Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

JOURNAL OF NEUROTRAUMA, 2017 · DOI: 10.1089/neu.2016.4565 · Published: May 1, 2017

Simple Explanation

Restoring walking ability after spinal cord injury (SCI) is a major rehabilitation goal. Effective strategies must target neural elements at all levels, including supraspinal circuits, not just spinal circuits. Physical therapy strategies are currently the most effective interventions. Optimizing the nervous system's response to training is key to meeting individual needs. Predicting future walking function and responsiveness to training is valuable. Clinical measures of volitional lower extremity strength are important indicators.

Study Duration

Not specified

Participants

Persons with spinal cord injury

Evidence Level

Not specified

Key Findings

1
Volitional lower extremity strength significantly influences walking behavior, highlighting the importance of supraspinal centers.
2
Even simple segmental reflex circuits in humans respond to training, demonstrating neural plasticity.
3
Recovery of locomotor function in rodent models depends largely on activation of spared supraspinal pathways.

Research Summary

Effective locomotor training requires understanding how the nervous system produces locomotion, how SCI changes this, and how the injured nervous system responds to interventions. Supraspinal mechanisms are increasingly recognized as important for locomotor function, especially after SCI, informing rehabilitation approaches to strengthen these pathways. Clinical prediction rules, association models, and correlations between volitional control and walking function illustrate the strong influence of supraspinal centers on walking after SCI.

Practical Implications

Tailored Interventions

Future studies can tailor interventions to individual needs by considering factors contributing to walking and its improvement after injury.

Combined Therapies

Combining effective locomotor training with physical therapeutic interventions (e.g., nerve, spinal cord, or cortical stimulation) may enhance outcomes.

Predictive Modeling

Further research is needed to develop studies that randomize participants with different acute/subacute presentations to different forms of training.

Study Limitations

1
Association models are often based on relatively small samples
2
Models are based on outcomes from specific training programs with great variability
3
Clinical usefulness of electrophysiological approaches for prediction of outcomes has yet to be established

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