The incidence and prevalence of traumatic spinal cord injury (SCI) worldwide have increased over time. As per the study by Weizhong Ding et al., globally, there were 0.9 million incident cases, 20.6 million prevalent cases, and 6.2 million YLDs of total SCI in 2019. Similarly, as per the data presented by WHO, every year, about 250,000-500,000 people suffer a spinal cord injury (SCI) worldwide, and up to 90% of spinal cord injuries are due to traumatic causes. In the United States, the annual incidence of spinal cord injury is about 54 cases per one million people, and about 17,700 new SCI cases are registered each year.
Spinal cord injury encompasses various injury types and severities that affect mobility and functions. Road accidents or crashes, fall, and violence are some of the major factors leading to the rise in the cases of spinal cord injuries worldwide. Similarly, a disease or a degenerative disorder may also lead to impairment or damage to the spinal cord. About thirty-one pairs of spinal nerves emerge segmentally from the spinal cord and extend to the various parts of the body. The spinal cord is crucial in transmitting messages between the brain and the rest of the body. Spinal cord injury leads to the blockage or stoppage of nerve impulses through the spinal column. Due to injury or disease, the nerves above the level of injury keep working as they did before. But below the level of injury, messages from the brain to the body may become fully or partially blocked. It is reported that young adults (20-29 years) and old age people (70+) are at higher risk than people from other age groups. Similarly, the male-to-female ratio for spinal cord injury is around 2:1 among adults, and in some geographies and regions, it may be much higher.
Spinal cord injury is often associated with a risk of developing several other complications and ailments. A person with severe spinal cord injury may depend on their families and caregivers to carry out daily activities. deep vein thrombosis, urinary tract infections, muscle spasms, changes in bowel and bladder function, osteoporosis, pressure ulcers, chronic pain, and respiratory difficulties are some of the key complications closely associated with spinal cord injuries. Around 20-30% of people with spinal cord injury often demonstrate clinically significant signs of depression which can negatively impact their mental and social behavior and overall health. Over the past few years, there have been significant improvements in functional outcomes for patients with SCI due to the developments in medications, physical and occupational therapies, and the growth in overall holistic care.
Spinal cord injury can severely impact the social well-being of the affected person and their families. Moreover, it can create a financial burden and growth in demand on the health care systems. It can have several far-reaching physical, emotional, and economic outcomes for patients, thus hampering growth. Spinal cord injury has been associated with very high mortality rates. It is observed that people with a spinal cord injury are two to five times more likely to die prematurely than people without a spinal cord injury. In high-income countries, people with SCI can survive, live and flourish after injury due to better medical provisions and healthcare infrastructure. However, survival rates in low- and middle-income countries are quite low due to insufficient treatment and management options.
Several treatment options are available in the spinal cord injury market, including medications and surgeries. However, the medication may not be effective in every case. Early rehabilitation is observed to play a key to improve injury outcomes. Similarly, physical therapy and occupational therapy are also beneficial. Apart from these, globally, several key companies are actively working on various alternative tools and technologies to deal with the growing demand for better treatment options.
Emerging Trends and Technologies in Spinal Cord Injury Rehabilitation
To respond better and provide reasonably sufficient management options, MedTech and HealthTech giants are working on several assistive tools and technologies for spinal cord injury care. Assistive technology is regarded as a great tool in facilitating mobility, communication, self-care, or doing domestic activities. Some of the leading trends and technologies in the spinal cord injury rehabilitation market include-
Virtual reality (VR) plays a key role in the healthcare segment across different verticals ranging from treatment to education. In the treatment segment, it has significantly improved the clinical outcomes for stress and anxiety management. Similarly, its role in pain management is growing. The application of VR in pediatric and general medicine is growing at an enormous pace. Similarly, the demand is also increasing in spinal cord injury management and several other musculoskeletal disorders care.
There are very limited treatment options for spinal cord injury (SCI)-associated neuropathic pain and the available products have very little efficacy, which is a major challenge in the SCI market. Moreover, it is observed that patients with SCI often exhibit a high degree of resistance to pharmacologic treatment. Virtual reality (VR) therapy is a non-invasive, non-pharmacologic alternative and emerged as a key tool for managing SCI with minimal adverse effects. VR employs some of the programs designed to promote activity-based training exercises to help to improve functional mobility and rehabilitate mental well-being. Virtual Reality is in use in the healthcare setting with the highest safety and is easier to use.
Virtual Reality Neurotherapy uses innovative design to create an environment that tricks the brain into believing that it is physically performing actions. It activates the brain’s mirror neurons that use the neurological pathways and execute goal-related motor actions. It encourages the brain to shoot neurological pathways under different circumstances that have otherwise been turned off for some time. Virtual Reality Neurotherapy is intended to promote physical improvements, improve mobility, and create a stronger sense of independence and confidence. Overall it improves life quality and enjoyment. MieronGO is one of the leading Virtual Reality Neurotherapy for managing spinal cord injury (SCI)-associated neuropathic pain. Currently, several studies are going on globally to evaluate the effectiveness of Virtual Reality Neurotherapy in SCI-associated neuropathic pain. Some studies have shown favorable results with VR therapy for SCI-associated neuropathic pain.
