The Role of Peripheral Nerve Electrotherapy in Functional Recovery of Muscle Motor Units in Patients after Incomplete Spinal Cord Injury  
[PERSON]  
1 Department of Pathophysiology of Locomotor Organs, Poznan University of Medical Sciences, 28 Czerwca 1956 nr 135/147, 60-545 Poznan, Poland; [EMAIL_ADDRESS] (K.L. ); [EMAIL_ADDRESS] (A.W. ); [EMAIL_ADDRESS] (A.S.-S)  
2 Department of Neurosurgery, Wroach Medical University, Borowska 213, 50-556 Wroclaw, Poland; [EMAIL_ADDRESS] (W.F. ); [EMAIL_ADDRESS] (P.T.) [PERSON]  
3B Bacteriophage Laboratory, Ludwik Hirzfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, [PERSON] 12, 53-114 Wroclaw, Poland
transmission of different neural impulses within the injured spinal pathways [2]. However, after iSCI, the secondary changes in the fibers of lower extremities nerves occur, which may be caused by the disturbances of different impulses transmission from the supraspinal centers to motor cells below the damage level [3,4]. Several studies also revealed that despite no structural cause of damage at the lower spinal levels, degeneration in motor units might appear [5]. Thus, iSCI patients' treatment should include not only the surgical spine stabilization and continuous, intensive kinesotherapy, but also the methods that prevent the secondary degenerative changes in nerve fibers [6]. Electrostimulation may be such a treatment, preferably of nerves rather than muscles, and the strategy should rely on personally adjusted parameters of impulses based on the current state of the neural transmission. This type of electotherapy may be personalized, safe, and controlled in use, and it may give better, and long-lasting functional effects than the previously proposed algorithms. This therapy's main aim in iSCI patients should be protection and the inhibition of inevitable atrophic changes in nerves and muscles because it generates the spread of neural impulses in orthodromic and antidromic directions. It can be hypothesized that standard algorithms used in contemporary electrostimulation procedures sometimes lead to iatrogenic damage, or they may not bring the expected therapeutic effects [6]. Moreover, it can be assumed that electrostimulation of nerves is a safe technique with therapeutic potential for motor function rehabilitation following iSCI when parameters are adjusted to the current functional state of neural transmission in nerves and activity in muscle motor units in a treated patient; it is necessary to understand how this therapy can be optimized in the clinical practice. The expected changes in motor fibers during degenerative processes in iSCI patients may be of an axonal and later demyelinating type [5,7,8]. The quality of electrostimulation algorithms used for treatment of iSCI patients may be effectively improved by neurophysiological evaluation that consists of electroneurography (ENG), and surface electromyography (sEMG) recordings. These objective, non-invasive tests assess abnormalities in the transmission of neural impulses and preserved the activity of neuromuscular synapses, respectively. Effects of electrostimulation treatment in iSCI patients are mostly case presentations or evidence of a weak efficiency in motor function rehabilitation following applied kinesotherapy and physical therapy procedures in a limited number of subjects. Several studies have also analyzed the improvement of neural signal transmission in injured fibers [6,9,10]. Positive effects of electrical stimulation of the motor cortex, spinal cord, or peripheral nerves, which modulate lumbar spinal cord excitability, are mainly presented in experimental studies on animals, and rarely in human trials [11,12]. Studies on humans do not present electrotherapy algorithms based on physiological premises or parameters referred to as high-frequency (or low combined with high-frequency) and high-strength stimulation.