Electrical Stimulation and Motor Recovery

Young, Wise

doi:10.3727/096368915x686904

Cited by 76Spinal Cord Injury ResearchStroke Rehabilitation and RecoveryNerve injury and regeneration

Electrical Stimulation and Motor Recovery

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Young, Wise·2015·Cell Transplantation

DOI 10.3727/096368915x686904

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Abstract

In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as “neurons that fire together, wire together.” This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory.

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“3(a)) in restoring sensory perception and motor functions has been shown in numerous studies [103], [104].”

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Authors: Young, W.
Affiliations: Rutgers, The State University of New Jersey (US)
Corresponding author: Young, Wise
Venue: Cell Transplantation
Publisher: SAGE Publications
Published: 2015-03
Volume: 24
Issue: 3
Pages: 429-446
ISSN: 0963-6897 (ISSN-L)
1555-3892
DOI: 10.3727/096368915x686904
OpenAlex: W2011550232
Cited by: 76
References: 285
Citations by year: 2026: 6 · 2025: 9 · 2024: 4 · 2023: 7 · 2022: 8 · 2021: 10 · 2020: 9 · 2019: 9 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 1
FWCI: 0.64
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Cell Transplantation (publishedVersion)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics: Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Nerve injury and regeneration
Keywords: electrical stimulation, motor recovery, spinal cord injury, locomotor training, central pattern generator, epidural spinal cord stimulation, motor cortex stimulation, functional electrical stimulation, synaptic plasticity, Hebbian learning, axon regeneration, corticospinal tract
MeSH terms: Animals, Electric Stimulation, Humans, Locomotion, Motor Cortex, Peripheral Nerves, Spinal Cord, Spinal Cord Injuries, Recovery of Function

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Electrical Stimulation and Motor Recovery

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