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Huang S, Xiao R, Lin S, Jang G, Hong E, Gupta S, Lu F, Chen B, Liu X, Sahasrabudhe A, Zhang Z, He Z, Crosby AJ, Sumaria K, Liu T, Wang Q, Rao S. Anisotropic Hydrogel Microelectrodes for Intraspinal Neural Recordings in vivo. RESEARCH SQUARE 2024:rs.3.rs-4693073. [PMID: 39184098 PMCID: PMC11343277 DOI: 10.21203/rs.3.rs-4693073/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Creating durable, motion-compliant neural interfaces is crucial for accessing dynamic tissues under in vivo conditions and linking neural activity with behaviors. Utilizing the self-alignment of nano-fillers in a polymeric matrix under repetitive tension, here, we introduce conductive carbon nanotubes with high aspect ratios into semi-crystalline polyvinyl alcohol hydrogels and create electrically anisotropic percolation pathways through cyclic stretching. The resulting anisotropic hydrogel fibers (diameter of 187 ± 13 µm) exhibit fatigue resistance (20,000 cycles at 20% strain) with a stretchability of 64.5 ± 7.9%, and low electrochemical impedance (900 ± 149 kΩ @ 1kHz). We observe the re-constructed nanofillers' axial alignment and a corresponding anisotropic impedance decrease along the direction of cyclic stretching. We fabricate fiber-shaped hydrogels into bioelectronic devices and implant them into wild-type and transgenic Thy1-ChR2-EYFP mice to record electromyographic signals from muscles in anesthetized and freely moving conditions. These hydrogel fibers effectively enable the simultaneous recording of electrical signals from ventral spinal cord neurons and the tibialis anterior muscles during optogenetic stimulation. Importantly, the devices maintain functionality with repeatable recording results over eight months after implantation, demonstrating their durability and potential for long-term monitoring in neurophysiological studies.
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Affiliation(s)
- Sizhe Huang
- Department of Biomedical Engineering, State University of New York at Binghamton, Binghamton, NY 13902, United States
| | - Ruobai Xiao
- Department of Biomedical Engineering, State University of New York at Binghamton, Binghamton, NY 13902, United States
| | - Shaoting Lin
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824, United States
| | - Geunho Jang
- Department of Biomedical Engineering, State University of New York at Binghamton, Binghamton, NY 13902, United States
| | - Eunji Hong
- Department of Biomedical Engineering, State University of New York at Binghamton, Binghamton, NY 13902, United States
| | - Shovit Gupta
- Department of Biomedical Engineering, State University of New York at Binghamton, Binghamton, NY 13902, United States
| | - Fake Lu
- Department of Biomedical Engineering, State University of New York at Binghamton, Binghamton, NY 13902, United States
| | - Bo Chen
- Department of Neurobiology, The University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Xinyue Liu
- Department of Chemical Engineering and Materials Science, Michigan State University, East Lansing, MI 48824, United States
| | - Atharva Sahasrabudhe
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Zicong Zhang
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, United States
| | - Zhigang He
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, United States
| | - Alfred J. Crosby
- Department of Polymer Science and Engineering, University of Massachusetts, Amherst, MA 01003, United States
| | - Kaushal Sumaria
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA 01003, United States
| | - Tingyi Liu
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA 01003, United States
| | - Qianbin Wang
- Department of Biomedical Engineering, State University of New York at Binghamton, Binghamton, NY 13902, United States
| | - Siyuan Rao
- Department of Biomedical Engineering, State University of New York at Binghamton, Binghamton, NY 13902, United States
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Shukla PD, Burke JF, Kunwar N, Presbrey K, Balakid J, Yaroshinsky M, Louie K, Jacques L, Shirvalkar P, Wang DD. Human Cervical Epidural Spinal Electrogram Topographically Maps Distinct Volitional Movements. J Neurosci 2024; 44:e2258232024. [PMID: 38960719 PMCID: PMC11308355 DOI: 10.1523/jneurosci.2258-23.2024] [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: 11/27/2023] [Revised: 04/22/2024] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
Little is known about the electrophysiologic activity of the intact human spinal cord during volitional movement. We analyzed epidural spinal recordings from a total of five human subjects of both sexes during a variety of upper extremity movements and found that these spinal epidural electrograms contain spectral information distinguishing periods of movement, rest, and sensation. Cervical epidural electrograms also contained spectral changes time-locked with movement. We found that these changes were primarily associated with increased power in the theta (4-8 Hz) band and feature increased theta phase to gamma amplitude coupling, and this increase in theta power can be used to topographically map distinct upper extremity movements onto the cervical spinal cord in accordance with established myotome maps of the upper extremity. Our findings have implications for the development of neurostimulation protocols and devices focused on motor rehabilitation for the upper extremity, and the approach presented here may facilitate spatiotemporal mapping of naturalistic movements.
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Affiliation(s)
- Poojan D Shukla
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California 94143
| | - John F Burke
- Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma 73104
| | - Nikhita Kunwar
- School of Medicine, University of California San Diego, San Diego, California 92093
| | - Kara Presbrey
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California 94143
| | - Jannine Balakid
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California 94143
| | - Maria Yaroshinsky
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California 94143
| | - Kenneth Louie
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California 94143
| | - Line Jacques
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California 94143
| | - Prasad Shirvalkar
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California 94143
- Department of Anesthesia and Pain Management, University of California, San Francisco, California 94143
- Department of Neurology, University of California, San Francisco, San Francisco, California 94143
| | - Doris D Wang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California 94143
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Keesey R, Hofstoetter U, Hu Z, Lombardi L, Hawthorn R, Bryson N, Rowald A, Minassian K, Seáñez I. FUNDAMENTAL LIMITATIONS OF KILOHERTZ-FREQUENCY CARRIERS IN AFFERENT FIBER RECRUITMENT WITH TRANSCUTANEOUS SPINAL CORD STIMULATION. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.26.603982. [PMID: 39211255 PMCID: PMC11361147 DOI: 10.1101/2024.07.26.603982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The use of kilohertz-frequency (KHF) waveforms has rapidly gained momentum in transcutaneous spinal cord stimulation (tSCS) to restore motor function after paralysis. However, the mechanisms by which these fast-alternating currents depolarize efferent and afferent fibers remain unknown. Our study fills this research gap by providing a hypothesis-and evidence-based investigation using peripheral nerve stimulation, lumbar tSCS, and cervical tSCS in 25 unimpaired participants together with computational modeling. Peripheral nerve stimulation experiments and computational modeling showed that KHF waveforms negatively impact the processes required to elicit action potentials, thereby increasing response thresholds and biasing the recruitment towards efferent fibers. While these results translate to tSCS, we also demonstrate that lumbar tSCS results in the preferential recruitment of afferent fibers, while cervical tSCS favors recruitment of efferent fibers. Given the assumed importance of proprioceptive afferents in motor recovery, our work suggests that the use of KHF waveforms should be reconsidered to maximize neurorehabilitation outcomes, particularly for cervical tSCS. We posit that careful analysis of the mechanisms that mediate responses elicited by novel approaches in tSCS is crucial to understanding their potential to restore motor function after paralysis.
