Careers in Medical Research

CAREERS IN

MEDICAL RESEARCH

Institute Research Number 148 ISBN 1-58511-148-1 O*Net SOC Code 19-1042.00

CAREERS IN

MEDICAL RESEARCH FINDING CURES FOR PARALYSIS Spinal Cord Injuries, Stroke, Multiple Sclerosis, Cerebral Palsy, Amyotrophic Lateral Sclerosis Unlocking the Mysteries of the Brain and Fixing a Broken Body ON THE SCREEN HE SOARED AS SUPERMAN. HIS ACTING CAREER WAS REACHING

new heights with ever-expanding roles in movies, on stage and in television. At age forty-two he was tall, handsome, wealthy, in great physical condition, happily married with a family. Christopher Reeve had it all. Soon he would face the greatest challenge in his life and to his life.

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On May 27, 1995, Reeve, an accomplished equestrian, was entered in the trials for a cross-country horse jumping competition. He and his horse had walked the course several times for both to become familiar with the course. On the third jump his horse stopped without warning and Reeve was thrown over the fence and landed on his head because his hands were still entangled in the bridle and he could not get them free to break the fall. He was knocked unconscious. A doctor who had also been on the course quickly came to Reeve and began mouth-to-mouth resuscitation and restored his breathing until the paramedics arrived. Quick action prevented brain damage and his life was saved, but Christopher Reeve was paralyzed from the neck down, unable to move his arms or legs or breathe without a respirator – a quadriplegic. We begin this report with this high-profile case because Christopher Reeve did for paralysis what the actor Michael J. Fox has done for Parkinson’s Disease, and numerous female luminaries have done for breast cancer – share their experiences, bring the illness out in the open, and lend their prestige in the efforts to fund research and rehabilitation programs and find new treatments and ultimately a cure. More than eight thousand people a year suffer spinal cord injuries through acts of violence, sports activities and motor vehicle accidents that result in various levels of paralysis. Add to this the hundreds of thousands who suffer strokes every year and experience varying degrees of paralysis. There are also thousands more who are diagnosed each year with paralyzing diseases such as multiple sclerosis and cerebral palsy, and this adds up to about five million men, women and children who are experiencing partial or total paralysis and are struggling to cope with daily living.

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WHAT IS PARALYSIS? ACCORDING TO THE EXPERTS AT THE CHRISTOPHER AND DANA REEVE PARALYSIS

Resource Center paralysis can be defined as a loss of function or feeling. Injury or disease to a person’s nervous system can affect the ability to move or feel. This reduced motor or sensory ability is called paralysis. The central nervous system consists of the brain and the spinal cord and controls most functions of the body. It does many jobs at the same time, controlling all voluntary movement like talking and walking, and involuntary movements like breathing and blinking. Other body systems and organs usually have just one function. Through the skull and the spinal column, the central nervous system is better protected than other parts of the body. When there is a disconnect between the central nervous system and the body, paralysis occurs. Scientists know why this disconnect happens in outside traumas such as motor vehicle accidents and sports injuries. But they have yet to completely understand the disconnect in internal illnesses such as multiple sclerosis (MS), a disorder of the brain and spinal cord, or amyotrophic lateral sclerosis (ALS), a progressive neurological disease. Other organs and tissues in the body can recover with time and little or no intervention. But the central nervous system is a very complex system and the cells – called neurons – are so specialized that they cannot regenerate or create new cells, making recovery very difficult. Reconnecting the brain to the spinal cord cells is the huge challenge facing 21st century research scientists. From the Christopher Reeve Paralysis Foundation: The spinal cord is the highway for communication between the body and the brain. When the spinal cord is injured, the exchange of information between the brain and other parts of the body is disrupted.

Hope for the Future? Definitely! There are thousands of doctors, researchers, rehabilitation and pain specialists, and other healthcare professionals working on two fronts: The first and primary concern is trying to recreate or regenerate the central nervous system as it was before an injury or a disease such as amyotrophic lateral sclerosis.

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The second area is the condition of the patient and what can be done to make the disabling experience better. This involves not only the medical condition, but the emotional, mental, social, and family/friends/community problems that a person with a paralysis faces. This report is an important attempt to interest you in checking out the research and rehabilitative opportunities in the medical enigma we call paralysis. Most of the career opportunities require undergraduate degrees at the least, and graduate degrees for the top jobs, especially in research. These career possibilities can truly be called medicine, on the cutting edge. Unlocking the mysteries of the brain and the central nervous system and fixing a broken body are the stuff that science dreams of. Thousands of doctors, researchers and rehabilitation specialists are in public, private and government hospitals, medical centers, laboratories, pharmaceutical companies, veterans facilities, and the National Institutes of Health, trying to unravel the puzzle.

AN ARRAY OF PARALYZING CONDITIONS BECAUSE THERE IS NO-ONE-CURE-WILL-FIT-ALL SCENARIO, THE WORK IS ONGOING

on many fronts. As each new piece of the puzzle is identified and given its place in the whole, it will open up a new pathway to unraveling yet another part of the puzzle. In order to understand the magnitude of this mission, you must know about some of the illnesses and diseases categorized as paralysis, who they affect and what the current status of research is.

Spinal Cord Injury Any injury of the neural or nerve elements within the spinal canal is in this category. Most spinal cord injuries are the result of trauma to the vertebral column and affect the ability to send and receive messages from the brain to the important body systems that control sensory, motor and autonomic (involuntary) functions below the injured area. Usually, nerves above the injury area will continue to function. There are about 450,000 Americans who have sustained spinal cord injuries, with more than 8,000 new cases reported every year. Most of these injuries are caused by motor vehicle accidents, also acts of violence, falls, sports-related accidents, and work-related injuries, especially in fields like construction. Teenagers and young adults in their twenties account for more than three-quarters of the injuries, and about 80 percent are male. 5

More than half of spinal cord injuries are in the cervical, or neck area, about a third in the thoracic, or chest area, and the rest in the lumbar, or lower back area. There is no cure, but the research across the country and around the world is ongoing, with the emphasis on testing surgical and drug therapies. The Christopher Reeve Paralysis Foundation alone received grants totaling almost $8 million in one recent year and disbursed that money for research to over 50 individuals and research groups across the United States, Canada, and Europe.

