Spinal Cord Lesion: Effects of and Perspectives for Treatment
Following central motor lesions, two forms of adaptation can be observed which lead to improved mobility: (1) the development of spastic muscle tone, and (2) the activation of spinal locomotor centers induced by specific treadmill training. Tension development during spastic gait is different from t...
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| Main Author: | |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2001-01-01
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| Series: | Neural Plasticity |
| Online Access: | http://dx.doi.org/10.1155/NP.2001.83 |
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| Summary: | Following central motor lesions, two forms
of adaptation can be observed which lead to
improved mobility: (1) the development of spastic
muscle tone, and (2) the activation of spinal
locomotor centers induced by specific treadmill
training. Tension development during spastic
gait is different from that during normal gait
and appears to be independent of exaggerated
monosynaptic stretch reflexes. Exaggerated
stretch reflexes are associated with an absence
or reduction of functionally essential polysynaptic
reflexes. When supraspinal control of spinal
reflexes is impaired, the inhibition of monosynaptic
reflexes is missing in addition to a
reduced facilitation of polysynaptic reflexes.
Therefore, overall leg muscle activity becomes
reduced and less well modulated in patients with
spasticity. Electrophysiologicai and histological
studies have shown that a transformation of
motor units takes place following central motor
lesions with the consequence that regulation of
muscle tone is achieved at a lower level of
neuronal organization which in turn enables the
patient to walk. Based on observations of the
locomotor capacity of the spinal cat, recent
studies have indicated that spinal locomotor
centers can be activated and trained in patients
with complete or incomplete paraplegia when
the body is partially unloaded. However, the
level of electromyographic activity in the
gastrocnemius (the main antigravity muscle
during gait) is considerably lower in the patients
compared to healthy subjects. During the course
of a daily locomotor training program, the
amplitude of gastrocnemius, electromyographic
activity increases significantly during the stance
phase, while inappropriate tibialis anterior
activation decreases. Patients with incomplete
paraplegia benefit from such training programs
such that their walking ability on a stationary
surface improves. The pathophysiology and
functional significance of spastic muscle tone and
the effects of treadmill training on the locomotor
pattern underlying new attempts to improve the
mobility of patients with paraplegia are reviewed. |
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| ISSN: | 2090-5904 1687-5443 |