Respiratory Training and Plasticity After Cervical Spinal Cord Injury

Spinal cord injuries (SCIs) can cause many life-threatening problems, but most SCIs are not complete. This means that some neural pathways are still working and can help the body adapt and recover. This review focuses on how respiratory treatments can use the body's ability to adapt to improve long-term recovery after cervical SCI. The review looks at respiratory training strategies used in clinics, like strength training, and those still being tested, like using different levels of inhaled oxygen or carbon dioxide to stimulate breathing. The review also considers how training affects other areas, like movement. The goal is to provide insight into how to enhance plasticity and improve functional outcomes after SCI. Respiratory training encompasses rehabilitative, resistive, and activity-based training methods to improve and strengthen the neural respiratory circuitry and their corresponding muscles. Early use of respiratory training aimed to strengthen respiratory muscles, using techniques to target inspiratory and expiratory muscles.

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  Spontaneous respiratory neuroplasticity has been reported in both clinical and experimental studies, serving as an excellent example of how the nervous system adapts to injury in order to maintain a vital, physiological function.
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  Anatomical respiratory plasticity typically refers to changes within respiratory circuitry, especially neuronal connectivity, that can arise spontaneously after injury or be driven by treatment.
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  Molecular neuroplasticity encompasses an altered synthesis of cytokines, such as trophic factors, that can create a plasticity-promoting environment, attracting axons to the appropriate targets.