Integrated Neuroregenerative Techniques for Plasticity of the Injured Spinal Cord

Abstract

On the slow path to improving the life expectancy and quality of life of patients post spinal cord injury (SCI), recovery remains controversial. The potential role of the regenerative capacity of the nervous system has led to numerous attempts to stimulate the SCI to re-establish the interrupted sensorimotor loop and to understand its potential in the recovery process. Numerous resources are now available, from pharmacological to biomolecular approaches and from neuromodulation to sensorimotor rehabilitation interventions based on the use of various neural interfaces, exoskeletons, and virtual reality applications. The integration of existing resources seems to be a promising field of research, especially from the perspective of improving living conditions in the short to medium term. Goals such as reducing chronic forms of neuropathic pain, regaining control over certain physiological activities, and enhancing residual abilities are often more urgent than complete functional recovery. In this perspective article, we provide an overview of the latest interventions for the treatment of SCI through broad phases of injury rehabilitation. The underlying intention of this work is to introduce a spinal cord neuroplasticity-based multimodal approach to promote functional recovery and improve quality of life after SCI. Nonetheless, when used separately, biomolecular therapeutic approaches have been shown to have modest outcomes.

The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury

“…The main problem for these people becomes a change in the flow of information in ascending and descending pathways. Over time, the neuronal projections become weaker, and this may lead to secondary degenerative changes in the subcortical and cortical structures and brain reorganisation [ 3 , 5 , 40 ]. Therefore, it seems reasonable to look for stimulation methods that enhance activity-dependent neuroplasticity and residual signals and alter neuronal activity [ 10 , 41 ].…”

“…The challenge and the main limitation of all research related to spinal cord injury is the highly heterogeneous pathophysiology and different dynamic of the spontaneous regeneration process [ 5 ]. Most cases involve incomplete injury, but even in this group, the severity depends on the level of damage and which parts of the spinal cord are affected.…”

“…It also does not require a surgical procedure like direct epidural spinal cord stimulation. It is, therefore, simpler and less expensive to apply [ 5 , 19 ].…”

“…Regardless of the mechanism of injury and highly heterogeneous pathophysiology [ 4 ], most often, patients have varying degrees of loss to the sensory and motor functions below the level of the injury, the presence of pain, and a wide range of autonomic dysfunctions. In addition, people with iSCI have many problems with mental health, and their condition very often affects the entire community [ 5 ]. Over the past decades, neurosurgical and rehabilitation advances have opened new horizons for spinal cord regeneration.…”

“…Today, efforts to find methods that support cortical and spinal cord plasticity and functional recovery after iSCI continue to be even more desirable and still remain controversial [ 6 ]. Although many different treatment options have been suggested for the management of SCI, including surgery, kinesiotherapy, physical therapy, cell-based therapy, or a combination of these approaches [ 5 , 6 , 7 , 8 , 9 ], there is still no agreement on which method provides the best chance of clinical improvement [ 10 ]. Moreover, the more presented clinical interventions are often difficult to compare due to the lack of standardised objective evaluation methods.…”