A Systematic Review: Exercise Based Approaches to Activate Central Pattern Generator in Spinal Cord Injury Survivors

Abstract

<i>Background: </i>Locomotion is a basic motor act which is essential for the survival of humans. The basic muscle synergies which are responsible for body propulsion are generated by the neurons in spinal cord collectively known as Central Pattern Generator for Locomotion. Spinal Cord is the major conduit for the transmission of information between brain and the rest of the body. Injury to the spinal cord is the insult to the neural elements of the spinal canal from foramen magnum to cauda equina. SCIs are heterogeneous in casualty, severity and location of injury but locomotion is the ultimate goal for the post-SCI survivors. In order for locomotion to occur, a complex CPG center of locomotion activation is required. Exercise based approach is the cornerstone in the treatment and management of individuals with SCI.<i> Objective</i>: To study the existing evidence on the effectiveness of Exercise-based approaches to activate Central Pattern Generator in Spinal Cord Injury Survivors with a focus on randomized controlled trials and cross over trials studies. <i>Methodology</i>: Literature published in English language. Original publications including RCTs and cross over trials published in peer-reviewed journals focused on traumatic or non-traumatic spinal cord injury published from 2014 to 2022. A key literature search adopted, for a more targeted search the following terms were used: effect of exercise, task-based approaches, body weight supported treadmill training, over ground training, balance and coordination training on the activation. <i>Search Strategy</i>: Database used were PubMed, Cochrane, Scopus, EMBASE, CINAHL and Medline. <i>Results</i>: Assessment of Risk of Bias was done using PeDro analysis. Eleven studies met the inclusion criteria out of 300 studies searched. <i>Discussion</i>: Exercise based approaches are highly essential and integrated part of the rehabilitation of spinal cord injury survivors. It has been concluded that activity-based therapies are highly effective but under-utilized by the rehabilitation specialists.