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Is the Recovery of Stepping Following Spinal Cord Injury Mediated by Modifying Existing Neural Pathways or by Generating New Pathways? A Perspective

RD de Leon, PhD, is Assistant Professor, Department of Kinesiology and Physical Education, California State University, Physical Education Bldg, Room 206, 5151 State University Dr, Los Angeles, CA 90032-8162 (USA). Address all correspondence to Dr de Leon
R Roy, PhD, is Researcher, Brain Research Institute, University of California at Los Angeles
VR Edgerton, PhD, is Professor, Department of Physiological Science and Brain Research Institute, University of California at Los Angeles

The recovery of stepping ability following a spinal cord injury may be achieved by restoring anatomical connectivity within the spinal cord. However, studies of locomotor recovery in animals with complete spinal cord transection suggest that the adult mammalian spinal cord can acquire the ability to generate stepping after all descending input is eliminated and in the absence of neuronal regeneration. Moreover, rehabilitative gait training has been shown to play a crucial role in teaching existing spinal pathways to generate locomotion and appropriately respond to sensory feedback. This brief review presents evidence that neural networks in the mammalian spinal cord can be modulated pharmacologically and/or with task-specific behavioral training to generate weight-bearing stepping after a spinal injury. Further, the role that spinal learning can play in the management of humans with spinal cord injury is discussed in relation to interventions that are designed primarily to enhance neuronal regeneration.

Key Words: Locomotion • Recovery • Spinal cord injury • Spinal learning

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