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Calderone A, Cardile D, De Luca R, Quartarone A, Corallo F, Calabrò RS. Brain Plasticity in Patients with Spinal Cord Injuries: A Systematic Review. Int J Mol Sci 2024; 25:2224. [PMID: 38396902 PMCID: PMC10888628 DOI: 10.3390/ijms25042224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
A spinal cord injury (SCI) causes changes in brain structure and brain function due to the direct effects of nerve damage, secondary mechanisms, and long-term effects of the injury, such as paralysis and neuropathic pain (NP). Recovery takes place over weeks to months, which is a time frame well beyond the duration of spinal shock and is the phase in which the spinal cord remains unstimulated below the level of injury and is associated with adaptations occurring throughout the nervous system, often referred to as neuronal plasticity. Such changes occur at different anatomical sites and also at different physiological and molecular biological levels. This review aims to investigate brain plasticity in patients with SCIs and its influence on the rehabilitation process. Studies were identified from an online search of the PubMed, Web of Science, and Scopus databases. Studies published between 2013 and 2023 were selected. This review has been registered on OSF under (n) 9QP45. We found that neuroplasticity can affect the sensory-motor network, and different protocols or rehabilitation interventions can activate this process in different ways. Exercise rehabilitation training in humans with SCIs can elicit white matter plasticity in the form of increased myelin water content. This review has demonstrated that SCI patients may experience plastic changes either spontaneously or as a result of specific neurorehabilitation training, which may lead to positive outcomes in functional recovery. Clinical and experimental evidence convincingly displays that plasticity occurs in the adult CNS through a variety of events following traumatic or non-traumatic SCI. Furthermore, efficacy-based, pharmacological, and genetic approaches, alone or in combination, are increasingly effective in promoting plasticity.
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Affiliation(s)
- Andrea Calderone
- Graduate School of Health Psychology, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
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Lin DJ, Backus D, Chakraborty S, Liew SL, Valero-Cuevas FJ, Patten C, Cotton RJ. Transforming modeling in neurorehabilitation: clinical insights for personalized rehabilitation. J Neuroeng Rehabil 2024; 21:18. [PMID: 38311729 PMCID: PMC10840185 DOI: 10.1186/s12984-024-01309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/24/2024] [Indexed: 02/06/2024] Open
Abstract
Practicing clinicians in neurorehabilitation continue to lack a systematic evidence base to personalize rehabilitation therapies to individual patients and thereby maximize outcomes. Computational modeling- collecting, analyzing, and modeling neurorehabilitation data- holds great promise. A key question is how can computational modeling contribute to the evidence base for personalized rehabilitation? As representatives of the clinicians and clinician-scientists who attended the 2023 NSF DARE conference at USC, here we offer our perspectives and discussion on this topic. Our overarching thesis is that clinical insight should inform all steps of modeling, from construction to output, in neurorehabilitation and that this process requires close collaboration between researchers and the clinical community. We start with two clinical case examples focused on motor rehabilitation after stroke which provide context to the heterogeneity of neurologic injury, the complexity of post-acute neurologic care, the neuroscience of recovery, and the current state of outcome assessment in rehabilitation clinical care. Do we provide different therapies to these two different patients to maximize outcomes? Asking this question leads to a corollary: how do we build the evidence base to support the use of different therapies for individual patients? We discuss seven points critical to clinical translation of computational modeling research in neurorehabilitation- (i) clinical endpoints, (ii) hypothesis- versus data-driven models, (iii) biological processes, (iv) contextualizing outcome measures, (v) clinical collaboration for device translation, (vi) modeling in the real world and (vii) clinical touchpoints across all stages of research. We conclude with our views on key avenues for future investment (clinical-research collaboration, new educational pathways, interdisciplinary engagement) to enable maximal translational value of computational modeling research in neurorehabilitation.