Multiple Sclerosis MS is a disorder of the brain and spinal cord where the body’s own defense system attacks myelin, the fatty substance that surrounds and protects the nerve fibers of the central nervous system. When any part of the myelin or nerve fiber is damaged or destroyed, the nerve impulses to and from the brain are distorted or interrupted. Symptoms also include various stages of paralysis. MS episodes can last days, or weeks, or months and alternate with times of reduced or no symptoms, called remission, and recurrence, called relapse. About 300,000 people have MS, the majority female and generally diagnosed between the ages of 20 and 50. There is no cure, but the National MS Society reports there are currently several federally-approved medications that treat MS. Steroids may also be used to shorten acute attacks. In addition, more than 300 research grants and fellowships, including clinical trials, are funded by the Society each year.

Amyotrophic Lateral Sclerosis Also called Lou Gehrig’s disease after the famous baseball player who died from it, ALS is a progressive motor neuron (nerve cell) disease which is usually fatal within five years of diagnosis. The loss of nerve cells causes the muscles under their control to weaken and waste away causing paralysis. Thus the vital communication link between the brain and the spinal cord is interrupted. As muscles weaken, symptoms can include tripping, falling, loss of control of hands and arms, difficulties in speech, swallowing and/or breathing, twitching, cramping and fatigue. The disease does not impair the mind, intelligence, memory or personality.

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ALS strikes in mid-life, more men than women. About 20,000 Americans have ALS, with some 5,000 new cases occurring every year. There is no cure nor even a proven theory or therapy to reverse or slow its course, but the Food and Drug Administration (FDA) has approved a drug called Riluzole that has been shown to prolong survival. Research is ongoing.

Cerebral Palsy This disease affects approximately 500,000 children in the United States. CP is usually diagnosed when a child is between two and three years of age. CP refers to a group of conditions affecting the control of movement and posture with symptoms ranging from mild to severe, including various levels of paralysis. Many children also have accompanying problems that include mental retardation, seizures, learning disabilities, and vision, hearing and speech problems. Some known causes include infections during pregnancy, complications of labor and delivery, premature births, and acquired CP, which happens when a child has a brain injury or infection such as meningitis. There is some hope for drugs that ease symptoms or reduce abnormal movements. Medical research is looking into everything from cell development in early pregnancy to low birth-weight, to various forms of brain damage, blood flow or shortage of oxygen in the brain and many other possible contributing factors.

Transverse Myelitis This neurological disorder of children and adults is caused by an inflammation across a segment of the spinal cord. About 33,000 Americans are affected with TM, and 1,400 new cases are diagnosed in an average year. Mild symptoms can include lower back pain and muscle weakness and some people recover with minor or no residual problems. But more severe symptoms include paralysis and loss of bowel control and can cause permanent impairments. In severe cases there is damage that interrupts the communication between the nerves in the spinal cord and the rest of the body. There is no cure yet. Researchers are pursuing viral theories that include the virus that causes chickenpox and shingles, as well as bacterial pneumonia and others. Pain is a major problem in more than half of the affected, and research into various pain therapies and drugs is ongoing.

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Stroke The blood supply to the brain is suddenly blocked, or a blood vessel bursts in the brain and spills into spaces surrounding the brain causing a stroke. The severity of the stroke and the ensuing paralysis depends upon how long the blood flow to the brain has been interrupted. Paralysis can be mild to severe and can affect any and all parts of the body. Some brain cells may be temporarily damaged and can resume functioning, much to the surprise of the patient and doctor. Early intervention is crucial. Researchers have been able to restore blood flow to the brain cells by administering a clot-dissolving agent called tissue plasminogen activator (known as t-PA) within three hours of the onset of the stroke. More than four million Americans are stroke survivors, and about 300,000 more experience strokes each year. Stroke is one of society’s most expensive illnesses, costing billions of dollars in productivity and billions more in medical care and rehabilitation. Other conditions causing paralysis include Spina Bifida, a birth defect that results in a cleft spine or incomplete closure of the spinal column; Guillain Barre Syndrome, an autoimmune disease where the body’s immune system attacks part of the nervous system; Friedreich’s Ataxia, an inherited disease that affects one in every 50,000 people and causes progressive damage or degeneration of nerve tissue in the spinal cord and of the nerves that control arm and leg movement. Post-Polio Syndrome is the effect of poliomyelitis (infantile paralysis) that was eradicated thanks to the Salk vaccine in 1955 and the Sabin vaccine in 1962 . The World Health Organization estimates there are 12 million people around the globe living with some degree of paralysis due to this disease. It is estimated that there are about a million polio survivors in the United States. What can be done to help these millions of paralysis victims and the millions more who will be stricken in the future? Keep reading and consider becoming part of the search.

