Comprar Camisetas de fútbol baratas Tienda online

Un uniforme de fútbol de calidad hace que un equipo se vea y se sienta genial, es lo suficientemente resistente para sobrevivir incluso en las condiciones de juego más duras y crea solidaridad en el grupo. Debe ser cómodo de usar y capaz de absorber el sudor, lo que ayuda a regular la temperatura corporal del jugador. Los uniformes de fútbol se pueden personalizar para la individualidad del equipo, o un equipo puede pedir y usar copias de los uniformes de sus jugadores de fútbol profesionales favoritos.

El fútbol es una gran manera de hacer que los niños se mantengan activos y enseñarles sobre el trabajo en equipo y el juego cooperativo. Estas son algunas de las cosas que un pequeño jugador de fútbol necesitará para completar su uniforme de fútbol:

Jersey

Las camisetas de fútbol para jóvenes vienen en muchos colores y patrones, generalmente con un color dominante y una raya decorativa en los costados y las mangas. Los colores se pueden especializar o elegir de una lista proporcionada por una empresa de suministros de fútbol. Las mangas son cortas, el cuello redondo o en pico y la tela está hecha de poliéster, mezclas de algodón o nailon. Algunos uniformes de fútbol tienen un patrón tejido en la tela, lo que lo hace llamativo. Es importante que las camisetas sean livianas, duraderas, transpirables y que puedan mantener su color sin decolorarse.

Bermudas

Los pantalones cortos de uniforme de fútbol deben ofrecer al jugador mucho apoyo sin ser demasiado apretados o restrictivos. La malla lateral permite el flujo de aire y un cordón en la cintura permite un ajuste perfecto. Los pantalones cortos de fútbol generalmente están hechos de poliéster, son de punto o tejidos, y tienen una entrepierna de 3 a 4 pulgadas para tallas jóvenes. Es importante que los pantalones cortos de fútbol se ajusten cómodamente, nunca rocen la piel ni restrinjan el movimiento. Los pantalones cortos demasiado holgados también dificultarán la capacidad de carrera del jugador.

tacos

Los tacos cómodos y bien ajustados son una parte esencial de un uniforme de fútbol. Los tacos mal ajustados provocan ampollas, esguinces de tobillo y caídas. Cuando compre botines para niños, asegúrese de que le queden cómodos incluso con los calcetines y las espinilleras puestos y tenga en cuenta el clima y las condiciones de juego.

Medias

Los calcetines pueden no parecer muy significativos, pero pueden hacer o deshacer un uniforme de fútbol. Los buenos calcetines mantienen los pies del jugador secos, calientes y protegidos de las ampollas. El material sintético funciona mejor para los calcetines de fútbol, ​​porque los calcetines tradicionales de algodón absorben el sudor y se mantienen húmedos. Esto puede provocar ampollas. Los calcetines de calidad hacen que los zapatos de fútbol sean más cómodos y protegen los pies de los estragos del correr constante.

Camisetas Cádiz CF Todas las noticias sobre fútbol en el diario de actualidad elEconomista. Descubra toda la actualidad relacionada con fútbol.

Más especialmente en estos días, los jugadores ya no solo usan camisetas de fútbol en el campo; los fanáticos también están preparados y rugiendo. Estos seguidores encuentran el tiempo y el dinero para comprar camisetas de fútbol que pueden usar para el juego. Como cada vez más personas prefieren usar camisetas como símbolo de apoyo a sus equipos, la tendencia se ha vuelto muy popular. Se ve a personas de todas las edades y nacionalidades usando camisetas, pero la locura realmente se ha apoderado de los jóvenes que van a la universidad.

Las ventas de camisetas de fútbol ganan aún más impulso cuando se avecinan partidos internacionales como la Copa del Mundo y la Eurocopa. La gente acude en masa a las tiendas de fútbol para comprar camisetas de fútbol meses antes de estas competiciones. Las tiendas de deportes se preparan con anticipación y se abastecen de las camisetas porque saben cuán alta es la demanda de ellas. Los que pueden permitírselo van a por los auténticos. Estas son las camisetas de fútbol originales que usan los jugadores. La mayoría de estas camisetas se subastan al mejor postor. Los precios casi siempre terminan muy altos porque hay tantos fanáticos ávidos que matarían solo por comprar una camiseta de fútbol para su colección.

