Corticospinal Motor Circuit Plasticity After Spinal Cord Injury: Harnessing Neuroplasticity to Improve Functional Outcomes.

Spinal cord injury (SCI) is a devastating condition that affects approximately 294,000 people in the USA and several millions worldwide. The corticospinal motor circuitry plays a major role in controlling skilled movements and in planning and coordinating movements in mammals and can be damaged by SCI. While axonal regeneration of injured fibers over long distances is scarce in the adult CNS, substantial spontaneous neural reorganization and plasticity in the spared corticospinal motor circuitry has been shown in experimental SCI models, associated with functional recovery. Beneficially harnessing this neuroplasticity of the corticospinal motor circuitry represents a highly promising therapeutic approach for improving locomotor outcomes after SCI. Several different strategies have been used to date for this purpose including neuromodulation (spinal cord/brain stimulation strategies and brain-machine interfaces), rehabilitative training (targeting activity-dependent plasticity), stem cells and biological scaffolds, neuroregenerative/neuroprotective pharmacotherapies, and light-based therapies like photodynamic therapy (PDT) and photobiomodulation (PMBT). This review provides an overview of the spontaneous reorganization and neuroplasticity in the corticospinal motor circuitry after SCI and summarizes the various therapeutic approaches used to beneficially harness this neuroplasticity for functional recovery after SCI in preclinical animal model and clinical human patients' studies.

Gait recovery in a girl with ischemic spinal cord stroke.

BACKGROUND AND PURPOSE: This case report describes an aggressive, task-specific program for the recovery of gait in a girl with a spinal cord stroke. CASE DESCRIPTION: The 11-year-old girl sustained a spinal cord stroke resulting in a T4 motor-incomplete lesion. Therapy was initiated 6 months after onset when she was not ambulating. INTERVENTION: The focus of all interventions was on the restoration of gait. Locomotor treadmill training and over ground walking were the primary practice interventions. Walking was facilitated by orthoses, neuromuscular electrical stimulation, laser treatments, and strengthening. Treatment continued for 18 months. OUTCOMES: At the conclusion of therapy, the client was able to walk independently in the community with a single ankle foot orthosis and reverse rolling walker. DISCUSSION: The outcome was not anticipated for this client, given the type and level of her injury and the delay in starting gait training.

Manual therapy and therapeutic exercise in patient with symptomatic cervical spondylotic myelopathy: a case report.

Cervical spondylotic myelopathy (CSM) is caused by narrowing of the cervical spinal canal, although surgical decompression is an obvious indication for spinal cord stenosis, there are not enough data to determine that surgery is the most indicated intervention for milder forms. The purpose of the present case report was to describe the outcomes results of the physical therapy treatment with emphasis on manual therapy and therapeutic exercise for a patient with CSM. A 58-year-old male patient attended the physical therapy clinic due to pain and paresthesia in the upper and lower limbs. The magnetic resonance imaging was compatible with spondylotic myelopathy. Following physical therapy treatment, the patient exhibited an improvement in functional capacity (triangle step test and timed 10-m walk), pain, paresthesia, mJOA scale and Neck Disability Index. Based on the lack of rapid evolution of neurological impairment, physical therapy treatment was indicated, which achieved satisfactory results.

Intravesical electrostimulation versus sacral neuromodulation for incomplete spinal cord patients suffering from neurogenic non-obstructive urinary retention.

OBJECTIVES: To compare the efficacy of intravesical electrostimulation (IVES) versus sacral neuromodulation (SNM) in patients with incomplete spinal cord lesions (SCL) and neurogenic non-obstructive urinary retention (N-NOR). METHODS: In this retrospective study, 77 N-NOR patients underwent IVES (minimum 28 sessions), then after returning to voiding baseline symptoms, percutaneous first stage of SNM (lasting for minimum 4 weeks). After the two neuromodulation treatments, responders were categorized as patients experiencing both a 50% reduction of volume per catheterization per ml and a 50% reduction in number of catheterizations per day when comparing the 7-day voiding diaries at the end of both procedures to baselines. New urodynamics were performed subsequently. Responders to first stage of SNM underwent permanent SNM. RESULTS: Forty-eight patients responded to neither of the treatments, whereas 29 responded to both IVES and first-stage SNM. No significant statistical differences (P>0.05) were detected in the voiding diaries. Following the two procedures, the first sensation of bladder filling was either maintained or recovered by all responders, whereas the same 11 patients reached a bladder contractility index of >100. The 29 IVES responders lost their clinical benefits in a mean follow-up of 9.6 months. Only 10 out of the 29 patients became nonresponsive to permanent SNM, in a mean follow-up of 54 months. CONCLUSION: A strict correlation in terms of clinical and urodynamic patterns was demonstrated in patients with incomplete SCL and N-NOR, following IVES and first stage of SNM. However, voiding improvement through IVES was short-term when compared with the effects of permanent SNM.

A pilot study of spirituality and inpatient rehabilitation outcomes in persons with spinal cord dysfunction and severe neurological illnesses.

