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Zoghi et al. Neuroimmunol Neuroinflammation 2019;6:14 I http://dx.doi.org/10.20517/2347-8659.2019.03 Page 11 of 14

14/Incomplete RQ: NR RQ: RP RQ: NR RQ: NR
RTS: NR RTS: RP RTS: NR RTS: NR
LQ: NR LQ: NR LQ: NR LQ: NR
LTS: NR LTS: RP LTS: NR LTS: NR
15/Incomplete RQ: MLR RQ: NR RQ: NR RQ: NR
RTS: MLR RTS: NR RTS: NR RTS: NR
LQ: MLR LQ: RP LQ: RP LQ: MLR
LTS: NR LTS: NR LTS: NR LTS: NR
16/Complete RQ: NR RQ: NR RQ: NR NA
RTS: NR RTS: RP RTS: RP
LQ: NR LQ: NR LQ: NR
LTS: NR LTS: NR LTS: NR
17/Complete RQ: RP RQ: RP NA NA
RTS: RP RTS: NR
LQ: MLR LQ: MLR
LTS: MLR LTS: NR
18/Complete RQ: MLR RQ: NR NA RQ: NR
RTS: NR RTS: RP RTS: NR
LQ: MLR LQ: RP LQ: NR
LTS: NR LTS: NR LTS: NR

MLR: multi-level response; NR: no response; RP: response present; NA: not assessed; SCI: spinal cord injury; RQ: right quadriceps; RTS:
right triceps surae; LQ: left quadriceps; LTS: left triceps surae

[Figure 3A]. These results show that the ISNCSCI strength assessment only provides information about
one element for evaluating treatment efficacy properly in this population. The ISNCSCI “improvement”
noted in the current study may be non-specific for indicating clinically useful improvement. Thus,
neurophysiological assessments similar to BMCA can increase the resolution of assessment, enabling
clinicians to more reliably understand changes in motor control in their patients.

Significant functional recovery after incomplete SCI depends on the plasticity that is occurring through
propriospinal network, intraspinal circuits and supraspinal influences through descending systems. Many
factors can influence the effectiveness of different rehabilitation strategies in this group of patients, e.g.,
the level of injury, onset of training and the intensity of the training (how much, how often and how
long). To be able to understand which strategy would maximise the activity-dependent plasticity in these
patients with significant functional recovery, it would be desirable to undertake routine neurophysiological
assessment to collect valuable information from this population during their rehabilitation period. The
results reported here illustrate the variability of responses between patients and highlight the importance
of collection of larger datasets for interpretation of changes over time and in response to different
rehabilitation strategies.

In this study, all 10 participants who were categorised as having complete SCI showed some sub-clinical
[25]
supraspinal influences over the muscles below the level of injury. This is in line with previous studies . It
has been shown that a TVR response in people with clinically complete SCI can be considered as a sub-
clinical supraspinal response so they should be classified as having discomplete SCI [2,26,27] . In the present
study, Participants 8, 10, 12, 13, 16, 17 and 18 showed TVR in 1-4 targeted muscles, which indicates that
[28]
they should be categorised as discomplete. Gillies et al. showed that the TVR could be observed in a cat
with SCI only if the lateral vestibulospinal and pontine reticulospinal tracts were intact. It has been argued
that, during vibration, the sensory information is transmitted to the brainstem, the reticular formation
[27]
and associated tracts, as well as other parts of the brain that all are involved in controlling this response .
In the present study, Participants 8, 10, 12, 13, 16, 17 and 18 showed TVR in 1-4 targeted muscles.
These subclinical responses should not be ignored as they might open a new window for exploring new
rehabilitation techniques to improve the supraspinal influences over the muscles under the level of injury
that these patients could benefit [3,29] .