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Lam DV, Chin J, Brucker-Hahn MK, Settell M, Romanauski B, Verma N, Upadhye A, Deshmukh A, Skubal A, Nishiyama Y, Hao J, Lujan JL, Zhang S, Knudsen B, Blanz S, Lempka SF, Ludwig KA, Shoffstall AJ, Park HJ, Ellison ER, Zhang M, Lavrov I. The role of spinal cord neuroanatomy and the variances of epidurally evoked spinal responses. Bioelectron Med 2024; 10:17. [PMID: 39020366 PMCID: PMC11253499 DOI: 10.1186/s42234-024-00149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/28/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Spinal cord stimulation (SCS) has demonstrated multiple benefits in treating chronic pain and other clinical disorders related to sensorimotor dysfunctions. However, the underlying mechanisms are still not fully understood, including how electrode placement in relation to the spinal cord neuroanatomy influences epidural spinal recordings (ESRs). To characterize this relationship, this study utilized stimulation applied at various anatomical sections of the spinal column, including at levels of the intervertebral disc and regions correlating to the dorsal root entry zone. METHOD Two electrode arrays were surgically implanted into the dorsal epidural space of the swine. The stimulation leads were positioned such that the caudal-most electrode contact was at the level of a thoracic intervertebral segment. Intraoperative cone beam computed tomography (CBCT) images were utilized to precisely determine the location of the epidural leads relative to the spinal column. High-resolution microCT imaging and 3D-model reconstructions of the explanted spinal cord illustrated precise positioning and dimensions of the epidural leads in relation to the surrounding neuroanatomy, including the spinal rootlets of the dorsal and ventral columns of the spinal cord. In a separate swine cohort, implanted epidural leads were used for SCS and recording evoked ESRs. RESULTS Reconstructed 3D-models of the swine spinal cord with epidural lead implants demonstrated considerable distinctions in the dimensions of a single electrode contact on a standard industry epidural stimulation lead compared to dorsal rootlets at the dorsal root entry zone (DREZ). At the intervertebral segment, it was observed that a single electrode contact may cover 20-25% of the DREZ if positioned laterally. Electrode contacts were estimated to be ~0.75 mm from the margins of the DREZ when placed at the midline. Furthermore, ventral rootlets were observed to travel in proximity and parallel to dorsal rootlets at this level prior to separation into their respective sides of the spinal cord. Cathodic stimulation at the level of the intervertebral disc, compared to an 'off-disc' stimulation (7 mm rostral), demonstrated considerable variations in the features of recorded ESRs, such as amplitude and shape, and evoked unintended motor activation at lower stimulation thresholds. This substantial change may be due to the influence of nearby ventral roots. To further illustrate the influence of rootlet activation vs. dorsal column activation, the stimulation lead was displaced laterally at ~2.88 mm from the midline, resulting in variances in both evoked compound action potential (ECAP) components and electromyography (EMG) components in ESRs at lower stimulation thresholds. CONCLUSION The results of this study suggest that the ECAP and EMG components of recorded ESRs can vary depending on small differences in the location of the stimulating electrodes within the spinal anatomy, such as at the level of the intervertebral segment. Furthermore, the effects of sub-centimeter lateral displacement of the stimulation lead from the midline, leading to significant changes in electrophysiological metrics. The results of this pilot study reveal the importance of the small displacement of the electrodes that can cause significant changes to evoked responses SCS. These results may provide further valuable insights into the underlying mechanisms and assist in optimizing future SCS-related applications.
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Affiliation(s)
- Danny V Lam
- Neural Lab, Abbott Neuromodulation, Plano, TX, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Veterans Affairs Medical Center, Advanced Platform Technology Center, Louis Stokes Cleveland, Cleveland, OH, USA
| | - Justin Chin
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Meagan K Brucker-Hahn
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Megan Settell
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA
- Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Ben Romanauski
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | - Aniruddha Upadhye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Ashlesha Deshmukh
- Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA
| | - Aaron Skubal
- Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA
| | | | - Jian Hao
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - J Luis Lujan
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Simeng Zhang
- Neural Lab, Abbott Neuromodulation, Plano, TX, USA
| | - Bruce Knudsen
- Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA
| | - Stephan Blanz
- Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Kip A Ludwig
- Department of Biomedical Engineering, University of Wisconsin Madison, Madison, USA
- Wisconsin Institute for Translational Neuroengineering (WITNe), Madison, WI, USA
- Department of Neurosurgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew J Shoffstall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Veterans Affairs Medical Center, Advanced Platform Technology Center, Louis Stokes Cleveland, Cleveland, OH, USA
| | | | | | | | - Igor Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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Chen W, Wang S, Bao J, Yu C, Jiang Q, Song J, Zheng Y, Hao Y, Xu K. Restoration of coherent reach-grasp-pull movement via sequential intraneural peripheral nerve stimulation in rats. J Neural Eng 2024; 21:046007. [PMID: 38885677 DOI: 10.1088/1741-2552/ad5935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/17/2024] [Indexed: 06/20/2024]
Abstract
Objective.Peripheral nerve stimulation (PNS) has been demonstrated as an effective way to selectively activate muscles and to produce fine hand movements. However, sequential multi-joint upper limb movements, which are critical for paralysis rehabilitation, has not been tested with PNS. Here, we aimed to restore multiple upper limb joint movements through an intraneural interface with a single electrode, achieving coherent reach-grasp-pull movement tasks through sequential stimulation.Approach.A transverse intrafascicular multichannel electrode was implanted under the axilla of the rat's upper limb, traversing the musculocutaneous, radial, median, and ulnar nerves. Intramuscular electrodes were implanted into the biceps brachii (BB), triceps brachii (TB), flexor carpi radialis (FCR), and extensor carpi radialis (ECR) muscles to record electromyographic (EMG) activity and video recordings were used to capture the kinematics of elbow, wrist, and digit joints. Charge-balanced biphasic pulses were applied to different channels to recruit distinct upper limb muscles, with concurrent recording of EMG signals and joint kinematics to assess the efficacy of the stimulation. Finally, a sequential stimulation protocol was employed by generating coordinated pulses in different channels.Main results.BB, TB, FCR and ECR muscles were selectively activated and various upper limb movements, including elbow flexion, elbow extension, wrist flexion, wrist extension, digit flexion, and digit extension, were reliably generated. The modulation effects of stimulation parameters, including pulse width, amplitude, and frequency, on induced joint movements were investigated and reach-grasp-pull movement was elicited by sequential stimulation.Significance.Our results demonstrated the feasibility of sequential intraneural stimulation for functional multi-joint movement restoration, providing a new approach for clinical rehabilitation in paralyzed patients.
