![]() The loss of these vital inputs reduces the generation, regulation, and patterning of motor outputs. Substantial recovery after trauma is challenging because of the poor ability of supraspinal axons to regenerate and form functional networks below the level of injury. Although regeneration within the adult spinal cord is limited, some spontaneous or activity-dependent sensorimotor recovery still occurs, mostly mediated by localized sprouting and plasticity of axon terminals ( Waters et al., 1996 Burns et al., 1997). Spinal cord injury (SCI) often results in life-long sensorimotor dysfunction. Finally, we discuss genetic tools for afferent modulation as an emerging method to facilitate the search for the mechanisms of action. ![]() ![]() In this review, we discuss several sensorimotor plasticity mechanisms that we hypothesize may enable epidural stimulation to promote recovery, including changes in local lumbar circuitry, propriospinal interneurons, and the internal model. The mechanisms that EES induces to drive these improvements in sensorimotor function remain largely unknown. Since then, epidural electrical stimulation (EES) has been demonstrated to improve voluntary mobility across the knee and/or ankle in several SCI patients, highlighting its utility in enhancing motor activation. In 1976, epidural stimulation was introduced to alleviate spasticity in Multiple Sclerosis. Despite this, animal models and humans exhibit many motor behaviors indicative of recovery when electrical stimulation is applied epidurally to the dorsal aspect of the lumbar spinal cord. Spontaneous recovery from SCI is limited, as supraspinal fibers cannot spontaneously regenerate to form functional networks below the level of injury. Spinal cord injury (SCI) often results in life-long sensorimotor impairment. 2Department of Neuroscience, Shriners Hospitals Pediatric Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.1Department of Bioengineering, College of Engineering, Temple University, Philadelphia, PA, United States. ![]()
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