From the Guidelines
Physical therapy, including targeted exercises and functional electrical stimulation (FES), is the cornerstone of rehabilitation for enhancing motor recovery after spinal cord injury. This approach promotes neuroplasticity through repetitive movement patterns, helping to rewire neural pathways and prevent secondary complications like muscle atrophy and contractures 1. The use of medications such as methylprednisolone is not recommended due to the lack of evidence supporting its effectiveness in improving neurological outcomes and the potential for increased infectious complications 1.
Some key strategies for enhancing motor recovery include:
- Body-weight supported treadmill training
- Robotic-assisted therapy devices
- Transcranial magnetic stimulation (TMS)
- Epidural electrical stimulation These interventions work by promoting neuroplasticity and preventing secondary complications, ultimately improving motor function and quality of life for individuals with spinal cord injuries 1. It is essential to note that the management of spinal cord injuries requires a multidisciplinary approach, involving cooperation between emergency teams, anaesthesiologists, surgeons, and rehabilitation specialists 1.
In terms of specific recommendations, physical therapy should be initiated early in the rehabilitation process, with a focus on targeted exercises and functional electrical stimulation. The use of other interventions, such as body-weight supported treadmill training and robotic-assisted therapy devices, should be considered on a case-by-case basis, taking into account the individual's specific needs and goals 1. Overall, the goal of rehabilitation should be to promote neuroplasticity, prevent secondary complications, and improve motor function and quality of life for individuals with spinal cord injuries.
From the FDA Drug Label
Tizanidine’s capacity to reduce increased muscle tone associated with spasticity was demonstrated in two adequate and well controlled studies in patients with multiple sclerosis or spinal cord injury. The answer is: Tizanidine can be used to enhance motor recovery for spinal cord injury by reducing increased muscle tone associated with spasticity, as demonstrated in clinical studies 2 and 2.
- Key points:
- Tizanidine has been shown to reduce muscle tone in patients with spasticity secondary to spinal cord injury.
- The reduction in muscle tone was statistically significant in both single dose and multiple dose studies.
- Tizanidine should be used with caution in certain patient populations, such as those with renal insufficiency.
From the Research
Enhancing Motor Recovery for Spinal Cord Injury
Several approaches can be used to enhance motor recovery for spinal cord injury, including:
- Rehabilitative training, which is currently one of the most successful treatments to promote functional recovery following spinal cord injury 3
- Activity-dependent plasticity and spinal cord stimulation, which can improve sensorimotor function and induce neural plasticity to enhance motor recovery 4
- Motor rehabilitation, which can have anti-inflammatory effects and improve functional capacity and prevent secondary health implications 5
- Pharmacological treatments, such as methylprednisolone, although the evidence for its effectiveness is limited and it may be associated with increased risks for adverse events 6
- Strengthening corticospinal synaptic transmission, which can enhance motor recovery by modulating the efficacy of synapses between corticospinal axons and spinal motoneurons 7
Key Findings
- Rehabilitative training can promote functional recovery, but more research is needed to optimize its effect on functional outcome 3
- Spinal cord stimulation can promote long-term neuroplasticity and improve sensorimotor function 4
- Motor rehabilitation can have anti-inflammatory effects and improve functional capacity, but more research is needed to understand its effects on inflammation in the context of spinal cord injury 5
- Methylprednisolone may not be associated with significant long-term benefits for motor recovery, and its use may be limited by increased risks for adverse events 6
- Strengthening corticospinal synaptic transmission can enhance motor recovery by modulating the efficacy of synapses between corticospinal axons and spinal motoneurons 7