates pluripotent stem cells that, together with studies of other types of pluripotent stem cells, will help researchers learn how to reprogram cells to repair damaged tissues in the human body.
Human embryonic and adult stem cells each have advantages and disadvantages regarding potential use for cell-based regenerative therapies. One major difference between adult and embryonic stem cells is their different abilities in the number and type of differentiated cell types they can become. Embryonic stem cells can become all cell types of the body because they are pluripotent. Adult stem cells are thought to be limited to differentiating into different cell types of their tissue of origin. Embryonic stem cells can be grown relatively easily in culture. Adult stem cells are rare in mature tissues, so isolating these cells from an adult tissue is challenging, and methods to expand their numbers in cell culture have not yet been worked out. This is an important distinction, as large numbers of cells are needed for stem cell replacement therapies. Scientists believe that tissues derived from embryonic and adult stem cells may differ in the likelihood of being rejected after transplantation. We don't yet know whether tissues derived from embryonic stem cells would cause transplant rejection, since the first phase 1 clinical trial testing the safety of cells derived from hESCS has only recently been approved by the United States Food and Drug Administration (FDA). Adult stem cells, and tissues derived from them, are currently believed less likely to initiate rejection after transplantation. This is because a patient's own cells could be expanded in culture, coaxed into assuming a specific cell type (differentiation), and then reintroduced into the patient. The use of adult stem cells and tissues derived from the patient's own adult stem cells would mean that the cells are less likely to be rejected by the immune system. This represents a significant advantage, as immune rejection can be circumvented only by continuous administration of immunosuppressive drugs, and the drugs themselves may cause deleterious side effects
An adult stem cell is thought to be an undifferentiated cell, found among differentiated cells in a tissue or organ that can renew itself and can differentiate to yield some or all of the major specialized cell types of the tissue or organ. The primary roles of adult stem cells in a living organism are to maintain and repair the tissue in which they are found. Scientists also use the term somatic stem cell instead of adult stem cell, where somatic refers to cells of the body (not the germ cells, sperm or eggs). Unlike embryonic stem cells, which are defined by their origin (the inner cell mass of the blastocyst), the origin of adult stem cells in some mature tissues is still under investigation.
Research on adult stem cells has generated a great deal of excitement. Scientists have found adult stem cells in many more tissues than they once thought possible. This finding has led researchers and clinicians to ask whether adult stem cells could be used for transplants. In fact, adult hematopoietic, or blood-forming, stem cells from bone marrow have been used in transplants for 40 years. Scientists now have evidence that stem cells exist in the brain and the heart. If the differentiation of adult stem cells can be controlled in the laboratory, these cells may become the basis of transplantation-based therapies.
The history of research on adult stem cells began about 50 years ago. In the 1950s, researchers discovered that the bone marrow contains at least two kinds of stem cells. One population, called hematopoietic stem cells, forms all the types of blood cells in the body. A second population, called bone marrow stromal stem cells (also called mesenchymal stem cells, or skeletal stem cells by some), were discovered a few years later. These non-hematopoietic stem cells make up a small proportion of the stromal cell population in the bone marrow, and can generate bone, cartilage, fat, cells that support the formation of blood, and fibrous connective tissue.
In the 1960s, scientists who were studying rats discovered two regions of the brain that contained dividing cells that ultimately become nerve cells. Despite these reports, most scientists believed that the adult brain could not generate new nerve cells. It was not until the 1990s that scientists agreed that the adult brain does contain stem cells that are able to generate the brain's three major cell types—astrocytes and oligodendrocytes, which are non-neuronal cells, and neurons, or nerve cells.
A. Where are adult stem cells found, and what do they normally do?
Adult stem cells have been identified in many organs and tissues, including brain, bone marrow, peripheral blood, blood vessels, skeletal muscle, skin, teeth, heart, gut, liver, ovarian epithelium, and testis. They are thought to reside in a specific area of each tissue (called a "stem cell niche"). In many tissues, current evidence suggests that some types of stem cells are pericytes, cells that compose the outermost layer of small blood vessels. Stem cells may remain quiescent (non-dividing) for long periods of time until they are activated by a normal need for more cells to maintain tissues, or by disease or tissue injury.
Typically, there is a very small number of stem cells in each tissue, and once removed from the body, their capacity to divide is limited, making generation of large quantities of stem cells difficult. Scientists in many laboratories are trying to find better ways to grow large quantities of adult stem cells in cell culture and to manipulate them to generate specific cell types so they can be used to treat injury or disease. Some examples of potential treatments include regenerating bone using cells derived from bone marrow stroma, developing insulin-producing cells for type 1 diabetes, and repairing damaged heart muscle following a heart attack with cardiac muscle cells.
B. What tests are used for identifying adult stem cells?
Scientists often use one or more of the following methods to identify adult stem cells: (1) label the cells in a living tissue with molecular markers and then determine the specialized cell types they generate; (2) remove the cells from a living animal, label them in cell culture, and transplant them back into another animal to determine whether the cells replace (or "repopulate") their tissue of origin.
Importantly, it must be demonstrated that a single adult stem cell can generate a line of genetically identical cells that then gives rise to all the appropriate differentiated cell types of the tissue. To confirm experimentally that a putative adult stem cell is indeed a stem cell, scientists tend to show either that the cell can give rise to these genetically identical cells in culture, and/or that a purified population of these candidate stem cells can repopulate or reform the tissue after transplant into an animal.
C. What is known about adult stem cell differentiation?
Figure 2. Hematopoietic and stromal stem cell differentiation. Click here for larger image. (© 2001 Terese Winslow)
As indicated above, scientists have reported that adult stem cells occur in many tissues and that they enter normal differentiation pathways to form the specialized cell types of the tissue in which they reside.
