Daily intermittent hypoxia improves walking in chronic SCI

Novel ways of promoting plasticity in incomplete SCI

Approximately 59% of all spinal injuries are incomplete, leaving spared pathways capable of plasticity. While spontaneous plasticity partially restores walking ability, it seldom enables return to functional, overground walking. Acute intermittent hypoxia (AIH) is a novel, noninvasive means to induce spinal plasticity, strengthening spared pathways to motoneurons after iSCI. Hypoxia in rodents activates carotid chemoafferents that stimulate serotonin, which triggers synthesis of brain-derived neurotrophic factor (BDNF) and activation of TrkB, enhancing synaptic input and motor output of respiratory and somatic motor nuclei. In humans with iSCI, hypoxia increases ankle strength. 

With dAIH alone, the primary benefit was increased speed (10MWT), whereas the combined intervention of dAIH + walking had greater impact on walking endurance (6MWT). All subjects improved walking ability on the 10MWT or 6MWT, and improvements persisted for more than 3 days in 18 of 19 subjects. With a single AIH exposure, subjects improved 10MWT times by 17.6% over baseline, and 15% after dAIH + walking. Subjects improved 6MWT distance by 24% with dAIH alone, and 36.6% with the combined intervention of dAIH + walking. Hypoxia alone or combined with overground walking holds promise as a safe, effective intervention to restore function in persons with chronic iSCI. 

> From: Hayes et al., Neurology 82 (2014-10-13 22:35:57) 104-113 . All rights reserved to American Academy of Neurology. Click here for the online summary.

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