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A 21ST CENTURY CAREER HEALTHCARE AND TECHNOLOGY WILL DEFINE THE 21ST CENTURY. THERE IS A

flood of opportunities to set new agendas in research and discovery in order to reach greater levels of knowledge. Healthcare will lead the way as we face ever-growing populations around the world; disease and illnesses that are now so easily transported from country to country; more street violence, more sports injuries, more vehicular and workplace accidents; the significant number of men and women who will live longer and the added health risks, like Alzheimer’s, they face; and the significant number of children and young people around the globe who struggle day-to-day just to stay alive. What science can do to better understand and repair the body will be a main focus of 21st century healthcare. The brain and the central nervous system will be at the forefront of the breakthrough work. There will be new surgical procedures to pioneer; new medications to discover; new rehabilitative therapies to test, and on and on. The curious, the determined and the best minds will be needed to unravel the mysteries of what causes paralysis and what can be done about it. The men and women who want to make a difference and leave their mark will consider a career in paralysis research and rehabilitative therapies. At the start of the 20th century we were still trying to get off the ground and fly. At the start of the 21st century we are sending unmanned space shuttles to other planets in our universe and using the pictures they send back to plan a manned voyage to another planet, probably Mars. This is not science fiction. This is the result of a hundred years of research and discovery. We are standing on the edge of new research and discovery in so many aspects of medicine. We have unlocked many mysteries of the body, but there is so much left to do.

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WHERE IT BEGAN ARCHEOLOGICAL DIGS REVEAL THAT PARALYSIS IN MEN AND WOMEN WAS A FACT

of life from the earliest time of human life. A Chinese practitioner in 3000 BC wrote about the value of massage and exercise. More than 2,500 years ago, Egyptian hieroglyphics noted that a spinal injury was a condition not to be treated. Those suffering from a paralysis, or indeed most types of disease or injury, had no future, literally. Therapy or treatment of some kind has always been part of the healing process going back to cavemen. The first recorded treatment was heat in the form of fire and then the sun. Early inhabitants of our planet noted on cave walls that whatever wounds they had healed faster when the sun shone brightly than in the dark periods. Greeks, Egyptians, Indians and Persians worshiped the sun’s healing powers and erected temples to sun gods. Later on, ice or cold drinks would be used to help bring down fevers. Rivers, such as the Ganges in India and the Nile in Egypt, were said to have healing powers. The ancient Romans were thought to be the first to use a form of hydrotherapy – the use of water for healing – within their public baths called “sweat houses,” with hot and cold rooms. They also pioneered the use of underwater exercises in warm spring water to treat paralysis from war wounds. Electricity, or electric shocks, in therapy was first recommended, and a Greek physician wrote about holding a magnet over the arthritic joints of his patients. By the early 1800s, doctors began making drawings of patients showing their various physical maladies. In 1838, medical drawings were specific in capturing the effects of what we now know is multiple sclerosis, but the doctors had no understanding of what they saw and were recording. In 1848, a doctor published his description of a syndrome involving muscular weaknesses and thought it had neurogenic roots. We now know this to be amyotrophic lateral sclerosis. Slowly the doctors began to link these diseases with the brain and the central nervous system. In 1868, a professor of neurology at the University of Paris wrote the first complete description of multiple sclerosis and the changes that happen in the brain. As the 1800s drew to a close, physicians and scientists began organizing a better process to properly identify these conditions, even though they had no idea what caused the conditions and really had no specific treatments. It became important to share information. 10

By the beginning of the 1900s, the effects of certain illnesses such as heart disease were reaching epidemic proportions and patients who were afflicted were doomed to either die or spend the rest of their days in bed. By 1915, a pioneering group of physicians and social workers in New York City formed the first association to dispense information about heart disease and stroke. This effort spread to other major cities such as Chicago, Boston and Philadelphia and soon doctors were sharing information about patients and treatments. In 1924 this effort became the American Heart Association. In the 1930s, Lou Gehrig was a first baseman with the New York Yankees and had played a record 2,130 consecutive baseball games when he was diagnosed with amyotrophic lateral sclerosis (ALS) and was forced to retire in 1939. He died in 1941 and from that time on, ALS has been known as Lou Gehrig’s disease. From the early 1800s scientists were puzzled by what was preventing the spinal cord from regenerating. In his 1998 autobiography Still Me, Christopher Reeve writes, “For a long time it was assumed that the damaged nerves were simply, for some reason, incapable of growth. It was suggested that the central nervous system failed to regenerate because of an ‘inhospitable environment.’ In 1981 Alberto Aguaya, a researcher at McGill University in Montreal, posited that the spinal cord could not regenerate because some vital ingredient was missing from its environment, and this theory became widely accepted.” From the 1940s to the 1980s, the American Heart Association (AHA) grew in size and stature as heart disease and stroke began to take its toll on the population. Research came to the forefront; identifying health risks in smoking, alcohol, food and little or no exercise; educating the public through government, corporate, community and school programs; and finally including more women and minorities in research studies. By the 1990s, scientific findings moved quickly from the laboratories and clinics to doctors’ offices, healthcare centers and American households. Sports medicine and therapies took off in the 1980s. By 1988, more than a thousand independent sports therapy centers were in operation, and with hospital facilities served about 18 million American patients. Today, the value of therapy and exercise is well known and trusted among healthcare personnel. From the 1998, Rehabilitation Institute of Chicago Functional Rehabilitation of Sports and Musculoskeletal Injuries, “The first and immediate reason for 11

rehabilitation is to resolve the clinical symptoms and signs that exist at the time of the injury . . . return to activity is (also) a goal. The issue is not simply treatment of symptoms; it is restoration of function.” Technological advancements during the 20th century enabled medicine and science to view paralysis and other illnesses in a new light. Computers helped scientists dissect the tiniest particles; CAT scanners (CT) and magnetic resonance imaging (MRI) let doctors see into the brain and the body; lasers bring treatments like fusing to new heights. The innovations have just begun as this new century promises to unfold and explode with treatments and cures once thought impossible. All over the world there are men and women working in medical centers, private and veterans hospitals, research and biotech centers, universities, pharmaceutical companies, government entities like the National Institutes of Health and other venues on many fronts in advancing the healing process. If the past is prologue, then the 21st century will be an exciting time for finding the right pieces to fit into the puzzle to unravel the mysteries of the brain and central nervous system.

