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Neuroplasticity After Spinal Cord Injury and Training: An Emerging Paradigm Shift in Rehabilitation and Walking Recovery

AL Behrman, PT, PhD, is Associate Professor, Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, PO Box 100154, UFHSC, Gainesville, FL 32610-0154 (USA), and Research Scientist, Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Fla
MG Bowden, PT, MS, is Research Physical Therapist, Brain Rehabilitation Research Center, Malcom Randall VA Medical Center
PM Nair, BPhT, is a doctoral candidate, Rehabilitation Science Doctoral Program, University of Florida

Address all correspondence to Dr Behrman at: abehrman{at}phhp.ufl.edu

Physical rehabilitation after spinal cord injury has been based on the premise that the nervous system is hard-wired and irreparable. Upon this assumption, clinicians have compensated for irremediable sensorimotor deficits using braces, assistive devices, and wheelchairs to achieve upright and seated mobility. Evidence from basic science, however, demonstrates that the central nervous system after injury is malleable and can learn, and this evidence has challenged our current assumptions. The evidence is especially compelling concerning locomotion. The purpose of this perspective article is to summarize the evidence supporting an impending paradigm shift from compensation for deficits to rehabilitation as an agent for walking recovery. A physiologically based approach for the rehabilitation of walking has developed, translating evidence for activity-dependent neuroplasticity after spinal cord injury and the neurobiological control of walking. Advanced by partnerships among neuroscientists, clinicians, and researchers, critical rehabilitation concepts are emerging for activity-based therapy to improve walking recovery, with promising clinical findings.

Key Words: Locomotion • Recovery of function • Spinal cord injuries

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