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Affiliation(s)
- Weihuang Chen
- Qiushi Academy for Advanced Studies (QAAS), Zhejiang University, Hangzhou, People's Republic of China
- Nanhu Brain-computer interface institute, Hangzhou 311100, People's Republic of China
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou 311100, People's Republic of China
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Key Laboratory of Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou, People's Republic of China
| | - Suhao Wang
- Nanhu Brain-computer interface institute, Hangzhou 311100, People's Republic of China
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou 311100, People's Republic of China
- Department of Engineering Mechanics, Soft Matter Research Center, and Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Jieting Bao
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Key Laboratory of Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou, People's Republic of China
| | - Chaonan Yu
- Nanhu Brain-computer interface institute, Hangzhou 311100, People's Republic of China
| | - Qianqian Jiang
- Nanhu Brain-computer interface institute, Hangzhou 311100, People's Republic of China
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou 311100, People's Republic of China
- Department of Engineering Mechanics, Soft Matter Research Center, and Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Jizhou Song
- Nanhu Brain-computer interface institute, Hangzhou 311100, People's Republic of China
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou 311100, People's Republic of China
- Department of Engineering Mechanics, Soft Matter Research Center, and Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Yongte Zheng
- Cereblink (Hangzhou) Technology Co., Ltd, Hangzhou, People's Republic of China
| | - Yaoyao Hao
- Nanhu Brain-computer interface institute, Hangzhou 311100, People's Republic of China
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou 311100, People's Republic of China
| | - Kedi Xu
- Qiushi Academy for Advanced Studies (QAAS), Zhejiang University, Hangzhou, People's Republic of China
- Nanhu Brain-computer interface institute, Hangzhou 311100, People's Republic of China
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou 311100, People's Republic of China
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Key Laboratory of Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou, People's Republic of China
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Cuellar C, Lehto L, Islam R, Mangia S, Michaeli S, Lavrov I. Selective Activation of the Spinal Cord with Epidural Electrical Stimulation. Brain Sci 2024; 14:650. [PMID: 39061391 PMCID: PMC11274919 DOI: 10.3390/brainsci14070650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Spinal cord epidural electrical stimulation (EES) has been successfully employed to treat chronic pain and to restore lost functions after spinal cord injury. Yet, the efficacy of this approach is largely challenged by the suboptimal spatial distribution of the electrode contacts across anatomical targets, limiting the spatial selectivity of stimulation. In this study, we exploited different ESS paradigms, designed as either Spatial-Selective Stimulation (SSES) or Orientation-Selective Epidural Stimulation (OSES), and compared them to Conventional Monopolar Epidural Stimulation (CMES). SSES, OSES, and CMES were delivered with a 3- or 4-contact electrode array. Amplitudes and latencies of the Spinally Evoked Motor Potentials (SEMPs) were evaluated with different EES modalities. The results demonstrate that the amplitudes of SEMPs in hindlimb muscles depend on the orientation of the electrical field and vary between stimulation modalities. These findings show that the electric field applied with SSES or OSES provides more selective control of amplitudes of the SEMPs as compared to CMES. We demonstrate that spinal cord epidural stimulation applied with SSES or OSES paradigms in the rodent model could be tailored to the functional spinal cord neuroanatomy and can be tuned to specific target fibers and their orientation, optimizing the effect of neuromodulation.
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Affiliation(s)
- Carlos Cuellar
- School of Sport Sciences, Universidad Anáhuac México, Huixquilucan 52786, Mexico;
| | - Lauri Lehto
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA; (L.L.); (S.M.)
| | - Riaz Islam
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Silvia Mangia
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA; (L.L.); (S.M.)
| | - Shalom Michaeli
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA; (L.L.); (S.M.)
| | - Igor Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA;
- Laboratory of Neuromodulation, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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McIntosh JR, Joiner EF, Goldberg JL, Greenwald P, Dionne AC, Murray LM, Thuet E, Modik O, Shelkov E, Lombardi JM, Sardar ZM, Lehman RA, Chan AK, Riew KD, Harel NY, Virk MS, Mandigo C, Carmel JB. Timing-dependent synergies between motor cortex and posterior spinal stimulation in humans. J Physiol 2024; 602:2961-2983. [PMID: 38758005 PMCID: PMC11178459 DOI: 10.1113/jp286183] [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: 12/21/2023] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
Volitional movement requires descending input from the motor cortex and sensory feedback through the spinal cord. We previously developed a paired brain and spinal electrical stimulation approach in rats that relies on convergence of the descending motor and spinal sensory stimuli in the cervical cord. This approach strengthened sensorimotor circuits and improved volitional movement through associative plasticity. In humans, it is not known whether posterior epidural spinal cord stimulation targeted at the sensorimotor interface or anterior epidural spinal cord stimulation targeted within the motor system is effective at facilitating brain evoked responses. In 59 individuals undergoing elective cervical spine decompression surgery, the motor cortex was stimulated with scalp electrodes and the spinal cord was stimulated with epidural electrodes, with muscle responses being recorded in arm and leg muscles. Spinal electrodes were placed either posteriorly or anteriorly, and the interval between cortex and spinal cord stimulation was varied. Pairing stimulation between the motor cortex and spinal sensory (posterior) but not spinal motor (anterior) stimulation produced motor evoked potentials that were over five times larger than brain stimulation alone. This strong augmentation occurred only when descending motor and spinal afferent stimuli were timed to converge in the spinal cord. Paired stimulation also increased the selectivity of muscle responses relative to unpaired brain or spinal cord stimulation. Finally, clinical signs suggest that facilitation was observed in both injured and uninjured segments of the spinal cord. The large effect size of this paired stimulation makes it a promising candidate for therapeutic neuromodulation. KEY POINTS: Pairs of stimuli designed to alter nervous system function typically target the motor system, or one targets the sensory system and the other targets the motor system for convergence in cortex. In humans undergoing clinically indicated surgery, we tested paired brain and spinal cord stimulation that we developed in rats aiming to target sensorimotor convergence in the cervical cord. Arm and hand muscle responses to paired sensorimotor stimulation were more than five times larger than brain or spinal cord stimulation alone when applied to the posterior but not anterior spinal cord. Arm and hand muscle responses to paired stimulation were more selective for targeted muscles than the brain- or spinal-only conditions, especially at latencies that produced the strongest effects of paired stimulation. Measures of clinical evidence of compression were only weakly related to the paired stimulation effect, suggesting that it could be applied as therapy in people affected by disorders of the central nervous system.