Normal differentiation pathways of adult stem cells. In a living animal, adult stem cells are available to divide, when needed, and can give rise to mature cell types that have characteristic shapes and specialized structures and functions of a particular tissue. The following are examples of differentiation pathways of adult stem cells (Figure 2) that have been demonstrated in vitro or in vivo.
Hematopoietic stem cells give rise to all the types of blood cells: red blood cells, B lymphocytes, T lymphocytes, natural killer cells, neutrophils, basophils, eosinophils, monocytes, and macrophages.
Mesenchymal stem cells give rise to a variety of cell types: bone cells (osteocytes), cartilage cells (chondrocytes), fat cells (adipocytes), and other kinds of connective tissue cells such as those in tendons.
Neural stem cells in the brain give rise to its three major cell types: nerve cells (neurons) and two categories of non-neuronal cells—astrocytes and oligodendrocytes.
Epithelial stem cells in the lining of the digestive tract occur in deep crypts and give rise to several cell types: absorptive cells, goblet cells, paneth cells, and enteroendocrine cells.
Skin stem cells occur in the basal layer of the epidermis and at the base of hair follicles. The epidermal stem cells give rise to keratinocytes, which migrate to the surface of the skin and form a protective layer. The follicular stem cells can give rise to both the hair follicle and to the epidermis.
Transdifferentiation. A number of experiments have reported that certain adult stem cell types can differentiate into cell types seen in organs or tissues other than those expected from the cells' predicted lineage (i.e., brain stem cells that differentiate into blood cells or blood-forming cells that differentiate into cardiac muscle cells, and so forth). This reported phenomenon is called transdifferentiation.
Although isolated instances of transdifferentiation have been observed in some vertebrate species, whether this phenomenon actually occurs in humans is under debate by the scientific community. Instead of transdifferentiation, the observed instances may involve fusion of a donor cell with a recipient cell. Another possibility is that transplanted stem cells are secreting factors that encourage the recipient's own stem cells to begin the repair process. Even when transdifferentiation has been detected, only a very small percentage of cells undergo the process.
In a variation of transdifferentiation experiments, scientists have recently demonstrated that certain adult cell types can be "reprogrammed" into other cell types in vivo using a well-controlled process of genetic modification (see Section VI for a discussion of the principles of reprogramming). This strategy may offer a way to reprogram available cells into other cell types that have been lost or damaged due to disease. For example, one recent experiment shows how pancreatic beta cells, the insulin-producing cells that are lost or damaged in diabetes, could possibly be created by reprogramming other pancreatic cells. By "re-starting" expression of three critical beta-cell genes in differentiated adult pancreatic exocrine cells, researchers were able to create beta cell-like cells that can secrete insulin. The reprogrammed cells were similar to beta cells in appearance, size, and shape; expressed genes characteristic of beta cells; and were able to partially restore blood sugar regulation in mice whose own beta cells had been chemically destroyed. While not transdifferentiation by definition, this method for reprogramming adult cells may be used as a model for directly reprogramming other adult cell types.
In addition to reprogramming cells to become a specific cell type, it is now possible to reprogram adult somatic cells to become like embryonic stem cells (induced pluripotent stem cells, iPSCs) through the introduction of embryonic genes. Thus, a source of cells can be generated that are specific to the donor, thereby avoiding issues of histocompatibility, if such cells were to be used for tissue regeneration. However, like embryonic stem cells, determination of the methods by which iPSCs can be completely and reproducibly committed to appropriate cell lineages is still under investigation.
D. What are the key questions about adult stem cells?
Many important questions about adult stem cells remain to be answered. They include:
How many kinds of adult stem cells exist, and in which tissues do they exist?
How do adult stem cells evolve during development and how are they maintained in the adult? Are they "leftover" embryonic stem cells, or do they arise in some other way?
Why do stem cells remain in an undifferentiated state when all the cells around them have differentiated? What are the characteristics of their “niche” that controls their behavior?
Do adult stem cells have the capacity to transdifferentiate, and is it possible to control this process to improve its reliability and efficiency?
If the beneficial effect of adult stem cell transplantation is a trophic effect, what are the mechanisms? Is donor cell-recipient cell contact required, secretion of factors by the donor cell, or both?
What are the factors that control adult stem cell proliferation and differentiation?
What are the factors that stimulate stem cells to relocate to sites of injury or damage, and how can this process be enhanced for better healing? 
A. What stages of early embryonic development are important for generating embryonic stem cells?
Embryonic stem cells, as their name suggests, are derived from embryos. Most embryonic stem cells are derived from embryos that develop from eggs that have been fertilized in vitro—in an in vitro fertilization clinic—and then donated for research purposes with informed consent of the donors. They are not derived from eggs fertilized in a woman's body. The embryos from which human embryonic stem cells are derived are typically four or five days old and are a hollow microscopic ball of cells called the blastocyst. The blastocyst includes three structures: the trophoblast, which is the layer of cells that surrounds the blastocoel, a hollow cavity inside the blastocyst; and the inner cell mass, which is a group of cells at one end of the blastocoel that develop into the embryo proper.
B. How are embryonic stem cells grown in the laboratory?
Growing cells in the laboratory is known as cell culture. Human embryonic stem cells are isolated by transferring the inner cell mass into a plastic laboratory culture dish that contains a nutrient broth known as culture medium. The cells divide and spread over the surface of the dish. The inner surface of the culture dish is typically coated with mouse embryonic skin cells that have been treated so they will not divide. This coating layer of cells is called a feeder layer. The mouse cells in the bottom of the culture dish provide the inner cell mass cells a sticky surface to which they can attach. Also, the feeder cells release nutrients into the culture medium. Researchers have devised ways to grow embryonic stem cells without mouse feeder cells. This is a significant scientific advance because of the risk that viruses or other macromolecules in the mouse cells may be transmitted to the human cells.
