title: Motor Control of Human Spinal Cord Disconnected from the Brain and Under External Movement.
abstract: Motor control after spinal cord injury is strongly depending on residual ascending and descending pathways across the lesion. The individually altered neurophysiology is in general based on still intact sublesional control loops with afferent sensory inputs linked via interneuron networks to efferent motor outputs. Partial or total loss of translesional control inputs reduces and alters the ability to perform voluntary movements and results in motor incomplete (residual voluntary control of movement functions) or motor complete (no residual voluntary control) spinal cord injury classification. Of particular importance are intact functionally silent neural structures with residual brain influence but reduced state of excitability that inhibits execution of voluntary movements. The condition is described by the term discomplete spinal cord injury. There are strong evidences that artificial afferent input, e.g., by epidural or noninvasive electrical stimulation of the lumbar posterior roots, can elevate the state of excitability and thus re-enable or augment voluntary movement functions. This modality can serve as a powerful assessment technique for monitoring details of the residual function profile after spinal cord injury, as a therapeutic tool for support of restoration of movement programs and as a neuroprosthesis component augmenting and restoring movement functions, per se or in synergy with classical neuromuscular or muscular electrical stimulation.
authors.affiliation: Center for Medical Physics and Biomedical Engineering, General Hospital Vienna, 4L, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. winfried.mayr@meduniwien.ac.at.
authors.forename: Winfried
authors.initials: W
authors.lastname: Mayr
authors.affiliation: Center for Medical Physics and Biomedical Engineering, General Hospital Vienna, 4L, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.|Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Gusshausstrasse 25-27, 1040, Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Krenn
authors.affiliation: Baylor College of Medicine Houston, Houston, Texas, USA.
authors.forename: Milan R
authors.initials: MR
authors.lastname: Dimitrijevic
mesh_terms: D001921:Brain / Q000503:physiopathology; D004558:Electric Stimulation; D004576:Electromyography; D006801:Humans; D009068:Movement / Q000502:physiology*; D009415:Nerve Net / Q000503:physiopathology; D013116:Spinal Cord / Q000503:physiopathology*; D013119:Spinal Cord Injuries / Q000503:physiopathology*
keywords: Discomplete; EMG; Functional electrical stimulation (FES); Injury; Motor unit; Neurorehabilitation; Spinal reflex; Sublesional control; Supraspinal control; Surface polielectromyography