Cellular, Molecular, Physiological, and Behavioral Aspects of Spinal Cord Injury

Front Cover
Cellular, Molecular, Physiological, and Behavioral Aspects of Spinal Cord Injury: The Neuroscience of Spinal Cord Injury
Copyright
Dedication
Contents
Contributors
Preface
Section A: Setting the scene and introductory chapters
Chapter 1: Causes of spinal injury: Motor vehicle accidents and beyond
Introduction
Spinal injury in automobile drivers
Role of seatbelt and airbag in protecting spine
Prevention of spinal injury among motorcycle riders
Application to other areas of neuroscience
Mini-dictionary of terms
Key facts of spinal injury simulation
Summary points
References
Chapter 2: Magnetic resonance imaging (MRI) findings in spinal cord injury during acute and chronic phases
Introduction
MRI sequences used in SCI
Conventional MRI
Novel and quantitative MRI sequences
Protocols for MRI in SCI
MRI findings in acute SCI
Extra-medullary findings
Ligamentous injury
Disc damage
Other soft tissues
Vascular injury
Extramedullary hematoma
Fractures
Intramedullary findings
Cord concussion
Cord compression
Cord edema
Hemorrhagic contusion
Cord hematoma
Cord ischemia
Cord transection
MRI findings in subacute SCI
Subacute progressive ascending myelopathy
Early syrinx
MRI findings in chronic SCI
Neurodegeneration and demyelination of the spinal cord post SCI
Neurodegeneration of the brain post-SCI
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of SPAM
Summary points
References
Chapter 3: Exercise programs and spinal cord injury (SCI): Linking the clinical, physiological, and psychological consequ ...
Prevalence and consequences of spinal cord injury
Clinical, physiological, and psychological consequences of SCI (Fig. 1)
Primary consequences of SCI: Paralysis and ANS
Secondary consequences of SCI
Physical inactivity and sedentary behavior
Body composition and poor metabolic profile
Poor musculoskeletal conditions
Poor mental health and low QoL
Exercise and SCI (Fig. 2)
Exercise programs for people with SCI
UB aerobic and strength exercise
FES-assisted LB and/or WB exercise
Tailored exercise for people with SCI
Conclusion and future perspective
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts on exercises and people with SCI
Summary points
References
Chapter 4: Use of anodal transcranial direct current stimulation: Features, facets, and applications to incomplete spinal ...
Introduction
Discovery of the direct current therapeutic effect and technological progress
Neurophysiological basis of the a-tDCS
Importance of the a-tDCS after iSCI
A-tDCS outcomes after iSCI
CE and neuroplasticity-related outcomes
Motor function and functionality outcomes
Chronic neuropathic pain (NP)
Other a-tDCS outcomes
Characteristics of the iSCI individuals under a-tDCS protocols
Parameters of the a-tDCS after iSCI
Short and long-term effects of the a-tDCS
A-tDCS safety and adverse effects (AEs)
Clinical practice based on the a-tDCS
Applications to other areas of neuroscience
Dictionary of terms
Key facts of anodal transcranial direct current stimulation
Summary points
References
Further reading
Chapter 5: Neuromodulation and restoration of motor responses after severe spinal cord injury
Neuromodulation exploits intrinsic information processing
A residual functional potential remains after SCI
Central nervous system reorganization after SCI
Mechanisms of spinal neuromodulation
The ideal candidate for the restoration of volitional motor responses through neuromodulation
Neuromuscular electrical stimulation for the recovery of independent stepping
Rationale for combining NMES with other neuromodulation modalities
Regaining of motor function after severe spinal cord injury
Multimodal rehabilitation
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of neuromodulation and restoration of motor responses after severe spinal cord injury
Summary points
References
Further reading
Chapter 6: Rehabilitation and wheelchair users after spinal cord injury: An overview
Introduction
Epidemiology
Classification and prognosis
Objectives in spinal cord rehabilitation
Robotic rehabilitation of movement
Main clinical aspects for rehabilitation
Pain
Spasticity
Heterotopic ossification
Autonomic dysreflexia
Neurogenic bladder
Neurogenic bowel dysfunction
Pressure ulcers
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of clinical classification of SCI and mobility
Key facts on clinical complications of SCI
Summary points
References
Section B: Cellular and molecular aspects of spinal injury
Chapter 7: Gene expression and bone loss following spinal cord injury
Introduction
Incidence and pathophysiological mechanisms of spinal cord injury
Altered gene expression due to spinal cord injury
Bone remodeling and osteometabolic dysfunction due to SCI
Molecular mechanisms of SCI-induced bone loss
Acute and chronic stages of bone loss following SCI
Changes in bone quality and quantity following SCI
Secondary complication due to SCI-induced bone loss
Conclusions
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of gene expression, bone loss, and spinal cord injury
Summary points
References
Chapter 8: Sperm DNA fragmentation and its relevance to men with spinal cord injury
Introduction
How does SDF in men with SCI compare to other causes of infertility?