The process of generating an embryonic stem cell line is somewhat inefficient, so lines are not produced each time an inner cell mass is placed into a culture dish. However, if the plated inner cell mass cells survive, divide and multiply enough to crowd the dish, they are removed gently and plated into several fresh culture dishes. The process of re-plating or subculturing the cells is repeated many times and for many months. Each cycle of subculturing the cells is referred to as a passage. Once the cell line is established, the original cells yield millions of embryonic stem cells. Embryonic stem cells that have proliferated in cell culture for six or more months without differentiating, are pluripotent, and appear genetically normal are referred to as an embryonic stem cell line. At any stage in the process, batches of cells can be frozen and shipped to other laboratories for further culture and experimentation.
C. What laboratory tests are used to identify embryonic stem cells?
At various points during the process of generating embryonic stem cell lines, scientists test the cells to see whether they exhibit the fundamental properties that make them embryonic stem cells. This process is called characterization.
Scientists who study human embryonic stem cells have not yet agreed on a standard battery of tests that measure the cells' fundamental properties. However, laboratories that grow human embryonic stem cell lines use several kinds of tests, including:
Growing and subculturing the stem cells for many months. This ensures that the cells are capable of long-term growth and self-renewal. Scientists inspect the cultures through a microscope to see that the cells look healthy and remain undifferentiated.
Using specific techniques to determine the presence of transcription factors that are typically produced by undifferentiated cells. Two of the most important transcription factors are Nanog and Oct4. Transcription factors help turn genes on and off at the right time, which is an important part of the processes of cell differentiation and embryonic development. In this case, both Oct 4 and Nanog are associated with maintaining the stem cells in an undifferentiated state, capable of self-renewal.
Using specific techniques to determine the presence of paricular cell surface markers that are typically produced by undifferentiated cells.
Examining the chromosomes under a microscope. This is a method to assess whether the chromosomes are damaged or if the number of chromosomes has changed. It does not detect genetic mutations in the cells.
Determining whether the cells can be re-grown, or subcultured, after freezing, thawing, and re-plating.
Testing whether the human embryonic stem cells are pluripotent by 1) allowing the cells to differentiate spontaneously in cell culture; 2) manipulating the cells so they will differentiate to form cells characteristic of the three germ layers; or 3) injecting the cells into a mouse with a suppressed immune system to test for the formation of a benign tumor called a teratoma. Since the mouse’s immune system is suppressed, the injected human stem cells are not rejected by the mouse immune system and scientists can observe growth and differentiation of the human stem cells. Teratomas typically contain a mixture of many differentiated or partly differentiated cell types—an indication that the embryonic stem cells are capable of differentiating into multiple cell types.
D. How are embryonic stem cells stimulated to differentiate?
Figure 1. Directed differentiation of mouse embryonic stem cells. Click here for larger image. (© 2001 Terese Winslow)
As long as the embryonic stem cells in culture are grown under appropriate conditions, they can remain undifferentiated (unspecialized). But if cells are allowed to clump together to form embryoid bodies, they begin to differentiate spontaneously. They can form muscle cells, nerve cells, and many other cell types. Although spontaneous differentiation is a good indication that a culture of embryonic stem cells is healthy, it is not an efficient way to produce cultures of specific cell types.
So, to generate cultures of specific types of differentiated cells—heart muscle cells, blood cells, or nerve cells, for example—scientists try to control the differentiation of embryonic stem cells. They change the chemical composition of the culture medium, alter the surface of the culture dish, or modify the cells by inserting specific genes. Through years of experimentation, scientists have established some basic protocols or "recipes" for the directed differentiation of embryonic stem cells into some specific cell types (Figure 1). (For additional examples of directed differentiation of embryonic stem cells, refer to the NIH stem cell reports available at /info/2006report/ and /info/2001report/2001report.htm.)
If scientists can reliably direct the differentiation of embryonic stem cells into specific cell types, they may be able to use the resulting, differentiated cells to treat certain diseases in the future. Diseases that might be treated by transplanting cells generated from human embryonic stem cells include Parkinson's disease, diabetes, traumatic spinal cord injury, Duchenne's muscular dystrophy, heart disease, and vision and hearing loss.
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Stem cells differ from other kinds of cells in the body. All stem cells—regardless of their source—have three general properties: they are capable of dividing and renewing themselves for long periods; they are unspecialized; and they can give rise to specialized cell types.
Stem cells are capable of dividing and renewing themselves for long periods. Unlike muscle cells, blood cells, or nerve cells—which do not normally replicate themselves—stem cells may replicate many times, or proliferate. A starting population of stem cells that proliferates for many months in the laboratory can yield millions of cells. If the resulting cells continue to be unspecialized, like the parent stem cells, the cells are said to be capable of long-term self-renewal.
Scientists are trying to understand two fundamental properties of stem cells that relate to their long-term self-renewal:
why can embryonic stem cells proliferate for a year or more in the laboratory without differentiating, but most non-embryonic stem cells cannot; and
what are the factors in living organisms that normally regulate stem cell proliferation and self-renewal?
Discovering the answers to these questions may make it possible to understand how cell proliferation is regulated during normal embryonic development or during the abnormal cell division that leads to cancer. Such information would also enable scientists to grow embryonic and non-embryonic stem cells more efficiently in the laboratory.
The specific factors and conditions that allow stem cells to remain unspecialized are of great interest to scientists. It has taken scientists many years of trial and error to learn to derive and maintain stem cells in the laboratory without them spontaneously differentiating into specific cell types. For example, it took two decades to learn how to grow human embryonic stem cells in the laboratory following the development of conditions for growing mouse stem cells. Therefore, understanding the signals in a mature organism that cause a stem cell population to proliferate and remain unspecialized until the cells are needed. Such information is critical for scientists to be able to grow large numbers of unspecialized stem cells in the laboratory for further experimentation.
