Neuroplasticity Key to Recovery After Central Nervous System Injury

West J Med, 1993 · DOI: · Published: July 1, 1993

Neurology Neuroplasticity Neurorehabilitation

Simple Explanation

After an injury to the central nervous system, physical and cognitive impairments and disabilities often abate. These gains may be partly mediated by mechanisms that allow reorganizing of the structure and function within gray and white matter. The potential to enhance neurologic recovery by manipulating the brain and spinal cord must now be considered in clinical practice. Today's rehabilitation routines may not encourage maximum recovery. Therapies that use our expanding knowledge of neuroplasticity could lead to better results for patients.

Study Duration

3 to 18 months

Participants

Survivors of stroke, traumatic brain injury, and spinal cord injury

Evidence Level

Review

Key Findings

1
The primate motor cortex has separate clusters of output neurons that can facilitate the same spinal motor neuron. Also, a single cortical motor cell can project to the spinal motoneurons for several muscles, even those that might act across a joint.
2
Compensation after a central or peripheral injury can be due to a functional shift to neighboring neurons. In humans, cortical sensory reorganization has occurred within four weeks after amputation of an arm.
3
The inherent adaptability offers the possibility that specific training plans and drugs that increase local synaptic activity might augment remodeling and, in turn, improve sensorimotor and higher cognitive functioning.

Research Summary

After an injury to the central nervous system, physical and cognitive impairments and disabilities often abate. These gains may be partly mediated by mechanisms that allow reorganizing of the structure and function within gray and white matter. The intact, parallel systems from cortical and especially subcortical areas might partially compensate or substitute for injured ones. This might require specific cognitive and motor retraining. static physical therapies in cats impede recovery, whereas rhythmic alternating movement of the limbs with joint loading seems critical to the recovery of locomotor output.

Practical Implications

Rehabilitation Strategies

Rehabilitation specialists can incorporate modulation of cortical centers into treatment strategies using specific training plans to improve sensorimotor and cognitive functions.

Pharmacological Interventions

Clinicians should select medications with special care in the months after a cerebral injury and monitor for effects that speed or impede recovery.

Locomotion Training

Rehabilitation specialists can use findings in animals to improve locomotion training.

Study Limitations

1
Clinical trials in rehabilitation are often not scientifically designed and interventions are poorly defined.
2
Drug studies in humans are complicated by various factors such as lesion type, location, extent, age, drug dosage, and timing.
3
The techniques to manipulate the promoters and inhibitors of neuroplasticity are still in early development.

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