Plasticity of Corticospinal Neural Control after Locomotor Training in Human Spinal Cord Injury

Neural Plasticity, 2012 · DOI: 10.1155/2012/254948 · Published: April 10, 2012

Spinal Cord Injury Neuroplasticity Rehabilitation

Simple Explanation

Spinal cord injuries disrupt walking ability, especially in young individuals, impacting their life quality. Damaged nerve cells in the spinal cord don't regenerate easily. Body-weight-supported treadmill training (BWSTT) helps individuals with spinal cord injuries walk on a treadmill, reducing body weight using a harness. BWSTT enhances walking rhythm, muscle activation, and overall results for SCI patients. These improvements likely stem from changes in the brain and spinal cord circuits. This study examines cortical control of movement, spinal reflex circuits, and how corticospinal control adjusts after locomotor training in SCI patients. Neurophysiological studies suggest that corticospinal plasticity aids in regaining walking ability post-training. However, the specific neural mechanisms remain unclear. Further translational neuroscience research is essential for creating patient-focused rehabilitation plans.

Study Duration

Not specified

Participants

One 49 year old female

Evidence Level

Review Article and Case Study

Key Findings

1
BWSTT increases the MEP amplitude, changes the common drive of antagonist muscles from corticospinal inputs with subjects seated, and alters the TA MEP modulation pattern during BWS assisted stepping.
2
BWSTT reestablished the TMS-induced long-latency soleus H-reﬂex facilitation and potentiated the short-latency soleus H-reﬂex depression following subthreshold TMS with subjects at rest, while cortical modulation of the soleus H-reﬂex during stepping changed signiﬁcantly.
3
BWSTT changed the cortical control of reciprocal inhibition during BWS assisted stepping in a manner that promotes bipedal gait.

Research Summary

Spinal cord injury (SCI) leads to changes in body homeostasis, affecting multiple systems. In most cases, the spinal cord isn't completely severed, leaving some nerve pathways intact. This allows the lesioned motor system to reorganize spontaneously after injury and training. Electrophysiological studies show that body weight-supported treadmill training (BWSTT) increases motor evoked potential (MEP) amplitude, alters the common drive of antagonist muscles from corticospinal inputs, and changes the tibialis anterior (TA) MEP modulation pattern during body weight support (BWS)-assisted stepping. BWSTT modifies the cortical control of reciprocal inhibition during BWS-assisted stepping, promoting bipedal gait. These findings suggest that improvements in walking from treadmill training are partially due to changes in corticospinal drive of spinal reflex circuits and leg muscle output during walking.

Practical Implications

Rehabilitation Strategy Development

A detailed understanding of the neural mechanisms that support restoration of motor function is essential for developing effective interventions.

Optimization of Current Strategies

Further translational neuroscience research is needed to outline the neural mechanisms underlying restoration of lost voluntary motor function.

Patient-Oriented Rehabilitation

The development of new rehabilitation strategies and/or optimization of the currently available strategies, and to patient-orientated rehabilitation protocols promoting evidence-based rehabilitation.

Study Limitations

1
Neural mechanisms underlying restoration of voluntary motor function are not well understood.
2
Limited evidence exists on plastic changes of the cortical control of spinal reﬂexes after locomotor training in neurological disorders.
3
More studies are needed on the neuronal mechanisms mediating improvement of locomotor function after training in spinal lesions of diﬀerent segmental levels and types.

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