Stem cells are unspecialized. One of the fundamental properties of a stem cell is that it does not have any tissue-specific structures that allow it to perform specialized functions. For example, a stem cell cannot work with its neighbors to pump blood through the body (like a heart muscle cell), and it cannot carry oxygen molecules through the bloodstream (like a red blood cell). However, unspecialized stem cells can give rise to specialized cells, including heart muscle cells, blood cells, or nerve cells.
Stem cells can give rise to specialized cells. When unspecialized stem cells give rise to specialized cells, the process is called differentiation. While differentiating, the cell usually goes through several stages, becoming more specialized at each step. Scientists are just beginning to understand the signals inside and outside cells that trigger each stem of the differentiation process. The internal signals are controlled by a cell's genes, which are interspersed across long strands of DNA, and carry coded instructions for all cellular structures and functions. The external signals for cell differentiation include chemicals secreted by other cells, physical contact with neighboring cells, and certain molecules in the microenvironment. The interaction of signals during differentiation causes the cell's DNA to acquire epigenetic marks that restrict DNA expression in the cell and can be passed on through cell division.
Many questions about stem cell differentiation remain. For example, are the internal and external signals for cell differentiation similar for all kinds of stem cells? Can specific sets of signals be identified that promote differentiation into specific cell types? Addressing these questions may lead scientists to find new ways to control stem cell differentiation in the laboratory, thereby growing cells or tissues that can be used for specific purposes such as cell-based therapies or drug screening.
Adult stem cells typically generate the cell types of the tissue in which they reside. For example, a blood-forming adult stem cell in the bone marrow normally gives rise to the many types of blood cells. It is generally accepted that a blood-forming cell in the bone marrow—which is called a hematopoietic stem cell—cannot give rise to the cells of a very different tissue, such as nerve cells in the brain. Experiments over the last several years have purported to show that stem cells from one tissue may give rise to cell types of a completely different tissue. This remains an area of great debate within the research community. This controversy demonstrates the challenges of studying adult stem cells and suggests that additional research using adult stem cells is necessary to understand their full potential as future therapies.
 Why are they important?
Stem cells have the remarkable potential to develop into many different cell types in the body during early life and growth. In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is still alive. When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell.
Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions, they can be induced to become tissue- or organ-specific cells with special functions. In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and replace worn out or damaged tissues. In other organs, however, such as the pancreas and the heart, stem cells only divide under special conditions.
Until recently, scientists primarily worked with two kinds of stem cells from animals and humans: embryonic stem cells and non-embryonic "somatic" or "adult" stem cells. The functions and characteristics of these cells will be explained in this document. Scientists discovered ways to derive embryonic stem cells from early mouse embryos nearly 30 years ago, in 1981. The detailed study of the biology of mouse stem cells led to the discovery, in 1998, of a method to derive stem cells from human embryos and grow the cells in the laboratory. These cells are called human embryonic stem cells. The embryos used in these studies were created for reproductive purposes through in vitro fertilization procedures. When they were no longer needed for that purpose, they were donated for research with the informed consent of the donor. In 2006, researchers made another breakthrough by identifying conditions that would allow some specialized adult cells to be "reprogrammed" genetically to assume a stem cell-like state. This new type of stem cell, called induced pluripotent stem cells (iPSCs), will be discussed in a later section of this document.
Stem cells are important for living organisms for many reasons. In the 3- to 5-day-old embryo, called a blastocyst, the inner cells give rise to the entire body of the organism, including all of the many specialized cell types and organs such as the heart, lung, skin, sperm, eggs and other tissues. In some adult tissues, such as bone marrow, muscle, and brain, discrete populations of adult stem cells generate replacements for cells that are lost through normal wear and tear, injury, or disease.
Given their unique regenerative abilities, stem cells offer new potentials for treating diseases such as diabetes, and heart disease. However, much work remains to be done in the laboratory and the clinic to understand how to use these cells for cell-based therapies to treat disease, which is also referred to as regenerative or reparative medicine.
Laboratory studies of stem cells enable scientists to learn about the cells’ essential properties and what makes them different from specialized cell types. Scientists are already using stem cells in the laboratory to screen new drugs and to develop model systems to study normal growth and identify the causes of birth defects.
Research on stem cells continues to advance knowledge about how an organism develops from a single cell and how healthy cells replace damaged cells in adult organisms. Stem cell research is one of the most fascinating areas of contemporary biology, but, as with many expanding fields of scientific inquiry, research on stem cells raises scientific questions as rapidly as it generates new discoveries.
Research into Blood Flow In the Brain and Venous Insufficiency, or CCSVI, in MS
A few recent reports have revived ages-old speculation about a possible dysfunction of brain blood flow and/or drainage in individuals who have MS. For example, one study involving 65 people with different types of MS compared with 235 people who were healthy or had other neurological disorders, a strong relationship was found between MS and signs of venous insufficiency – suggesting that blood drainage by veins may be blocked, causing or contributing to nerve tissue damage. This study, by Paulo Zamboni, MD (University of Ferrara - Ferrara, Italy) and colleagues, was published in the June 2009 (J Neurol Neurosurg Psychiatry 2009; 80:392-399). If confirmed, these findings may open up new research avenues into the underlying pathology of MS. Further research is now underway.
The idea that MS may involve a problem in blood circulation was an early idea that was eventually dismissed as more research suggested that immune-system attacks and inflammation played a pivotal role in the damage to nervous system tissues. A few recent studies have posed the idea that lower blood flow in the brain might contribute to nervous system damage.
