Spinal Cord Injury Research
The step-by-step training appears to jump-start the connection between brain and body through the use of virtual reality walking simulations, specially designed exoskeletons and tactile feedback, said senior researcher Dr. Miguel Nicolelis. He is director of the Duke University Center for Neuroengineering.
Weekly training with these machines re-awakened undamaged but unused spinal cord nerves that had survived the car crashes, falls and other accidents that caused paralysis, he said.
Effectiveness of Intense, Activity-Based Physical Therapy for Individuals with Spinal Cord Injury in Promoting Motor and Sensory Recovery
Rehabilitation for individuals with spinal cord injury (SCI) is expanding to include intense, activity-based, out-patient physical therapy (PT). The study's primary purposes were to (i) examine the effectiveness of intense PT in promoting motor and sensory recovery in individuals with SCI and (ii) compare recovery for individuals who had an olfactory mucosa autograft (OMA) with individuals who did not have the OMA while both groups participate in the intense PT program.
Variability in Step Training Enhances Locomotor Recovery After a Spinal Cord Injury
Performance of a motor task is improved by practicing a specific task with added “challenges” to a training regimen. We tested the hypothesis that in the absence of brain control the performance of a motor task is enhanced by training using specific variations of that task. We utilized modifications of step performance training to improve the ability of spinal rats to forward step. After a complete thoracic spinal cord transection, 20 adult rats were divided randomly to bipedally step on a treadmill in the forward, sideward, or backward direction for 28 sessions (20 min, 5d/week) and subsequently tested for their ability to step in the forward direction. Although the animals from all trained groups showed improvement, the rats in the sideward trained and backward trained groups had greater step consistency and coordination along with higher peak amplitudes and total integrated activity of the rectified electromyography signals from selected hindlimb muscles per step during forward stepping than the rats in the forward trained group. Our results demonstrate that by retaining the fundamental features of a motor task (bipedal stepping) the ability to perform that motor task can be enhanced by the addition of specific contextual variations to the task (direction of stepping). Our data suggest that the forward stepping neuronal locomotor networks are partially complemented by synchronous activation of interneuronal/motoneuronal populations that are also a part of the sideward or backward stepping locomotor networks. Accordingly, the overlap and interaction of neuronal elements may play a critical role in positive task transference.
A Systematic Review of the Effects of Pharmacological Agents on Walking Function in People with Spinal Cord Injury
Studies of spinalized animals indicate that some pharmacological agents may act on receptors in the spinal cord, helping to produce coordinated locomotor movement. Other drugs may help to ameliorate the neuropathological changes resulting from spinal cord injury (SCI), such as spasticity or demyelination, to improve walking. The purpose of this study was to systematically review the effects of pharmacological agents on gait in people with SCI. A keyword literature search of articles that evaluated the effects of drugs on walking after SCI was performed using the databases MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO, and hand searching. Two reviewers independently evaluated each study, using the Physiotherapy Evidence Database (PEDro) tool for randomized clinical trials (RCTs), and the modified Downs & Black scale for all other studies. Results were tabulated and levels of evidence were assigned. Eleven studies met the inclusion criteria. One RCT provided Level 1 evidence that GM-1 ganglioside in combination with physical therapy improved motor scores, walking velocity, and distance better than placebo and physical therapy in persons with incomplete SCI. Multiple studies (levels of evidence 1-5) showed that clonidine and cyproheptadine may improve locomotor function and walking speed in severely impaired individuals with incomplete SCI. Gains in walking speed associated with GM-1, cyproheptadine, and clonidine are low compared to those seen with locomotor training. There was also Level 1 evidence that 4-aminopyridine and L-dopa were no better than placebo in helping to improve gait. Two Level 5 studies showed that baclofen had little to no effect on improving walking in persons with incomplete SCI. There is limited evidence that pharmacological agents tested so far would facilitate the recovery of walking after SCI. More studies are needed to better understand the effects of drugs combined with gait training on walking outcomes in people with SCI.