Noninvasive neuromodulation and rehabilitation to promote functional restoration in persons with spinal cord injury

Abstract

Purpose of reviewThis review will focus on the use of clinically accessible neuromodulatory approaches for functional restoration in persons with spinal cord injury (SCI).Recent findingsFunctional restoration is a primary rehabilitation priority for individuals with SCI. High-tech neuromodulatory modalities have been used in laboratory settings to improve hand and walking function as well as to reduce spasticity and pain in persons with SCI. However, the cost, limited accessibility, and required expertise are prohibitive for clinical applicability of these high-tech modalities. Recent literature indicates that noninvasive and clinically accessible approaches targeting supraspinal, spinal, and peripheral neural structures can modulate neural excitability. Although a limited number of studies have examined the use of these approaches for functional restoration and amelioration of secondary complications in SCI, early evidence investigating their efficacy when combined with training is encouraging.SummaryLarger sample studies addressing both biomarker identification and dosing are crucial next steps in the field of neurorehabilitation research before novel noninvasive stimulation approaches can be incorporated into standard clinical practice.

Chronic exercise increases excitability of lamina X neurons through enhancement of persistent inward currents and dendritic development in mice

“…Blockade of L‐type channels by nimodipine decreased the frequency of step cycles and increased the duration of the locomotor bursts (Büschges et al., 2001). Locomotor training has been used throughout the world as a method for improving functional ambulation after spinal cord injury (Iddings et al., 2021). It is believed that locomotor circuits within the spinal cord below the level of injury can be activated by repetitive and intensive locomotor training which provides appropriate afferent feedback (Rossignol et al., 2011).…”

Effect of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis

“…Secord, most the patients with cervical SCI have severe secondary complications, leading to poorer adherence to trial training speci cations [42,43]. Third, unilateral hemisphere stimulation may not be the most e cacious approach for improving upper extremity function in SCI, because the motor dysfunction of the upper extremity after SCI is typically bilateral [17]. Four, arm and hand function are a complex issue both in spinal cord injury and non-spinal cord injury patients with tetraplegia, including a wide variety of highly acyclic movements that are not easily objectively measurable [42, 44. Overall, our results are important for the emerging eld of NIBS on motor recovery of lower limbs after SCI and support previous evidence suggesting.…”

“…As a new neuromodulation technique, NIBS has been reviewed in improving motor function after SCI [3,17]. The present systematic review and meta-analysis evaluate the effect and summarize the safety pro les of NIBS.…”

“…From a motor control perspective, damage to spinal tracts disturbs the information transmission from the brain to the spinal cord and results in maladaptive reorganization of the entire neuraxis that contributes to motor dysfunction [17]. At the spinal level, maladaptive reorganization of spinal circuits leads to spasticity, due in part to the loss of descending control of inhibitory spinal circuits [31].…”

“…In addition, several high-quality randomized controlled trials (RCTs) have been published in the last few years [15]. The transience of single-session effects of NIBS suggests that multiple sessions may be needed to induce persistent effects [16,17], the aim of this review is therefore to quantitatively investigate the effectiveness and update the evidence of NIBS on motor dysfunction by evaluating all RCTs with multiple sessions involving people with SCI.…”