In the recent study by Dr. Zamboni and colleagues, they screened for abnormalities of blood outflow in major veins draining from the brain to the heart in 65 people with different types of MS, compared with 235 people who were either healthy or who had other neurological disorders. They used sophisticated sonography techniques to detect abnormalities of vein drainage. The investigators found significant evidence of slowed and obstructed drainage in the veins draining the brain in many of those with MS. They also found evidence of the opening of “substitute circles” – where the flow is deviated to smaller vessels to bypass obstructions, and these were often found to have reverse flow (reflux) of blood back into the brain.
The investigators called this venous obstruction “chronic cerebrospinal venous insufficiency,” or CCSVI. The treatment status of the people with MS did not appear to influence whether they showed signs of CCSVI. The authors speculate that the reverse flow of blood back into the brain might set off the inflammation and immune-mediated damage that has been well described in MS.
If confirmed, these findings may open up new research avenues into the underlying pathology of MS, and further research is now underway. One study getting underway was described at the 2009 ECTRIMS meeting in September. It involves a collaboration between researchers in Italy, Buffalo (NY) and Birmingham (AL) who are attempting to treat venous obstruction in 16 individuals using balloon dilation such as has been used for many years to treat blocked arteries.
Many questions remain about how and when this phenomenon might play a role in nervous system damage seen in MS, and at the present time there is insufficient evidence to suggest that this phenomenon is the cause of MS.
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Frequently Asked Questions About CCSVI and MS
Q: Do these reports of a possible association between insufficient vein drainage and MS mean that MS is caused by venous insufficiency?
A: No. Based on results published about these findings to date, there is not enough evidence to say that obstruction of veins causes MS, or to determine when this obstruction may occur in the course of disease.
Q: If CCSVI turns out to be important in MS, can it be treated?
A: No one knows yet. At least one small study is testing the effects of balloon dilation inside an obstructed vein to determine whether that procedure would be beneficial.
Q: I have MS. Should I be tested for signs of CCSVI?
A: No, unless you are involved in a research study exploring this phenomenon, since at this time there is no proven therapy to resolve any abnormalities that might be observed, and it is still not clear whether relieving venous obstructions would be beneficial.
Q: Does CCSVI make the standard treatments of MS meaningless?
A: No. There is ample evidence proving that the FDA-approved therapies for MS provide benefit for people with most forms of MS.
Q: Will the National MS Society fund research into CCSVI in MS?
A: The National MS Society welcomes research proposals from any qualified investigators whose research questions are relevant to multiple sclerosis. All proposals received are thoroughly evaluated for their relevance and excellence by our volunteer scientific peer review panels. At the present time, we have not been approached for funding any projects related to CCSVI. If we receive a proposal related to CCSVI that is found to be outstanding and relevant to MS, we would likely commit to fund such a study.
Published Online First: 5 December 2008. doi:10.1136/jnnp.2008.157164
Journal of Neurology, Neurosurgery, and Psychiatry 2009;80:392-399
Copyright © 2009 by the BMJ Publishing Group Ltd.
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by Lorna J. Moorhead, MS Moms Speech is one of the first things that we recognize in children as a great step towards becoming an adult. It is also occasionally one of the first symptoms in MSers who are effected more cognitively than physically. At the times in our life when we most need to communicate about our feelings and needs, our brain cuts off its long term relationship with our mouth. I have tried repeatedly to get these two back together but have only succeeded in a rocky relationship that quits half the time. Yet it amazes me that when I feel I am speaking with the proficiency of a drooling two year old, no-one seems to notice. (Except the two year olds.) I am beginning to believe that Multiple Sclerosis is not only a sneaky MonSter but that it has a very sick sense of humor. On days when I am proud of myself for appearing only half psychotic, my family tells me that my speech is slurred. I do not hear this; in fact I think my speech has been clearer than ever. Yet when I feel I am struggling to get words out and my mind feels is having some sort of syllable traffic jam, people tell me that they notice nothing. To make things worse, when I apologize for this jolted speech they reply, "Why your speech is much clearer than normal!" (These people should know that there are rules about teasing the crazy people.) Now either my family is playing a nasty trick on me, and considering the fact that my family's jokes range from perverse to little rubber frogs wrapped as Christmas gifts , this IS possible. Or this feeling of an inability to speak is another one of those brilliantly mischievous and invisible symptoms of MS. When researching this odd occurrence, I found that the slurring of speech is technically referred to as "dysarthria". Saying this word alone would make a person slur. "Doctor I have Dysssarthhria." Dysarthria is difficult, poorly articulated speech. Looking at this definition I resigned to diagnose all workers of a fast food drive-thru with dysarthria. (I always knew it wasn't MY hearing!) I also vowed to add "dysarthria" to my list of big words as it sounded much more educated than "slurred speech." I have wondered if my doctor even used this word. On further examination I found that this horrible condition is caused by: Alcohol, badly fitted dentures, or (big surprise) a degenerative neurological disorder. Hmm. Now my family and friends would not believe the denture excuse for one minute. Blaming it on alcohol would not be prudent when at the grocery store at 10am. (Especially if my 5 year old son's kindergarten teacher was there.) I never imagined that alcohol, dentures, and neurological disorder could be put it in the same medical arena. This then led me to wonder about those of us with MS who drink and have dentures. How do they know if it is dysarthria or their teeth? How do the doctor's know that we have MS? Maybe we are all denture sufferers led to drink by our ill fitting teeth. To make things more complicated as I read on another word flashed across the page. Another word that when pronounced, would cause a dialect teacher to slur. Aphasia. (How is that pronounced anyhow? Af-asia? That sounds like some old historical term for Asia. "Af-Asia", after Asia. But I digress.) Aphasia is impaired expression or comprehension of the spoken or written word, but it has the common courtesy to go away after a period. Hmmm, I wondered so when I have speech attacks, does this mean it's Dysarthria or Aphasia? I glanced over the causes for Aphasia and accidentally snorted my soda. Head trauma, stroke, and