A Review on Locomotor Training after Spinal Cord Injury: Reorganization of Spinal Neuronal Circuits and Recovery of Motor Function.
Locomotor training is a classic rehabilitation approach utilized with the aim of improving sensorimotor function and walking ability in people with spinal cord injury (SCI). Recent studies have provided strong evidence that locomotor training of persons with clinically complete, motor complete, or motor incomplete SCI induces functional reorganization of spinal neuronal networks at multisegmental levels at rest and during assisted stepping. This neuronal reorganization coincides with improvements in motor function and decreased muscle cocontractions. In this review, we will discuss the manner in which spinal neuronal circuits are impaired and the evidence surrounding plasticity of neuronal activity after locomotor training in people with SCI. We conclude that we need to better understand the physiological changes underlying locomotor training, use physiological signals to probe recovery over the course of training, and utilize established and contemporary interventions simultaneously in larger scale research studies. Furthermore, the focus of our research questions needs to change from feasibility and efficacy to the following: what are the physiological mechanisms that make it work and for whom? The aforementioned will enable the scientific and clinical community to develop more effective rehabilitation protocols maximizing sensorimotor function recovery in people with SCI.
Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL 60611, USA.
Andrew C
0000-0001-5020-8094
AC
Smith
The Graduate Center, City University of New York, New York, NY 10016, USA; Department of Physical Therapy, College of Staten Island, City University of New York, Staten Island, NY 10314, USA.
Maria
0000-0002-6277-236X
M
Knikou
D005081:Exercise Therapy / Q000379:methods; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009473:Neuronal Plasticity / Q000502:physiology*; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000628:therapy*