Restoring Walking after SCI: Operant Conditioning of Spinal Reflexes Can Help

Neuroscientist, 2015 · DOI: 10.1177/1073858414527541 · Published: April 1, 2015

Spinal Cord Injury Mental Health Neurorehabilitation

Simple Explanation

People with incomplete spinal cord injuries often have motor disabilities due to spasticity and poor muscle control, even after therapy. Abnormal spinal reflex activity can cause these issues. Operant conditioning, which targets specific reflex pathways, can improve recovery. Studies showed that up-conditioning of the right soleus H-reflex in rats improved stance and gait symmetry. In people, down-conditioning of the soleus H-reflex improved walking speed and symmetry, with improvements noticeable in daily life. This approach could be used for other reflexes and combined with therapies to enhance recovery.

Study Duration

Not specified

Participants

People with hyperreflexia due to incomplete SCI

Evidence Level

Not specified

Key Findings

1
Up-conditioning of the soleus H-reflex in rats with SCI strengthened stance and eliminated gait asymmetry.
2
Down-conditioning of the soleus H-reflex in humans with SCI improved walking speed and symmetry.
3
Modulation of EMG activity during walking improved bilaterally, indicating widespread plasticity from targeting a specific pathway.

Research Summary

People with incomplete SCI often have motor disabilities due to spasticity and poor muscle control, which can be caused by abnormal spinal reflex activity. Operant conditioning of spinal reflexes can target plasticity to specific reflex pathways, which may enhance recovery. In rats with gait asymmetry, up-conditioning of the soleus H-reflex strengthened stance and eliminated asymmetry. In humans with SCI, down-conditioning of the soleus H-reflex improved walking speed and symmetry. Modulation of EMG activity during walking improved bilaterally, implying that a protocol targeting a specific pathway can trigger widespread plasticity, enhancing recovery beyond the targeted pathway. Conditioning protocols could modify spinal reflexes or corticospinal connections and be combined with other therapies to enhance recovery.

Practical Implications

Targeted Therapy

Operant conditioning can target specific reflex pathways, strengthening or weakening them as needed to address specific motor deficits.

Combined Approaches

Conditioning protocols can be combined with existing therapies like treadmill training and constraint-induced movement therapy to maximize functional recovery.

Broader Applications

Conditioning protocols might improve treatment of other peripheral or central neuromuscular disorders beyond spinal cord injury.

Study Limitations

1
Current therapies are seldom fully effective.
2
Investigation of operant conditioning as a new approach to rehabilitation has just begun.
3
It should also be possible to design conditioning protocols that complement existing therapeutic methods

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