When Spinal Neuromodulation Meets Sensorimotor Rehabilitation: Lessons Learned From Animal Models to Regain Manual Dexterity After a Spinal Cord Injury

Frontiers in Rehabilitation Sciences, 2021 · DOI: 10.3389/fresc.2021.755963 · Published: December 7, 2021

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Electrical neuromodulation has shown potential in spinal cord injury (SCI) repair by engaging spinal cord circuits to recover lost motor functions. However, it should be applied together with sensorimotor rehabilitation to efficiently execute movements. This review explores the challenges in using neuromodulation and rehabilitation to restore manual dexterity after SCI. It describes rehabilitation interventions in animal research and outlines recent findings in electrical neuromodulation for animal models and human patients. The paper highlights the potential for cervical neuromodulation, drawing parallels with lumbar stimulation, and discusses the critical role of rehabilitation in maximizing the benefits of neuromodulation for skilled hand functional recovery.

Study Duration

Not specified

Participants

Animal models and human patients

Evidence Level

Review article

Key Findings

1
Electrical stimulation delivered concomitantly to the performance of sensorimotor rehabilitation, spinal neuromodulation can be understood as an extended rehabilitation tool, increasing the spinal circuit’s excitability to enable the execution of movement.
2
Optimal training protocols are still not well-established and the underlying neuronal mechanisms resulting in motor improvements remain poorly understood, factors such as timing and training intensity, or those limiting training enrolment, have a decisive impact on successful motor recovery and must be carefully considered.
3
Rehabilitative training aims to recover sensorimotor function by promoting adaptive neuroplastic changes through repetition of speciﬁc movements, if not applied during particular time windows, or under speciﬁc conditions after injury, it may lead to suboptimal or even maladaptive neural changes.

Research Summary

This review discusses the convergence of spinal neuromodulation and sensorimotor rehabilitation in restoring manual dexterity following spinal cord injury, emphasizing the necessity of combining these approaches for optimal outcomes. It explores rehabilitation strategies in animal models, highlighting critical factors like timing, intensity, and task specificity, while addressing challenges such as patient enrollment and learned nonuse. The review also presents the latest advancements in cervical spinal cord neuromodulation, drawing parallels with lumbar stimulation and emphasizing the importance of understanding cervical spinal networks to improve arm and hand movements.

Practical Implications

Optimizing Rehabilitation Protocols

Careful consideration of timing, intensity, and task-specific training is crucial for effective motor recovery after SCI.

Combining Therapies

Integrating spinal neuromodulation with sensorimotor rehabilitation can enhance the recovery of voluntary motor functions.

Personalized Treatment Plans

Tailoring rehabilitation programs to address specific deficits and maximize patient engagement is essential for successful outcomes.

Study Limitations

1
Variability in protocols tested and the lack of methodological consensus.
2
Reporting training intensity and/or dosage details is often omitted.
3
Understanding the underlying mechanisms of action governing the plasticity remain unknown.

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