Recovery of control of posture and locomotion after a spinal cord injury: solutions staring us in the face

Prog Brain Res, 2009 · DOI: 10.1016/S0079-6123(09)17526-X · Published: January 1, 2009

Simple Explanation

Spinal cord injury (SCI) often leads to a loss of movement control because of the inability to activate motor pools effectively. This review highlights that functional alterations of the spinal circuitry disrupt the coordination of motor pools. Additionally, the level of motor unit recruitment can be insufficient for some muscles while exceeding normal levels for others. After a spinal cord injury, the spinal cord and brain undergo adaptation, including the formation of new, often abnormal, connections. These aberrant connections can lead to poor coordination, unintended movements, and spasticity, hindering effective stepping. The skeletal muscles become weak and easily fatigued due to chronic decreased activation and loading following SCI. Countermeasures, such as electrical stimulation under loaded conditions, are important to maintain the muscles in an optimal state for regaining standing and stepping ability.

Study Duration

Not specified

Participants

Rats, cats, mice, and humans with spinal cord injuries

Evidence Level

Review

Key Findings

1
After a spinal cord injury, pathways can be rendered either hyper- or hypoexcitable. Successful rehabilitation requires properly managing the level of excitability, as necessary, of each of the critical locomotor circuits.
2
Even limited amounts of daily muscle stimulation can help to maintain muscle properties and the effectiveness of stimulation depends, in part, on how the subjects are trained.
3
The spinal cord has the ability to utilize cutaneous and proprioceptive sensory information to adapt to different environmental conditions during locomotion and these capabilities are retained after spinal cord injury.

Research Summary

Spinal cord injury (SCI) research has made significant advances, yet a unified vision is needed to integrate these findings for improved patient outcomes. Effective strategies involve combining treatments to recover stepping and standing after severe SCI. Key areas of focus include maintaining functional muscle properties, sharpening the sensitivity of locomotor circuitry, and managing sensory stimuli to favor recovery. Promising approaches involve pharmacological interventions, spinal cord stimulation, and rehabilitative motor training. Integrating bioengineering advances, such as robotic training systems and high-density electrode arrays, can enhance treatment precision and minimize invasiveness. Combining complementary treatment effects and efficiently integrating technical advances represents an untapped potential for immediate impact.

Practical Implications

Combination Therapies

Employing multiple therapeutic interventions simultaneously, such as pharmacological treatments combined with robotic training, can yield synergistic benefits in locomotor recovery compared to single-modality approaches.

Personalized Rehabilitation

Tailoring treatment protocols to individual patient needs, considering injury severity, specific motor deficits, and stage of recovery, is crucial for optimizing outcomes. This may involve customizing drug cocktails, stimulation parameters, and training paradigms.

Neuroengineering Integration

Leveraging advancements in neuroengineering, such as high-density electrode arrays and robotic training systems, can enhance the precision and efficacy of spinal cord stimulation and locomotor training, ultimately improving motor function recovery.

Study Limitations

1
Variability in spinal cord injuries necessitates customized treatment.
2
Long-term effectiveness of combined therapies requires further investigation.
3
The complexity of neural mechanisms underlying locomotor recovery after SCI remains a challenge for targeted interventions.

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