Effect of Acute Physical Interventions on Pathophysiology and Recovery After Spinal Cord Injury: A Comprehensive Review of the Literature

Neurospine, 2022 · DOI: https://doi.org/10.14245/ns.2244476.238 · Published: September 1, 2022

Spinal Cord Injury Neuroplasticity Rehabilitation

Simple Explanation

Physical rehabilitation is important for spinal cord injury (SCI) recovery, but besides early surgery and blood pressure management, there aren't proven treatments for the acute phase. This review looks at studies on physical activities started within 8 days after SCI to see how they affect recovery. The review found that starting treadmill training too soon (within 3 days) can worsen outcomes, while lower-intensity exercises like reach training can be helpful. Starting rehabilitation around 4 days post-injury seems to improve motor recovery. Overall, the review suggests that low-intensity exercise is better in the very early stages after SCI, with higher-intensity exercise becoming safer and more helpful after about 4 days.

Study Duration

Not specified

Participants

46 rat studies and 6 mice studies

Evidence Level

Review Article

Key Findings

1
Treadmill training initiated very early (within 3 days post-injury) may worsen autonomic function, inflammation, and locomotor outcomes.
2
Lower-intensity rehabilitation, such as reach training, ladder training, or voluntary wheel/ball training, can show benefits when implemented during the first 3 days post-injury.
3
Rehabilitation initiated at 4 days post-injury is associated with enhanced motor recovery, suggesting a critical window for higher-intensity interventions.

Research Summary

This review examines the effects of acute physical interventions on pathophysiology and recovery after spinal cord injury (SCI), focusing on interventions initiated within the first 8 days post-injury. The findings suggest that early rehabilitation can impact molecular and structural nervous system changes, behavioral function, and body systems. The review concludes that lower intensity or voluntary rehabilitation during the hyperacute phase is more appropriate until at least 4 days postinjury, after which higher-intensity activity becomes safer and more beneficial.

Practical Implications

Clinical Guidelines

The findings suggest that rehabilitation protocols for SCI patients should be carefully timed and dosed, with an emphasis on low-intensity interventions in the immediate aftermath of the injury and a transition to higher-intensity exercise after the first few days.

Future Research

Further studies should investigate optimal timing and type of rehabilitation interventions in the hyperacute phase of SCI, as well as the potential benefits of combining physical rehabilitation with emerging therapies.

Therapeutic Development

The molecular and cellular changes induced by early rehabilitation (e.g., changes in neurotrophic factors, inflammation, and synaptic plasticity) could be targeted by pharmacological or other interventions to enhance recovery.

Study Limitations

1
Variability in injury models and rehabilitation paradigms across studies makes it difficult to draw definitive conclusions.
2
There is a discrepancy between animal and human biological and recovery timelines, limiting translation.
3
Data in the hyperacute phase are scarce, and more research is needed to identify which interventions are safe and most effective during this period.

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