WHERE THE JOBS ARE THIS IS A FIELD OF DETECTIVES – INQUISITORS WHO ASK QUESTIONS AND THEN

search for answers. They are the men and women who pour over minute details searching for the what, how, why, when. They are meticulous in their search for answers. These professionals have tenacity and determination. Their education and experience are thorough in science, mathematics and medicine. They are pioneers in every sense of the word.

Research Of the many career possibilities in this field dealing with the injuries and illnesses of paralysis, research is perhaps the most prominent. Research takes place in many venues and on many fronts all over the world. There is research into the particular injury, disease or illness; research focused on the workings and mysteries of the brain and central nervous system; research into the drugs and treatments to help patients live longer and better lives; research into the equipment and other rehabilitation technologies that are used in therapy; and research into how social policy affects various disabilities.

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Every medical and disease association is involved in research in a big way. Every treatment, every therapy, every pill or shot was once a part of a research process to test its efficacy and safety. From the aspirin on up, we take our research very seriously. And so do the men and women who choose to work in this field.

Physiatrists Doctors specializing in physical medicine and rehabilitation who treat spinal cord injuries, stroke, multiple sclerosis, acute and chronic pain, and musculoskeletal disorders. These are the professionals who coordinate the long-term rehabilitation process for patients with a variety of neurological disorders.

Rehabilitation Nurses Professionals with specialized training in rehabilitative and restorative work to help solve problems and manage complex medical issues. Rehab nurses must be expert in bladder and bowel control, breathing, pain, nutrition, self care where possible, medical regimens, and ongoing patient and family education and goals.

Spinal Cord Injury Nurses Nurses who specialize in SCI impairments. These professionals are encouraged to conduct research in order to develop a scientific body of knowledge related to spinal cord injury nursing practices with the goal of improving patient care. SCI nurses can design innovative care delivery systems to help meet the demands of a changing healthcare system.

Physical Therapists The professionals who specialize in motor and sensory impairments to increase strength and endurance, improve coordination, reduce spasticity, maintain muscles in paralyzed limbs, etc. They provide educational information as well as hands-on exercise movements. Other career possibilities in paralysis include professionals who have specialized training in Occupational Therapy, Recreational Therapy, Vocational Therapy, Rehabilitation Psychologists and Social Workers, Sex and Family Counselors, etc. But research is the main focus because it offers so many challenging possibilities for the 21st century.

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RESEARCH CAREERS RESEARCH IS THE KEY TO UNLOCKING MYSTERIES. NOWHERE IS THIS MORE

important than in science and medicine. And the diseases and illnesses that inflict paralysis are a priority because of the millions of people they affect. Men and women of science and medicine will be needed throughout the 21st century to keep the research process moving onward, adding to the hope that generations to come will be better able to cope with paralysis in any form and have a chance at a brighter future. While researchers have their own focal points for their particular research projects, more often than not a piece of an unrelated research effort may be helpful in ways that are not always predictable. That emphasizes the need to share findings and other information across disciplines.

Research Into a Particular Affliction Each illness has its own particular fingerprints that distinguishes it from the others. So when all may result in a form of paralysis, their cause and effect can be very individual and different. Examples: Multiple Sclerosis results from an inflammation of the brain and spinal cord that destroys the myelin sheath that covers nerve fibers resulting in a slowing or blockage of nerve impulse transmission to a particular area. Spinal Cord Injuries are the result of trauma to the spinal canal or vertebral column affecting the ability of the spinal cord to send out and receive the messages from the brain to the body’s systems that control sensory, motor and autonomic function below the level of injury. Lou Gehrig’s Disease (ALS), is a nerve cell, or motor-neuron disease that affects the communication links between the nervous system and the voluntary muscles of the body causing then to weaken and waste away. Stroke happens when the blood supply to a part of the brain suddenly stops, or is blocked, or a blood vessel bursts spilling the blood into the spaces surrounding the brain cells causing an interruption into the normal flow of blood to the brain.

Research Into a Particular Part of the Body There is a never-ending quest of researchers to understand how and why our body functions. In any forms of paralysis, it is important to know the impact of paralysis on a limb such as an arm or leg; or what happens to blood vessels around the heart; or what happens when swallowing or blinking is no longer possible. How do paralysis traumas and illnesses affect our vital organs such as kidneys, liver, heart, etc. Research is going on in every area of the body, and some research is so 14

focused that it might concentrate on one muscle, or a single gene. From the top of the head to tip of the toes research projects cover everything.

Research Into Drug and Treatment Therapies Professionals search for a compound that can improve the condition, and/or relieve the pain, and perform with as few side effects and risks as possible. Treating the symptoms becomes every bit as important as searching for causes. Because much of the research into paralysis is still in its early stages, a good deal of the drug and treatment research is centered around minimizing pain and providing movement flexibility. Pharmaceutical laboratories work with other medical and scientific laboratories in the research process. For example, several new drugs have become available in the past year for the treatment of helping reduce new brain lesions and relapses in Multiple Sclerosis. The drug and/or treatment may be new, but the medical and scientific researchers know about the many years and the frustrations and disappointments they traveled, and the studies and trials needed before finding the right combination to produce the current results that may only help some patients.

Research Into Rehabilitation and Recreational Therapies Research has shown that an active paralysis victim will remain healthier with the proper rehab treatments and equipment than the ones who do nothing and allow their muscles to atrophy. These research professionals are body builders as they are familiar with body parts and muscles. They are also scientists and rehabilitation specialists as they design complex equipment and exercise treatments that will help even the most severely paralyzed patient – a quadriplegic like Christopher Reeve, who maintains a rigorous workout and exercise regimen. There are other research possibilities, but these are the major areas of study at this time. The research goes on in every city and state across the country; in hospitals, medical centers and clinics; in colleges and universities; in rehabilitation centers; in nonprofit associations; in public and private entities like pharmaceutical companies; in government organizations like veterans hospitals and the National Institutes of Health, and more.