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Affiliation(s)
- David J Lin
- Department of Neurology, Division of Neurocritical Care and Stroke Service, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Veterans Affairs, Rehabilitation Research and Development Service, Center for Neurorestoration and Neurotechnology, Providence, RI, USA.
| | - Deborah Backus
- Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Stuti Chakraborty
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Sook-Lei Liew
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Francisco J Valero-Cuevas
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Carolynn Patten
- Department of Physical Medicine and Rehabilitation, UC Davis School of Medicine, Sacramento, CA, USA
- Department of Veterans Affairs, Northern California Health Care System, Martinez, CA, USA
| | - R James Cotton
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
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Urbin MA, Lafe CW, Bautista ME, Wittenberg GF, Simpson TW. Effects of noninvasive neuromodulation targeting the spinal cord on early learning of force control by the digits. CNS Neurosci Ther 2024; 30:e14561. [PMID: 38421127 PMCID: PMC10851178 DOI: 10.1111/cns.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS Control of finger forces underlies our capacity for skilled hand movements acquired during development and reacquired after neurological injury. Learning force control by the digits, therefore, predicates our functional independence. Noninvasive neuromodulation targeting synapses that link corticospinal neurons onto the final common pathway via spike-timing-dependent mechanisms can alter distal limb motor output on a transient basis, yet these effects appear subject to individual differences. Here, we investigated how this form of noninvasive neuromodulation interacts with task repetition to influence early learning of force control during precision grip. METHODS The unique effects of neuromodulation, task repetition, and neuromodulation coinciding with task repetition were tested in three separate conditions using a within-subject, cross-over design (n = 23). RESULTS We found that synchronizing depolarization events within milliseconds of stabilizing precision grip accelerated learning but only after accounting for individual differences through inclusion of subjects who showed upregulated corticospinal excitability at 2 of 3 time points following conditioning stimulation (n = 19). CONCLUSIONS Our findings provide insights into how the state of the corticospinal system can be leveraged to drive early motor skill learning, further emphasizing individual differences in the response to noninvasive neuromodulation. We interpret these findings in the context of biological mechanisms underlying the observed effects and implications for emerging therapeutic applications.
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Affiliation(s)
- Michael A. Urbin
- Human Engineering Research Laboratories, VA RR&D Center of ExcellenceVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Charley W. Lafe
- Human Engineering Research Laboratories, VA RR&D Center of ExcellenceVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Manuel E. Bautista
- Human Engineering Research Laboratories, VA RR&D Center of ExcellenceVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - George F. Wittenberg
- Human Engineering Research Laboratories, VA RR&D Center of ExcellenceVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Rehabilitation Neural Engineering Laboratories, Department of Physical Medicine & RehabilitationUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Tyler W. Simpson
- Rehabilitation Neural Engineering Laboratories, Department of Physical Medicine & RehabilitationUniversity of PittsburghPittsburghPennsylvaniaUSA
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van Helden JFL, Alexander E, Cabral HV, Strutton PH, Martinez-Valdes E, Falla D, Chowdhury JR, Chiou SY. Home-based arm cycling exercise improves trunk control in persons with incomplete spinal cord injury: an observational study. Sci Rep 2023; 13:22120. [PMID: 38092831 PMCID: PMC10719287 DOI: 10.1038/s41598-023-49053-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
Arm cycling is used for cardiorespiratory rehabilitation but its therapeutic effects on the neural control of the trunk after spinal cord injury (SCI) remain unclear. We investigated the effects of single session of arm cycling on corticospinal excitability, and the feasibility of home-based arm cycling exercise training on volitional control of the erector spinae (ES) in individuals with incomplete SCI. Using transcranial magnetic stimulation, we assessed motor evoked potentials (MEPs) in the ES before and after 30 min of arm cycling in 15 individuals with SCI and 15 able-bodied controls (Experiment 1). Both groups showed increased ES MEP size after the arm cycling. The participants with SCI subsequently underwent a 6-week home-based arm cycling exercise training (Experiment 2). MEP amplitudes and activity of the ES, and movements of the trunk during reaching, self-initiated rapid shoulder flexion, and predicted external perturbation tasks were measured. After the training, individuals with SCI reached further and improved trajectory of the trunk during the rapid shoulder flexion task, accompanied by increased ES activity and MEP amplitudes. Exercise adherence was excellent. We demonstrate preserved corticospinal drive after a single arm cycling session and the effects of home-based arm cycling exercise training on trunk function in individuals with SCI.
