Neuroplasticity: An Essential Part Of Spinal Cord Injury Recovery

Neuroplasticity is an essential part of spinal cord injury recovery, insofar as this ability within the brain and the spinal cord is what makes recovery possible. The rehabilitation of people with spinal cord injury was previously based on the assumption that the nervous system is irreparable after injury. The focus was on learning compensatory strategies and how to adapt to life in a wheelchair with impaired function. Contemporarily, other approaches working with neuroplasticity have been developed, which unfortunately do not appear in many clinical environments. Spinal cord injury still cannot be cured, but research has shown that progress can be made with either traditional physiotherapy or other innovative therapeutic methods.

Activity-based therapies are the basis of functional recovery, and at the same time, the number of technical devices that therapists can use in the treatment of spinal cord injury cases has also increased. The new tools are very useful for improving neuroplasticity. Activity-based and innovative procedures go hand in hand and complement each other in order to achieve better outcomes. Task-specific physical training for several hours a day is still essential for the recovery of functions and neural regulation after the injury. However, as a result of innovations such as epidural stimulation, possibilities to treat spinal cord injuries have been expended.

What is Neuroplasticity?

Broadly, the term plasticity refers to the body's ability to change. Neuroplasticity specifically refers to the physiological change in synaptic functioning that occurs during learning. In other words, the nervous systems' ability to grow, change and memorize.

Human bodies have adapted so that tissue regeneration takes place after it is damaged, in order to allow them to survive. Due to the highly organized and complex nature of human central nervous systems, these types of automatic recovery mechanisms are quite limited with trauma such as complete spinal cord injury. However, the human central nervous system is capable of considerable reorganization. In incomplete SCI, many of the links between brain and body are still partially intact, such as the cortical, subcortical and, to a larger extent, the local spinal cord pathway systems.

A process called ‘Synaptic Plasticity’ occurs, induced both by lesion and by the need for functional development. Synapses are the structures in the brain circuits which allow the electric ‘nerve’ signals to pass through. After SCI some of the circuits are destroyed, but those which still exist strengthen and this is known as synaptic plasticity. It responds to changes in the strength of nerve signaling, so as the body learns new processes, the strength of the nerve signals increases. They are stimulated by the operational experiences of previous synapses. In other words, the brain already has an idea of how to perform these processes from having done so prior to injury. Therefore, it is not so much starting from scratch but re-learning.
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Neuroplasticity In The Spinal Cord Recovery Process

Research reports that the immobility created after paralysis stops the activity of neural circuits in the spinal cord, but these circuits can be restarted with intensive,repetitive training. There are a number of principles of Neuroplasticity, including:
  • Use it or lose it

    If patients do not maintain rehabilitation efforts, the learning will be lost.
  • Use it and improve it

    The more patients practice, the better the learning will be. This is why patients’ improvement after SCI is continuous.
  • Be specific

    Performing extremely targeted and focused exercises creates better learning.
  • Be repetitive

    Similarly to the ‘use it and improve it’ principle, being repetitive with an action allowing the synapses to strengthen further, in other words, allows the learning to be more deeply entrenched.
  • Be intensive

    Patients should increase the intensity of their rehabilitation over time, as they see improvements. This ensures that their progress will not plateau.
  • Be prompt

    The quicker patients begin the re-learning process after injury, the more successful their recovery is likely to be.
At Verita Neuro, our epidural stimulation protocol promotes neuroplasticity, by both improving the transmission of the electrical signals in the brain, and by enforcing the learning with physical rehabilitation.
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Denisz Kovács

Physical Therapist


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