Alzheimer's. I'd rather be drunk with bad dentures. (Make that into a bumper sticker and put it on your car.) This still did not explain the fact that when I slurred I did not notice it and when I felt I was stuttering no-one heard it. Nevertheless, after blowing my nose and cleaning up the soda, it dawned on me. Drunk people believe their speech is clear and I know my Grandpa never seemed to realize his dentures where sticking out of his mouth. (And boy did that lead to some horrible nightmares. Nothing worse than a bushy eye-browed old man with his teeth hanging out chasing you down a hall.) Now I could begin to grasp the idea that although I did not hear it, it could still be going on. This left me to look for a cure. Surely there was a way to get my tongue back in order. For dysarthria, slurring, the suggested care was "speaking slowly and using hand gestures." I pictured myself giving orders to my pharmacist while slowly speaking and waving my hands. I was pretty sure it wouldn't go over well, although he might slip an extra bottle of pills into my order. Then this report stated that family and friends needed to give me, "the afflicted person" time enough to express themselves. (It was my understanding that even when we die; we feel that we never had enough time to express ourselves anyway.) Yeah right, my five year old was really going to stand around while mommy figured out how to say "clean your room" slowly and while pantomiming sweeping. He might giggle for a moment, but he wouldn't be around for me to finish. To cure Aphasia the family is urged to give the person reminders when they slip up, such as why the house smells like smoke and they have a string on their finger. It follows by saying that for both afflictions a "calm environment where external stimuli is kept to a minimum is extremely important." A calm environment. I was equally sure that my family was not going to appreciate my decision to move into the mountains and bury myself in a hole, because that is about where I'd need to go to get calmness in my life. Moreover, how can a person exist without external stimuli and in the case of a MSer external stimuli is everything! The air on our skin can be a disrupting stimuli. I resigned to write my own description of what this speech problem was and how to cure it. Speech problems in MS are usually caused by brain "notwork-a" and tongue "displace-a". The only way to live with this affliction is to repeat yourself until you get it right, pretend you don't sound funny, or laugh. I suggest the last cure, as it always works for me.
FRIDAY, Sept. 11 (HealthDay News) -- Two genes in mice have been linked to improvements in the body's ability to repair itself when afflicted with multiple sclerosis, potentially leading to more effective treatments, a U.S. scientist reports.
"Most MS genetic studies have looked at disease susceptibility -- or why some people get MS and others do not," study author Allan Bieber, a Mayo Clinic neuroscientist, said in a Mayo news release. "This study asked, among those who have MS, why do some do well with the disease while others do poorly, and what might be the genetic determinants of this difference in outcome."
The study, which was scheduled to be presented Friday at the Congress of the European Committee for Treatment and Research in Multiple Sclerosis in Dusseldorf, Germany, identified two genes that appear to lead to repair of damage caused by multiple sclerosis in mice.
Multiple sclerosis affects about 330,000 people in the United States. The disease targets the central nervous system and damages the insulation that covers nerves. People with the disease suffer from a variety of symptoms, including loss of strength, vision, balance and muscle coordination.
"It's possible that the identification of these genes may provide the first important clue as to why some patients with MS do well, while others do not," Bieber said in the news release.
Here is another organization that might be helpful:
The Multiple Sclerosis Association of America (MSAA) is a national nonprofit organization dedicated to enriching the quality of life for everyone affected by multiple sclerosis. MSAA provides ongoing support and direct services to these individuals with MS and the people close to them. MSAA also serves to promote greater understanding of the needs and challenges of those who face physical obstacles.
In addition to a variety of programs and services - such as consultations, equipment distribution, MRI diagnostic funding, and public awareness campaigns - MSAA also provides valuable information through its quarterly magazine and other literature.
Since 1970, MSAA's philosophy and efforts have focused on improving the quality of day-to-day life, for everyone affected by MS. This organization strives to help each individual on a personal level, and relies heavily on volunteers and the ongoing support of the general public. MSAA invites everyone within their community to join our cause - working together to break down barriers (physical, emotional, and social) and build up hope for those who are physically challenged. A national board of directors oversees MSAA's activities and the services it provides. Members of the Board include people with MS as well as leaders in business and community. Through their combined experience with MS, medicine, business, and government, these individuals are able to provide increased understanding and improved design to MSAA's staff and programs.
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The Accelerated Cure Project for Multiple Sclerosis is a national nonprofit organization dedicated to curing Multiple Sclerosis (MS) by determining the cause of MS. We believe the route to finding the cure will most quickly come from determining the cause or causes of MS. The causes will be found by developing a logical, organized, straight-forward process based on what is known about the causes of disease in general. This process must be clearly spelled out and presented in a manner that is accessible to those involved: researchers, clinicians, and individuals with MS. We call the plan that is emerging from this process the "Cure Map." The development and execution of the Cure Map is supported by: A top notch Scientific Advisory Board An Information Portal to distribute information on MS, the Cure Map, and related materials Fundraising efforts to pay for the development of the Cure Map A Community, both online and off, of our constituency Our constituency includes: Individuals with MS and their families - Involving and educating those who are most affected by MS as to what is known, what is being done, and what should be done is critical. Ultimately it is people with MS and their loved ones who are responsible for promoting the efforts for a cure. Clinicians treating individuals with MS and researchers working on areas related to MS - We collect all the news and information on MS that we can. We make this information available in a single, easy-to-use forum called MSNews so that it is not difficult to keep up to date with what is happening in the world of MS. Other nonprofit MS organizations - We share our research, framework, and technology with any organization who can help people with MS. It is important for any beneficial information or technology to reach as many people as necessary.
