Poster Session
(Alphabetical by Presenting Author)
Neuroimmune Mechanisms of Male Infertility after Spinal Cord Injury
Spinal cord injury (SCI) is a devastating condition causing lifelong neurological impairments and systemic complications, including male infertility. While previous studies have reported reduced semen quality in over 90% of men with SCI, the underlying mechanisms remain poorly understood. One potential mechanism is disrupted sympathetic innervation of the testes following SCI; however, this has not been fully explored.
This project aims to determine whether male infertility after SCI results from dysregulated neural control of testicular function. We employed a trans-synaptic tracing strategy using pseudorabies virus (PRV) to map sympathetic pathways from the spinal cord to the testes in adult male rats. To ensure full disruption of descending neural inputs, we adopted a complete thoracic (T8) spinal cord transection model instead of a contusion model.
In addition to optimizing spinal cord tissue clearing to quantify PRV-infected testicular neurons, we conducted several flow cytometry optimizations to confirm immune cell markers in rat testis. Our pilot study demonstrated the presence of immune cells in the testis and epididymis of SCI rats. We also observed significant differences in sperm motility between SCI and sham groups, further supporting the relationship between SCI and reduced semen quality.
Future studies will expand on these findings to test neuromodulatory or anti-inflammatory interventions aimed at reversing testicular pathology. This work addresses a critical gap in SCI research and may provide a foundation for fertility-preserving therapies in men with SCI.
Presenting Author: Akram Esfandani - Texas A&M University, College Station
Coauthors: K. Anderson, P. Ajobo, J. Dulin,
Preliminary Findings on the Role of Testosterone in Neurophysiological and Autonomic Function in Men with Chronic Spinal Cord Injury
Spinal cord injury (SCI) not only disrupts the nerves controlling movement, but also disrupts nerves regulating functions like heart rate and blood pressure (i.e., autonomic nervous system; ANS). In addition to testosterone’s (T) important role in the regulation of metabolism and body composition, T plays a significant role in brain health and ANS reflex function. However, little is known about the relationships between T, nerve, and ANS function after SCI. Interestingly, up to 50% of men with chronic SCI exhibit persistently low T, which may worsen neural dysfunction. We are conducting the first study assessing the relationships between the endogenous serum T profile and motor and ANS function in males with SCI, and the first study examining the immediate and short-term (1-month open label) effects of a novel intranasal (i)TRT delivery system. We will present preliminary effects on the serum T profile, central nervous system excitability, motor output, and cardiovagal reflex function. Our preliminary findings suggest that intranasal delivery of TRT may improve neural and cardiovascular ANS deficits following SCI, which will improve engagement in rehabilitation to promote independence and quality of life in men with chronic SCI. This preliminary trial will lead to longer duration treatment trials examining the chronic effects of iTRT combined with task-specific exercise on multiple body systems and further evaluating the safety profile of iTRT in men with SCI and low T.
Presenting Author: Jacob A. Goldsmith, PhD - James J. Peters VAMC, Icahn School of Medicine at Mount Sinai
Coauthors: Arnero, D., Sigafose, C., Castano, F., Harel, N., Wecht, J. M., Yarrow, J. F., Weir, J. P., Delgado, A.
Effects of A Single Bout of High-Intensity Interval Exercise on Cognitive and Cerebrovascular Functions in People with Spinal Cord Injury
Objectives: To evaluate the effects of a single bout of high-intensity interval exercise (HIIE) on cognitive and cerebrovascular function in people with spinal cord injury (pwSCI), T6 and above.
