The dependence of spinal cord development on corticospinal input and its significance in understanding and treating spastic cerebral palsy.

The final phase of spinal cord development follows the arrival of descending pathways which brings about a reorganisation that allows mature motor behaviours to emerge under the control of higher brain centres. Observations made during typical human development have shown that low threshold stretch reflexes, including excitatory reflexes between agonist and antagonist muscle pairs are a feature of the newborn. However, perinatal lesions of the corticospinal tract can lead to abnormal development of spinal reflexes that includes retention and reinforcement of developmental features that do not emerge in adult stroke victims, even though they also suffer from spasticity. This review describes investigations in animal models into how corticospinal input may drive segmental maturation. It compares their findings with observations made in humans and discusses how therapeutic interventions in cerebral palsy might aim to correct imbalances between descending and segmental inputs, bearing in mind that descending activity may play the crucial role in development.