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BioMed Research International
Volume 2013, Article ID 516427, 8 pages
Research Article

Corticospinal Reorganization after Locomotor Training in a Person with Motor Incomplete Paraplegia

1Electrophysiological Analysis of Gait and Posture Laboratory, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60611, USA
2Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
3Department of Physical Therapy and the Graduate Center, The City University of New York, Staten Island, NY 10314, USA

Received 28 August 2012; Accepted 15 November 2012

Academic Editor: Francisco Miró

Copyright © 2013 Nupur Hajela et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Activity-dependent plasticity as a result of reorganization of neural circuits is a fundamental characteristic of the central nervous system that occurs simultaneously in multiple sites. In this study, we established the effects of subthreshold transcranial magnetic stimulation (TMS) over the primary motor cortex region on the tibialis anterior (TA) long-latency flexion reflex. Neurophysiological tests were conducted before and after robotic gait training in one person with a motor incomplete spinal cord injury (SCI) while at rest and during robotic-assisted stepping. The TA flexion reflex was evoked following nonnociceptive sural nerve stimulation and was conditioned by TMS at 0.9 TA motor evoked potential resting threshold at conditioning-test intervals that ranged from 70 to 130 ms. Subthreshold TMS induced a significant facilitation on the TA flexion reflex before training, which was reversed to depression after training with the subject seated at rest. During stepping, corticospinal facilitation of the flexion reflex at early and midstance phases before training was replaced with depression at early and midswing followed by facilitation at late swing after training. These results constitute the first neurophysiologic evidence that locomotor training reorganizes the cortical control of spinal interneuronal circuits that generate patterned motor activity, modifying spinal reflex function, in the chronic lesioned human spinal cord.