Methods: Fifteen pwSCI and 15 age- and sex-matched non-injured (NI) controls participated. The HIIE protocol included a 2-minute warm-up at 10% peak power output (PPO), three 20-second high-intensity arm-cycling bouts at 100% PPO interspersed with two 2-minute low-intensity bouts at 10% PPO, and a 3-minute cool-down. Cognitive assessments of memory, learning, processing speed, verbal fluency, and executive function were conducted pre-HIIE and ~41 minutes post-HIIE. Cerebrovascular function was assessed through middle and posterior cerebral artery blood flow velocities during the cognitive tasks. Linear mixed-effects models examined pre- to post-HIIE changes between groups, adjusting for premorbid intelligence, with Bonferroni correction applied (p < 0.05).
Results: Pre-HIIE, participants with SCI demonstrated poorer short-term memory (p=0.047), long-term memory (p=0.005), processing speed (p=0.006), and verbal fluency (p=0.040) compared to the NI controls. A single bout of HIIE did not significantly change cognitive performance in either group. Cerebrovascular function was preserved pre-HIIE in participants with SCI compared to NI controls and was not altered by the acute HIIE session in either group.
Conclusions: A single bout of HIIE did not significantly affect cognitive or cerebrovascular function in individuals with SCI T6 and above. Future studies should examine the effects of higher intensity HIIE protocols for longer training paradigms on cognitive performance and cerebrovascular function.
Presenting Author: Wenjie Ji - James J Peters VA Medical Center (Spinal Cord Damage Research Center), Bronx New York; the Icahn School of Medicine at Mount Sinai (Department of Rehabilitation and Human Performance), New York, NY
Coauthors: Wecht, J. M., Miecznikowski J., Jo, H. J., Stefanovic, F., Chiaravalloti, N., Sisto, S. A.
Exploring Respiratory Outcomes for SCI Participants in a Community-based Exercise Program
Individuals with spinal cord injuries (SCI) often experience significant respiratory function (RF) impairment, which can lead to severe health complications. While exercise guidelines for SCI populations exist, evidence on the impact of intensive exercise programs on RF remains limited. This study explores the relationship between participation in the Courage Kenny Activity-Based Locomotor Exercise (ABLE) program and changes in RF among clients with SCI. Secondary data were collected and analyzed from periodic assessments of RF, comparing initial and final measurements for each participant. A paired t-test revealed a statistically significant improvement in RF over time (t = -3.0086, p = 0.0035), with a small effect size (Cohen’s d = 0.3283), indicating modest but meaningful changes. These findings suggest that community-based exercise programs like ABLE may contribute to improved respiratory outcomes for individuals with SCI. While causality cannot be established due to study design, the results support further investigation into structured exercise interventions as a strategy to enhance respiratory health in this population.
Presenting Author: Nicholas Latterell, MS - Courage Kenny Rehabilitation Institute, ABLE Program
Sex and Income Level Influence Heavy Episodic Alcohol Use after Spinal Cord Injury
Following spinal cord injury (SCI), patients experience major changes in independence and quality of life that put them at risk for alcohol abuse. The factors associated with alcohol use after SCI are poorly understood. We explore how socioeconomic factors correlate with heavy episodic alcohol use (HEAU) post-SCI, which will help identify patients requiring additional support in the future.
Survey responses between 2012 and 2021 were collected from the National Spinal Cord Injury Statistical Center. Cohorts were identified through the questions “How often did you have six or more drinks on one occasion?”. Responses of at least monthly were the HEAU group. We compared this group to the rest of the participants using the student t-test and chi-squared test.
14,954 participants were included with 5,012 (33.52%) identified in the HEAU group. From 2012, there was an increase in the proportion of participants in this group from 29.05% to 34.80% in 2021. There was a greater number of male participants in the HEAU group (odds ratio: 1.35, p-value < 0.001). Patients with an income level of at least $75,000 were more likely to have HEAU (odds ratio = 0.3, p-value < 0.001).
While the risk of alcohol abuse after SCI is known, the factors that amplify this risk are poorly understood. This is increasingly important to understand as the rate of HEAU post-SCI increases. In this analysis, we identified male sex and high income as variables associated with higher rates of HEAU.