Las camisetas auténticas también se usan incluso después de que finaliza la temporada de fútbol. Los colores brillantes que tienen estas camisas de manga corta son una gran adición al conjunto de una persona a la moda. Dado que el material utilizado en estas camisetas es liviano, son muy cómodas para usar de forma informal o durante los días activos. Si desea comprar una camiseta auténtica, lo mejor es ir a las tiendas populares que venden dichos artículos o ir directamente a la tienda de merchandising del equipo para obtener sus equipos oficiales. Los precios pueden ser muy altos ya que estas son las ofertas reales. Algunas de estas camisetas también están autografiadas.

Aparte de los originales, hay réplicas que se venden más baratas. Estos también son populares, ya que cualquiera puede obtener uno y recolectar tantos como pueda para adaptarse a cada juego que ve. Los compradores deben tener cuidado con las réplicas que se venden como auténticas; tienen un precio mucho más alto de lo que deberían vender. No querrás terminar pagando por una réplica que pronto quedará obsoleta con el final de la temporada. Muchas de las tiendas de fútbol ahora también tienen sus tiendas en línea. Esto hace que sea más fácil para las personas comprar camisetas de fútbol, ​​ya que solo deben iniciar sesión en una cuenta para ver todo el catálogo de camisetas de fútbol disponibles. La mayoría de las tiendas tienen todas las marcas, equipos y países para que un fanático pueda tener en sus manos tantas camisetas como pueda.

Los sitios web de las tiendas de fútbol te lo ponen fácil, ya que tienen un carrito donde puedes resumir todas las camisetas en las que has hecho clic. Al finalizar la compra, se le entregará un estado de cuenta que puede pagar a través de instalaciones en línea con tarjeta de crédito asegurada. Las camisetas se entregarán por correo postal o mensajería en uno o dos días, según la disponibilidad de la camiseta elegida. Los fanáticos también pueden recibir actualizaciones periódicas sobre los últimos lanzamientos de camisetas de fútbol por correo electrónico. Estos sitios web presentan noticias deportivas, blogs y otra información que podría ser de interés para los fanáticos del fútbol.

Con estas tiendas que ahora atienden a millones en línea, uno puede comprar camisetas de fútbol de manera rápida y más conveniente también.

Camisetas Entrenamiento España Últimas noticias de fútbol y toda la actualidad nacional e internacional sobre el deporte rey

Introduction

Physical activity is an essential part of being healthy. In children, activity helps build strong bones and muscles, decreases the likelihood of developing obesity, and promotes positive mental health. Children are recommended to have 60 minutes or more of physical activity daily.

In the United States, more than 30 million children and teens participate in sports. Of that number, approximately 3.5 million children and adolescents ages fourteen and under are hurt annually while participating in recreational activities. In 2002, The National Safe Kids Campaign estimated that 13,700 children were treated in hospital emergency rooms for ice skating related injuries. Many of these are preventable head injuries if protective equipment, such as helmets or halos, is used.

Gliding across the ice, with the cool wind whipping across a skater’s face is an exhilarating feeling. One push can propel a skater far down the glistening, snowy surface. Worrying about a head injury is often far from a skater’s mind, as many participants are not aware of the possibility of head injury from ice skating. The goals of this article are to raise awareness about potential head injury from ice skating and to promote the use of helmets in skating, similar to what is required in cycling, skiing, and ice hockey.

Review of Injury Statistics

A concussion is a mild form of head injury, usually due to a blow to the head, which may cause disorientation, memory loss, or unconsciousness. Repeated concussions and loss of consciousness can result in traumatic brain injury or TBI.

An estimated 10% of all head and spinal cord injuries are due to sports related activities. Socially, athletes can feel undue pressure from family, coaches, and teammates to return to play quickly after a head injury. These influences can prevent an athlete from receiving the medical care he or she requires. In particular, parents and coaches can push their children too hard in an attempt to fulfill their own athletic aspirations. Athletes who return to play too soon or who suffer repeated injury to the head can develop chronic traumatic encephalopathy, or CTE, whose symptoms can include slowed speech, confusion, tremors, and mental deterioration. Most recently, CTE gained media attention when a settlement was reached with the National Football League, or NFL and thousands of players and families. The case, which involved more than 4,500 plaintiffs, calls for the NFL to pay for medical exams, compensation, and research related to head injuries sustained while playing professional football. Plaintiffs are committed to making the game safer at all levels and to educate the public; including parents of the four million children who play youth and high school football. Plaintiffs are committed to helping the focus on player safety trickle down to the youth level.

