Restorative Neurology of Spinal Cord Injury

Neurobiological Problem and Novel Methods for Assessment and Intervention

Vancouver: American Congress on Rehabilitation Medicine, 9-13 October, 2012.

Keith Tansey, MD PhD, Barry McKay, Shepherd Center, Atlanta, GA;  Justin Brown, MD, University of California, San Diego, San Diego, CA

Little work has linked the neurophysiology of the injured spinal cord to its capacity to express the sensorimotor control needed for functional recovery. Nor has the field focused effort on improving neurorehabilitation to address specific sensorimotor control profiles across our patients. This is related to most clinical assessment tools only characterizing how well a patient performs a behavior, the speed of walking for instance. Slow walking could be due to weakness despite normal patterns of muscle activation OR because of disordered muscle activation (co-contractions, dysynergias) with normal strength. It is unlikely that a single intervention would help both of these sensorimotor control profiles. Therefore, it will be important to characterize and follow features of sensorimotor control, and their capacity for plasticity in the face of therapeutic intervention, to best develop future neurorehabilitation strategies. Work has now been started from this new frame of reference.

In the symposium, Tansey, a neurologist, will review what SCI means for neural circuits above, across, at and below the level of injury. Next, McKay, a research electrophysiologist, will report how the Brain Motor Control Assessment characterizes and tracks changes in spinal cord neurophysiological profiles. Brown, a neurosurgeon, will then describe surgical approaches to restoring function, including peripheral nerve reconnections to re-establish voluntary control of muscles below the SCI. Finally, Tansey will report on activity based therapies to engender plasticity and functional recovery and how they could be augmented, specifically by spinal cord stimulation.

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