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Affiliation(s)
- James R McIntosh
- Department of Neurology, Columbia University, New York, NY, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Evan F Joiner
- Department of Neurological Surgery, Columbia University, New York, NY, USA
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Phoebe Greenwald
- Department of Neurological Surgery, Columbia University, New York, NY, USA
| | - Alexandra C Dionne
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - Lynda M Murray
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Med. Ctr., Bronx, NY, USA
| | - Earl Thuet
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Oleg Modik
- Department of Neurology, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Evgeny Shelkov
- Department of Neurology, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Joseph M Lombardi
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - K Daniel Riew
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Noam Y Harel
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Med. Ctr., Bronx, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
| | - Christopher Mandigo
- Department of Neurological Surgery, Columbia University, New York, NY, USA
- New York Presbyterian, The Och Spine Hospital, New York, NY, USA
| | - Jason B Carmel
- Department of Neurology, Columbia University, New York, NY, USA
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medicine - New York Presbyterian, Och Spine, New York, NY, USA
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Liu M, Zhang W, Han S, Zhang D, Zhou X, Guo X, Chen H, Wang H, Jin L, Feng S, Wei Z. Multifunctional Conductive and Electrogenic Hydrogel Repaired Spinal Cord Injury via Immunoregulation and Enhancement of Neuronal Differentiation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2313672. [PMID: 38308338 DOI: 10.1002/adma.202313672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/16/2024] [Indexed: 02/04/2024]
Abstract
Spinal cord injury (SCI) is a refractory neurological disorder. Due to the complex pathological processes, especially the secondary inflammatory cascade and the lack of intrinsic regenerative capacity, it is difficult to recover neurological function after SCI. Meanwhile, simulating the conductive microenvironment of the spinal cord reconstructs electrical neural signal transmission interrupted by SCI and facilitates neural repair. Therefore, a double-crosslinked conductive hydrogel (BP@Hydrogel) containing black phosphorus nanoplates (BP) is synthesized. When placed in a rotating magnetic field (RMF), the BP@Hydrogel can generate stable electrical signals and exhibit electrogenic characteristic. In vitro, the BP@Hydrogel shows satisfactory biocompatibility and can alleviate the activation of microglia. When placed in the RMF, it enhances the anti-inflammatory effects. Meanwhile, wireless electrical stimulation promotes the differentiation of neural stem cells (NSCs) into neurons, which is associated with the activation of the PI3K/AKT pathway. In vivo, the BP@Hydrogel is injectable and can elicit behavioral and electrophysiological recovery in complete transected SCI mice by alleviating the inflammation and facilitating endogenous NSCs to form functional neurons and synapses under the RMF. The present research develops a multifunctional conductive and electrogenic hydrogel for SCI repair by targeting multiple mechanisms including immunoregulation and enhancement of neuronal differentiation.
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Affiliation(s)
- Mingshan Liu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
| | - Wencan Zhang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
| | - Shuwei Han
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
| | - Dapeng Zhang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
| | - Xiaolong Zhou
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
| | - Xianzheng Guo
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
| | - Haosheng Chen
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
| | - Haifeng Wang
- Department of Orthopaedics, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Tianqiao District, Jinan, 250033, China
| | - Lin Jin
- International Joint Research Laboratory for Biomedical Nanomaterials of Henan, Zhoukou Normal University, No. 6, Middle Section of Wenchang Avenue, Chuanhui District, Zhoukou, 466001, China
| | - Shiqing Feng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
- Department of Orthopedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Zhijian Wei
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan, 250012, China
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Huang XL, Wu MY, Wu CC, Yan LC, He MH, Chen YC, Tsai ST. Neuromodulation techniques in poststroke motor impairment recovery: Efficacy, challenges, and future directions. Tzu Chi Med J 2024; 36:136-141. [PMID: 38645790 PMCID: PMC11025597 DOI: 10.4103/tcmj.tcmj_247_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 04/23/2024] Open
Abstract
Cerebrovascular accidents, also known as strokes, represent a major global public health challenge and contribute to substantial mortality, disability, and socioeconomic burden. Multidisciplinary approaches for poststroke therapies are crucial for recovering lost functions and adapting to new limitations. This review discusses the potential of neuromodulation techniques, repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, spinal cord stimulation (SCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), as innovative strategies for facilitating poststroke recovery. Neuromodulation is an emerging adjunct to conventional therapies that target neural plasticity to restore lost function and compensate for damaged brain areas. The techniques discussed in this review have different efficacies in enhancing neural plasticity, optimizing motor recovery, and mitigating poststroke impairments. Specifically, rTMS has shown significant promise in enhancing motor function, whereas SCS has shown potential in improving limb movement and reducing disability. Similarly, VNS, typically used to treat epilepsy, has shown promise in enhancing poststroke motor recovery, while DBS may be used to improve poststroke motor recovery and symptom mitigation. Further studies with standardized protocols are warranted to elucidate the efficacy of these methods and integrate them into mainstream clinical practice to optimize poststroke care.
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Affiliation(s)
- Xiang-Ling Huang
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Yung Wu
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ciou-Chan Wu
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Lian-Cing Yan
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Mei-Huei He
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Chen Chen
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medical Informatics, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Tzung Tsai
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Katic Secerovic N, Balaguer JM, Gorskii O, Pavlova N, Liang L, Ho J, Grigsby E, Gerszten PC, Karal-Ogly D, Bulgin D, Orlov S, Pirondini E, Musienko P, Raspopovic S, Capogrosso M. Neural population dynamics reveals disruption of spinal circuits' responses to proprioceptive input during electrical stimulation of sensory afferents. Cell Rep 2024; 43:113695. [PMID: 38245870 PMCID: PMC10962447 DOI: 10.1016/j.celrep.2024.113695] [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: 05/30/2023] [Revised: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
While neurostimulation technologies are rapidly approaching clinical applications for sensorimotor disorders, the impact of electrical stimulation on network dynamics is still unknown. Given the high degree of shared processing in neural structures, it is critical to understand if neurostimulation affects functions that are related to, but not targeted by, the intervention. Here, we approach this question by studying the effects of electrical stimulation of cutaneous afferents on unrelated processing of proprioceptive inputs. We recorded intraspinal neural activity in four monkeys while generating proprioceptive inputs from the radial nerve. We then applied continuous stimulation to the radial nerve cutaneous branch and quantified the impact of the stimulation on spinal processing of proprioceptive inputs via neural population dynamics. Proprioceptive pulses consistently produce neural trajectories that are disrupted by concurrent cutaneous stimulation. This disruption propagates to the somatosensory cortex, suggesting that electrical stimulation can perturb natural information processing across the neural axis.
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Affiliation(s)
- Natalija Katic Secerovic
- School of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia; The Mihajlo Pupin Institute, University of Belgrade, 11060 Belgrade, Serbia; Laboratory for Neuroengineering, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Oleg Gorskii
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia; Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint-Petersburg, Russia; National University of Science and Technology "MISIS," 4 Leninskiy Pr., 119049 Moscow, Russia
| | - Natalia Pavlova
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia
| | - Lucy Liang
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Jonathan Ho
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Erinn Grigsby
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Dzhina Karal-Ogly
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia
| | - Dmitry Bulgin
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia; Sirius University of Science and Technology, 354340 Sochi, Russia
| | - Sergei Orlov
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Pavel Musienko
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia; Sirius University of Science and Technology, 354340 Sochi, Russia; Life Improvement by Future Technologies Center "LIFT," 143025 Moscow, Russia
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland.