Multiple Sclerosis is a mysterious disease. Scientist have yet to discover its cause or a way to counteract the disease's progressive nature. It also does not receive the same level of attention or government backed funding because it only affects a small percentage of the population. However, it is a very difficult medical condition. People who suffer from Multiple Sclerosis suffer from degenerative nerves damage. Multiple Sclerosis This can affect the nerves of your eyes, spinal cord and brain. This disease, Multiple Sclerosis actually refers to the number of sclerosis areas that are a result of the demyelination of your nerves. These damaged areas are also known as plaques or lesions. Sometimes the nerve fiber itself is damaged or broken. MS Multiple Sclerosis affects young adults, usually between the ages of twenty and forty years old.The disease tends to Multiple Sclerosis affect more women then men. The ratio is almost 2 to 1 when comparing the number of women to men that develop Multiple Sclerosis. When diagnosed with Multiple Sclerosis, there are periods of flare- ups and periods of remission. There are several phases of MS. Relapsing-Remitting Characteristics: People with this type of MS experience clearly defined flare-ups (also called relapses, attacks, or exacerbations). These are episodes of acute worsening of neurologic function. They are followed by partial or complete recovery periods (remissions) free of disease progression. Frequency: Most common form of MS at time of initial diagnosis. Approximately 85%. Primary-Progressive Characteristics: People with this type of MS experience a slow but nearly continuous worsening of their disease from the onset, with no distinct relapses or remissions. However, there are variations in rates of progression over time, occasional plateaus, and temporary minor improvements. Frequency: Relatively rare. Approximately 10%. Secondary-Progressive Characteristics: People with this type of MS experience an initial period of relapsing-remitting MS, followed by a steadily worsening disease course with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Frequency: 50% of people with relapsing-remitting MS developed this form of the disease within 10 years of their initial diagnosis, before introduction of the "disease-modifying" drugs. Long-term data are not yet available to demonstrate if this is significantly delayed by treatment. Progressive-Relapsing Characteristics: People with this type of MS experience a steadily worsening disease from the onset but also have clear acute relapses (attacks or exacerbations), with or without recovery. In contrast to relapsing-remitting MS, the periods between relapses are characterized by continuing disease progression. Frequency: Relatively rare. Approximately 5%.
This article shows how society has become aware of the needs of the disabled and is accommodating those needs. I am creating this post using voice software from "Nuance" on a blog provided by "Google" with software from "Microsoft". In order to do this there are many other companies that have provided products that I am using along with knowledge that I have gained over the years. I thank these companies because without these tools, as I have Multiple Sclerosis I would have no choice but to watch television and watch the paint dry.
HOW TECH FOR THE DISABLED IS GOING MAINSTREAM;
Designs conceived for the handicapped, such as voice commands for PCs, often lead to products for the masses
Apple is widely celebrated for making devices as easy to use as they are elegantly designed. What customers probably don't know is that some of these features aren't exactly new--they evolved from software Apple created to help disabled people use PCs. Among them: the new iPhone's voice control option, which allows users to speak to their handsets to prompt an action, such as calling Mom, or to get a spoken answer to such questions as "What song is playing?"
And "mainstreaming" tools for the disabled is spreading. Software developer Nuance Communications, for instance, invented voice command technology to help people who are unable to type on a computer. Today, the company's algorithms are used in products ranging from Amazon.com's latest Kindle e-reader to cars from Ford Motor. Meantime, Mattel is incorporating technology, initially intended to help paraplegics, into a soon-to-be-released game controlled by players' brainwaves.
Other companies should consider following these trailblazers, say innovation consultants. "Companies could look at designing for accessibility as a sales opportunity. Most features that are accessible for the disabled have great value to everybody," says Donald A. Norman, a former Apple vice-president for advanced technology who heads a joint business and engineering program at Northwestern University.
BENEFITS FOR THE BLIND
Mainstreaming has a long history. Thomas Edison saw his invention of the phonograph as a way to open the printed world to the blind by recording book readings. More recently, predictive-text software, the algorithms that finish words people type in search engines or e-mail, had its roots in technology geared to the disabled, according to patents filed for related programs.
Apple's VoiceOver feature can be traced back to the late 1980s, says Norman, when the computer maker decided to try to embed "universal access" in its Macintosh PC line. The term is used in engineering and design circles to describe goods, from scissors to cell phones, made in such a way that people of any age or physical ability can use them. VoiceOver became a standard feature of Apple computers in 2006. When it's activated, the Mac reads everything highlighted by the cursor, from text on a Web page to numbers in a database, in a natural-sounding voice.
While VoiceOver helped broaden Apple's reach to the blind, it also became a mini-engine for innovation within the company. "When we created the VoiceOver idea and concept for the Mac, we also realized we could take advantage of it by mainstreaming it," says Greg Joswiak, Apple's vice-president for iPod and iPhone marketing. |
Now the technology has made its way into the iPod Shuffle. Unlike its larger brethren, the Shuffle is too small to have a screen to display information about its music content. The latest model, introduced last March, gets around this shortcoming with software that can say what song is playing. Sales were 51% higher in the new Shuffle's first week than they were for the previous model's debut, says Barclays Capital analyst Benjamin Reitzes. The low $79 price undoubtedly was part of the reason. But many users raved online about the voice interface, indicating that the feature helped popularize the music player, too.
Apple added a reverse version of VoiceOver to its third-generation iPhone, released in June, that enables users to tell the phone to perform functions rather than type commands. That permits hands-free use of the smartphone and makes the device functional for people with visual and other physical handicaps, as well as for motorists. "Some customers need assistive technologies, and other people want convenience," says Joswiak. "We try to solve problems for the disabled community, then we drive the solutions into the mainstream, to let everyone take advantage of them."
