Could enhanced reflex function contribute to improving locomotion after spinal cord repair?

Although numerous treatments have been found to improve locomotion in spinal cord injured mammals, the underlying mechanisms are very poorly understood. Some of the main possibilities are: (1) regeneration of axons across the injury site and the re-establishment of descending pathways needed to voluntarily initiate and maintain stepping in the hind legs, (2) enhanced effectiveness of undamaged neurons in preparations with incomplete transections of the cord, (3) non-specific facilitation of reflexes and intrinsic spinal networks by transmitters released from regenerated axons and/or by substances introduced by the treatment, and (4) enhanced trunk movements close to the injury site strengthening the mechanical coupling of the trunk to the hind legs via spinal reflexes. In addition, any procedure that even slightly improves stepping may be further enhanced by use-dependent modification of reflex pathways and interneuronal networks in the lumbar cord. The emphasis of this review is on the contribution of spinal reflexes to the patterning of motor activity for walking, and how enhancing reflex function may contribute to the improvement of locomotion by treatments aimed at restoring locomotion after complete transection of the spinal cord.