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Li M, Sun H, Hou Z, Hao S, Jin L, Wang B. Engineering the Physical Microenvironment into Neural Organoids for Neurogenesis and Neurodevelopment. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2306451. [PMID: 37771182 DOI: 10.1002/smll.202306451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/04/2023] [Indexed: 09/30/2023]
Abstract
Understanding the signals from the physical microenvironment is critical for deciphering the processes of neurogenesis and neurodevelopment. The discovery of how surrounding physical signals shape human developing neurons is hindered by the bottleneck of conventional cell culture and animal models. Notwithstanding neural organoids provide a promising platform for recapitulating human neurogenesis and neurodevelopment, building neuronal physical microenvironment that accurately mimics the native neurophysical features is largely ignored in current organoid technologies. Here, it is discussed how the physical microenvironment modulates critical events during the periods of neurogenesis and neurodevelopment, such as neural stem cell fates, neural tube closure, neuronal migration, axonal guidance, optic cup formation, and cortical folding. Although animal models are widely used to investigate the impacts of physical factors on neurodevelopment and neuropathy, the important roles of human stem cell-derived neural organoids in this field are particularly highlighted. Considering the great promise of human organoids, building neural organoid microenvironments with mechanical forces, electrophysiological microsystems, and light manipulation will help to fully understand the physical cues in neurodevelopmental processes. Neural organoids combined with cutting-edge techniques, such as advanced atomic force microscopes, microrobots, and structural color biomaterials might promote the development of neural organoid-based research and neuroscience.
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Affiliation(s)
- Minghui Li
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400045, China
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Heng Sun
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400045, China
| | - Zongkun Hou
- Key Laboratory of Infectious Immune and Antibody Engineering of Guizhou Province, Engineering Research Center of Cellular Immunotherapy of Guizhou Province, School of Biology and Engineering/School of Basic Medical Sciences, Guizhou Medical University, Guiyang, 550025, China
| | - Shilei Hao
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400045, China
| | - Liang Jin
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400045, China
| | - Bochu Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400045, China
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Chuang K. Symptomatic Treatment of Myelopathy. Continuum (Minneap Minn) 2024; 30:224-242. [PMID: 38330480 DOI: 10.1212/con.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article discusses the effects of myelopathy on multiple organ systems and reviews the treatment and management of some of these effects. LATEST DEVELOPMENTS Recent advances in functional electrical stimulation, epidural spinal cord stimulation, robotics, and surgical techniques such as nerve transfer show promise in improving function in patients with myelopathy. Ongoing research in stem cell therapy and neurotherapeutic drugs may provide further therapeutic avenues in the future. ESSENTIAL POINTS Treatment for symptoms of spinal cord injury should be targeted toward patient goals. If nerve transfer for upper extremity function is considered, the patient should be evaluated at around 6 months from injury to assess for lower motor neuron involvement and possible time limitations of surgery. A patient with injury at or above the T6 level is at risk for autonomic dysreflexia, a life-threatening condition that presents with elevated blood pressure and can lead to emergent hypertensive crisis. Baclofen withdrawal due to baclofen pump failure or programming errors may also be life-threatening. Proper management of symptoms may help avoid complications such as autonomic dysreflexia, renal failure, heterotopic ossification, and fractures.
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13
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Taitano RI, Yakovenko S, Gritsenko V. Muscle anatomy is reflected in the spatial organization of the spinal motoneuron pools. Commun Biol 2024; 7:97. [PMID: 38225362 PMCID: PMC10789783 DOI: 10.1038/s42003-023-05742-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: 03/27/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024] Open
Abstract
Neural circuits embed limb dynamics for motor control and sensorimotor integration. The somatotopic organization of motoneuron pools in the spinal cord may support these computations. Here, we tested if the spatial organization of motoneurons is related to the musculoskeletal anatomy. We created a 3D model of motoneuron locations within macaque spinal cord and compared the spatial distribution of motoneurons to the anatomical organization of the muscles they innervate. We demonstrated that the spatial distribution of motoneuron pools innervating the upper limb and the anatomical relationships between the muscles they innervate were similar between macaque and human species. Using comparative analysis, we found that the distances between motoneuron pools innervating synergistic muscles were the shortest, followed by those innervating antagonistic muscles. Such spatial organization can support the co-activation of synergistic muscles and reciprocal inhibition of antagonistic muscles. The spatial distribution of motoneurons may play an important role in embedding musculoskeletal dynamics.
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Capogrosso M, Balaguer JM, Prat-Ortega G, Verma N, Yadav P, Sorensen E, de Freitas R, Ensel S, Borda L, Donadio S, Liang L, Ho J, Damiani A, Grigsby E, Fields D, Gonzalez-Martinez J, Gerszten P, Weber D, Pirondini E. Supraspinal control of motoneurons after paralysis enabled by spinal cord stimulation. RESEARCH SQUARE 2024:rs.3.rs-3650257. [PMID: 38260333 PMCID: PMC10802737 DOI: 10.21203/rs.3.rs-3650257/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.
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Affiliation(s)
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
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Chen X, Liu Y, Stavrinou P, Stavrinou L, Hu W, Goldbrunner R, Zheng F, He H. Spinal cord injury: Olfactory ensheathing cell-based therapeutic strategies. J Neurosci Res 2024; 102:e25283. [PMID: 38284859 DOI: 10.1002/jnr.25283] [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: 03/25/2023] [Revised: 08/22/2023] [Accepted: 11/16/2023] [Indexed: 01/30/2024]
Abstract
Spinal cord injury (SCI) is a highly disabling neurological disorder that is difficult to treat due to its complex pathophysiology and nerve regeneration difficulties. Hence, effective SCI treatments are necessary. Olfactory ensheathing cells (OECs), glial cells derived from the olfactory bulb or mucosa, are ideal candidates for SCI treatment because of their neuroprotective and regenerative properties, ample supply, and convenience. In vitro, animal model, and human trial studies have reported discoveries on OEC transplantation; however, shortcomings have also been demonstrated. Recent studies have optimized various OEC transplantation strategies, including drug integration, biomaterials, and gene editing. This review aims to introduce OECs mechanisms in repairing SCI, summarize the research progress of OEC transplantation-optimized strategies, and provide novel research ideas for SCI treatment.
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Affiliation(s)
- Xinli Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yibin Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Pantelis Stavrinou
- Department of Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Neurosurgery, Metropolitan Hospital, Athens, Greece
| | - Lampis Stavrinou
- 2nd Department of Neurosurgery, "Attikon" University Hospital, National and Kapodistrian University, Athens Medical School, Athens, Greece
| | - Weipeng Hu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Roland Goldbrunner
- Department of Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Feng Zheng
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hefan He
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Ho JC, Grigsby EM, Damiani A, Liang L, Balaguer JM, Kallakuri S, Barrios-Martinez J, Karapetyan V, Fields D, Gerszten PC, Kevin Hitchens T, Constantine T, Adams GM, Crammond DJ, Capogrosso M, Gonzalez-Martinez JA, Pirondini E. POTENTIATION OF CORTICO-SPINAL OUTPUT VIA TARGETED ELECTRICAL STIMULATION OF THE MOTOR THALAMUS. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.08.23286720. [PMID: 36945514 PMCID: PMC10029067 DOI: 10.1101/2023.03.08.23286720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cerebral white matter lesions prevent cortico-spinal descending inputs from effectively activating spinal motoneurons, leading to loss of motor control. However, in most cases, the damage to cortico-spinal axons is incomplete offering a potential target for new therapies aimed at improving volitional muscle activation. Here we hypothesized that, by engaging direct excitatory connections to cortico-spinal motoneurons, stimulation of the motor thalamus could facilitate activation of surviving cortico-spinal fibers thereby potentiating motor output. To test this hypothesis, we identified optimal thalamic targets and stimulation parameters that enhanced upper-limb motor evoked potentials and grip forces in anesthetized monkeys. This potentiation persisted after white matter lesions. We replicated these results in humans during intra-operative testing. We then designed a stimulation protocol that immediately improved voluntary grip force control in a patient with a chronic white matter lesion. Our results show that electrical stimulation targeting surviving neural pathways can improve motor control after white matter lesions.