Awareness and education are key factors in injury prevention and return to play decisions. When an athlete suffers a head injury, a sideline assessment using the Standardized Assessment of Concussion should be completed by a medical professional. If a physician is not available, the coach can complete a basic assessment, until medical attention is available. The assessment includes tests of eye response, verbal response, and motor response. Telling a child to «shake it off» could have a grave impact on the child’s long term health.

Research concluded that safety measures in organized sports should include helmet requirements. There are approximately 230,000 cases of hospitalization due to traumatic brain injury annually of which 80,000 suffer long term disability and 50,000 result in fatalities. Five to twenty percent of these injuries are incurred during sports and recreational activities. Organized team sports, in particular football, soccer and ice hockey, have high instances of concussion annually in addition to recreational sports such as skating and bicycling. Helmets that are properly fitted and worn by participants of these activities can help reduce the risk of head injury among participants.

Sports and Helmet Rules

Cycling

In March 2003, professional cyclist Andrey Kivilev collided with two other riders during the Paris Nice ride. Kivilev was not wearing a helmet and catapulted head first off his bicycle. He fell immediately into a coma and was diagnosed with a serious skull fracture. Kivilev underwent surgery, but died shortly thereafter due to the severity of the head injury. He was 29 years old and the leader of the Cofidis cycling team. His death triggered the International Cycling Union, or UCI to implement compulsory wearing of helmets in all endorsed races.

Helmets protect the head by reducing the rate at which the skull and the brain are accelerated and decelerated during an impact effectively acting as a shock absorber between the force of the impact and the brain. Upon impact, the polystyrene liner of the helmet crushes thereby dissipating energy over a wider area. Instituting mandatory helmet policies in sports proves to be a divisive and controversial issue. Although research has demonstrated that helmets reduce injury in low speed crashes, helmet evidence is not conclusive with respect to high speed crashes. Kivilev’s accident occurred at approximately 35 kilometers per hour or about 22 miles per hour which is considered relatively low speed. At the time, he was ranked among the top 100 racers in the world.

Due to his high profile in the global cycling community, Kivilev’s death elevated the helmet debate into the media spotlight. Following this seminal UCI rule change, USA Cycling also revised their helmet policy to provide that in order to host an event sanctioned by USA Cycling, all participants are required to wear helmets.

In recreational cycling in the United States, bicycle helmet laws can vary widely. Currently, only twenty one states and the District of Columbia have instituted helmet laws for bicyclists below a certain age, which is generally 16 years-old. California requires helmets for riders 18 years and younger and only the Virgin Islands requires helmets for all riders. Twenty nine states have no bicycle helmet laws currently in place.

Researchers conducted a study which demonstrates helmet usage. This study directly observed 841 children in Texas who participated in bicycle riding, in line skating, skateboarding, and scooter riding over an eight week period. Whereas helmet rules vary county to county within Texas, most counties require helmets for riders age 16 years-old and younger. This study employed a randomly selected sample of children engaging in such activities from communities with populations equal to or greater than 1000. Children under 6 years-old, females and those riding on specified bike paths were found to wear helmets more frequently than other children.

Several factors often contribute to children not wearing helmets. During warmer months, children complain about high temperatures and accordingly are less inclined or willing to wear their helmets as riders feel they do not have proper ventilation inside the helmet. Parental knowledge and awareness is another contributing factor. Parents are often unfamiliar with applicable helmet laws nor are they informed of the potential risks of injury resulting from the failure to wear proper safety equipment. In a study examining data from1990 2005, there were in excess of 6,000,000 cases of children age 18 years-old and younger treated in emergency rooms for bicycle related injuries.

Skiing

In March 2009, actress Natasha Richardson sustained a head injury while taking a routine, beginner ski lesson. Initially she refused medical attention, however seven hours later, she was admitted to the hospital suffering from an epidural hematoma, a type of traumatic brain injury. She succumbed to her injuries and died the following day. Michael Kennedy, son of Robert F. Kennedy, died in 1997 following a skiing accident in Aspen, Colorado. A week later, Sonny Bono, television star and politician, died on the slopes of South Lake Tahoe. Richardson, Kennedy, and Bono were not wearing helmets.