Presenting Author: Alexa Lauinger - Carle Illinois College of Medicine
Coauthors: Polites, G. M., Arnold, P. M.
Transcutaneous Spinal Neuromodulation Combined with Constraint-Induced, Task-Specific Training Restores Sensorimotor and Autonomic Function After 12 Years of Clinically Complete Spinal Cord Injury
The adult human spinal cord retains capacity for plasticity after chronic, sensorimotor-complete spinal cord injury (SCI), yet recovery beyond the subacute phase is rare. We report a longitudinal case study of a 34-year-old male with traumatic T4 AIS A SCI of 12 years’ duration and right brachial plexus root avulsion (C5–C7), demonstrating sensorimotor and autonomic recovery following a five-year intervention integrating transcutaneous electrical spinal stimulation (tSES) with task-specific, constraint-induced rehabilitation.
Training emphasized active participation with maximal voluntary effort, full weight-bearing stepping, and enriched afferent sensory feedback under spinal neuromodulatory input. Interventions included exoskeleton-assisted overground ambulation, treadmill locomotor training, assisted sit-to-stand transitions, and recumbent elliptical exercise. Constraint-induced principles were applied through reduction of external assistance to promote engagement of impaired neuromotor pathways. Reductions in robotic assistance from 100% to 20% coincided with emergence of volitional stepping, lower-extremity joint kinematics, and EMG activation consistent with supraspinal re-engagement.
Sensorimotor recovery included restoration of proprioceptive and load-related input below the lesion, enabling upright ambulation without visual compensation despite severe upper-limb deafferentation. Structural adaptations included hypertrophy of previously paralyzed musculature and bone mineral density improvements approaching age-matched norms.
Autonomic recovery was clinically meaningful. Bladder capacity increased from 50 to 230 mL with restored urge awareness. Bowel care time was reduced by over 50% with return of rectal sensation. Thermoregulation normalized. Sexual function improved, including restoration of genital sensation and ejaculatory reflexes. Cardiovascular stability improved with orthostatic tolerance.
These findings demonstrate that spinal neuromodulation combined with constraint-induced, high-effort rehabilitation can drive integrative neuroplasticity after complete SCI.
Presenting Author: Ignacio Montoya - Georgia Institute of Technology
Coauthors: Mitchell, C., Tsai, W., Solano, H. T., Zhong, H., Johnson, C., Richter, J., Loomba, P., Edgerton, V. R.
Example Methodology for Distinguishing which Individuals Do or Don’t Respond to Rehabilitation Interventions after SCI: An Exploratory Analysis
When testing new interventions for people with spinal cord injury (SCI), typical statistical approaches report average changes across participant groups. In simple terms, this is done by comparing the range and variability of group outcomes before versus after an intervention. This does not delineate if individuals are responders or non-responders, and thus if specific individuals benefit from an intervention. Historical examples exist showing “failed” clinical trials may contain sub-groups of participants who experienced benefits from a new intervention, meaning new therapies may not be approved despite offering genuine improvements to some individuals. Individual changes are often reported as absolute or percent changes of an outcome, which does not compare the range and variability of one person’s outcome before versus after an intervention to conclusively determine if this person experienced positive or negative changes in function. Multiple methods to accomplish this type of “n-of-one” analysis have been proposed for breathing, walking, and upper limb function in neurologic populations, but these analytical approaches remain underutilized (Morris & Gozal, 2004; Lang et al., 2023; Klarner et al., 2014).
Utilizing data from two experiments in participants with SCI, this presentation will compare group versus individual changes in corticospinal excitability and parasympathetic function following testosterone replacement therapy, and on blood pressure responses to transcutaneous spinal cord stimulation in participants with SCI. Methods for calculating individual statistical significance and effect sizes (Lakens 2013) will be presented. The advantages and limitations of this approach in the context of existing data and future study designs will be discussed.
