Movement rehabilitation after spinal cord injuries: emerging concepts and future directions

Considerable inroads are being made into developing new treatments for spinal cord injury (SCI) which aim to facilitate functional recovery, including locomotion. Research on rehabilitative strategies following SCI using animal models has demonstrated that regaining and maintaining motor function, such as standing or stepping, is governed by principles of skill acquisition. Mechanisms key to learning motor tasks, including retention and transfer of skill, feedback and conditions of practice, all have examples in the SCI animal literature, although the importance of many concepts may often be overlooked. Combinatorial strategies which include physical rehabilitation are beginning to yield promising results. However, the effects of molecular-cellular interventions including chondroitinaseABC, anti-NogoA, foetal stem cell transplantation, etc., are still poorly understood with reference to the changes made to spinal plasticity by training and exercise. Studies that investigate the interplay between rehabilitation and other treatments have had mixed results; it appears likely that precise timings of different interventions will help to maximize recovery of function. Understanding how the time-course of injury and different rehabilitative and treatment modalities might factor into spinal plasticity will be critical in future therapeutic interventions.