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Affiliation(s)
- Jonathan C. Ho
- School of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA, USA 15213
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
| | - Erinn M. Grigsby
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA, USA, 15213
| | - Arianna Damiani
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Lucy Liang
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Josep-Maria Balaguer
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Sridula Kallakuri
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Neuroscience, University of Pittsburgh, A210 Langley Hall, Pittsburgh, PA, USA, 15260
| | - Jessica Barrios-Martinez
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Vahagn Karapetyan
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Daryl Fields
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Peter C. Gerszten
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - T. Kevin Hitchens
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
| | - Theodora Constantine
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Gregory M. Adams
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Donald J. Crammond
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Marco Capogrosso
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Jorge A. Gonzalez-Martinez
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
| | - Elvira Pirondini
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
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Balaguer JM, Prat-Ortega G, Verma N, Yadav P, Sorensen E, de Freitas R, Ensel S, Borda L, Donadio S, Liang L, Ho J, Damiani A, Grigsby E, Fields DP, Gonzalez-Martinez JA, Gerszten PC, Fisher LE, Weber DJ, Pirondini E, Capogrosso M. SUPRASPINAL CONTROL OF MOTONEURONS AFTER PARALYSIS ENABLED BY SPINAL CORD STIMULATION. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.29.23298779. [PMID: 38076797 PMCID: PMC10705627 DOI: 10.1101/2023.11.29.23298779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.
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Affiliation(s)
- Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Genis Prat-Ortega
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Nikhil Verma
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Prakarsh Yadav
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Erynn Sorensen
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Roberto de Freitas
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Scott Ensel
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Luigi Borda
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Serena Donadio
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
| | - Lucy Liang
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Jonathan Ho
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- School of Medicine, University of Pittsburgh, Pittsburgh, US
| | - Arianna Damiani
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Erinn Grigsby
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
| | - Daryl P. Fields
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | | | - Peter C. Gerszten
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Lee E. Fisher
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
- Dept. of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Douglas J. Weber
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, US
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
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18
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Fan J, Li X, Wang P, Yang F, Zhao B, Yang J, Zhao Z, Li X. A Hyperflexible Electrode Array for Long-Term Recording and Decoding of Intraspinal Neuronal Activity. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2303377. [PMID: 37870208 PMCID: PMC10667843 DOI: 10.1002/advs.202303377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/23/2023] [Indexed: 10/24/2023]
Abstract
Neural interfaces for stable access to the spinal cord (SC) electrical activity can benefit patients with motor dysfunctions. Invasive high-density electrodes can directly extract signals from SC neuronal populations that can be used for the facilitation, adjustment, and reconstruction of motor actions. However, developing neural interfaces that can achieve high channel counts and long-term intraspinal recording remains technically challenging. Here, a biocompatible SC hyperflexible electrode array (SHEA) with an ultrathin structure that minimizes mechanical mismatch between the interface and SC tissue and enables stable single-unit recording for more than 2 months in mice is demonstrated. These results show that SHEA maintains stable impedance, signal-to-noise ratio, single-unit yield, and spike amplitude after implantation into mouse SC. Gait analysis and histology show that SHEA implantation induces negligible behavioral effects and Inflammation. Additionally, multi-unit signals recorded from the SC ventral horn can predict the mouse's movement trajectory with a high decoding coefficient of up to 0.95. Moreover, during step cycles, it is found that the neural trajectory of spikes and low-frequency local field potential (LFP) signal exhibits periodic geometry patterns. Thus, SHEA can offer an efficient and reliable SC neural interface for monitoring and potentially modulating SC neuronal activity associated with motor dysfunctions.
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Affiliation(s)
- Jie Fan
- Center for Excellence in Brain Science and Intelligence TechnologyInstitute of NeuroscienceChinese Academy of SciencesShanghai200031P. R. China
| | - Xiaocheng Li
- Center for Excellence in Brain Science and Intelligence TechnologyInstitute of NeuroscienceChinese Academy of SciencesShanghai200031P. R. China
| | - Peiyu Wang
- Center for Excellence in Brain Science and Intelligence TechnologyInstitute of NeuroscienceChinese Academy of SciencesShanghai200031P. R. China
| | - Fan Yang
- Center for Excellence in Brain Science and Intelligence TechnologyInstitute of NeuroscienceChinese Academy of SciencesShanghai200031P. R. China
| | - Bingzhen Zhao
- Center for Excellence in Brain Science and Intelligence TechnologyInstitute of NeuroscienceChinese Academy of SciencesShanghai200031P. R. China
| | - Jianing Yang
- Center for Excellence in Brain Science and Intelligence TechnologyInstitute of NeuroscienceChinese Academy of SciencesShanghai200031P. R. China
| | - Zhengtuo Zhao
- Center for Excellence in Brain Science and Intelligence TechnologyInstitute of NeuroscienceChinese Academy of SciencesShanghai200031P. R. China
| | - Xue Li
- Center for Excellence in Brain Science and Intelligence TechnologyInstitute of NeuroscienceChinese Academy of SciencesShanghai200031P. R. China
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19
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Song D, Tresch M. Prediction of isometric forces from combined epidural spinal cord and neuromuscular electrical stimulation in the rat lower limb. RESEARCH SQUARE 2023:rs.3.rs-3377679. [PMID: 37886495 PMCID: PMC10602082 DOI: 10.21203/rs.3.rs-3377679/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Both epidural spinal cord and muscle stimulation have been widely used for restoration of movement after spinal cord injury. However, using both approaches simultaneously could provide more flexible control compared to using either approach alone. We evaluate whether responses evoked by combined spinal and muscle stimulation can be predicted by the linear summation of responses produced by each individually. Should this be true, it would simplify the prediction of co-stimulation responses and the development of control schemes for spinal cord injury rehabilitation. In anesthetized rats, we measured hindlimb isometric forces in response to spinal and muscle stimulation across a range of amplitudes. Force prediction errors were calculated as the difference between predicted co-stimulation vectors and observed co-stimulation vectors whereby small errors signified evidence for linear summation. We found that the errors for spinal and muscle co-stimulation were significantly larger than expected. Using a bootstrapping analysis, we find that these larger errors do not reflect a nonlinear interaction between spinal and muscle responses. Instead, they can be attributed to the variability of spinal stimulation responses. We discuss the implications of these results to the use of combined muscle and spinal stimulation for the restoration of movement following spinal cord injury.
