Acute intermittent hypoxia as a potential adjuvant to improve walking following spinal cord injury: evidence, challenges, and future directions

Curr Phys Med Rehabil Rep., 2020 · DOI: 10.1007/s40141-020-00270-8 · Published: September 1, 2020

Spinal Cord Injury Physiology Rehabilitation

Simple Explanation

Acute intermittent hypoxia (AIH) is a potential therapy to promote walking recovery after incomplete spinal cord injury (SCI) via endogenous mechanisms of neuroplasticity. Repetitive AIH is a safe and an efficacious treatment to enhance strength, walking speed and endurance, as well as, dynamic balance in persons with chronic, incomplete SCI. The potential for AIH as a treatment for SCI remains high, but further research is necessary to understand treatment targets and effectiveness in a large cohort of persons with SCI.

Study Duration

Not specified

Participants

Persons with incomplete SCI

Evidence Level

Review

Key Findings

1
Repetitive AIH is a safe and efficacious treatment to enhance strength, walking speed and endurance, as well as, dynamic balance in persons with chronic, incomplete SCI.
2
AIH alone or paired with walking practice increased walking ability in persons with chronic, motor-incomplete SCI.
3
Walking speed increased 18% following daily (5 consecutive days) AIH alone, while walking endurance increased ~37% that persisted two weeks following daily AIH combined with 30-min of walking endurance practice.

Research Summary

Preliminary findings detailed in this review affirm that breathing mild episodes of oxygen-deprived air appears to be a safe and effective therapeutic primer to enhance motor function (i.e., walking) after SCI. Studies identified AIH as a non-invasive method to treatment paralysis without report of serious adverse side effects. We evaluated the evidence of AIH as an adjuvant for SCI therapy and the potential challenges that may hamper this translation.

Practical Implications

Rehabilitation Strategy

AIH can be used as an adjuvant therapy to improve walking ability in individuals with SCI.

Clinical Practice

Further research is needed to understand the optimal AIH dosing regimens and identify biomarkers that predict treatment response.

Future Research

Future studies should investigate the mechanisms by which AIH promotes neuroplasticity and motor recovery after SCI.

Study Limitations

1
Uncertainty in optimal AIH dosing regimens.
2
Variations in individual responsiveness to AIH treatment.
3
Potential influence of concurrent inflammation and sleep-disordered breathing on AIH efficacy.

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