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THE WORK YOU WOULD DO IF YOU WERE READY TO ASSUME YOUR RESEARCH IN A LABORATORY, HERE IS WHAT

you could be doing in two specific areas of paralysis.

Research in Spinal Cord Injuries Regenerating damage to the central nervous system is a prime focus of ongoing research. From the Laboratory of Genetics, The Salk Institute in California: “It is self-evident that the adult mammalian brain and spinal cord do not regenerate after injury, but recent discoveries have forced a reconsideration of this accepted principle. Advances in our understanding of how the brain develops have provided a rough blueprint for how we may bring about regeneration in the damaged brain.” These discoveries and advances are the direct result of years of tedious and dogged research by scientists and assistants in laboratories across the country and around the world to find any shred of information to open the door a little wider to discover and understand the puzzle and how a particular piece fits in. By the time you are ready to assume your place in a laboratory, you could be researching developmental neurobiology, intracellular signalling or neuroimmunology in your quest to help regenerate damage to the central nervous system. Or you could be among the fortunate to receive a grant from the Christopher Reeve Paralysis Foundation in intervention strategies and continue work on Treatments Immediately Following an Accident, such as limiting initial degeneration (different mechanisms of cell death at play) or Treating Inflammation, where the spinal cord swells and proteins from the immune system invade the injured zone, fostering secondary damage. There is major research to be done on Longer-Term Treatments such as Promoting New Growth Through Substrate or Guidance Molecules, where proteins act as road maps, steering axons (the snaky extensions from nerve cells that transmit electrical impulses) to their correct targets. Another promising project is Building Bridges to Span the Lesion Cavity, which is how best to build these bridges and what molecules to use to encourage new growth and enhance survival of new connections. Both short and long-term interventions are crucial to limiting degeneration and stimulating regeneration in spinal cord injuries. 16

When you are ready to start your research, you will be building upon the knowledge that will have come from a better understanding of promoting axon growth or neuron survival, and stem cells that will have to be harvested, then treated to encourage growth and eventually injected into the injured cord hopefully to divide and then form new cells. You may do your research at a major medical/educational entity such as the Stanford University Medical Center where a team of researchers identified the mechanism and some key cells involved in controlling regeneration. Researchers note that the coming years and decades hold hope for new understanding and the distinct possibility that there will be new treatments to offer patients. Research in spinal cord injuries is also conducted in clinical trials where drugs and treatments are developed from studies and experiments in the laboratory. New therapies are only tested on people after laboratory and animal studies and testing show promising results. These clinical trials are conducted with the utmost care and are the fastest and safest way to determine if a drug or treatment will work on humans. The clinical trials are usually carried out in phases and begin with the animals, then advance to a controlled group of humans at a number of medical centers. If the efficacy and safety of the new drug have been documented, then the clinical trials are broadened to include hundreds, even thousands, of human subjects at many medical venues. This is a long procedure and usually takes years before researchers gather and study all the facts and figures and determine if a drug or treatment is ready for approval by the United States Food and Drug Administration (FDA), and finally made available to doctors and their patients. The process is very lengthy and time-consuming because it has strict safeguards to protect those who participate in the clinical trials and insure that the risks are as low as possible.

Research in Strokes According to the American Heart Association (AHA), diseases of the heart are the #1 killer in America, and stroke is the #3 killer. These dramatic facts make research projects and clinical trials all the more crucial to getting a better handle on stroke prevention, survival, treatment and rehabilitation. Research and clinical trials are ongoing and are conducted in the same venues as other medical research. In the early 1900s when AHA was first formed, the main focus of doctors and social workers was the 17

prevention aspect and how lifestyles and our environment could and would impact on our health problems. Throughout the course of the 20th century we learned, thanks to research, that smoking, obesity, stress, and lack of exercise are bad for the heart and the brain. We also learned that clean air and water have a positive effect on our health. In many instances, stroke is a collaborative effort of many factors. This is due to the fact that diseases of the heart and stroke affect hundreds of thousands of men and women every year. If you were ready for your research assignment you could be part of one such effort begun in 2000 and involving the Burke Consortium for the Study of Stroke, in New York, the Massachusetts Institute of Technology (MIT), Duke University, Veterans Administration hospitals in Baltimore, Maryland and Cleveland, Ohio, and all funded by a grant from the National Institutes of Health. A central collection data center on stroke was set up at Duke, and researchers are proceeding to study what effect, if any, amphetamine has in stroke recovery. Or you could be involved with rehabilitation research and clinical trials with the National Stroke Association, where findings will determine whether constraint-induced movement is beneficial for the hands and the arms. Multi-site clinical trials are also being conducted to test muscle stiffness and pain (spasticity) in moderate to severe stroke patients who are at least six months post-stroke and less than 80 years of age. You could have a grant from the National Institute of Neurological Disorders and Stroke (NINDS), of the National Institutes of Health, and be part of one of their research projects, which were cited in a recent neuroscience news update: Researchers Combine a Common Dietary Supplement with an Antibiotic to Treat Lou Gehrig’s Disease Bone Marrow Generates New Neurons in Human Brains Study Links Chronic Pain to Signals in the Brain Common Cholesterol-Lowering Drug Reduces Multiple Sclerosis Symptoms in Mice Study Identifies Gene That Prevents Nerve Cell Death Researchers Successfully Deliver Drugs to the Primate Brainstem

