**4.4 Biomaterials**

The cascade of secondary events following acute injury to the spinal cord results in demyelination, axonal degeneration, and cavitation formation. Therefore, regeneration is hindered by the lack of substrate to support cell migration and axonal growth [56, 57]. The development of tissue engineering technology has opened up new avenues for treating SCI. The main strategy of tissue engineering is to inoculate living cells on extracellular matrix substitutes (biomaterial scaffolds) that can provide a physical structure for cell growth and differentiation, as well as to guide the growth of transplanted cells and promote axonal regeneration of residual neurons [58].

The Neuro-Spinal Scaffold (InVivo Therapeutics Corp, Cambridge, Massachusetts) is a proprietary bioresorbable polymer scaffold that promotes appositional healing, spares white matter, decreases post-traumatic cyst

formation, and improves functional recovery in animal models of SCI. A pilot study evaluating the safety of Neuro-Spinal Scaffold implantation has completed recruitment and is currently in the follow-up phase. Moreover, a case report of the first patient to undergo implantation of the Neuro-Spinal Scaffold as part of this trial has been published previously. The patient was a 25-year-old man with a T11–12 fracture-dislocation following a motocross accident. At 3 months after implantation, neurological function had improved, and no complications were seen during the follow-up [31, 59].

## **5. Exoskeleton**

In the past decade, research in SCI rehabilitation has expanded to include robotic devices that initiate or augment movement. These robotic devices are used with two goals: to enhance recovery through functional movement and to act as a mobility aid beyond orthoses and wheelchairs [60]. In fact, exoskeleton training has been developed as a rehabilitation tool and is approved for the rehabilitation of individuals with SCI. Several studies have shown that robotic exoskeleton gait training has positive effects in terms of spasticity and pain reduction, as well as improved gait function without physical assistance [61–66].

Robotic devices may offer the greatest advantages for patients with incomplete SCI, turning measurable but functionally insignificant motor function into true mobility and independence. However, the global effects of restoring motion to the skeleton and joints in terms of cardiovascular benefits, prevention of contractures, osteoclastic activity, and psychological health have not yet been measured [67].

## **6. Conclusion**

Significant advances over the past decades have decrease the morbidity and mortality following SCI. Unfortunately, these advances have not impacted on the majority of patients affected by SCI, decreasing long-term health and quality of life. Current treatment options for SCI are restricted to systemic delivery of MP, early surgical decompression, and rehabilitation, all of which result in minimal functional recovery. Neuroprotection as well as neuroregeneration are our current targets for both pharmacological and non-pharmacological therapies; however, further research is still needed to find the best option for SCI patients.

**9**

**Author details**

Diego Incontri-Abraham and José Juan Antonio Ibarra Arias\*

\*Address all correspondence to: jose.ibarra@anahuac.mx

Norte Huixquilucan, Estado de México, México

provided the original work is properly cited.

Health Sciences Research Center (CICSA), Universidad Anáhuac México, Campus

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Introductory Chapter: Clinical Approaches for Treating Paraplegia*

*DOI: http://dx.doi.org/10.5772/intechopen.97395*

*Introductory Chapter: Clinical Approaches for Treating Paraplegia DOI: http://dx.doi.org/10.5772/intechopen.97395*

*Paraplegia*

seen during the follow-up [31, 59].

function without physical assistance [61–66].

**5. Exoskeleton**

measured [67].

**6. Conclusion**

patients.

formation, and improves functional recovery in animal models of SCI. A pilot study evaluating the safety of Neuro-Spinal Scaffold implantation has completed recruitment and is currently in the follow-up phase. Moreover, a case report of the first patient to undergo implantation of the Neuro-Spinal Scaffold as part of this trial has been published previously. The patient was a 25-year-old man with a T11–12 fracture-dislocation following a motocross accident. At 3 months after implantation, neurological function had improved, and no complications were

In the past decade, research in SCI rehabilitation has expanded to include robotic devices that initiate or augment movement. These robotic devices are used with two goals: to enhance recovery through functional movement and to act as a mobility aid beyond orthoses and wheelchairs [60]. In fact, exoskeleton training has been developed as a rehabilitation tool and is approved for the rehabilitation of individuals with SCI. Several studies have shown that robotic exoskeleton gait training has positive effects in terms of spasticity and pain reduction, as well as improved gait

Robotic devices may offer the greatest advantages for patients with incomplete SCI, turning measurable but functionally insignificant motor function into true mobility and independence. However, the global effects of restoring motion to the skeleton and joints in terms of cardiovascular benefits, prevention of contractures, osteoclastic activity, and psychological health have not yet been

Significant advances over the past decades have decrease the morbidity and mortality following SCI. Unfortunately, these advances have not impacted on the majority of patients affected by SCI, decreasing long-term health and quality of life. Current treatment options for SCI are restricted to systemic delivery of MP, early surgical decompression, and rehabilitation, all of which result in minimal functional recovery. Neuroprotection as well as neuroregeneration are our current targets for both pharmacological and non-pharmacological therapies; however, further research is still needed to find the best option for SCI

**8**
