G. Heiner Sell Memorial Lecture: Neuronal Plasticity After Spinal Cord Injury: Significance for Present and Future Treatments

J Spinal Cord Med, 2006 · DOI: · Published: January 1, 2006

Spinal Cord Injury Neuroplasticity Rehabilitation

Simple Explanation

Recent understanding of movement control helps define the requirements for successful rehabilitation after spinal cord injury (SCI). Load- and hip joint position–related afferent input is crucial for locomotor training success. Animal experiments show axonal regeneration can be induced after SCI. Functional training and regeneration are complementary: regenerating fibers need training for connections, and training is enhanced by regenerating fibers. Clinical and neurophysiologic measures are needed for precise assessment of spinal cord function, predicting outcomes, and recognizing improvements from new treatments. European SCI centers collaborate using a standardized protocol.

Study Duration

Not specified

Participants

Patients with acute SCI from 14 European spinal cord injury centers

Evidence Level

Not specified

Key Findings

1
Locomotor training can improve functional locomotor abilities by exploiting the neuronal plasticity of the spinal cord, reinforcing appropriate connections in an activity-dependent manner.
2
Afferent input from receptors signaling contact forces during the stance phase of gait, and hip joint-related afferent input, are essential for activating spinal locomotor centers.
3
Regeneration of even a small percentage (10-15%) of functioning tract fibers may be sufficient to allow basic functions like locomotion in individuals with complete SCI.

Research Summary

Recent progress in understanding movement control emphasizes the importance of load- and hip joint position-related afferent input for successful locomotor training after SCI. Animal studies suggest axonal regeneration is possible after SCI, making functional training and regeneration complementary approaches for treatment. Standardized clinical and neurophysiologic measures are vital for assessing spinal cord function, predicting functional outcomes, and evaluating improvements from new SCI treatments.

Practical Implications

Rehabilitation Strategies

Focus on optimizing preserved sensorimotor functions and reorganizing neuronal circuits through repetitive training sessions.

Future Therapies

Combine functional training with regeneration-inducing therapies to maximize positive mutual effects and facilitate appropriate neuronal connections.

Clinical Monitoring

Implement comprehensive assessment protocols that integrate clinical, functional, and neurophysiologic measures to accurately monitor recovery and evaluate new treatments.

Study Limitations

1
Contusion injuries in humans, unlike transections in animal models, involve damage over multiple spinal cord segments.
2
The quadrupedal organization of locomotion in animals versus complex autonomic functions in humans presents challenges for translating animal behavior to human SCI recovery.
3
Damage to motoneurons and roots associated with spinal cord contusion is not fully addressed in current translational studies.

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