Molecular mechanisms of SDF
Etiologies of SDF in men with SCI
Hormone alterations
Elevated scrotal temperature
Ejaculation frequency
Sperm chromatin maturity
Reactive oxygen species
Leukocytospermia and ROS-related damage
Sperm concentration
Seminal vesicular secretions
Immune function and cytokine production
Other seminal plasma biochemical compounds
Improving sperm DNA quality in men with SCI
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of sperm DNA fragmentation
Summary points
References
Chapter 9: Beneficial and detrimental effects of cytokines after spinal cord injury
Introduction
Cytokine expression after SCI
Cytokines promoting cell death and neurodegeneration after SCI
Cytokines in inflammation and glial scar formation
Macrophage and microglia polarization
Glial scar formation
Cytokines in neuroprotection and repair
Enhancement of antiinflammatory cytokine levels
Inhibition of proinflammatory cytokine pathways
Epigenetic regulation of cytokine expression
Histone acetylation
Noncoding RNAs
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts
Key facts of glial scar
Key facts of inflammation after SCI
Key facts on the major effects of cytokines
Summary points
References
Chapter 10: Neurovascular pathology following traumatic spinal cord injury
Introduction
Secondary pathogenesis
Hemodynamic response
Neurovascular unit (NVU)
Endothelial cell (EC) response
Pericytic response
Astrocytic response
Level-specific differences in the vascular architecture of the spinal cord
Therapeutic approach
Pharmacological interventions
Acute infusion of mesenchymal stromal cells to attenuate vascular disruption
Acute IgG infusion for immunomodulation and rescue of BSCB disruption
Conclusions
Application to other areas of neuroscience
Mini-dictionary of terms
Key facts
Key facts of the American Spinal Injury Association (ASIA) Impairment Scale
Key facts of the spinal neurovascular unit (NVU)
Summary points
References
Chapter 11: Protein degradome in spinal cord injury
Introduction
Protease-substrate repertoires
Degradomes in SCI
Cytoskeletal proteins
Extracellular matrix
Cell junction proteins
Ion channels
Clinical perspectives
Application to other neuroscience areas
Mini-dictionary of terms
Key facts of spinal cord degradomics
Summary points
References
Chapter 12: Proteomics of pressure ulcers in spinal cord injury
Background
Patients management
Clinical proteomics
Proteomics in pressure ulcers
The importance of precision medicine
Limitations of proteomics
Conclusions
Application to other areas of neuroscience
Key facts of proteomics in PUs of spinal cord patients
Mini-dictionary of terms
Summary points
References
Chapter 13: Innate immune responses of glia and inflammatory cells in spinal cord injury
Introduction
Overview of PRRs
TLRs
NLRs, inflammasome complexes, and TLR-inflammasome cooperation
CLRs and RLRs
Role of TLRs in SCI
TLR2 in SCI
TLR4 in SCI
TLR9 in SCI
Non-immune functions of TLRs in neurons: Relevance to SCI
Modulation of ECM proteins by TLRs: Relevance to SCI
Applications to other areas of neuroscience
Conclusions
Mini-dictionary of terms
Key facts of innate immunity in central nervous system injury
Summary points
References
Chapter 14: The role of oxidative stress in spinal cord injury animal models: A focus on nuclear factor erythroid-2 relat ...