Researchers studied injury rates at the three largest ski areas in Scotland during three winter seasons. The study found that first day participants are at an increased risk of injury due in part to low skill levels amongst the beginners. They concluded that first day participants should be targeted in educational programs about gear selection and protective equipment.

A study of skiers and snowboarders was conducted in Colorado where approximately 10 fatalities occur annually. Among the fatally injured, head injury proved the cause of death in 87.5% of the cases and none were wearing helmets. Of the 400 skiers and snowboarders admitted to the hospital with traumatic brain injuries, only five were wearing helmets. In the most serious case, the patient ascended off a 40 foot cliff, landed on his head, cracking his helmet in half. Whereas he sustained a severe concussion with unconsciousness, the computed topography, or CT scan proved negative and with inpatient rehabilitation, the patient has made a full recovery and is attending college.

In 2011, New Jersey Governor Chris Christie signed a bill into law requiring all skiers and snowboarders under 18 years to wear helmets with the intent to reduce head injuries on the slopes. California Governor Arnold Schwarzenegger signed a similar bill in 2010 however the measure was nullified following his veto of a companion bill that would have required California ski resorts to submit safety plans and reports to state officials. At the professional levels, the governing body of skiing, the Federation Internationale de Ski, requires a helmet as mandatory equipment for all downhill and Super G events.

Ice Hockey

In 1968, Bill Masterson of the Minnesota North Stars landed headfirst on the ice after being checked by two players from the Oakland Seals. He was not wearing a helmet and as a direct result died due to the severity of his head injury. Prior to this incident, the helmets use had been stigmatized which contributed to a lack of widespread use. However, as a consequence of this incident, the stigma surrounding the use of helmets began to diminish and ultimately in 1979, the National Hockey League, or NHL instituted a mandatory helmet policy. The policy did not apply uniformly at the outset as certain veteran players were grandfathered out of the new requirement. Such players elected to continue playing without helmets alongside new players who were subject the policy. Initially, the NHL and the players themselves faced harsh criticism from fans and the media. Despite the clear evidence of risks associated without helmets, some believed the policy harmed the integrity of the game and diminished the players’ masculinity.

Since the policy was first instituted more than three decades ago, significant research supporting the value and need for helmets has been documented. The hockey community has become supportive of the rule change particularly as a significant number of current hockey enthusiasts have never experienced the sport in which helmets were not employed and required. As with many elements of professional sports, the helmet policy was then instituted within youth hockey. The youth hockey governing board, USA Hockey, not only requires all players to wear helmets, they have mandated that all helmets employed by the players must be approved by the Hockey Equipment Certification Council, or HECC. Additionally, beginning in 2006, USA Hockey extended the helmet requirement to coaches who must wear helmets during on ice practice. The requirement for coaches provides the dual benefit of increased safety for all on ice participants as well as an opportunity for the authority figure to model appropriate safety practices. This continues to reinforce the value and importance of the use of safety equipment and in turn minimizes any residual stigma associated with wearing helmets on the ice.

In order to meet the requirements of the HECC, all helmets must undergo rigorous testing procedures including, without limitation, verifying the sufficiency of the coverage area, the quality of the protective material, and the degree of shock absorption. Aside from the specifications, the age, amount of use and type of each helmet all serve to impact the helmet’s effectiveness. The use of helmets with facial protection has proven effective in order to significantly decrease player injury at the amateur level. Whereas ice hockey is by nature a contact sport and checking is a significant cause of injury, the potential for injury is heightened further due to speed and surface tension. A study was conducted a study of 192 high schools in which 7,257 sports related injuries from 20 different sports were reported. From this total sample, 1,056, or 14.6% of injuries were concussions, 24% of which were sustained during boys’ ice hockey.

Ice Skating

In 1999, United Skates Pairs figure skaters, J. Paul Binnebose and Laura Handy were on track to make the 2002 Olympic team. While training at the University of Delaware, with Coach Ron Luddington, Binnebose fell on the ice, fracturing his skull. He suffered seizures, his heart stopped twice, and he was in a coma. Doctors removed a piece of his skull, allowing his brain to swell without pressure and heal. He was given a 10% chance of survival. Against the odds, he recovered.

