Exploring the potential for neural recovery after incomplete tetraplegia through nonsurgical interventions

Persons with tetraplegia resulting from a cervical spinal cord injury believe that increasing upper limb (UL) function will improve their quality of life. Various lines of evidence demonstrate that persons with incomplete tetraplegia have the potential for improvements in both neural plasticity and function of the arms and hands. Therefore treatment to improve UL function in persons with incomplete tetraplegia should focus on improving motor control, not just compensation for the paralysis and sensory loss that follows a spinal cord injury. This article highlights the principles that underlie the facilitation of neural plasticity and functional changes: intensity, repeated practice, attention, and somatosensory augmentation. Evidence is presented for the application of these principles through the use of activity-based interventions in persons with tetraplegia and the hypothesis is proposed that the use of activity-based interventions will lead to greater, more beneficial neural plasticity as well as gains in UL function, in persons with incomplete tetraplegia.