Harnessing neuroplasticity for clinical applications

Extract

Sir, The recent review article ‘Harnessing neuroplasticity for clinical applications’ (Cramer et al., 2011) is in many respects an impressively sophisticated summary of current knowledge of CNS plasticity and its potential translation to important new therapeutic applications. However, this otherwise excellent article has one very major omission: anyone reading it who did not already know better would assume that neuroplasticity essentially ends at the foramen magnum. Apart from several brief references to corticospinal tract plasticity, there is no mention of spinal cord plasticity, of its importance in sensorimotor function, and of the rapidly growing evidence that appropriate engagement and guidance of spinal cord plasticity could play a major role in restoring useful function after spinal cord injuries, strokes and other trauma or disease. A major area of active and successful research that applies directly to the subject of the article, ‘Harnessing neuroplasticity for clinical applications,’ is not addressed.

A full review of activity-dependent spinal cord plasticity and its potential clinical applications would be nearly as lengthy as Cramer et al. (2011). The relevant information comprises at least six substantial bodies of data, three coming from pathological situations or reduced preparations and three coming from normal life. These six areas are briefly summarized and illustrated here.