Introduction
Oxidative stress characteristics and mechanisms
The implications of oxidative damage in SCI pathophysiology
Protection mechanisms by endogenous antioxidants via Nrf2-ARE system
Involvement of Nrf2 in blockage of oxidative stress post-SCI induced by exogenous stimuli
Concluding remarks
Application to others areas of neuroscience
Mini-dictionary of terms
Key facts of oxidative stress
Summary points
References
Chapter 15: Novel agent ONO-2506 suppresses astrocytic activation and attenuates post-spinal cord injury pain
Introduction
Secondary injury of the spinal cord and astrocytic activation
Primary and secondary injury of the spinal cord
Astrocytes and their activation
Reactive astrocytes and glial scarring
Astrocytic activation and post-SCI neuropathic pain
Mechanisms of post-SCI neuropathic pain by astrocytic activation
Increase in extracellular glutamate
Decrease in extracellular GABA
Attenuation of post-SCI neuropathic pain by ONO-2506
S100B
ONO-2506
Action mechanisms of ONO-2506
Effects of ONO-2506 on post-SCI neuropathic pain
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of ONO-2506
Summary points
References
Chapter 16: Neural tissue loss after spinal cord injury
Introduction
Dysfunction of vascular system
The reduced blood supply of spinal cord
Intraparenchymal hemorrhages
Spinal cord edema
Raised intraspinal pressure
Breakdown of BSCB
The inflammatory response and elimination of necrotic debris
Development of cysts/cavities and syrinx
The post-traumatic spinal cord shrinkage
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of post-traumatic loss of spinal cord tissue
Summary points
References
Chapter 17: Remodeling mitochondrial transport and cellular energetics in axonal regeneration and spinal cord injury
Introduction
Complex motility patterns of axonal mitochondria
Molecular motors driving mitochondrial bi-directional transport in axons
Mitochondrial motor adaptors and receptors
Declined axonal mitochondrial transport in mature neurons
SNPH immobilizes axonal mitochondria in mature neurons and adult brains
Deleting SNPH anchoring boosts axon regeneration in vitro and in vivo
Enhanced mitochondrial transport facilitates axon regeneration
Remodeling mitochondrial transport promotes regeneration after SCI
Boosting energetic metabolism promotes regeneration after SCI
Conclusions and new challenges
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of SNPH-mediated decline of axonal mitochondrial transport in mature neurons
Key facts of the energy crisis that accounts for regeneration failure
Key facts of boosting local energy supply in injured axons
Summary points
References
Chapter 18: Neurotrophins and their role in axonal outgrowth following spinal cord injury
Introduction
Structure and function of the neurotrophins
Nerve growth factor
Brain-derived neurotrophic factor
Neurotrophin-3
Neurotrophin-4/5
Neurotrophic gradients for guiding regenerating axons
Preclinical models of neurotrophin delivery to promote axonal outgrowth and regeneration following SCI
Acute localized injections and continuous infusions
Ex-vivo gene therapy
In vivo gene therapy
Biomaterial-based approaches
Challenges and considerations for neurotrophin delivery and clinical translation
Concluding remarks
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of neurotrophins in spinal cord injury
Summary points
References
Chapter 19: The neuroscience of transient receptor potential vanilloid type 4 (TRPV4) and spinal cord injury
Introduction
Transient receptor potential vanilloid type 4 (TRPV4)
Spinal cord injury
TRPV4 and spinal cord injury
TRPV4 role in non-injured conditions
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts about SCI
Key facts about TRPV4
Summary points
References
Chapter 20: Autoantibodies in spinal cord injury
Introduction
Targets and possible origin of autoantibodies increased after SCI in humans
The levels of autoantibodies after SCI are independent of lesion level and severity
Autoantibodies increased after SCI target both CNS and peripheral antigens
Local versus systemic production of autoantibodies
