Spinal cord plasticity and neuromodulation

Abstract

Rehabilitation of people with spinal cord injury, traumatic brain injury, and other neurological disorders can be improved by the use of methods that rely on modulating and guiding the plasticity of the central nervous system including the spinal cord itself. This chapter first provides a general overview of the evidence for spinal cord plasticity. It reviews the definitions of quality of life (QOL) and discusses how typical research priorities are not well aligned with the priorities expressed by people with these disabilities. Typically, research as well as therapeutic efforts focus on such functions as locomotion and arm/hand control. In contrast, studies of people with spinal cord injury and other injuries or disorders of the nervous system reveal that their highest priorities are often restoration of such autonomic functions as bladder and bowel control and sexual function. This review therefore focuses on rehabilitation methods such as neuromodulation, including sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS), that target restoration of these functions, with some additional discussion of the pain abatement that is often produced incidentally with use of these methods. In designing new therapies and planning new research programs, it would be highly beneficial to take into serious consideration assessments of their potential to improve QOL and to use QOL measures as an additional metric in evaluating the impact of results.