A Latent Propriospinal Network Can Restore Diaphragm Function After High Cervical Spinal Cord Injury

Spinal cord injury (SCI) above cervical level 4 disrupts descending axons from the medulla that innervate phrenic motor neurons, causing permanent paralysis of the diaphragm. Using an ex vivo preparation in neonatal mice, we have identified an excitatory spinal network that can direct phrenic motor bursting in the absence of medullary input. After complete cervical SCI, blockade of fast inhibitory synaptic transmission caused spontaneous, bilaterally coordinated phrenic bursting. Here, spinal cord glutamatergic neurons were both sufficient and necessary for the induction of phrenic bursts. Direct stimulation of phrenic motor neurons was insufficient to evoke burst activity. Transection and pharmacological manipulations showed that this spinal network acts independently of medullary circuits that normally generate inspiration, suggesting a distinct non-respiratory function. We further show that this “latent” network can be harnessed to restore diaphragm function after high cervical SCI in adult mice and rats

The Therapeutic Alliance and Early Recollections

There is mounting evidence in the research literature that supports a cluster of common factors that if implemented by the therapist will increase his or her effectiveness with clients. These common factors include the therapeutic alliance, client resources, client expectations, and a theoretical approach. The purpose of this article is to describe a method based on principles of Individual Psychology that may be used to complement the development of the therapeutic alliance in the therapy process. The Therapeutic Alliance Building Early Recollections intervention was developed by the first author and refined with the support of the other authors of this article for the purpose of assisting clinicians to address systematically the therapeutic alliance with clients in sessions. The authors review literature with a focus on the therapeutic alliance, the connection with Individual Psychology, and a description of specific case scenarios of some of the ways that clients have expressed help to therapists who are presently using the technique in therapy. We conclude with several early recollections from clients in therapy sessions where the technique has been used. Clinical suggestions and interpretations are used to describe ways in which clinicians or therapists might use and understand the dynamics of the processPsichologijos katedraVytauto Didžiojo universiteta