Although the media widely publicizes celebrity sports related accidents, J. Paul Binnebose was not a well known star around the world. His story did not receive international media attention, but it is well known within the figure skating world. He and his coach have been working toward a helmet rule in skating for over a decade. They contend that many of the skating related injuries could be prevented or minimized with the use of a helmet.

Research suggests this notion is correct. An examination of pediatric skating related injuries was conducted in the years 1993-2003. The researchers sampled 1,235,467 children from emergency rooms with skating related injuries. Non random, purposeful sampling was used in this study. The data was collected from the National Electronic Injury Surveillance System, or NEISS, and the U.S. Consumer Product Safety Commission, known as CPSC.

The NEISS system has consumer product codes for each type of activity. Injuries were identified as ice skating, roller skating, or in line skating related, and coded accordingly. Ice hockey, roller hockey, and skateboarding were excluded from the study. Variables included the child’s gender and age, site of the injury, type of skating activity, mechanism of injury, use of protective equipment, and the injury diagnosis. Further, the injuries were categorized into 5 regions of the body.

The Centers for Disease Control report during the years 2001-2005, more than 200,000 emergency room visits for concussions and other traumatic brain injuries were recorded annually in the United States. Of those, 65% were found to be children ages 5 18 years-old who were participating in a sport or recreational activity. Children are at a greater risk for traumatic brain injuries with increased severity and a prolonged recovery. Thirty categories of sports and recreation head injuries were examined. Most of the sports demonstrated 2 7% annual emergency room visits for concussions and traumatic brain injuries. However, horseback riding, all terrain vehicle riding, and ice skating reported the highest instances of emergency room visits for traumatic brain injuries, with ice skating at 11.4%. Horseback riding and all terrain vehicle riding are activities where a secondary force carries the participant at a potentially high rate of speed; ice skating is a self propelled activity.

Researchers studied 419 children with injuries from ice skating, skateboarding, roller skating, and in line skating with the focus on head injury. Most injuries were to the face; 23 of 60 cases, 38.3%; and 12 additional injuries were to the head; 20%. Adult supervision was reported in 98.2% of the cases, and 78% reported no protective equipment use. The proportion of head injuries among ice skaters was greater than the participants in other types of skating, for which helmet use is recommended or required. Currently, there are no formal guidelines regarding the use of protective equipment in ice skating; however, studies show helmet use should be mandated for children.

A study of 80 patients who visited the Accident Service at John Radcliffe Hospital in Oxford for ice skating related injuries found that 56% were beginner skaters, defined as having skated less than 10 times. Eighty two and a half percent of the patients were 11 to 25 years-old. The study suggests that children who are beginner skaters are more likely to sustain injury than experienced skaters. Other research studies show similar results. In a study of 43 patients admitted to the Pamela Youde Nethersole Eastern Hospital with ice skating related injuries, 65% were first time skaters. The study found need for increased public awareness about the risk of potential injury from ice skating and for preventative measures to improve safety.

Insurance companies strongly urge skating facilities to post a warning potential of risks at the entrance of the buildings, which releases the facilities from general liability. However, people visiting ice skating rinks are not well informed about the potential risks of the activity before arrival. Often they do not read posted placards. If provided with the background knowledge, ahead of their visit to the ice skating rink, many guests would have the opportunity to bring safety equipment from home. A need exists for a public awareness campaign.

Positive Effect of Sports Involvement

An ice skating rink is a place for children to visit on a regular basis, during their out of school time, to engage in positive, fun exercise. The key to helping the child enjoy their experience, and continue to return to the ice skating rink, is to make sure they have a positive first experience. This may not mean becoming an expert skater, but becoming competent on the ice that he/she can have a positive social experience and be «ice safe.» In order for this to happen, the participants must learn to skate with the proper safety equipment, including helmets. Once they learn the skill, he/she will continue to return to the facility with their friends. Having a positive place to go during out of school time will help the children avoid risky behaviors.