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PROFESSIONALS TELL ABOUT THEIR WORK I Do Spinal Cord Injury Research “Research is challenging, tedious, frustrating, exciting and wonderful all at once, and there is nothing else I’d rather be doing. Each day is different and you never know what you will turn up, even if you have looked at the same piece of evidence hundreds of times. You always look with fresh eyes and a new perspective hopefully to see something, no matter how small, that you may have missed before. It was in the mid 1980s, when I was in my second year of a residency to become an orthopedic surgeon, that my younger brother became paralyzed from the waist down in a backyard football game accident. Quick thinking on my part and immediate help from two other medical students present prevented additional problems. In less than 30 minutes he was in the hospital emergency room, and I was on my way to rethinking my focus from orthopedic surgery to spinal cord injury specialist of some kind. I always wanted to be a doctor, even though most of my immediate family is into business and sales, and repairing broken bones became a passion. Maybe it was because I had so many of them growing up. In any event, my brother’s accident changed everything for our family and friends as we realized that life as we had known it was no more because one of us would live life in a wheel chair. Spinal cord injuries became the focus of my medical life, and I talked with my advisor about changing the course of my career. I wanted more courses in neurology and neuroscience and was able to design a course program to give me the additional knowledge I would need to proceed. Research was not in my thoughts at first, but rather treatment. I felt that the combination of orthopedics and neurology would be a good fit. But well into my studies I realized how little was known about paralysis in general and spinal cord injuries in particular. Research became my passion.

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It took almost five years after completing my medical school education and a research fellowship, to land my current research position, which is in a major medical rehabilitation center where cases of paralysis are numerous and varied. The focus of my work is on the damage to the spinal cord from the waist down and how it effects other functions of the body, impacts on general health and lifestyle. There are so many facets to consider such as bladder control and kidney failure. Then there are the skin problems which can be devastating due to lack of movement or shifting positions when sitting or lying down. I am part of a research team and currently we are in the second year of a grant to help chronicle all that science knows to date about spinal cord injuries below the waist and its effect on the rest of the body. When we have all the known pieces before us, then we will better understand where we have to go to get to the next level. I helped write this grant. My brother is almost through college and he plays wheelchair basketball among other activities. He wants to write an account of his experiences. He has already participated in a clinical trial for a new pain drug. He is taking an active part in his rehabilitation along with his family and friends. I am playing a very minute part in a big research picture, but I am exhilarated every time we make even the smallest advance. It is worth every frustrating moment when I can see how far my brother’s condition has improved from the first year. Research may not always provide that elusive breakthrough, but there are enough small victories to make it all worthwhile. I encourage your readers to check out this field.”

I Am A Spinal Cord Injury Nurse “My first hospital floor assignment when I became a registered nurse was in an intensive care unit where victims of various forms of paralysis were being treated. It would be another year before I would take care of my first spinal cord injury patient, a young man who was thrown from his motorcycle not wearing a helmet. His internal injuries were too great and unfortunately he did not make it, but I became very interested in this type of injury and eventually went back to school to learn more and specialize. 20

I now work in a Veterans Administration hospital as a spinal cord injury nurse, and I also do research into this impairment and how nursing can help advance care. My patient load covers older veterans who have been living with spinal cord injuries most of their adult lives and the younger ones whose injuries can be service-related, but more likely are vehicular and sports related. To those whose injuries can go back to World War II, not much has happened to improve the quality of their lives until the last decade or two. But the more recently injured are benefitting from the research and rehabilitation progress that has been made in the last 10 to 15 years. I was pleased to learn that registered nurses in certain specialties are eligible for research grants to help improve the care and thus the quality of life for patients with these impairments from day one. Because there is as yet no cure, or way to regenerate growth in the spinal cord, this injury can be a devastating life sentence to anyone, especially a young person. Ensuring that he or she not only receives the appropriate medical care, but also the necessary mental and physical care to cope with an injury of this magnitude, is crucial to their future well-being. I jumped at the chance to do some detective work in this area, and I got my start as a consultant with two other spinal cord injury nurses who had won a grant of $3,000 to study the relationship between patient and family. Because I had already been involved in such work, my input was considered valuable. This experience convinced me to try to get my own grant to study other aspects of my work with these patients. One of the most daunting tasks is to determine just when it is right to intervene with help. Too soon and you scare the patient. Too late and you lose the chance to make meaningful progress. I received my first grant for $1,000 to be followed by another $1,000 if my research proved helpful. I studied and followed 27 patients for two years and found that early intervention, even if the patient was not cooperating or in denial, was preferable to waiting. My details were convincing enough to cause my hospital to make some changes in the way we handle these impaired patients.

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Since my research proved valuable, I put in for another grant for $3,000, with a co-investigator, and this time we will study the relationship between patients and their families and friends. My co-investigator is a spinal cord injury nurse at a major medical center that is allied with the veterans hospital. We will have a wider study to draw from. I love my work. Nursing would have been enough, but to also be able to do research and have input into my work is really a great feeling. I am making a contribution in ways I could have not imagined when I first wanted to become a nurse. Nursing has changed. Healthcare has changed. We’re beginning to make a real difference!”

I Do Stroke Research “I have been a researcher specializing in strokes for more than 10 years. It is an exciting time to be in this field because so much is going on and technology is enabling us to delve into areas we could not reach before. Currently, I am involved in a multi-site clinical trial involving participants who had a stroke at least six months ago, only affecting the right side of the body, and who are at least 18 years old. For those who don’t know it, a stroke on the left side of the brain affects the right side of the body, and a stroke on the right side of the brain affects the left side of the body. So we study one side and then the other. In the trials, we take into account everything from the testing like EEGs (electroencephalograms) and neuroimaging, to cognitive or awareness testing, to rehabilitation therapy. We hope to start with at least 500 patients and go from there. Eventually thousands will be studied, results analyzed and recommendations made for treatment. The whole process is geared toward making the healthcare system more responsive to the changes taking place in today’s world. Ongoing research tells us that we must do things differently than we did even a few years ago.

