Rehabilitation after spinal cord injury

The therapeutic impact of high-altitude climate is already used in rehabilitation after injuries to the spinal cord. As a result of its interaction mediates the release of brain-derived neurotrophic factor (BDNF), which affects neuronal plasticity. In this way, individuals with incomplete spinal interruption gradual recover faster mobility in the limbs, and people with high spinal cord injury are able to return to independent breathing with the diaphragm.

 

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It has been proven that being in conditions of reduced oxygen content supports the dropped connection of neurons. Low levels of oxygen results in the release of significant amounts of serotonin within the brain. This in turn stimulates the production of brain-derived neurotrophic factor (BDNF). BDNF has proven action on neuronal differentiation inducing their maturation, synapse formation and growth of neurons. Such an adaptive response in people with incomplete spinal cord interruption leads to the creation of new connections, so that it comes to improving the functionality of the niepełnie innervated distal parts of the body (limbs). At maturation, the survival and function of the nervous system are also affected by other factors, resulting in significant numbers during hypoxia. It is, inter alia, hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and erythropoietin (EPO). Erythropoietin is of particular importance because it has a protective effect on neurons under conditions of hypoxia, inflammation, and – what is most important – streamlines the process of regeneration of neuromuscular connections after mechanical damage (Vinit S. 2009). Vascular endothelial growth factor expanding network of blood mikrokapilarnych, so that blood can reach the damaged and dead tissues.

 

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Below is a brief description of one of the most significant studies using the heights achieved by reducing oxygen during rehabilitation after discontinuation of part of the spinal cord. The study, which involved 19 people with a history of spinal cord injury after a 5-day treatment under hypoxic conditions there was significant improvement in the speed of the walking the  length of 10 feet (10 m walk test). The average speed of walking improved by the passage of 3.8 s compared to the control group, rehabiltated in a „normal” content of oxygen (Hayes B.H. 2013).

In case of hight breaking of spinal cord (cervical vertebrea), which results in paralysis of the respiratory muscles with the diaphragm, it is necessary to carry out replacement of ventilation. In such situations, there is a risk of dependence on a ventilator, which in the long run makes it impossible to wean from respiratory replacement. At the same time, remember that paralysis of respiratory muscles except asphyxia (suffocation) leads to other fatal complications (such as pneumonia). For this reason early initiation of effective rehabilitation process is essential, with particular regard to the possibility of neurotrophic and neuroplastic nervous system. High efficiency in this type of rehabilitation also provides the use of simulated altitude conditions. With the advent of neurotrophic growth factors comes to the resumption of the motor neuron membrane transduction and rapid involvement of other respiratory muscles. At the same time be aware of the increased impulses from peripheral chemoreceptors to the reduced oxygen content in the arterial blood and the response of the respiratory center in the form of higher impulses (HVR – hypoxic ventilatory response) and increased sensitivity to hypoxia (HVS – hypoxic ventilatory sensitivity).

 

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Numerous studies have proven the effectiveness of this type of therapy. Studies used different protocols and all proved to be effective. In one study of high-altitude conditions were applied during sleep. Spontaneous return of movable diaphragm was observed after 2 weeks (Fuller D.D 2003).  In another study, which lasted seven days, and exposure to hypoxia took the form of a broken and was done during the day, also observed the resumption of conduction to the diaphragm (Lovett-Bar MR. 2012).

 

Rehabilitation after craniocerebral trauma and stroke patients

The release of the above-mentioned neurotrophic factor origin (BDNF), vascular endothelial growth factor (VEGF) at the same time increasing the presence of nerve growth factor (NGF) and the glial growth factor (GPF) – plus the controlled under the influence of hypoxia – to significantly modulate plasticity brain. This is particularly important after injuries and strokes, which is the most significant consequence of hypoxia, cerebral cortex, leading to the death of. Necrosis of the cerebral cortex gives results in the form of neurological deficits, such as paresis, amnesia, personality disorders, inability to speak, to say the loss of intellectual abilities. Activation of these growth factors can stimulate nerve cells (neurons and synapses) to their reconstruction.

 

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At the same time carried out rehabilitation in the form of science gives much higher results in restoring lost motor skills and intellectual, which greatly improves the quality of life (Schega L. 2013). Although human exposure after injury / stroke cerebral hypoxia seem to be harmful, but it has a different character. It is not as strong as in the case of trouble hematoma brain structures or interruption of blood supply to a particular part due to congestion (ischemic stroke). The type discussed here is mild hypoxia, stimulating and stimulating the body to adaptive responses targeted, and not sudden and very strong, comprising a piece of tissue, as is the case with injury / stroke.