Neuromodulation for Standing Balance

Neuroplasticity refers to the capacity of the nervous system to modify its structural and functional organization, adjusting itself to a changing environment (De Ridder et al. 2016). Neuromodulation is linked to neuroplasticity and can be defined as the induction of neuroplastic changes via local application of electrical, magnetic, acoustic, optic, tactile, or pharmacological stimuli (De Ridder et al. 2016). The International Neuromodulation Society defines neuromodulation as “a technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area” (https://www.neuromodulation.com/about-neuromodulation). More specifically, the SCIRE YouTube channel (https://www.youtube.com/watch?v=ks-RkYNjPZQ) refers to neuromodulation as the modification of nerve function through a number of ways, including chemically (intrathecal baclofen), via electrical stimuli (FES and epidural stimulation), and magnetic fields (transcranial magnetic stimulation). Neuromodulation can be applied to three main areas of the body: the brain, the spinal cord and the peripheral nerves, through invasive and/or non-invasive approaches.

Researchers, clinicians, and people with SCI are excited about the promising therapeutic potential in neuromodulation for movement, sensation, bowel, bladder, and sexual function. In recent years, the combination of rehabilitative training with neuromodulation of the brain or the spinal cord has been investigated as a means to enhance the excitability of motor circuits and to increase training efficacy, promoting motor recovery (Hofer & Schwab 2019). Over the last few years, the translation of stimulation-enhanced activity-based rehabilitation from the pre-clinical to a clinical setting has been carried out successfully, yielding substantial improvements in motor functionality (Hofer & Schwab 2019).