Biological Basis of Exercise-based Treatments: Spinal Cord Injury

PM R, 2011 · DOI: 10.1016/j.pmrj.2011.02.019 · Published: June 1, 2011

Spinal Cord Injury Neurorehabilitation Rehabilitation

Simple Explanation

This review discusses the biological underpinnings of training paradigms that promote motor relearning and recovery after spinal cord injury. The review also discusses how exercise interacts with cellular cascades after spinal cord injury, highlighting clinical implications throughout. Optimal recovery will likely depend on activity-based, task-specific training that personalizes the timing of intervention with the severity of injury.

Study Duration

Not specified

Participants

Animal models (rats)

Evidence Level

Review

Key Findings

1
Spinal learning and synaptic plasticity after SCI depend on intact sensory drive and task-specific training.
2
Intensity of training, modulated through body-weight support and stepping frequency, is crucial for locomotion recovery after SCI.
3
Training variability, which allows for error correction, is critical to locomotor recovery, as demonstrated by robotic training studies.

Research Summary

The review emphasizes the importance of task-specific training, intensity, complexity, and timing of exercise interventions for promoting motor relearning and recovery after SCI. It highlights that exercise paradigms can be both beneficial and detrimental, acting as a biological intervention, thus requiring careful modulation. The review also discusses the impact of exercise on cellular factors such as inflammation, mitochondrial dysfunction, and trophic/growth factors after SCI.

Practical Implications

Personalized Rehabilitation Strategies

Tailoring exercise interventions to the specific type, severity, and timing of SCI is crucial for optimizing recovery outcomes.

Careful Consideration of Exercise Parameters

The intensity, complexity, and task-specificity of training must be carefully considered to maximize benefits and minimize potential harm.

Drug Combinations

Combining pharmaceutical interventions with activity-based training requires careful consideration to avoid potential negative interactions.

Study Limitations

1
The breadth of skill learning appears limited when the SCI is complete.
2
Drugs that activate GABA receptors should be carefully considered because they may create a lasting barrier to activity-dependent relearning and recovery.
3
Little is known about which exercise interventions and which dosing schedules will promote relearning and recovery for different SCI severities.

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