Stem cells are blank cells, or undifferentiated cells, which are capable of transforming into specialized cell types. Stem cells have the ability for self-renewal or to multiply while maintaining the ability to develop into other cells. Globally, limited research activities are going to assess the potential use of stem cells to restore the spinal cord damaged by injury or disease. Studies assess the feasibility of treating spinal cord injury with allogeneic human umbilical cord tissue-derived stem cells and autologous bone marrow-derived stem cells. However, it is a very complicated and not that straightforward procedure to intervene as the neurons have a limited ability to regenerate. Much conclusive research and a better understanding are required to generate precise chemical signals that tell the stem cells what to do to create the proper growth and regeneration in the SCI.
Stem cell therapy for spinal cord injury is still in the premature stage. The efficacy is encouraging but not sufficient to support the clinical translation. However, ongoing research activities by the global pharma and biotech giants in the segment, high-quality and well-designed clinical studies, a rise in investment, and promising preclinical results are expected to significantly improve the outcome for patients with SCI in the coming years.
Functional Electrical Stimulation (FES)
Functional electrical stimulation is an assistive device that produces some basic movements after paralysis. The technology is being used in orthopedic and neurological conditions. The concept was developed in the sixties; however, great development has been registered in recent decades. Functional Electrical Stimulation comes in various forms and is based on wired or wireless technologies. Functional Electrical Stimulation has observed significant changes and is also being used by patients with SCI and stroke as part of their rehabilitation. It uses computer technology to send low-level electrical impulses to specific muscles in the body and assists in recovering voluntary motor function. Electrical Stimulation uses electrodes that are placed over the nerves and stimulate the nerves to do activities such as standing, walking, grasping, cycling at stationary places, reaching, and holding certain items and others. Moreover, it can cause muscles to contract, which may promote increased muscle bulk or muscle control. Similarly, muscle activity may also help reduce muscle spasms.
Functional Electrical Stimulation has several benefits, as it can improve the range of motion and strengthen muscles. Similarly, it enhances blood circulation and heart health and improves the functional use of the hands, arms, or legs. Overall, Functional Electrical Stimulation has great benefits for performing daily activities and creating a wellness program at home. Globally, several key MedTech giants such as Mylan N.V., Sanofi S.A., GlaxoSmithKline plc, Merck & Co., Inc., Otsuka Pharmaceutical Co., Ltd., Eli Lilly and Company, Novartis International AG, F. Hoffmann-La Roche AG, Abbott Laboratories, Teva Pharmaceuticals Industries Ltd., and others are actively involved in the Functional Electrical Stimulation Market. Owing to the ongoing innovation and developments in the segment, the functional electrical stimulation market is expected to exhibit impressive growth in the coming years.
Brain-Computer Interfaces (BCI)
Brain-computer interfaces (BCIs) are one of the promising and evolving technologies in the SCI market. Brain-computer interfaces, when implanted, can provide a direct connection between the human brain and a computer and translate brain activity signals into control signals for external devices. Several BCI systems are already available in the market and used for SCI rehabilitation. Similarly, several research activities are going on in the segment.
A BCI system consists of components that execute functions such as signal acquisition, feature extraction, feature translation, and classification output, which interfaces to an output device. BCI combined with functional electrical stimulation can be immensely helpful in voluntary muscle movement to paralyzed muscles. With the ongoing innovations, BCI is greatly being recognized as a useful tool for providing alternative communication and mobility to patients with nervous system injuries. In the coming years, with more and more innovation and growth in technology, the BCI can make a brain to control a computer-assisted device.
BCIs can assist and augment the patients’ motor functions through brain-controlled robot arms, wheelchairs, or other devices with much higher accuracy. The BCI system can be used to combine multiple pathways for movements together and can assist the person in day-to-day activity and rehabilitation. With wide-ranging benefits and applications, Brain-Computer Interfaces hold immense potential to improve the quality of life by strengthening the residual neuronal pathways or controlling replacement devices.
Robotics over the past few decades have registered significant growth across different industries owing to the developments in sensors, actuators, miniature computers, and control system software. Similarly, in the healthcare system, wearable robotic exoskeletons systems developed as assistive devices are also getting massive attention. The growing demand has attracted significant attention among the major MedTech and HealthTech giants. These robotic exoskeletons improve the quality of life for people with spinal cord injuries, neurological disorders, and strokes. A wearable robotic exoskeleton helps regain balance, coordination, and strength and assists the hip and knee motion. A person with spinal cord injury (SCI) can stand upright, walk, turn, and climb and descend stairs. Similarly, the robotic exoskeleton is of great potential for patients with lower-extremity weakness to get up and move. As per the leading research, repetitive walking patterns can help the brain and spinal cord work together to re-route the signals damaged due to spinal cord injury.
Some Robotic exoskeleton has received FDA clearance for personal and rehabilitation for brain injury, multiple sclerosis (MS), SCI, and stroke. These approved robots provide rehabilitation for people across geographies and different age groups. In the coming years, the ongoing innovation, the rise in investment, and the active participation of the companies, Wearable Robots are expected to make a huge difference in the lives of people with SCI.
Spinal Cord Injury Rehabilitation: Future Perspective and Analysis
Spinal Cord Injury is a lifelong injury and creates a significant burden on the person and their families. The SCI creates several economic and physical barriers to the growth and development of the person. Currently, the Spinal Cord Injury market is dominated by physical therapy, occupational therapy, and other rehabilitation therapies. Similarly, several clinical and non-clinical pieces of research are going on in the spinal cord injury therapeutics market. Moreover, it is observed that people are trained to cope with their disabilities. However, the growth in assistive technology is significantly changing the overall market and treatment dynamics. The emerging technologies are providing necessary support to patients with SCI and providing scope for equal opportunity in employment and educational segments.