Conclusion

Cycling, skiing, and hockey have made changes in their safety guidelines based on the trends and statistics of head injuries in the sport. As the governing body for skating, the International Skating Union, known as the ISU has to take action to require worldwide helmet use for skaters. Once the ISU takes the first step, member countries can incorporate helmet rules into basic training programs and begin a public awareness campaign. Reducing the incidents of head injury will improve the overall safety of the sport. As safety improves, more people will continue participating in the sport of ice skating.

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Hello, my name is Buddy Sowell and I have ALS (Lou Gehrig’s Disease). In September 2007 I visited a Neurologist to get some answers as to why my muscles were persistently twitching. I had some muscle cramping & slight fatigue, but thought nothing of it. After some seemingly useless muscle strength testing, Dr Dooley looked at me with obvious concern on his face. I thought it was maybe the fact that he was in his upper 80s and he always looked that way…anyway, he suggested that I see a Neurology specialist named Dr. Robert Baloh at Washington University Medical Center. After some intense and painful testing and months of excruciating waiting… I was surprisingly diagnosed with ALS. «You’ve got to be kidding» I remember saying…

Never in a million years would I have guessed that something like this would have happened to me and to my family. My wife Lori and my daughters Carly and Casey are my entire world. I love them more than words can describe. They have all made me a better person. My prognosis is uncertain, but I will fight. My loving family doesn’t deserve this…so I fight for them.

Lori and I talked canididly about what we should do next. We decided to take advantage of what time we still have together and focus on having fun as a family. No more putting off travel plans. Let’s try to do as much as we can right now. I know people who have a «live for today» mentality, and I truly believe that we should all follow that philosophy. NEVER turn down a chance to have fun.

My dilemma: How do I tell my friends and family? Do I wait for the condition to worsen, or get the word out now and get the initial shock over with? I look normal, so maybe now would be a better choice before I’m in a wheel chair or look sickly. I don’t want anyone to look at me differently. I don’t want any special attention and I certainly don’t want anyone to feel sorry for me. (Thanks for those few who knew about me earlier and didn’t mention it.)

One of my fears is that someone will get the idea to offer up a special intention for me at church…and I’ll slowly sink into the pew. I appreciate the thoughts and prayers, but please don’t do that. I’ll find a way to get you back…

Seriously, my choice is to tell people as I see them or make contact by email. Since I don’t get out much, email seems the easiest way.

Now, on a more positive note, Dr. Baloh’s Lab has made progress in converting skin stem cells into nerve cells in mice. I know I’m not a mouse, but it’s a huge step. Once this science is further along, nerve cells (from stem cells) can be utilized to replace damaged nerve cells and hopefully find a cure for ALS and many other neurological diseases.

Just what is ALS? (Amyotrophic Lateral Sclerosis) is a motor neuron disease, first described in 1869 by the noted French neurologist Jean-Martin Charcot. Although the cause is not completely understood, the last decade has brought a wealth of new scientific understanding about the disease that provides hope for the future.

Lou Gehrig first brought national and international attention to the disease in 1939 when he abruptly retired from baseball after being diagnosed with ALS. Most commonly, the disease strikes people between the ages of 40 and 70, and as many as 30,000 Americans have the disease at any given time. This disease has cut short the lives of other such notable and courageous individuals as Hall of Fame pitcher Jim «Catfish» Hunter, Senator Jacob Javits, actors Michael Zaslow and David Niven, creator of Sesame Street Jon Stone, television producer Scott Brazil, boxing champion Ezzard Charles, NBA Hall of Fame basketball player George Yardley, pro football player Glenn Montgomery, golfer Jeff Julian, golf caddie Bruce Edwards, British soccer player Jimmy Johnstone, musician Lead Belly (Huddie Ledbetter), photographer Eddie Adams, entertainer Dennis Day, jazz musician Charles Mingus, composer Dimitri Shostakovich, former vice president of the United States Henry A. Wallace and U.S. Army General Maxwell Taylor.

ALS is a neurodegenerative disease that usually attacks both upper and lower motor neurons and causes degeneration throughout the brain and spinal cord. A common first symptom is a painless weakness in a hand, foot, arm or leg, which occurs in more than half of all cases. Other early symptoms include speech swallowing or walking difficulty. The biological mechanisms that cause ALS are only partially understood. The only known cause of ALS is a mutation of a specific gene: the SOD1 gene. This mutation is believed to make a defective protein that is toxic to motor nerve cells. The SOD1 mutation, however, accounts for only 1 or 2 percent of ALS cases, or 20 percent of the familial (inherited) cases. Familial ALS represents between five to 10 percent of all cases. The rest arise spontaneously and mysteriously, making seemingly random attacks on previously healthy adults. ALS can strike anyone, anytime.