Association of autoantibodies with neuropathic pain development
Roles of the autoantibodies increased after SCI in other pathologies
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of autoantibodies
Summary points
References
Chapter 21: Calpain role in the pathophysiology of spasticity after spinal cord injury
Introduction
Spasticity after spinal cord injury (SCI)
Animal models of spasticity after SCI
Network alterations contributing to spasticity after SCI
Cellular and molecular alterations contributing to spasticity after SCI
Calpains and their role in spasticity after SCI
Calpain expression and activity after SCI
Identified and putative calpain targets involved in the pathophysiology of spasticity
Physiological and pharmacological inhibition of calpains and effects on spasticity
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of ``spinal hyperexcitability´´
Key facts of ``spinal disinhibition´´
Summary points
References
Chapter 22: Targeting mTOR signaling to promote autophagy for functional recovery after spinal cord injury
Introduction
Natural compounds for inhibition of mTOR signaling and promotion of autophagy flux and functional recovery after SCI
Curcumin
Resveratrol
Salidroside
Scopoletin
Pharmacological inhibition of mTOR signaling for enhancing autophagy flux and functional recovery following SCI
Rapamycin
Metformin
Liraglutide
Simvastatin
Probucol
Genetic and non-genetic inhibitors of mTOR signaling to regulate autophagy in SCI
miR-223
Intermittent fasting
Future directions
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of targeting mTOR signaling in promotion of autophagy for functional recovery after SCI
Summary points
References
Chapter 23: Tertiary damage: Hippocampal and brain changes after spinal cord injury
Introduction
Sensorimotor cortex and corticospinal tract alterations after SCI in humans
Cognitive and emotional impairment after SCI
Humans
Animal models
The effect of SCI on the hippocampus
Hippocampal neurons
Neurogenesis
Neurogenesis during the acute phase
Neurogenesis during the chronic phase
Hippocampal neuroinflammation
Glial reaction during the acute phase
Glial reaction during the chronic phase
SCI and other brain regions
Possible mechanisms underlying the tertiary damage
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of tertiary damage
Summary points
References
Section C: Physiological and metabolic effects
Chapter 24: Hormonal events and spinal cord injury: A focus on vasopressin and natriuretic peptide
Introduction
Function of vasopressin (AVP)
Function of natriuretic peptides (NP)
SCI-induced polyuria/nocturia
AVP after SCI
ANP after SCI
Potential mechanisms causing changes in AVP and/or ANP after SCI
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of vasopressin and natriuretic peptide changes after SCI
Summary points
References
Chapter 25: Linking sensorimotor plasticity, the motor cortex, and spinal cord injury
Sensorimotor plasticity after spinal cord injury
Functional evaluation of motor cortex
TMS mapping studies
Single-pulse TMS
Paired-pulse TMS and paired associative stimulation
Discussion
Applications to other areas of neuroscience
Key facts
Mini-dictionary of terms
Summary points
References
Chapter 26: Bone loss at the knee after spinal cord injury: Radiographic imaging, fracture risk, and treatment
Introduction
Application to other areas of neuroscience
Bone loss at the knee after SCI
2D DXA imaging
Volumetric assessment of bone mineral and bone strength
Summary of bone loss after SCI-Temporal and spatial patterns
Relationship between bone loss and fracture risk after SCI
Interventions for bone loss after SCI
Non-pharmaceutical intervention
Pharmaceutical intervention
Summary of interventions for bone loss after SCI
Summary and conclusions
Mini-dictionary terms
Key facts
Summary points
References
Chapter 27: Functional and morphological reorganization of the brain following spinal cord injury: Insights from MRI
Introduction
Brain morphometry
Diffusion tensor imaging (DTI)
Functional MRI (fMRI)
MR spectroscopy
Structural reorganization-Insights from MRI
