Relearning of Locomotion in Injured Spinal Cord: New Directions for Rehabilitation Programs

Abstract

Locomotor activity-based rehabilitation programs seem to bring encouraging recovery to incomplete spinal cord injury paralytics. But in "complete" injuries recovery is long delayed and in small increments. Developmental and computer neural networks studies show that motor relearning requires the participation of redundant numbers of and activity-dependent competition of synapses among spinal interneurons. The present programs do not meet this prerequisite. They focus mainly on the mechanical (retraining) part while the neural (relearning) part plays a rather passive role. Here we suggest how retraining can be integrated with relearning by inductive lability procedures (Krishnan, 2003a, 2003b) with the objective of enhancing and hastening recovery.

Relation between physical exertion and postural stability in hemiparetic participants secondary to stroke

“…To assess the effect of the walking conditions on physical exertion, VO 2 consumption in the steady-state period, walking distance, RPE (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and VAS (0-10) were used as outcomes. The walking distance covered was recorded every minute to obtain walking speed.…”

“…As a consequence of the possible muscle atrophy, weakness, poor cardiovascular fitness prior to the stroke or as a result of the stroke, and hyper/hypotonic activity of the muscles contralateral to the side of the brain lesion [6] hemiparetic individuals have less endurance to accomplish activities of daily living [7][8][9][10]. Recent evidence indicated that, even after relatively short bouts of functional ambulation, individuals with stroke showed a significant decrease in their walking speed and endurance [9,11,12].…”

Spinal Cord Injury: Reversing the Incorrect Cortical Maps by Inductive Lability Procedure

“…Second, in chronic SCI paralytics the cerebral cortical, and brain-stem locomotor maps have erroneously remapped themselves and gotten stubbornly stabilized; and therefore not contributing to any realistic "higher center" control. The author has recommended that if the first problem is taken care of, by inductive lability procedure (Krishnan, 2003a(Krishnan, , 2003b(Krishnan, , 2003c, then the second will take care of itself (Krishnan et al, 2001b). This article discusses in detail the process of reversing the incorrect cortical and sub-cortical maps with an objective of enhancing and hastening motor-sensory recovery in SCI.…”

“…In the author's recent works (Krishnan, 2003b(Krishnan, , 2003c, he has discussed (1) the possible neural learning mechanisms that operate in the new rehabilitation programs that enabled the recovery; (2) the probable causes for the long delays (months/years) in the appearance of, and the relatively small increments in, the recovery process; and (3) prescribed measures to hasten and enhance recovery. He has cited two fundamental reasons for the delayed onset of recovery.…”

“…The extent and quality of sensory-motor recovery, if any appears, is affected by and compromised due to incorrect mapping processes. The treatment method based on inductive lability procedure (Krishnan, 2003a(Krishnan, , 2003b(Krishnan, , 2003c uses botulinum toxin for the purpose. It recreates competition among synapses in a locomotor training-based corrective re-selforganization of the maps in various steps of the ladder.…”