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20
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Wang H, Guo J, Pei S, Wang J, Yao Y. Upper limb modeling and motion extraction based on multi-space-fusion. Sci Rep 2023; 13:16101. [PMID: 37752182 PMCID: PMC10522613 DOI: 10.1038/s41598-023-36767-0] [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: 11/14/2022] [Accepted: 06/09/2023] [Indexed: 09/28/2023] Open
Abstract
Modeling and motion extraction of human upper limbs are essential for interpreting the natural behavior of upper limb. Owing to the high degrees of freedom (DOF) and highly dynamic nature, existing upper limb modeling methods have limited applications. This study proposes a generic modeling and motion extraction method, named Primitive-Based triangular body segment method (P-BTBS), which follows the physiology of upper limbs, allows high accuracy of motion angles, and describes upper-limb motions with high accuracy. For utilizing the upper-limb modular motion model, the motion angles and bones can be selected as per the research topics (The generic nature of the study targets). Additionally, P-BTBS is suitable in most scenarios for estimating spatial coordinates (The generic nature of equipment and technology). Experiments in continuous motions with seven DOFs and upper-limb motion description validated the excellent performance and robustness of P-BTBS in extracting motion information and describing upper-limb motions, respectively. P-BTBS provides a new perspective and mathematical tool for human understanding and exploration of upper-limb motions, which theoretically supports upper-limb research.
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Affiliation(s)
- Honggang Wang
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001, China
| | - Junlong Guo
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001, China
| | - Shuo Pei
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001, China
| | - Jiajia Wang
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001, China
| | - Yufeng Yao
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001, China.
- Tianzhi Institute of Innovation and Technology, Weihai, 264209, China.
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21
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Tian T, Zhang S, Yang M. Recent progress and challenges in the treatment of spinal cord injury. Protein Cell 2023; 14:635-652. [PMID: 36856750 PMCID: PMC10501188 DOI: 10.1093/procel/pwad003] [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: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 02/12/2023] Open
Abstract
Spinal cord injury (SCI) disrupts the structural and functional connectivity between the higher center and the spinal cord, resulting in severe motor, sensory, and autonomic dysfunction with a variety of complications. The pathophysiology of SCI is complicated and multifaceted, and thus individual treatments acting on a specific aspect or process are inadequate to elicit neuronal regeneration and functional recovery after SCI. Combinatory strategies targeting multiple aspects of SCI pathology have achieved greater beneficial effects than individual therapy alone. Although many problems and challenges remain, the encouraging outcomes that have been achieved in preclinical models offer a promising foothold for the development of novel clinical strategies to treat SCI. In this review, we characterize the mechanisms underlying axon regeneration of adult neurons and summarize recent advances in facilitating functional recovery following SCI at both the acute and chronic stages. In addition, we analyze the current status, remaining problems, and realistic challenges towards clinical translation. Finally, we consider the future of SCI treatment and provide insights into how to narrow the translational gap that currently exists between preclinical studies and clinical practice. Going forward, clinical trials should emphasize multidisciplinary conversation and cooperation to identify optimal combinatorial approaches to maximize therapeutic benefit in humans with SCI.
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Affiliation(s)
- Ting Tian
- Ministry of Education Key Laboratory of Protein Science, Beijing Advanced Innovation Center for Structural Biology, Beijing Frontier Research Center for Biological Structure, School of Life Sciences, Tsinghua University, Beijing 100084, China
| | - Sensen Zhang
- Ministry of Education Key Laboratory of Protein Science, Beijing Advanced Innovation Center for Structural Biology, Beijing Frontier Research Center for Biological Structure, School of Life Sciences, Tsinghua University, Beijing 100084, China
| | - Maojun Yang
- Ministry of Education Key Laboratory of Protein Science, Beijing Advanced Innovation Center for Structural Biology, Beijing Frontier Research Center for Biological Structure, School of Life Sciences, Tsinghua University, Beijing 100084, China
- Cryo-EM Facility Center, Southern University of Science and Technology, Shenzhen 518055, China
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22
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Mondello SE, Young L, Dang V, Fischedick AE, Tolley NM, Wang T, Bravo MA, Lee D, Tucker B, Knoernschild M, Pedigo BD, Horner PJ, Moritz CT. Optogenetic spinal stimulation promotes new axonal growth and skilled forelimb recovery in rats with sub-chronic cervical spinal cord injury. J Neural Eng 2023; 20:056005. [PMID: 37524080 PMCID: PMC10496592 DOI: 10.1088/1741-2552/acec13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 08/02/2023]
Abstract
Objective.Spinal cord injury (SCI) leads to debilitating sensorimotor deficits that greatly limit quality of life. This work aims to develop a mechanistic understanding of how to best promote functional recovery following SCI. Electrical spinal stimulation is one promising approach that is effective in both animal models and humans with SCI. Optogenetic stimulation is an alternative method of stimulating the spinal cord that allows for cell-type-specific stimulation. The present work investigates the effects of preferentially stimulating neurons within the spinal cord and not glial cells, termed 'neuron-specific' optogenetic spinal stimulation. We examined forelimb recovery, axonal growth, and vasculature after optogenetic or sham stimulation in rats with cervical SCI.Approach.Adult female rats received a moderate cervical hemicontusion followed by the injection of a neuron-specific optogenetic viral vector ipsilateral and caudal to the lesion site. Animals then began rehabilitation on the skilled forelimb reaching task. At four weeks post-injury, rats received a micro-light emitting diode (µLED) implant to optogenetically stimulate the caudal spinal cord. Stimulation began at six weeks post-injury and occurred in conjunction with activities to promote use of the forelimbs. Following six weeks of stimulation, rats were perfused, and tissue stained for GAP-43, laminin, Nissl bodies and myelin. Location of viral transduction and transduced cell types were also assessed.Main Results.Our results demonstrate that neuron-specific optogenetic spinal stimulation significantly enhances recovery of skilled forelimb reaching. We also found significantly more GAP-43 and laminin labeling in the optogenetically stimulated groups indicating stimulation promotes axonal growth and angiogenesis.Significance.These findings indicate that optogenetic stimulation is a robust neuromodulator that could enable future therapies and investigations into the role of specific cell types, pathways, and neuronal populations in supporting recovery after SCI.
