Rehabilitation Training after Spinal Cord Injury Affects Brain Structure and Function: From Mechanisms to Methods

Abstract

Spinal cord injury (SCI) is a serious neurological insult that disrupts the ascending and descending neural pathways between the peripheral nerves and the brain, leading to not only functional deficits in the injured area and below the level of the lesion but also morphological, structural, and functional reorganization of the brain. These changes introduce new challenges and uncertainties into the treatment of SCI. Rehabilitation training, a clinical intervention designed to promote functional recovery after spinal cord and brain injuries, has been reported to promote activation and functional reorganization of the cerebral cortex through multiple physiological mechanisms. In this review, we evaluate the potential mechanisms of exercise that affect the brain structure and function, as well as the rehabilitation training process for the brain after SCI. Additionally, we compare and discuss the principles, effects, and future directions of several rehabilitation training methods that facilitate cerebral cortex activation and recovery after SCI. Understanding the regulatory role of rehabilitation training at the supraspinal center is of great significance for clinicians to develop SCI treatment strategies and optimize rehabilitation plans.

Exposure to an enriched environment modulates the synaptic vesicle cycle in a mouse spinal cord injury model

“…Currently, there are many studies supporting a potential role for post-synaptic plasticity in encouraging axonal regeneration and recovery. Notably, recent studies have shown that following SCI, electrical stimulation can significantly increase the growth and branching of axons via upregulation of axon growth-and regeneration-promoting genes and factors, which also contributes to induction of Hebbian www.nature.com/scientificreports/ plasticity 46,47 . Furthermore, previously "silent" (NDMA-only) synapses have been found to undergo activation and reorganization in the face of electrical stimulation, which has been proposed to be a potential mechanism for rejuvenating neural pathways via encouragement of post-injury synaptic plasticity and axonal regrowth 46 .…”

The Impact of Treadmill Training on Tissue Integrity, Axon Growth, and Astrocyte Modulation

“…It has been demonstrated that physical exercises can reverse or prevent disruptions in GABAergic and glycinergic regulation, increasing the expression of glutamate decarboxylase 67 (GAD67), glycine receptor (GlyR), and gamma-aminobutyric acid subtype A (GABAA) in the lower thoracic Th10 and lumbar L2 segments [42], via BDNF-TrkBdependent pathways in SCI [43]. It has been shown that interneurons with increased expression of GAD67, GlyR, and GABAA play a role in locomotion, as they can modify the pace of the stepping cycle, and their reduction post-SCI may lead to prolonged activation of spinal motoneurons [44,45].…”

Combined Treatments and Therapies to Cure Spinal Cord Injury

“…Two reviews focus on the effects of rehabilitation in patients with SCIs. Indeed, He et al present a review of the effects of physical exercise on the reorganization of communication between the brain and the spinal cord, while Stanciu et al describe the reported effects of rehabilitation through hydrotherapy [28,29].…”