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The end of the 20th century brought remarkable advancements in technology, drugs and rehabilitation therapies. These innovations are continuing into the 21st century, and we must press forward continually to find new ways to treat old illnesses. Stroke is wreaking the same havoc that it did a hundred years ago. Then, most died or were invalids. Today, most live and can resume some if not all normalcy in their lives. Studies, treatments, drugs, clinical trials and dogged research have made the difference. We are slowly, but surely, discovering the root causes of stroke and are helping people better understand the stake they have in healthier living. It is not an easy chore, but very necessary. Sometimes when I look at the statistics at how we abuse our bodies, I want to scream in everyone’s face who smokes, or overeats or abuses alcohol or drugs. But I, along with thousands of others, are content to do the research and bring along a few more believers every year. I hope you will seriously consider medical research as a career path. It’s not glamorous – only a handful ever become a Jonas Salk. And don’t count on becoming a millionaire. But it is one of the most rewarding careers you could choose. The glory for a breakthrough is shared by all who contributed because it was made possible by the painstaking studies of thousands that was eventually narrowed down to some point, finally uncovered by an unsuspecting researcher somewhere. Everyone rejoices. Everyone benefits.”

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PERSONAL QUALIFICATIONS MEDICINE AND SCIENCE ARE VERY SERIOUS INDIVIDUAL CAREERS, BUT WHEN YOU

combine them in the area of paralysis, they can have the kind of profound effect not found in many other careers. While all career paths are to be taken seriously, the knowledge, training and personal qualifications necessary for this field must be solid and run deep. Medicine, mathematics, biology, cell and molecular biology, biochemistry, microbiology, biotechnology, research engineering, physics, and pharmaceuticals are among the specialties that drive this field. This is highly intellectual material. You can’t have just a passing interest and get anywhere. You must have passion and dedication for research and its promising career possibilities to become a medical doctor or PhD at the top levels, or at least a master’s degree graduate. This is a field of search and discovery. You are always looking for something. The clue. The footprint. The path. An overlooked sign that differentiates one slide from another even though they appear to be identical. You are the detective who will push the outer walls even farther where others might give up. Research is never being satisfied with the results no matter how many times the same answer might come up. Research is believing that anything is possible and then trying to prove it. The purpose of any research is to spend 100 percent of your time and effort on a particular, often minute, piece of the puzzle. These puzzles are large and very complex and you generally only see the very limited area you are involved with. This work requires a high level of concentration and a stick-to-itiveness that says you are focused on a mission and will stay the course no matter what. Disappointment and frustration can run high among researchers because answers can be so elusive. Research is a team effort and you must be willing to share data and information with colleagues near and far. A definite advantage in recent paralysis research is the shared knowledge that now exists and keeps growing. Research grants can be awarded to a single or team of investigators depending upon the funds available and how the grant is written. Many grants have an interdisciplinary approach. You will have to seek research funds for your piece of the puzzle and the case must be significantly above the competition to be successful. Competition for research dollars is very fierce. 24

Research is about truth. From time to time a problem will arise in some research paper where either the truth has been stretched or even the results falsified. The guilty parties are brought to justice, but damage has been done not only to the profession, but to the patients who are waiting for a breakthrough in their particular ordeal. Once you do your research and publish your results, others will try to duplicate your work as a verification of your findings. Peer review is essential to the research process. Research means continual learning. You will have to keep up with what other researchers are doing in related areas. There is a rising tide of relevant abstracts, journals, books and other materials to study which can exhaust even the best student. Seminars and professional meetings are essential for exchanging views and networking with colleagues. The men and women who choose research as a career path are of the highest caliber both professionally and personally. Throughout history they have made a difference in how we treat patients and their illnesses. Anticipation is high for a new corps of researchers to emerge in the coming decades to take medical areas like paralysis to a new level of understanding and treatment.

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POSITIVE ASPECTS RESEARCH IS ONE OF THE RESPECTED CAREER PATHS IN HEALTHCARE. IT IS A HIGH

calling because of the level of education and training necessary to succeed. It is an exciting field where you get to build on the work of others as well as open new research paths. No two days are the same as you must bring a new and fresh perspective to the work every day. The work is important because it involves life and death issues of disease and illness. Other healthcare professionals as well as patients and their families are counting on you to make the breakthrough connection that will impact their lives. The work is challenging as you investigate the old and the new. We know more about the brain and nervous system today than we did 25 years ago. Just think what the next 25 years will be like with new technologies and advanced theories, drugs and therapies to consider. You get to search out grant funding and write proposals that will help you focus on your specific area of research. You are the lead investigator and could be the one that discovers the breakthrough connection. Laboratories are exciting places to work in as the equipment is usually the most advanced, and the surroundings filled with promise and anticipation. The answers may be elusive, but the professionals are enthusiastic and focused on their mission. There is mutual respect for the researchers and the process. Each new day brings hope that another piece of the puzzle will fit into the picture. Imagine being able to identify a culprit gene; or improve on a drug that has too many side effects; or assemble the first data of a clinical trial testing a completely new treatment.

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NEGATIVE ASPECTS IT’S TEDIOUS AND IT’S FRUSTRATING AND IT’S NEVER ENDING. YOU CAN WORK ON

a piece of the puzzle for what seems like years and never make it fit. You can go over the same ground time and again with little results. It’s like spinning your wheels and going nowhere. It is really impossible to stay on top of all the related research in your field. Too much to read. Too many meetings to attend. Changing technology, especially computer programs handling research data and statistics, which sometimes become obsolete before they are fully implemented. Expectations for immediate success are usually unrealistic. People hurt and want miracles and express disappointment when progress is either slow or nonexistent. Stress levels are high as you feel the weight of the patients and their families hoping for that breakthrough. There are times when the pressure to find answers becomes overwhelming. Enough money is always a problem, and you are expected to search for grants to continue your research. There is fierce competition for every research dollar, and all the reports you must fill out to justify the spending are a waste of your precious time. You have to fight to receive credit for your work and make sure others do not make your research their own.

