Activity-dependent plasticity in spinal cord injury

J Rehabil Res Dev, 2008 · DOI: 10.1682/JRRD.2007.03.0047 · Published: February 1, 2008

Spinal Cord Injury Neuroplasticity Rehabilitation

Simple Explanation

The central nervous system (CNS) can change significantly, both when healthy and after injury. After a spinal cord injury (SCI), how much someone recovers depends on the injury and the care received. Rehabilitation focuses on using the CNS's ability to change to help regain lost functions. Strategies such as exercise and neuroprostheses can help people recover after SCI by improving how the brain and spinal cord work together. This article reviews how the CNS changes on its own after an SCI, and how it changes in response to therapies.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Reorganization of the CNS, including synaptic plasticity, axonal sprouting, and cellular proliferation, has long been known to spontaneously occur following spinal cord lesions.
2
Rehabilitative strategies could be used to enhance adaptive plasticity and/or mitigate maladaptive plasticity to enhance recovery after SCI.
3
Rehabilitative therapies can promote plasticity both rostral and caudal to injury in the spinal cord by activating the nervous system and influencing multiple substrates.

Research Summary

The adult mammalian CNS is capable of considerable spontaneous structural and functional plasticity, both in health and disease. Significant evidence from both human and animal studies indicates that rehabilitation strategies exploit this plasticity to promote recovery. Rehabilitative strategies are not limited to targeting activity-dependent plasticity of the spinal cord below an injury but appear to promote plasticity in both cortical and descending pathways.

Practical Implications

Enhance Rehabilitation Strategies

Optimize rehabilitative interventions to maximize recovery by understanding the underlying mechanisms of plasticity.

Develop Multifaceted Treatments

Create combined therapeutic regimens (rehabilitation, transplantation, and pharmacology) to target multiple aspects of recovery.

Personalized Therapy

Assess individual windows of opportunity for interventional strategies to tailor treatment plans for people with SCI.

Study Limitations

1
Significant gaps remain in the mechanisms and substrates underlying treatment-mediated recovery.
2
Studies using similar approaches after incomplete SCIs in rodents have not produced the anticipated additive results.
3
Development of successful multifaceted treatment paradigms applicable to people with SCI will require enhancing our knowledge of the mechanisms targeted by both the individual and combined therapeutic regimens.

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