Presenting Author: Tommy W. Sutor, MS, PhD - James J Peters VA Medical Center; Icahn School of Medicine at Mount Sinai
Coauthors: Goldsmith, J. A., Harel, N. Y., Wecht, J. M.
Transcutaneous Spinal Stimulation Drives Upper Extremity Recovery: Findings from a Multicenter RCT in Chronic SCI
Spinal cord injury (SCI) impacts approximately 15 million people worldwide, with nearly 500,000 new cases annually: about half of these individuals experience tetraplegia, significantly impairing upper limb function. Rehabilitation options remain limited, often relying on compensatory strategies and constrained by resource shortages, with most recovery plateauing within a year post-injury. Neuromodulation, particularly spinal cord stimulation, offers new therapeutic promise. While epidural stimulation can improve strength and sensation, its invasiveness poses additional risks. Transcutaneous spinal cord stimulation (TSS) has emerged as a non-invasive alternative, promoting spinal excitability and facilitating both motor and autonomic functions. The ASPIRE Study, a 14-site, prospective, randomized, double-masked trial, evaluated the safety and effectiveness of the ExaStim™ device paired with upper extremity therapy in chronic traumatic SCI. Over 8 weeks, 128 participants were randomized to active or sham stimulation; 120 completed the study. The active group received targeted, multi-channel cervical TSS during therapy, while the sham group received minimal stimulation. No serious device-related adverse events occurred. The primary endpoint, improvement in upper extremity strength per UEMS was met in favor of the active group, with secondary outcomes showing enhanced functional use, sensation, and quality of life. Gains were sustained at follow-up, suggesting promising long-term benefits. These findings support integrating TSS, such as ExaStim, into standard rehabilitation for chronic SCI to improve arm and hand function, with ongoing research exploring home-based applications for broader clinical impact.
Presenting Author: Arjun Kumar, OTR/L - TRYAbility NeuroRecovery
RESONATE: Pilot study on engaging with Marc Noël’s quantum paintings in peRson and in the mEtaverse for improvementS in mental bOdy represeNtations Affecting sensorimotor funcTion and emotional wEll-being in adults with spinal cord injury
The project focuses on NeuroArts-a field that merges art, science, and technology-to investigate how artistic experiences affect the brain and body. Adults with spinal cord injury (SCI) often struggle with poor body awareness, contributing to neuropathic pain in about 69% of this population. Long-term wheelchair use can also diminish the brain's memory of walking sensations.
Current interventions to improve body awareness and alleviate pain typically last 6-12 weeks. This study aims to deliver a quicker, scalable intervention through innovative visual arts that foster harmony between brain and body and includes technology that facilitates a sense of walking.
Artist Marc Noël employs Shodo-Japanese calligraphy-in his “quantum paintings,” which integrates breath and Chi (energy). Even those without martial arts/energy training often report sensations like warmth and pulsing while interacting with these paintings, helping them feel grounded.
The paintings can be experienced in physical form and virtual reality (VR) format within the metaverse, a VR environment. Adults with SCI will wear VR headsets to experience walking through an avatar, allowing exploration of the virtual art gallery at their own pace, making it more inclusive than traditional VR games that often require speed and agility. Participants will attend three sessions over three weeks, engaging with the quantum paintings in both formats. We will gather feedback on their experiences, assess effects on body awareness, and evaluate emotional well-being via surveys. The pilot data will support funding applications to the National Endowment for the Arts and the National Center for Complementary and Integrative Health.
Presenting Author: Ann Van de Winckel, PT, MSPT, PhD - Division of Physical Therapy and Rehab Sci, Department of Fam Medicine and Comm Health, Medical School, University of Minnesota
Coauthor: Tewari, M., Noël, M., Choowa, F.
Cognitive Multisensory Rehabilitation for Sensorimotor Recovery in Adults with Spinal Cord Injury: Pilot Clinical Trial
Spinal cord injury or disorder (SCI/D) often causes sensorimotor impairments, reducing independence and quality of life. Cognitive Multisensory Rehabilitation (CMR) restores body awareness in paralyzed limbs and trunk thereby improving sensorimotor function and alleviating neuropathic pain.
