During one of my scrolling sessions through social media I came upon a video of a women learning to walk again after a spinal cord injury, and I started to wonder what type of techniques are being used to help in the regaining of movement.
The most common and beneficial treatment for spinal injuries currently is rehabilitation through physical therapy (Bareyre & Loy, 2019). Rehabilitation is usually used to help improve the quality of life of those with complete spinal cord injuries, or in the case of those of incomplete spinal cord injuries to help with functional recovery. Treadmill training is one of the most common forms of rehabilitation for those with incomplete injuries and has shown to allow 92% of patients to regain the ability to walk independently (Bareyre, & loy 2019). Robotic exoskeletons and stem cell transplants have also been used in concurrence with traditional rehabilitation techniques but have failed to show improvement in results. One treatment that has been able to improve upon the results shown through rehabilitation is the use of implanted epidural electrical stimulation. Electrical stimulation mimics the way a muscle is usually stimulated by the nervous system, by providing the action potential needed for the muscle to contract. It has shown to help enable rehabilitation by allowing for restoration of leg movement in those with both complete and incomplete injuries (Inanici et al., 2021). In order to provide the most benefit the stimulation, preservation of proprioceptive information, position awareness, is required (Formento et al., 2019). Interestingly epidural electrical stimulation has shown higher success in animal models compared to humans due to the stimulation blocking a significant amount of proprioceptive information in humans but not in rats (Formento et al., 2019). Without the proper amount of proprioceptive information, perception of leg position is reduced making it harder to regain movement. Despite the success of epidural electrical stimulation, it is an invasive treatment option, an alternative is a non-invasive transcutaneous spinal cord stimulation. This treatment option has shown to improve hand function, even without intensive rehabilitation training, in those with incomplete and complete spinal cord injuries (Inanici et al., 2021). The benefits have even been shown to last for months after electrical stimulation, inducing neuroplasticity of the damaged spinal cord (Inanici et al., 2021). Neuroplasticity, or as we known in from physiology class LTP, is an important mechanism through which the nervous system adapts to new stimuli which can allow for the regaining of movement in those with spinal cord injuries.
To recap, rehabilitation is still the tried and true way of regaining of movement for those with spinal cord injuries, however, the introduction of transcutaneous spinal cord stimulation may help improve the results.
Bareyre, F. M., & Loy, K. (2019). Rehabilitation following spinal cord injury: How animal models can help our understanding of exercise-induced neuroplasticity. Neural Regeneration Research, 14(3), 405. https://doi.org/10.4103/1673-5374.245951
Formento, E., Minassian, K., Wagner, F., Mignardot, J. B., Le Goff-Mignardot, C. G., Rowald, A., Bloch, J., Micera, S., Capogrosso, M., & Courtine, G. (2018). Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with Spinal Cord Injury. Nature Neuroscience, 21(12), 1728–1741. https://doi.org/10.1038/s41593-018-0262-6
Inanici, F., Brighton, L. N., Samejima, S., Hofstetter, C. P., & Moritz, C. T. (2021). Transcutaneous spinal cord stimulation restores hand and arm function after spinal cord injury. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 29, 310–319. https://doi.org/10.1109/tnsre.2021.3049133
Hi Adrianne,
ReplyDeleteCool post! It brought to mind a lot of the patients I worked with as a rehab technician. We worked mostly with spinal injury patients from traumatic events or disease. I was surprised to that your research suggested that 90% use treadmills. In the preliminary treatment (first 1-3 months), I rarely ever saw our treadmill used. Instead a lot of assistive equipment was used and electro stimulation. I wonder if that is more in the longterm? Either way, the electrostimulation has a ton of applications and uses, but it is amazing to see how stroke patients or those who have completely lost touch can regain it through intense therapy. Thanks for talking about such an important topic!