Locomotor Training: As a Treatment of Spinal Cord Injury and in the Progression of Neurologic Rehabilitation

Department of Neurological Surgery, Kentucky Spinal Cord Research Center, University of Louisville, Louisville, KY, USA.
Archives of physical medicine and rehabilitation (Impact Factor: 2.57). 09/2012; 93(9):1588-97. DOI: 10.1016/j.apmr.2012.04.032
Source: PubMed

ABSTRACT Scientists, clinicians, administrators, individuals with spinal cord injury (SCI), and caregivers seek a common goal: to improve the outlook and general expectations of the adults and children living with neurologic injury. Important strides have already been accomplished; in fact, some have labeled the changes in neurologic rehabilitation a "paradigm shift." Not only do we recognize the potential of the damaged nervous system, but we also see that "recovery" can and should be valued and defined broadly. Quality-of-life measures and the individual's sense of accomplishment and well-being are now considered important factors. The ongoing challenge from research to clinical translation is the fine line between scientific uncertainty (ie, the tenet that nothing is ever proven) and the necessary burden of proof required by the clinical community. We review the current state of a specific SCI rehabilitation intervention (locomotor training), which has been shown to be efficacious although thoroughly debated, and summarize the findings from a multicenter collaboration, the Christopher and Dana Reeve Foundation's NeuroRecovery Network.

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    • " . We fear that aids are often implemented much too early due to economic considerations and misconceptions of what is the best for the patient . Knowledge from motor learning theory also makes us concerned that robotic devices that are designed to train and provide neurorehabilitation may not live up to cur - rent hopes ( Colomer et al . , 2013 ; Harkema et al . , 2012 ) . As already pointed out , providing passive movement without active participation from the patient is unlikely to have any major benefits . In addition , providing exter - nal sensory feedback to a patient who is attempting to ( re ) learn a given skill may confuse the establishment of a solid internal model / motor program . There i"
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    ABSTRACT: ABSTRACT Neuroscience has fundamentally changed the understanding of learning and memory within recent years. Here, the authors discuss a number of specific areas where they believe new understanding of the CNS from basic science is having a fundamental impact on neurorehabilitation and is leading to new therapeutic approaches. These areas have constituted a basis for development of some basic principles for neurorehabilitation: Optimal rehabilitation should involve (a) active (patient) participation in the training, (b) training that does not only involve many repetitions, but also continues to challenge the skill of the training person, (c) motivation and reward, (d) intensive training and practice over a long time, (e) careful organization of the training in relation to other activities, and (f) incorporation of other potentially beneficial parameters such as sleep and diet. It should in this relation also be pointed out that albeit neurorehabilitation may be predicted to have the most optimal effect early in life and as soon after injury as possible, there is no reason to believe that beneficial effects of training may not be obtained late in life or several years after injury.
    Journal of Motor Behavior 01/2015; 47(1):7-17. DOI:10.1080/00222895.2014.931273 · 1.42 Impact Factor
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    • "Neuroscience (2014), http:// reduce lower limb blood pooling (Phillips et al., 1998). In addition, locomotor training, usually with body-weight support on a treadmill, has also an impact on functional recovery (Wernig et al., 1995; Van Hedel and Dietz, 2010; Wessels et al., 2010; Barbeau, 2003; Harkema et al., 2012a,b). It has been generally assumed that this functional recovery is due to activation and/or relearning in the spinal circuits (Dietz and Harkema, 2004; Edgerton et al., 2004; Harkema et al., 2008, 2012b). "
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    ABSTRACT: Plasticity constitutes the basis of behavioral changes as a result of experience. It refers to neural network shaping and re-shaping at the global level and to synaptic contacts remodeling at the local level, either during learning or memory encoding, or as a result of acute or chronic pathological conditions. 'Plastic' brain reorganization after central nervous system lesions has a pivotal role in the recovery and rehabilitation of sensory and motor dysfunction, but can also be "maladaptive". Moreover, it is clear that brain reorganization it is not a "static" phenomenon but rather a very dynamic process. Spinal cord injury immediately initiates a change in brain state and starts cortical reorganization. In the long term, the impact of injury - with or without accompanying therapy - on the brain is a complex balance between supraspinal reorganization and spinal recovery. The degree of cortical reorganization after spinal cord injury is highly variable, and can range from no reorganization (i.e. "silencing") to massive cortical remapping. This variability critically depends on the species, the age of the animal when the injury occurs, the time after the injury has occurred, and the behavioral activity and possible therapy regimes after the injury. We will briefly discuss these dependencies, trying to highlight their translational value. Overall, it is not only necessary to better understand how the brain can reorganize after injury with or without therapy, it is also necessary to clarify when and why brain reorganization can be either "good" or "bad" in terms of its clinical consequences. This information is critical in order to develop and optimize cost-effective therapies to maximize functional recovery while minimizing maladaptive states after spinal cord injury.
    Neuroscience 07/2014; 283. DOI:10.1016/j.neuroscience.2014.06.056 · 3.36 Impact Factor
    • "Spinal cord injury has become one of the main causes of morbidity and mortality. Current treatment methods including surgery, medication and physiotherapy have limited efficacy[1314151617181920212223242526272829]. In recent years, mesenchymal stem cell transplantation for the treatment of neurological diseases has shown considerable therapeutic potential[303132]. "
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    ABSTRACT: We hypothesized that RNA interference to silence Nogo-66 receptor gene expression in bone marrow mesenchymal stem cells before transplantation might further improve neurological function in rats with spinal cord transection injury. After 2 weeks, the number of neurons and BrdU-positive cells in the Nogo-66 receptor gene silencing group was higher than in the bone marrow mesenchymal stem cell group, and significantly greater compared with the model group. After 4 weeks, behavioral performance was significantly enhanced in the model group. After 8 weeks, the number of horseradish peroxidase-labeled nerve fibers was higher in the Nogo-66 receptor gene silencing group than in the bone marrow mesenchymal stem cell group, and significantly higher than in the model group. The newly formed nerve fibers and myelinated nerve fibers were detectable in the central transverse plane section in the bone marrow mesenchymal stem cell group and in the Nogo-66 receptor gene silencing group.
    Neural Regeneration Research 04/2014; 9(8):806-14. DOI:10.4103/1673-5374.131595 · 0.22 Impact Factor
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