**5. Nonpharmacological therapies (clinical trials)**

Nonpharmacological therapies with clinical studies are hence limited in acute phases of the injury.

## **5.1 Stem cells neural stem cells**

Pilot studies cover the acute phase of SCI.

## *5.1.1 Neural stem cells*

Transplants with human NSCs in phase I/IIa assessed the safety and neurological effects after SCI. Of 19 treated subjects, 17 were sensorimotor complete and two were motor complete and sensory incomplete. They demonstrated that 1 year after cell transplantation, there was no evidence of SC damage, syrinx or tumor formation, neurological deterioration, and exacerbating neuropathic pain or spasticity [157]. Additional studies should be designed in order to afford more evidence about the efficacy of NSCs.

## *5.1.2 Bone marrow stem cells*

Regarding bone marrow stem cells (BMSC), an interesting study reported data from 20 patients with complete SCI who received transplants of BMSC. They showed improvement in motor and sensory functions [158]. In addition, a study with autologous BMSCs in three patients in the sub-acute phase of injury (<6 months of disease) demonstrated that, these cells could be safely administered through intrathecal injection in SCI patients [159]. Other study showed that 45.5% of transplanted patients presented improved neurological function. They showed some degree of improvement in sensitivity and motor function as well as in sexual function. In two patients, neuropathic pain disappeared and bladder and bowel control increased [160]. Nevertheless,

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*Trends in Neuroprotective Strategies after Spinal Cord Injury: State of the Art*

more investigation through clinical trials is required with a larger population of

that autologous transplantation is safe but further researches are needed.

Transplants with autologous OECs in three patients indicated that there were no adverse effects 1 year after transplantation. The neurosurgical process did not lead to any negative sequelae either during the operation or postoperatively. Additionally, they demonstrated the possibility of taking a nasal biopsy and reliably generating enough cells for transplantation within 4 weeks [161]. These observations suggest

A Phase I clinical trial with autologous human SCs was conducted to evaluate the safety of transplantation into the injury of six subjects with subacute SCI. There was no evidence of additional SC damage, mass lesion or syrinx formation. They conclude that it is feasible to identify eligible candidates, appropriately obtain informed consent, perform a peripheral nerve harvest to obtain SCs within 5–30 days of injury, and perform intra-spinal transplantation of highly purified autologous SCs within 4–7 weeks of injury [162]. Studies in acute phases using SCs are very few:

Timing as a specific prognostic factor in rehabilitation results and confirms that early specific rehabilitation treatment is associated with greater improvement. Several studies investigate the early rehabilitation as a therapeutic strategy to improve locomotor function, some of them have even shown physical functional independence [163–165]. Other studies indicated that in acute SCI physical therapy of body weight support on a treadmill and defined overground mobility therapy did not produce different results [166]. Further studies are required to afford conclusive

In conclusion, there are several pharmacological and nonpharmacological treatments that have been tested in preclinical and clinical phases. However, so far have not yielded fully satisfactory results; even using combined therapies. Further studies are needed in order to identify novel therapeutic targets and strategies that

We gratefully acknowledge to Universidad Anáhuac México Norte for the sup-

*DOI: http://dx.doi.org/10.5772/intechopen.89539*

*5.1.3 Olfactory ensheathing cells*

*5.1.4 Schwann cells*

**5.2 Physical therapy**

results.

**6. Conclusions**

**Acknowledgements**

port to this chapter.

**Conflict of interest**

patients before further conclusions can be drawn.

therefore, more studies are needed in this area.

provide a better medical care avoiding complications.

The authors declare no conflict of interest.

more investigation through clinical trials is required with a larger population of patients before further conclusions can be drawn.
