Effect of Acute Physical Interventions on Pathophysiology and Recovery After Spinal Cord Injury: A Comprehensive Review of the Literature

Abstract

Physical rehabilitation is essential for enhancing recovery in individuals with spinal cord injury (SCI); however, aside from early surgical intervention and hemodynamic management, there are no proven interventions for promoting recovery in the acute phase. In general, early rehabilitation is considered beneficial, but optimal parameters and potential contraindications for implementing rehabilitation at very early time points are unclear. Moreover, clinical trials to date are limited to studies initiating rehabilitation 2 weeks after injury and later. To address these gaps, this article reviews the preclinical literature on physical interventions initiated within the first 8 days postinjury. Effects of early rehabilitation on molecular and structural nervous system changes, behavioral function, and body systems are considered. Most studies utilized treadmill or cycle training as the primary intervention. Treadmill training initiated within the first 3 days and terminated by 1 week after injury worsened autonomic function, inflammation, and locomotor outcomes, while swim training during this period increased microvascular dysfunction. In contrast, lower-intensity rehabilitation such as reach training, ladder training, or voluntary wheel or ball training showed benefits when implemented during the first 3 days. Rehabilitation initiated at 4 days postinjury was also associated with enhanced motor recovery. Cycling appears to have the greatest risk-benefit ratio; however, the effects of cycle training in the first 3 days were not investigated. Overall, research suggests that lower intensity or voluntary rehabilitation during the hyperacute phase is more appropriate until at least 4 days postinjury, at which point higher-intensity activity becomes safer and more beneficial for recovery.

A dynamic nomogram for predicting the probability of irreversible neurological dysfunction after cervical spinal cord injury: research based on clinical features and MRI data

“…The efficacy and application potential of some rehabilitation measures, such as hyperbaric oxygen therapy, electrical stimulation and hydrotherapy, has been confirmed in previous studies [ 38 – 40 ]. In general, low-intensity rehabilitation can begin within three days of the injury, while high-intensity activities need to wait until at least four days after the injury to be relatively safe [ 41 ]. Earlier rehabilitation maximizes the important window of the first three months and offers greater potential for prognostic improvement.…”

The effect of early mobilisation (< 14 days) on pathophysiological and functional outcomes in animals with induced spinal cord injury: a systematic review with meta-analysis

“…This has led to the decision to further knowledge by exploring pre-clinical animal studies reporting outcomes following mobilisation initiated within 14-days of injury, where clinical studies have not investigated [ 18 – 20 ]. This has the advantage of an available body of data reporting both pathophysiological and functional outcomes following interventions of mobilisation (e.g.…”

“…This has the advantage of an available body of data reporting both pathophysiological and functional outcomes following interventions of mobilisation (e.g. treadmill training) initiated within this early period [ 18 , 19 ]. Measures of pathophysiology are commonly used in pre-clinical research including levels of brain-derived neurotrophic factor (BDNF) as an indicator of neuroplasticity and neural recovery (with higher levels a marker of better recovery), and indicators of inflammation, e.g.…”

Commentary on “Effect of Acute Physical Interventions on Pathophysiology and Recovery After Spinal Cord Injury: A Comprehensive Review of the Literature”

“…1,2 This article comprehensively reviewed 52 preclinical studies on the effect of acute physical interventions after SCI regarding histopathological aspects and clinical outcomes. 3 In this paper, the authors classified physical interventions as 2 types: "high intensity" like treadmill, cycling, and swim training, and "low intensity" such as wheel running, ball training, reach training. It is interesting that high intensity rehabilitation initiated within the first 3 days and terminated by 1 week after injury worsened autonomic function, inflammation, and locomotor outcomes, which might be from association with dynamic inflammation in the hyperacute stage, 4 while lower intensity exercise such as reach training, ladder training, or voluntary wheel or ball training showed benefits when implemented during the first 3 days.…”

“…Due to the heterogeneity of the timing, method, duration, and intensity of physical interventions, the appropriate use of rehabilitation has been the subject of debate [ 1 , 2 ]. This article comprehensively reviewed 52 preclinical studies on the effect of acute physical interventions after SCI regarding histopathological aspects and clinical outcomes [ 3 ].…”