Muscle and bone plasticity after spinal cord injury: Review of adaptations to disuse and to electrical muscle stimulation

• Published in: Journal of rehabilitation research and development Vol. 45; no. 2; pp. 283 - 296
• Main Authors: Dudley-Javoroski, Shauna, Shields, Richard K
• Format: Journal Article
• Language: English
• Published: United States Department of Veterans Affairs 01.01.2008; Superintendent of Documents
• Subjects: Adaptation, Physiological - physiology; Animals; Biomechanical Phenomena; Bone and Bones - physiopathology; Bone Density; Bone regeneration; Care and treatment; Circulatory system; Economic aspects; Electric Stimulation Therapy; Exercise Therapy; Fibers; Human subjects; Humans; Muscle, Skeletal - innervation; Muscle, Skeletal - physiopathology; Muscular system; Musculoskeletal system; Neural stimulation; Neuronal Plasticity - physiology; Patient outcomes; Physical fitness; Proteins; Reflexes; Spinal cord injuries; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - rehabilitation
• ISSN: 0748-7711; 1938-1352; 1938-1352
• DOI: 10.1682/JRRD.2007.02.0031

The paralyzed musculoskeletal system retains a remarkable degree of plasticity after spinal cord injury (SCI). In response to reduced activity, muscle atrophies and shifts toward a fast-fatigable phenotype arising from numerous changes in histochemistry and metabolic enzymes. The loss of routine gravitational and muscular loads removes a critical stimulus for maintenance of bone mineral density (BMD), precipitating neurogenic osteoporosis in paralyzed limbs. The primary adaptations of bone to reduced use are demineralization of epiphyses and thinning of the diaphyseal cortical wall. Electrical stimulation of paralyzed muscle markedly reduces deleterious post-SCI adaptations. Recent studies demonstrate that physiological levels of electrically induced muscular loading hold promise for preventing post-SCI BMD decline. Rehabilitation specialists will be challenged to develop strategies to prevent or reverse musculoskeletal deterioration in anticipation of a future cure for SCI. Quantifying the precise dose of stress needed to efficiently induce a therapeutic effect on bone will be paramount to the advancement of rehabilitation strategies.