Journal article
Rehabilitation Strategies after Spinal Cord Injury: Inquiry into the Mechanisms of Success and Failure
Journal of neurotrauma, v 34(10), pp 1841-1857
15 May 2017
PMID: 27762657
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Body-weight supported locomotor training (BWST) promotes recovery of load-bearing stepping in lower mammals, but its efficacy in individuals with a spinal cord injury (SCI) is limited and highly dependent on injury severity. While animal models with complete spinal transections recover stepping with step-training, motor complete SCI individuals do not, despite similarly intensive training. In this review, we examine the significant differences between humans and animal models that may explain this discrepancy in the results obtained with BWST. We also summarize the known effects of SCI and locomotor training on the muscular, motoneuronal, interneuronal, and supraspinal systems in human and non-human models of SCI and address the potential causes for failure to translate to the clinic. The evidence points to a deficiency in neuronal activation as the mechanism of failure, rather than muscular insufficiency. While motoneuronal and interneuronal systems cannot be directly probed in humans, the changes brought upon by step-training in SCI animal models suggest a beneficial re-organization of the systems' responsiveness to descending and afferent feedback that support locomotor recovery. The literature on partial lesions in humans and animal models clearly demonstrate a greater dependency on supraspinal input to the lumbar cord in humans than in non-human mammals for locomotion. Recent results with epidural stimulation that activates the lumbar interneuronal networks and/or increases the overall excitability of the locomotor centers suggest that these centers are much more dependent on the supraspinal tonic drive in humans. Sensory feedback shapes the locomotor output in animal models but does not appear to be sufficient to drive it in humans.
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Details
- Title
- Rehabilitation Strategies after Spinal Cord Injury: Inquiry into the Mechanisms of Success and Failure
- Creators
- Marie-Pascale Cote - Drexel UniversityMarion Murray - Drexel UniversityMichel A. Lemay - Temple University
- Publication Details
- Journal of neurotrauma, v 34(10), pp 1841-1857
- Publisher
- Mary Ann Liebert, Inc
- Number of pages
- 17
- Grant note
- R01NS083666 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) Craig H. Neilsen Foundation EB-012855 / National Institute of Biomedical Imaging and Bioengineering Grant NS-083666; NS055976 / National Institute of Neurological Disorders and Stroke Grant; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) R01EB012855 / NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Biomedical Imaging & Bioengineering (NIBIB)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurobiology and Anatomy
- Web of Science ID
- WOS:000400989900002
- Scopus ID
- 2-s2.0-85019213963
- Other Identifier
- 991019168232304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Critical Care Medicine
- Neurosciences