This pilot study compared in-person CMR to adaptive fitness for sensorimotor function in adults with SCI/D. Adults with SCI/D were randomized to eight weeks of CMR with a therapist or adaptive fitness (45 min, 3x/week). Sensorimotor function was evaluated with ISNCSCI Impairment Scale (AIS) and Neuromuscular Recovery Scale (NRS) at baseline, post-intervention, and three-month follow-up.
Sixteen adults participated (average age 51.6 years). Large effect sizes were seen after CMR (n=8) for AIS (touch: Cohen’s d=1.54; pinprick: d=1.83; lower limb motor function: d=1.32), vs moderate effects after adaptive fitness (n=6, touch: d=0.53; pinprick: d=0.57; lower limb motor function: d=0.59). Similarly, CMR achieved larger effect sizes for NRS (core: d=2.19; upper limb: d=0.69; lower limb: d=0.74) compared to adaptive fitness (core: d=0.64; upper limb: d=0.36; lower limb: d=0.00). Benefits were sustained at three months.
CMR led to increased activation in brain regions linked to sensorimotor function and body awareness during a leg imagery fMRI task. Both interventions increased brain activation during a whole-body imagery fMRI task. These preliminary results support CMR’s potential to enhance function in SCI/D; larger trials are needed for validation.
Presenting Author: Ann Van de Winckel, PT, MSPT, PhD - Division of Physical Therapy and Rehab Sci, Department of Fam Medicine and Comm Health, Medical School, University of Minnesota
Coauthors: Carpentier, S. T., Bottale, S., Blackwood, J., Zhang, L., Mueller, B. A., Morse, L. R., Lim, K. O.
Safety, Tolerability, Outcomes of Psilocybin for Depression (STOP Depression) in Veterans with Spinal Cord Injury
Introduction: Depression diminishes quality of life for civilians and Veterans with SCI, with prevalence rates up to 3X higher than uninjured cohorts. Poor responsiveness to conventional antidepressants and comorbid conditions such as chronic pain may exacerbate depression in SCI. Psilocybin, the active component of ‘magic mushrooms’, activates serotonergic neural pathways. In 2024, based on accumulating evidence, the FDA designated psilocybin a breakthrough therapy for major depressive disorders. However, people with SCI have been excluded from these groundbreaking studies.
The purpose of the study is to determine if psilocybin is safe and well tolerated in people with SCI and then to determine the effects on the severity of depressive symptoms in Veterans with SCI.
Objectives: 1) assess safety and tolerability of psilocybin; 2) track the incidence of medical and psychological complications throughout enrollment; 3) assess depressive symptom severity; 4) assess pain intensity, pain catastrophizing, and sensorimotor and autonomic function. Safety, tolerability, incidence of complications, and depressive symptom severity will be assessed with patient-reported and standardized clinician-assessed surveys.
Enrollment & Study Plan: Thirty Veterans with chronic SCI will be enrolled, 15 with paraplegia, 15 with tetraplegia. Each participant will receive one psilocybin dose: low (5mg), medium (10mg), or high (25mg). There will be up to 12 study visits, including in-person and remote medical and mental health check-ups, psilocybin assisted therapy, and three follow-up visits at 1-, 3-, and 12-months post-dosing.
Funding: Department of Defense Congressionally Directed Medical Research Program (Grant#240097).
Presenting Author: Jill M. Wecht, EdD - James J Peters VA Medical Center, Bronx New York; the Icahn School of Medicine at Mount Sinai, New York, NY
Coauthors: Harel, N. Y., Sutor, T. W., Goldsmith, J. A., Ji, W., Bryce, T. N., Weir, J. P., Lehrner, A. L., Haznedar, M. M.