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EDUCATION AND TRAINING A RECENT TYPICAL SAMPLING OF RESEARCH JOBS LISTED IN THE JOBS SECTION OF

one metropolitan newspaper called for these specialties: neuroscience, microbiology, scientific engineering, molecular biology, research chemistry, neurobiology, and biostatistics. As you can see, this is a field for highly educated and trained professionals. And while lab assistants and research associates can get jobs with a bachelor’s degree in science, the majority of the work is at the master’s degree level and higher. Researchers doing the important work in the area of paralysis are mostly medical doctors and/or PhDs. The field of medical research is continually expanding, especially in the area of paralysis, and there are many educational options available to these medical scientists. The best way to proceed is to narrow your search via your particular interest. Here are several sources available in your public library and on the Internet: Graduate Medical Education Directory, published by the American Medical Association www.ama-assn.org Academic Medicine, published by the Association of American Medical Colleges www.aamc.org www.medicalresearchjobs.com www.jobscience.com Each area of research has its own education and training requirements. It is very important to determine what your focus will be in order to plan your educational course work. To become a physiatrist (medical doctor), you will need four years of graduate medical education, and four additional years of postdoctoral residency training. The American Academy of Physical Medicine and Rehabilitation (www.aapmr org) notes, “There are 80 accredited residency programs in physical medicine and rehabilitation in the United States. Many physiatrists choose to pursue additional advanced degrees (MS, PhD) or complete fellowship training in a specific area of the specialty. Fellowships are available for specialized study in such areas as musculoskeletal rehabilitation, pediatrics, 28

traumatic brain injury, spinal cord injury, and sports medicine.” There is also board certification. Educational opportunities in related fields exist and examples of interdisciplinary study of the disabled and various aspects of human development can be found in many college and university programs. One such program is at the University of Illinois at Chicago, which offers a Master of Science degree in Disability and Human Development, and a Doctor of Philosophy degree in Disability Studies. UIC is designated a Research I university by the Carnegie Endowment, which means there are a number of centers there, conducting research across all types of disabilities.

EARNINGS POTENTIAL THIS IS NOT A GET-RICH CAREER. YES, THERE ARE THOSE WHO HAVE MADE THEIR

mark and monetary rewards have exceeded expectations. But the majority of researchers and rehabilitation specialists make a comfortable living. While rewards other than cash should be your guiding light, it is important to know that there is excellent money to be made in this field. Like most other professional career paths, compensation and benefits depend upon your level of education and experience, the work you do, the level of your responsibilities, who you work for and where. In tight economic times the available research funds are more limited. Entry level salaries with only a bachelor’s degree can be from $25,000 to $40,000. Add between $15,000 and $20,000 for a master’s degree. Medical doctors and PhDs make between $100,000 and $200,000 depending upon their particular work. Spinal cord injury nurses can make in excess of $60,000 and add to that for research opportunities. Physiatrists can make more than $100,000 annually. As in other career paths, government and nonprofits pay less than the private sector, such as corporations and pharmaceutical companies.

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OPPORTUNITIES RESEARCH AND REHABILITATION ARE CARRIED OUT IN ALL 50 STATES, CANADA AND

many countries around the globe. The work is carried out in: Hospitals and medical centers Veterans Administration facilities Rehabilitation centers Clinics Nursing homes Government organizations such as the National Institutes of Health and Centers for Disease Control Nonprofit associations Corporations Pharmaceutical companies

GET STARTED! THE BEST WAY TO FIND OUT ABOUT A CAREER AND IF IT COULD BE RIGHT FOR YOU IS

to do your own personal research on the field. The more you know up front the less likely you will be to make a mistake and get into a field that may not be suited for you and your talents. What are your talents? What are your interests? Are you a good student with good study habits? What kind of grades are you now getting? Are you ambitious? How much higher education can you handle? What are your financial expectations? Where do you want to be in 10, 15 or 20 years? Once you know yourself and what you think you want in a career, the next step is to find out everything possible about that career. The public library and the Internet are good resources. Visiting with professionals in the field at their laboratory in a hospital or clinic will give you added information. Keep a written record of your search including questions asked and answers provided. Be realistic about your ambition and ability to follow through. Discuss everything with your family, friends, school counselors and others. If research is to be your field, then this first search will provide a glimpse of how successful you can be when you have all the facts at hand. 30

PROFESSIONAL ASSOCIATIONS n American Academy of Physical Medicine & Rehabilitation www.aapmr.org n American Association of Spinal Cord Injury Nurses www.aascin.org n American Association of Spinal Cord Injury Psychologists & Social Workers www.aascipsw.org n American Heart Association www.americanheart.org n American Medical Association www.ama-assn.org n Amyotrophic Lateral Sclerosis www.alsa.org n Association of American Medical Colleges www.aamc.org n Christopher & Dana Reeve Paralysis Resource Center www.paralysis.org n Christopher Reeve Paralysis Foundation www.christopherreeve.org n National Institute of Neurological Disorders & Stroke www.ninds.nih.gov n National Multiple Sclerosis Society www.nationalmssociety.org n National Spinal Cord Injury Association www.spinalcord.org n National Rehabilitation Information Center www.naric.com n National Stroke Association www.stroke.org

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PERIODICALS n All of the professional associations have magazines and newsletters they are willing to share. n Active Living www.activelivingmagazine.com

BOOKS n Still Me, Christopher Reeve n Nothing Is Impossible/Reflections on a New Life, Christopher Reeve n GENESIS/A Portrait of a Spinal Cord Injury, Stephen Thompson n Rescuing Jeffrey, Richard Galli

COPYRIGHT 2007 Institute For Career Research CHICAGO CAREERS INTERNET DATABASE www.careers-internet.org

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