Mechanism-Based Neuromodulation in Augmenting Respiratory Motor Function in Individuals with Spinal Cord Injury

Spinal cord injury (SCI) is one of the most debilitating conditions that has profound effects on every physiological system, including respiratory dysfunction, which is listed among the most common causes of mortality and morbidity in this population. Previous research has demonstrated that respiratory training could facilitate respiratory motor- and autonomic activity-based plasticity. However, due to the reduced excitability of spinal networks below the level of injury, the effectiveness of such interventions is often limited to the residual functional capacity preserved after injury. In recent decades, several novel neuromodulatory techniques have been explored to enhance neuronal connectivity and integrate into respiratory rehabilitation strategies. In this review, we examine the mechanisms underlying respiratory deficits following SCI and discuss the neuromodulatory approaches designed to promote neural plasticity for respiratory recovery. Current evidence suggests that integrating multimodal neuromodulation with activity-based respiratory training holds promise; it may significantly enhance respiratory functional recovery and could become a standard component of respiratory rehabilitation protocols in individuals with SCI.