Physicians have limited choices for treating ALS, and the options that do exist have come into use within the last 10 years. Studies suggest that patients’ length of survival and quality of life are enhanced by night-time breathing assistance early in the course of the disease and by aggressive application of alternate feeding options to assure good nutrition once swallowing becomes difficult. At this time, riluzole is the only drug that has been approved by the FDA for treatment of ALS. In clinical trials, riluzole has shown a slight benefit in modestly increasing survival time.

Stem cell and gene therapy are promising areas of research. In a variety of studies, ALS mouse models are being used to develop treatments that may someday lead to similar human clinical trials. Gene therapy is one field of research where The ALS Association is concentrating support for more study. If you would like to send a donation click here.

More significant advances of research into ALS has occurred in the last decade than all of the time since Charcot identified the disease. Advances in technology and the genetic revolution are aiding researchers in unlocking the ALS mystery. As more scientists focus on this perplexing disease, the outlook for new understanding brightens each day.

What Are Stem Cells?

Stem cells, also known as progenitor cells, are cells that have not undergone differentiation to acquire a specific structure or role; they have the potential to self-renew, divide, and differentiate into specialized cell types. They are also sometimes termed «pluripotential» or «undifferentiated» cells because they can differentiate and develop into various cell lines. The differentiation of stem cells into mature cells is tightly regulated; otherwise, intricate plants and animals, with their many interrelated tissues, organs, and systems, could not exist.

By contrast, mature or differentiated cells have acquired specific structures and roles, and in many cases have lost the ability to divide and replicate. Also in contrast to stem cells, malignant cells or «dedifferentiated» cells divide in an uncontrolled fashion, and rather than resulting in useful, differentiated, or specialized cells, these types of cells threaten to kill the organism.

Stem cell differentiation must be turned on, given direction, and turned off as needed in order to properly supply the basic building blocks of tissues in different organ systems. This requirement for precise regulation applies to an even greater degree to the differentiation of neuronal progenitor cells, because effective neural function depends on establishing precise linkages and interactions between different individual neurons and classes of neurons.

By definition, stem cells, including neuronal progenitor cells, are present in embryos. Stem cells may be found in umbilical cord blood. In adults, these cells are present in bone marrow and in other organs in which controlled self-renewal is needed. Neuronal progenitor cells have also been shown to persist into adulthood in specific brain locations near the ventricles where they support ongoing learning and the establishment of new memories through their division, differentiation, migration, and insertion into new circuitry.

Is There a Role for Stem Cell Therapy? Stem cells could help patients with ALS in several ways. Ideally, they could be induced to differentiate into lower motor neurons in order to replace those neurons that die because of ALS. Perhaps stem cells could rescue dying motor neurons by reconnecting these neurons to partly denervated muscle before it has died completely. Better yet, they could be induced to differentiate into upper motor neurons in the cortex and connect to the lower motor neurons.

Unfortunately, the expectation that stem cells will play such a regenerative role in patients with Lou Gehrig’s disease is unrealistic because of the complexity of the task, which presents obstacles that currently are insurmountable. A more realistic expectation for stem cells is that they play a supportive role in maintaining the viability of or extending the function of surviving motor neurons. The stem cells could be induced to differentiate into supporting cells, glia, or interneurons that might produce factors that would support motor neurons, or perhaps the stem cells themselves might produce such factors.

What Do Existing Data Suggest?

Recent data from Clement and colleagues show that in chimeric, genetically engineered mouse models, motor neurons carry mutated SOD1 genes and glial cells carry healthy genes. Survival is extended in these chimeric mice, as compared with nonchimeric mice in which all motor neurons and all glial cells carry mutated SOD1 genes. This finding suggests that if healthy stem cells could get to the spinal cords of patients with ALS, their survival might also be extended. It remains to be determined whether a mechanism that compensates for a particular genetic error would apply to sporadic patients without that error. Nevertheless, even if this form of therapy were effective only for patients with familial disease, it would be a great leap forward.