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Affiliation(s)
- Joeri F L van Helden
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Emma Alexander
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Hélio V Cabral
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Paul H Strutton
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Joy Roy Chowdhury
- Midland Centre for Spinal Injuries, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHSFT, Oswestry, UK
| | - Shin-Yi Chiou
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Campos B, Choi H, DeMarco AT, Seydell-Greenwald A, Hussain SJ, Joy MT, Turkeltaub PE, Zeiger W. Rethinking Remapping: Circuit Mechanisms of Recovery after Stroke. J Neurosci 2023; 43:7489-7500. [PMID: 37940595 PMCID: PMC10634578 DOI: 10.1523/jneurosci.1425-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023] Open
Abstract
Stroke is one of the most common causes of disability, and there are few treatments that can improve recovery after stroke. Therapeutic development has been hindered because of a lack of understanding of precisely how neural circuits are affected by stroke, and how these circuits change to mediate recovery. Indeed, some of the hypotheses for how the CNS changes to mediate recovery, including remapping, redundancy, and diaschisis, date to more than a century ago. Recent technological advances have enabled the interrogation of neural circuits with ever greater temporal and spatial resolution. These techniques are increasingly being applied across animal models of stroke and to human stroke survivors, and are shedding light on the molecular, structural, and functional changes that neural circuits undergo after stroke. Here we review these studies and highlight important mechanisms that underlie impairment and recovery after stroke. We begin by summarizing knowledge about changes in neural activity that occur in the peri-infarct cortex, specifically considering evidence for the functional remapping hypothesis of recovery. Next, we describe the importance of neural population dynamics, disruptions in these dynamics after stroke, and how allocation of neurons into spared circuits can restore functionality. On a more global scale, we then discuss how effects on long-range pathways, including interhemispheric interactions and corticospinal tract transmission, contribute to post-stroke impairments. Finally, we look forward and consider how a deeper understanding of neural circuit mechanisms of recovery may lead to novel treatments to reduce disability and improve recovery after stroke.
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Affiliation(s)
- Baruc Campos
- Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095
| | - Hoseok Choi
- Department of Neurology, Weill Institute for Neuroscience, University of California-San Francisco, San Francisco, California 94158
| | - Andrew T DeMarco
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
| | - Anna Seydell-Greenwald
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- MedStar National Rehabilitation Hospital, Washington, DC 20010
| | - Sara J Hussain
- Movement and Cognitive Rehabilitation Science Program, Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas 78712
| | - Mary T Joy
- The Jackson Laboratory, Bar Harbor, Maine 04609
| | - Peter E Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- MedStar National Rehabilitation Hospital, Washington, DC 20010
| | - William Zeiger
- Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095
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Wolpaw JR, Thompson AK. Enhancing neurorehabilitation by targeting beneficial plasticity. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1198679. [PMID: 37456795 PMCID: PMC10338914 DOI: 10.3389/fresc.2023.1198679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
Neurorehabilitation is now one of the most exciting areas in neuroscience. Recognition that the central nervous system (CNS) remains plastic through life, new understanding of skilled behaviors (skills), and novel methods for engaging and guiding beneficial plasticity combine to provide unprecedented opportunities for restoring skills impaired by CNS injury or disease. The substrate of a skill is a distributed network of neurons and synapses that changes continually through life to ensure that skill performance remains satisfactory as new skills are acquired, and as growth, aging, and other life events occur. This substrate can extend from cortex to spinal cord. It has recently been given the name "heksor." In this new context, the primary goal of rehabilitation is to enable damaged heksors to repair themselves so that their skills are once again performed well. Skill-specific practice, the mainstay of standard therapy, often fails to optimally engage the many sites and kinds of plasticity available in the damaged CNS. New noninvasive technology-based interventions can target beneficial plasticity to critical sites in damaged heksors; these interventions may thereby enable much wider beneficial plasticity that enhances skill recovery. Targeted-plasticity interventions include operant conditioning of a spinal reflex or corticospinal motor evoked potential (MEP), paired-pulse facilitation of corticospinal connections, and brain-computer interface (BCI)-based training of electroencephalographic (EEG) sensorimotor rhythms. Initial studies in people with spinal cord injury, stroke, or multiple sclerosis show that these interventions can enhance skill recovery beyond that achieved by skill-specific practice alone. After treatment ends, the repaired heksors maintain the benefits.
