Retraining the injured spinal cord

Journal of Physiology, 2001 · DOI: · Published: May 1, 2001

Spinal Cord Injury Neuroplasticity Rehabilitation

Simple Explanation

Following spinal cord injury (SCI), the sensorimotor pathways below the injury site undergo significant reorganization. This is due to the loss of descending fibers and changes in synapses. Even without changes in synapses, the remaining inputs change in efficacy because postsynaptic neurons have acquired a new population of inputs. The effect of any input is likely to be interpreted differently. The spinal cord can relearn motor tasks like standing and stepping after a complete transection, especially with repetitive exposure to these activities. Robotic devices can assist in guiding limb movements to facilitate this process.

Study Duration

Not specified

Participants

Spinal rats, cats, and human subjects with SCI

Evidence Level

Review article summarizing multiple experimental studies

Key Findings

1
Loss of supraspinal input after SCI leads to changes in the functional efficacy of remaining synapses and neurons.
2
The lumbosacral spinal cord can recover greater motor performance after complete transection if exposed to activation patterns associated with standing and stepping.
3
Step training of spinalized animals results in a general reduction in GAD67 levels, suggesting the GABAergic system is elevated following SCI.

Research Summary

The loss of supraspinal input results in a marked change in the functional efficacy of the remaining synapses and neurons of intraspinal and peripheral afferent origin. The spinal cord can more readily reacquire the ability to stand and step following spinal cord transection with repetitive exposure to standing and stepping. The behavioural and physiological effects of spinal cord transection are reflected in adaptations in most, if not all, neurotransmitter systems in the lumbosacral spinal cord.

Practical Implications

Rehabilitation Strategies

Developing rehabilitative strategies to enhance recovery of posture and locomotion following spinal cord injury.

Robotic Assistance

Using robotic assistive devices to guide limb kinematics and quantify limb kinematics after SCI.

Neurotransmitter Modulation

Targeting neurotransmitter systems, such as GABAergic and glycinergic systems, to improve motor function after SCI.

Study Limitations

1
Improvements in humans with incomplete transection cannot be attributed to spinal mechanisms alone.
2
Specific mechanisms underlying spinal learning remain undefined.
3
The results are less conclusive in individuals with complete SCI.

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