Functional reorganization-Insights from MRI
Functional MRI (fMRI) studies
Resting-state fMRI studies
MR spectroscopy
Structural and functional reorganization-Insights from MRI
Mechanisms underlying reorganization
Challenges related to MRI evaluation of SCI data
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts
Summary points
References
Chapter 28: Cardiometabolic changes and upper exercise as an augmentative strategy in spinal cord injury
Introduction
Application to other areas of neuroscience
Main narrative text
Role of inflammation
Cardiometabolic changes
Cardiovascular disease
Body composition
Lipid disorders
Cardiometabolic syndrome
Peripheral vascular regulation
Role of exercise as a mitigating treatment
Mini-dictionary of terms
Key facts: Cardiometabolic changes and exercise in SCI
Summary points
References
Chapter 29: Electrophysiological outcome measures in spinal cord injury: A new narrative
Introduction
Electromyography (EMG)
Research application
Reflex EMG activity
Evoked potentials
Somatosensory evoked potentials (SSEPs)
Research application
Motor evoked potentials (MEPs)
Research application
Contact heat evoked potentials (CHEPs)
H-reflex
Research application
Nerve conduction studies (NCS)
Research application
Silent period (SP)
Sympathetic skin response (SSR)
Research application
Discussion
Applications to other areas of neuroscience
Key facts of electrophysiological measures
Summary points
References
Chapter 30: Features and physiology of spinal stretch reflexes in people with chronic spinal cord injury
Introduction
Spinal stretch reflexes
Function of the soleus stretch reflex pathways in intact human locomotion
Features of spinal stretch reflexes in people with SCI
Soleus stretch reflexes during locomotion in people with chronic incomplete SCI
Stretch reflexes in spastic gait after SCI
Consideration of CNS plasticity in addressing the reflex hyperexcitability in chronic SCI
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of spinal reflexes
Summary points
References
Chapter 31: Metabolic syndrome in spinal cord injury: Impact on health
Introduction
Changes in body composition after spinal cord injury
Insulin resistance in spinal cord injury: Pathophysiology and clinical features
Diagnostic challenges of metabolic syndrome in people with spinal cord injury
Cardiovascular reflections of metabolic syndrome in spinal cord injury
Pathophysiology of androgen deficiency in men with chronic spinal cord injury
Correlates of androgen deficiency in chronic spinal cord injury
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of metabolic syndrome in spinal cord injury: Impact on health
Summary points
References
Chapter 32: Body composition and spinal cord injury
Introduction
Body composition
Body composition changes following traumatic spinal cord injury
Sarcopenia and SCI
Body composition assessment
Bedside and field methods
Anthropometry
Weight and height
Body mass index
Waist circumference
Skinfolds and circumferences
Bioelectrical impedance
Ultrasound
Laboratory and research methods
Tracer dilution
Air-displacement plethysmograph
Imaging techniques
Dual-energy X-ray absorptiometry
Magnetic resonance imaging
Computed tomography
Peripheral quantitative computer tomography
Novel technique
Computerized digital image analysis
Summary of body composition assessment methods
Choosing a body composition method for use in SCI
Applications to other areas of neuroscience
Key facts
Mini-dictionary of terms
Summary points
References
Chapter 33: Energy requirements and spinal cord injury
Introduction
Energy expenditure
Energy expenditure following SCI
Methods for determining energy requirements
Doubly labeled water
Indirect calorimetry
Predictive equations
Predictive equations validated in SCI
Choosing an energy requirement method for use in SCI
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of energy metabolism
Summary points
References
Chapter 34: Virtual walking and spinal cord injury neuropathic pain
Introduction
SCI-related neuropathic pain as a deafferentation pain
Mirror therapy: A precursor to virtual walking
What is VR?