The rising demand for devices that can speak and be spoken to has been a boon for Nuance Communications. The Burlington (Mass.) company supplies voice control software for a growing number of products, from its Dragon NaturallySpeaking speech recognition software for PCs to hands-free voice dialing for phones from Nokia, Samsung, LG Electronics, and BlackBerry maker Research in Motion. Through a joint Ford-Microsoft venture called Sync, Nuance also provides voice command capabilities in top-selling GPS navigation devices, such as Garmin and TomTom, as well as in Ford, Lincoln, and Mercury vehicles.
"While the disabled aren't a significant percentage of our users today, they are our biggest power users," says Peter Mahoney, general manager of Nuance's Dragon unit. "They help us push the envelope" when it comes to improving products for mass-market customers.
Other companies are borrowing technology that aids the deaf. At Google, a deaf software engineer, Ken Harrenstein, spearheaded the creation of a captioning tool for videos posted on Google's YouTube site. His original intention was to help deaf users. But the company soon figured out the software could also help translate languages. That idea led in late 2008 to an auto-translation tool that allows people to add captions in 50 languages instantly to YouTube videos they upload, increasing the number of people who can watch and understand the clips. |
MIND CONTROL
Mattel is taking mainstreaming into the toy market. In October it plans to release Mindflex, an $80 game that borrows from technology used by severely disabled people to control electronic devices by channeling brainwaves via sensors. Mattel has licensed the toy's brainwave-harvesting technology from a San Jose company called NeuroSky. To play, users put on a headband with sensors. By focusing their thoughts on motion, they can cause a motor to propel small plastic balls through a tabletop obstacle course. When they relax, the objects stop moving.
Mattel is betting that the technology will become the basis for a line of mind-controlled physical games like Mindflex, opening up a new category for the toy industry, says Geoff Walker, a senior marketing vice-president at the El Segundo (Calif.) company.
As pioneers boost sales by incorporating technology once confined to products for the handicapped, other companies are sure to follow. They could come out ahead, says Tim Bajarin, president of technology consultancy Creative Strategies in Campbell, Calif. "It's smart, because there is an aging population that will need easier-to-use tech. It's even smarter to follow Apple's lead--and then call these features out and get people's attention. Then it becomes a competitive advantage." |
By themselves, there are no specific tests that can determine if a person has MS or is likely to have it in the future. Current diagnosis of definite MS involves both clinical (history and neurological exam) and paraclinical (MRI, Spinal Tap, Evoked potentials) evidence.
The diagnosis evolves from a discussion between the patient and the physician. A careful medical history is taken; symptoms and signs are assessed. Other ailments are ruled out. The diagnosis is highly dependent on the accuracy of the patient’s medical history and the physician's skill in eliciting and evaluating this information. The diagnosis is sometimes obvious and sometimes very difficult. Even in the hands of experts, the diagnosis is correct only 90 - 95 percent of the time.
The physician will ask about past surgeries, illnesses, allergies, any family neurological disorders including MS, geographic locations where you have lived, if adversely affected by heat, medications taken, history of substance abuse (alcohol, drugs, and tobacco).
During the neurological examination the physician will check for exaggerated reflexes such as Babinski's reflex, an upward movement of the big toe when the sole of the foot is stimulated. For patients with balance and gait difficulties, an eye examination is done to determine optic nerve damage.
The physician must be able to find neurological evidence of lesions or plaques in at least two distinct areas of the Central Nervous System white matter, evidence that the plaques have occurred at different points in time, and most importantly, that these plaques have no other reasonable explanation thus ruling out other illnesses that mimic MS.
For some patients no tests beyond medical history and neurologic exam are necessary to diagnose. However, most physicians will not rely entirely on this type of evaluation and will do at least one other test to confirm the diagnosis.
In this era, even a clear-cut diagnosis will usually be confirmed with an MRI of the brain, one of the major diagnostic tools currently used.
For further information, call our Program Services Department at 1-888-MSFOCUS(673-6287) or you can contact us by email: support@msfocus.org.
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Major Diagnostic tools
MRI of the brain and spinal cord with contrast, FLAIR MRI (fluid-attenuated inversion recovery), evoked potentials, lumbar puncture (spinal tap) are the major diagnostic tools at this time.
MRI is the most sensitive non-invasive method available to detect areas of demyelination, (damaged myelin surrounding the nerves). MRI is safe and accurate providing the clearest evidence of white matter lesions in the CNS, and is also used to monitor the disease.
Flair MR with Echo-Planner technology significantly reduces the time necessary to complete the FLAIR sequence and the standard MRI, while giving a greater picture of lesions on the brain.
Evoked Potential Tests include VEP, BAEP'S, and SSEP'S. A painless procedure where electrodes are placed on the head and body. Response is recorded to determine where delays in nerve transmission occur.
VEP (visual evoked potentials) an electrical response to repeated visual stimuli to detect optic neuritis.
BAEP (brain stem auditory evoked potentials) detect abnormalities in patients with demylenating lesions in the brainstem which cause delays in the transmission of sounds.
SSEP (somatosensory evoked potentials) delivers brief electrical stimulus to the wrist or ankle. Permits detection of disruptions in the pathways from the arms and legs to the brain at very specific positions of the CNS.
Spinal Fluid Analysis the brain, spinal cord are bathed in a fluid called cerebrospinal fluid (CSF). In some instances, the patient undergoes a lumbar puncture (spinal tap). This is done to make certain that some other disease is not masquerading as MS. The oligoclonal bands and the IgG index are abnormal in about 90% of MS patients.
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