In previous experiments, intraspinal transplantation of neurons derived from a human teratoma cell line was shown to ameliorate dysfunction and extend survival in G93A SOD1 transgenic mice. Furthermore, the life span of G93A SOD1 mice was extended by intravenous administration of human umbilical cord blood. The cells were shown to have migrated into the spinal cord and brain parenchyma and survived 10-12 weeks after infusion. They exerted their beneficial effect even though only a low number of transplanted cells expressed neural antigens. In another study, Sertoli cells, which are not neuronal stem cells, were implanted in the spinal cords of SOD1 transgenic mice and were shown to provide temporary protection to motor neurons in their proximity. However, viable Sertoli cells were not present at the time when the animals died.

Preliminary trials with autologous hematopoietic stem cells have been reported in humans. In one, peripheral blood-purified CD34+ cells were injected intrathecally into 3 patients with ALS. None reported side effects after 6-12 months, but no clinical efficacy was reported. In another, 7 patients received intraspinal transplantation of autologous bone marrow-derived stem cells. Minor postoperative adverse events were transient, but muscle strength continued to decline. After 3 months, however, the investigators reported a trend toward slowing of the decline in the proximal muscle groups of the lower limb in 4 patients and a mild increase in strength in 2 patients. Lack of placebo controls and longer follow-up preclude any inferences of efficacy from this study and none were made by the investigators.

Stem Cell Research: Ethics, Economics, Policy, and Public Health

The ethics of performing human studies at this early stage of stem cell research have been questioned, emphasizing the risks of premature human trials. Reports of stem cell transplantation performed in China without peer review of objective data on each patient before, immediately after, and at specific long-term points following the transplantation do not provide sufficient scientific evidence to demonstrate that the treatment is safe and effective.

«It is critical that scientists and clinicians are cautious, plan rigorous studies, and most importantly focus on key laboratory experiments that will provide answers to the many challenges that still face this therapeutic approach,» wrote Lucie Bruijn, PhD, the Science Director and Vice President of the ALS Association. «For this therapy to be safe and have potential in the clinic, it is critical that the appropriate studies are conducted to learn more about the properties and complexities of the various stem cells.»

In response to limitations on the type of stem cell research that may be performed with federal funds, the American Academy of Neurology and the American Neurological Association — the 2 leading professional neurology organizations in the United States — have both gone on record expressing the belief that both embryonic and adult stem cell research should be pursued rigorously and under close scrutiny, while respecting the concerns of their members and the public, regarding important ethical principles and values pertaining to research with human embryonic stem cells.

The scientific concerns are 2-fold. First, because the realistic likelihood for success of any individual research effort is low, parallel research in multiple directions is imperative for the field to advance rapidly. The essence of research is trial and error, which operates by identifying ineffective directions and thereby focusing on those that hold promise. It is usually a long time between initiating research and realizing a successful treatment with clinical applications. Therefore, any delay in identification of a potentially effective therapeutic intervention translates into delaying treatments for patients with the diseases in question. Second, excluding particular types of research from federal funding may translate into an exclusion of this research from federal oversight and protections, which might lead to its migration overseas. This may be detrimental to individual patients and to the broader community of patients, clinicians, and scientists.

In November 2004, California citizens approved a referendum measure to issue bonds to fund stem cell research, including embryonic stem cell research at $300 million a year for 10 years. Since then, several other states (Illinois, New Jersey, Maryland, New York, Delaware, and Wisconsin) are considering, or being asked to consider, initiatives for state-funded stem cell research to fill the federal funding gap. This is motivated, in part, by the desire to remain on the forefront of medical research and avert a brain drain toward states that provide an economic environment more conducive to cutting-edge research. The ripple effect of the California initiative is expected to result in acceleration of stem cell research nationwide.

Conclusion

Stem cell research carries promise for patients with ALS and may result in the development of new treatments to slow the progression of the disease. This hope needs to be tempered with caution because of the early stages of stem cell research in general, and in ALS in particular, and because of the track record of the limited efficacy of all pharmacologic interventions in transgenic murine and sporadic human ALS. Meticulous attention to the ethics and scientific rigor of future stem cell research should be supported by clinicians, scientists, and participating patients alike.

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