Non- or partially-immersive virtual walking in SCI
Immersion, embodiment, and interactivity
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of virtual walking and spinal cord injury neuropathic pain
Key facts of SCI neuropathic pain
Key facts of VR use for SCI neuropathic pain
Summary points
References
Chapter 35: Cervical spinal cord injury and thermoregulatory processes: A new narrative
Introduction
Homeostasis
Thermoregulatory process in able-bodied individuals
Differences between healthy individuals and cSCI patients
Alterations in the body composition and energy expenditure after cSCI
Alterations in the cardiovascular system after cSCI
Disruption in the vasomotor, sudomotor, and shivering responses after cSCI
Alterations in the blood pressure after cSCI
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of spinal cord injury
Key facts of American Spinal Injury Association
Summary points
References
Chapter 36: Spinal cord injury and the gut microbiota
Introduction
Spinal cord injury-induced dysautonomia
Gut dysbiosis after SCI: Pre-clinical studies
Gut dysbiosis after SCI: Clinical studies
Demographic factors (injury level, injury completeness, age, sex)
Gut dysbiosis and health/disease after SCI
Mini-dictionary of terms
Key facts of the gut microbiome
Summary points
References
Section D: Behavioral and psychological effects
Chapter 37: Risk factors and predictors of depression after spinal cord injury: Emphasis on the inflammatory process
Introduction
Pathophysiological overview: From local inflammation to systemic inflammation after SCI
Depression and spinal cord injury
Epidemiology, assessment, and risk factors of depression after SCI
Etiological factors for depression: The role of inflammation
Inflammatory aspects of depression after SCI
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of depression
Summary points
References
Chapter 38: Spirituality, hope, and resilience in the recovery and adaptation process following spinal cord injury
Introduction
Responses to trauma: The quest narrative and the role of spirituality, hope, and resilience
Spirituality after SCI
Hope after SCI
Resilience after SCI
The relationship between spirituality, hope, and resilience after SCI
Implications for SCI rehabilitation: Person-centered care that embraces spirituality, hope, and resilience
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of ``Spirituality, hope, and resilience in the recovery and adaptation process following spinal cord injury´´
Summary points
References
Chapter 39: Wellness intervention for persons with spinal cord injury
Introduction
What is wellness?
Measurement of wellness in SCI
Health behaviors: Targets for wellness interventions
Behavior change theory for supporting behavior change interventions in SCI
Exemplar wellness interventions for persons with SCI: Examples, settings, and results
Design of future wellness interventions for persons with SCI
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of wellness interventions
Summary points
References
Chapter 40: Sexual life in individuals with spinal cord injury and management
Introduction
Sexual life in men with SCI
Physiology of normal sexual function
Parasympathetic innervation
Sympathetic innervation
Neurophysiology of erection
Ejaculation
Problems affecting sexual life in men with SCI
Erectile dysfunction in men with SCI
Ejaculation disorders in men with SCI
Orgasm in men with SCI
Semen abnormalities and infertility
Management of sexual problems in men with SCI
Treatment of erectile dysfunction
Phosphodiesterase 5-inhibitors (PDE5-Is)
Intracavernous injections (ICI)
Intraurethral medication
Vacuum device and penile rings
Penile prostheses
Ejaculation dysfunction treatment
Penile vibrator stimulation
Electroejaculation
Prostate massage (PM)
Surgical sperm retrieval
Psychological support
Sex life in women with SCI
Problems affecting sexual life in women with SCI and their management
Difficulty in genital arousal
Orgasm
Position problems
Psychosocial problems
Bowel and bladder incontinence
Fertility
Birth control
Pregnancy
Conclusion
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of sexual life in individuals with SCI and management
Summary points
References
Chapter 41: Depressive symptoms in rehabilitation post-spinal cord injury
Introduction
Screening and assessment of depression post-SCI
Theoretical correlates of depression post-SCI
Management of depression post-SCI
Pharmacological
Non-pharmacological
Applications to other areas of neuroscience
Mini-dictionary of terms
Key facts of screening and diagnosis
Key facts of management
Summary points
References
Chapter 42: Self-harm behaviors in patients with spinal cord injuries: From non-adherence to suicide
Introduction
Self-harm behaviors and suicidal behaviors
Chapter clarifications
Self-harm behaviors as presenting symptoms
Adapting to disability
Depression
Existential (palliative/hospice)
Medical mistrust
Patient preferences
Suicide behaviors and SCI
Risk mitigation
Warning signs for suicide
What to assess
Social isolation
Reduce access to lethal means
Applications to other areas of neuroscience
Suicide mitigation safety planning for all populations
Conclusion
Mini-dictionary of terms
Key facts of self-harm
Summary points
References
Index
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