This prospective, observational pilot study was conducted on an academic inpatient rehabilitation unit. Ninety-three persons with spinal cord dysfunction or severe neurological illness participated. All completed admission surveys; 46 completed surveys six months after discharge. The aims were to describe admission and post-discharge spirituality and associations between spirituality and rehabilitation outcomes. At admission, participants reported spirituality similar to that of other samples of medical patients. After discharge, frequency of private spiritual practices increased and spiritual and existential well-being decreased. No significant associations were detected between spirituality and rehabilitation outcomes. Findings suggest the importance of spirituality to the participants and future research with a larger sample and modifications to the methodology.

[Neurorehabilitation in myelopathies caused by tuberculosis-induced ostitis and other diseases of the vertebral column].

An algorithm of stepwise neurorehabilitation has been developed for patients with vertebrogenic myelopathy. The algorithm is constructed as a hierarchy of parallel and series tasks to recovery movement capacities of a paralyzed patient. Their solution requires the use of original procedures, such as initiation of locomotor activity by dermal and epidural spinal cord electrostimulation, propriospinal stimulation, dynamic vertical posture training, as well as treadmill therapy, tetrapedal walk, and therapeutic exercises. Neurorehabilitative treatment by the proposed algorithm was performed in 41 patients with vertebrogenic myelopathy, including 41 patients with clinically complete plegia. In baseline complete plegias, recovery of varying degree or compensation of locomotor capacities was achieved in 71% of the patients, in incomplete plegias, improvement of motor function was observed in all the patients.

[Laser therapy and electric stimulation in rehabilitation treatment of peripheral neuropathy]. / Lazerterapiia i élektrostimuliatsiia v vosstanovitel'nom lechenii perifericheskikh neiropatii.

73 patients with compression-ischemic myeloradiculopathy received treatment including infrared laser radiation on the paravertebral fields, motor points of the affected nerves and biologically active points Y63, Y67, YB34, YB42, YB43, E34, E42 (1.0-5.0 mW/cm2; 5 and 5000 Hz), electrostimulation of motor nerve points and innervated by them muscles by double square impulses with a fixed gap 5 ms. Impulse infrared laser therapy relieves pain syndrome, stimulates repair processes in the affected nerve structures. Further modified electric stimulation activates a regenerative growth of the nerve fibers, reinnervation of the limb muscles.

[Spinal cord stepping electrostimulation as a method for recovery of locomotor activity in vertebrogenic myelopathies]. / Elektrostimuliatsiia spinnogo mozga s éffektom "shaganiia" kak metod vosstanovleniia lokomotornoi aktivnosti pri vertebrogennykh mielopatiiakh.

The paper summarizes accumulated data on the parameters effective in calling alternate leg stepping and the areas of application of spinal cord electrostimulation, as well as the results of its application to restore locomotor capacities (tetra- and bipedal walking) of paralyzed patients.

[Rehabilitation methods in small animal neurology]. / Rehabilitationsmassnahmen in der Kleintierneurologie.

Rehabilitation is an important part of the treatment of neurological diseases. The primary goal of these methods is an optimal functional restoring of the neuro-muscular system. Massages, thermo-, hydro- and electrotherapy, as well as therapy of movement are different treatment possibilities with their own indication, which are combined in a physiotherapy program. It follows an overview of the different physiotherapeutic methods and their application in some of the most common neurological diseases, as for example intervertebral disc problems or degenerative myelopathy.

[Electrostimulation of the spinal cord as a method of inducing locomotor activity in children (clinical aspects and technical problems)]. / Elektrostimuliatsiia spinnogo mozga kak sposob vyzova lokomotornoi aktivnosti u detei (klinicheskie aspekty i tekhnologicheskie problemy).

Coordination locomotor movements of the lower extremities are induced in children paralyzed due to spinal diseases and injuries. This is achieved by electrostimulation of the intumescentia lumbalis by individually selecting stimulating parameters. The prospects of wide introduction of the procedure into a package of motor rehabilitative treatment are associated with the design of automatic systems for selection and correction of these parameters.

Artificial respiration by phrenic nerve stimulation (diaphragm pacing) in patients with cervical cord and brain stem lesions.

In patients who are dependent upon respirators because of paralysis of respiratory muscles, pacemakers for electrical stimulation of the phrenic nerves, leading to contractions of the diaphragm, are available. We have implanted such diaphragm pacers in ten selected patients with partial or total respiratory insufficiency of central nervous origin. Preoperatively, transcutaneous phrenic nerve stimulation in the neck was undertaken with simultaneous fluoroscopy of the diaphragm and quantitative studies of ventilation and blood gases. Phrenic nerve stimulators were implanted bilaterally in eight and unilaterally in two patients. One patient died 3 weeks postoperatively from pneumonia, the remaining patients are entirely independent of respirator at a mean follow-up time of 20 months. Postoperative studies showed sufficient ventilation with diaphragm pacing in both sitting and recumbent body position. Their quality of life has improved. They still require permanent supervision and help with activities of daily life but all except one live in their homes. They can talk and some of them even attend school.