Exciting recovery: augmenting practice with stimulation to optimize outcomes after spinal cord injury

The discovery that the nervous system is plastic even in adulthood has been a great benefit to people with spinal cord injury (SCI) and other disorders of the central nervous system. Currently, practice and training provide the best opportunities to reverse the maladaptive plasticity associated with neuropathology and to promote adaptive plasticity that is supportive of function. Evidence suggests that several noninvasive, clinically accessible forms of stimulus energy, such as electrical, magnetic, and vibration stimuli may augment the effects of training. In essence, stimulation activates the same neural circuits that are activated by training, and when used in combination with training, stimulation has the potential to promote neuroplasticity beyond that achieved by practice or training alone. Studies involving neurologically healthy individuals have shown these approaches to enhance neural excitability and motor performance. Noninvasive, clinically available forms of stimulation may be used to modulate neural excitability as an adjuvant to programs designed to improve hand/arm function or to improve walking function in persons with neurological disorders. This chapter focuses on studies involving individuals with SCI and provides insights regarding how stimulation may be used to augment to training in this population.