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Affiliation(s)
- Jonathan R Wolpaw
- National Center for Adaptive Neurotechnologies, Albany Stratton VA Medical Center, Albany, NY, United States
- Department of Biomedical Sciences, School of Public Health, State University of New York, Albany, NY, United States
| | - Aiko K Thompson
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
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Grover FM, Chen B, Perez MA. Increased paired stimuli enhance corticospinal-motoneuronal plasticity in humans with spinal cord injury. J Neurophysiol 2023; 129:1414-1422. [PMID: 36752493 PMCID: PMC10259851 DOI: 10.1152/jn.00499.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
Paired corticospinal-motoneuronal stimulation (PCMS) has been used to enhance corticospinal excitability and functional outcomes in humans with spinal cord injury (SCI). Here, we examined the effect of increasing the number of paired pulses on PCMS-induced plasticity. During PCMS, corticospinal volleys evoked by transcranial magnetic stimulation (TMS) over the hand motor cortex were timed to arrive at corticospinal-motoneuronal synapses of the first dorsal interosseous (FDI) muscle 1-2 ms before the arrival of antidromic potentials elicited in motoneurons by electrical stimulation of the ulnar nerve. We tested motor-evoked potentials (MEPs) elicited by TMS over the hand motor cortex and electrical stimulation at the cervicomedullary junction (CMEPs) in the FDI muscle before and after 180 paired pulses (PCMS-180) followed up by another 180 paired pulses (PCMS-360) in humans with and without chronic incomplete cervical SCI. The nine-hole-peg-test (9HPT) was measured before and after PCMS paired pulses in individuals with SCI. We found that the size of MEPs and CMEPs increased after PCMS-180 in both groups compared with baseline and further increased after PCMS-360 in participants with SCI, suggesting a spinal origin for these effects. Notably, in people with SCI, the time to complete the 9HPT decreased after PCMS-180 and further decreased after PCMS-360 compared with baseline but not when the 9HPT was repeated overtime. Our findings demonstrate that increasing the number of PCMS paired pulses potentiates corticospinal excitability and voluntary motor output after SCI, likely through spinal plasticity. This proof-of-principle study suggests that increasing the PCMS dose represents a strategy to boost voluntary motor output after SCI.NEW & NOTEWORTHY Paired corticospinal-motoneuronal stimulation (PCMS) has been used to enhance corticospinal excitability and functional outcomes in humans with spinal cord injury (SCI). Here, we demonstrate that 360 paired pulses resulted in larger increases in motor-evoked potential size in a hand muscle and in a better ability to complete the nine-hold-peg-test compared with 180 paired pulses in people with SCI. This proof-of-principle study suggests that increasing the PCMS dose represents a strategy to boost motor output after SCI.
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Affiliation(s)
- Francis M Grover
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States
| | - Bing Chen
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Edward Hines Jr. VA Hospital, Chicago, Illinois, United States
| | - Monica A Perez
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
- Edward Hines Jr. VA Hospital, Chicago, Illinois, United States
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