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Affiliation(s)
- Sarah E Mondello
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Lisa Young
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Viet Dang
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Amanda E Fischedick
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Nicholas M Tolley
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Tian Wang
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Madison A Bravo
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Dalton Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Belinda Tucker
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Megan Knoernschild
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Benjamin D Pedigo
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
| | - Philip J Horner
- Center for Neuroregeneration, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Chet T Moritz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
- Center for Neurotechnology, Seattle, WA 98195, United States of America
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA 98195, United States of America
- Department of Physiology and Biophysics, University of Washington, Seattle, WA 98195, United States of America
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23
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Fan Y, Wu X, Han S, Zhang Q, Sun Z, Chen B, Xue X, Zhang H, Chen Z, Yin M, Xiao Z, Zhao Y, Dai J. Single-cell analysis reveals region-heterogeneous responses in rhesus monkey spinal cord with complete injury. Nat Commun 2023; 14:4796. [PMID: 37558705 PMCID: PMC10412553 DOI: 10.1038/s41467-023-40513-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
Spinal cord injury (SCI) leads to severe sensory and motor dysfunction below the lesion. However, the cellular dynamic responses and heterogeneity across different regions below the lesion remain to be elusive. Here, we used single-cell transcriptomics to investigate the region-related cellular responses in female rhesus monkeys with complete thoracic SCI from acute to chronic phases. We found that distal lumbar tissue cells were severely impacted, leading to degenerative microenvironments characterized by disease-associated microglia and oligodendrocytes activation alongside increased inhibitory interneurons proportion following SCI. By implanting scaffold into the injury sites, we could improve the injury microenvironment through glial cells and fibroblast regulation while remodeling spared lumbar tissues via reduced inhibitory neurons proportion and improved phagocytosis and myelination. Our findings offer crucial pathological insights into the spared distal tissues and proximal tissues after SCI, emphasizing the importance of scaffold-based treatment approaches targeting heterogeneous microenvironments.
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Affiliation(s)
- Yongheng Fan
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
- University of Chinese Academy of Sciences, 100049, Beijing, China
| | - Xianming Wu
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
| | - Sufang Han
- College of Animal Science, South China Agricultural University, 510642, Guangzhou, China
| | - Qi Zhang
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
| | - Zheng Sun
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
- University of Chinese Academy of Sciences, 100049, Beijing, China
| | - Bing Chen
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
| | - Xiaoyu Xue
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
| | - Haipeng Zhang
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
- University of Chinese Academy of Sciences, 100049, Beijing, China
| | - Zhenni Chen
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
- University of Chinese Academy of Sciences, 100049, Beijing, China
| | - Man Yin
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China
- University of Chinese Academy of Sciences, 100049, Beijing, China
| | - Zhifeng Xiao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China.
| | - Yannan Zhao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China.
| | - Jianwu Dai
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 100101, Beijing, China.
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24
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Liang L, Damiani A, Del Brocco M, Rogers ER, Jantz MK, Fisher LE, Gaunt RA, Capogrosso M, Lempka SF, Pirondini E. A systematic review of computational models for the design of spinal cord stimulation therapies: from neural circuits to patient-specific simulations. J Physiol 2023; 601:3103-3121. [PMID: 36409303 PMCID: PMC10259770 DOI: 10.1113/jp282884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/08/2022] [Indexed: 08/02/2023] Open
Abstract
Seventy years ago, Hodgkin and Huxley published the first mathematical model to describe action potential generation, laying the foundation for modern computational neuroscience. Since then, the field has evolved enormously, with studies spanning from basic neuroscience to clinical applications for neuromodulation. Computer models of neuromodulation have evolved in complexity and personalization, advancing clinical practice and novel neurostimulation therapies, such as spinal cord stimulation. Spinal cord stimulation is a therapy widely used to treat chronic pain, with rapidly expanding indications, such as restoring motor function. In general, simulations contributed dramatically to improve lead designs, stimulation configurations, waveform parameters and programming procedures and provided insight into potential mechanisms of action of electrical stimulation. Although the implementation of neural models are relentlessly increasing in number and complexity, it is reasonable to ask whether this observed increase in complexity is necessary for improved accuracy and, ultimately, for clinical efficacy. With this aim, we performed a systematic literature review and a qualitative meta-synthesis of the evolution of computational models, with a focus on complexity, personalization and the use of medical imaging to capture realistic anatomy. Our review showed that increased model complexity and personalization improved both mechanistic and translational studies. More specifically, the use of medical imaging enabled the development of patient-specific models that can help to transform clinical practice in spinal cord stimulation. Finally, we combined our results to provide clear guidelines for standardization and expansion of computational models for spinal cord stimulation.
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Affiliation(s)
- Lucy Liang
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Arianna Damiani
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matteo Del Brocco
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Evan R Rogers
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Maria K Jantz
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Lee E Fisher
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A Gaunt
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Elvira Pirondini
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Bryson N, Lombardi L, Hawthorn R, Fei J, Keesey R, Peiffer J, Seáñez I. Enhanced selectivity of transcutaneous spinal cord stimulation by multielectrode configuration. J Neural Eng 2023; 20:10.1088/1741-2552/ace552. [PMID: 37419109 PMCID: PMC10481387 DOI: 10.1088/1741-2552/ace552] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/07/2023] [Indexed: 07/09/2023]
Abstract
Objective.Transcutaneous spinal cord stimulation (tSCS) has been gaining momentum as a non-invasive rehabilitation approach to restore movement to paralyzed muscles after spinal cord injury (SCI). However, its low selectivity limits the types of movements that can be enabled and, thus, its potential applications in rehabilitation.Approach.In this cross-over study design, we investigated whether muscle recruitment selectivity of individual muscles could be enhanced by multielectrode configurations of tSCS in 16 neurologically intact individuals. We hypothesized that due to the segmental innervation of lower limb muscles, we could identify muscle-specific optimal stimulation locations that would enable improved recruitment selectivity over conventional tSCS. We elicited leg muscle responses by delivering biphasic pulses of electrical stimulation to the lumbosacral enlargement using conventional and multielectrode tSCS.Results.Analysis of recruitment curve responses confirmed that multielectrode configurations could improve the rostrocaudal and lateral selectivity of tSCS. To investigate whether motor responses elicited by spatially selective tSCS were mediated by posterior root-muscle reflexes, each stimulation event was a paired pulse with a conditioning-test interval of 33.3 ms. Muscle responses to the second stimulation pulse were significantly suppressed, a characteristic of post-activation depression suggesting that spatially selective tSCS recruits proprioceptive fibers that reflexively activate muscle-specific motor neurons in the spinal cord. Moreover, the combination of leg muscle recruitment probability and segmental innervation maps revealed a stereotypical spinal activation map in congruence with each electrode's position.Significance. Improvements in muscle recruitment selectivity could be essential for the effective translation into stimulation protocols that selectively enhance single-joint movements in neurorehabilitation.
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Affiliation(s)
- Noah Bryson
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - Lorenzo Lombardi
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - Rachel Hawthorn
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - Jie Fei
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - Rodolfo Keesey
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
| | - J.D. Peiffer
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
- Biomedical Engineering, Northwestern University
| | - Ismael Seáñez
- Biomedical Engineering, Washington University in St. Louis
- Division of Neurotechnology, Washington University School of Medicine in St. Louis
- Neurosurgery, Washington University School of Medicine in St. Louis
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Chandrasekaran S, Bhagat NA, Ramdeo R, Ebrahimi S, Sharma PD, Griffin DG, Stein A, Harkema SJ, Bouton CE. Targeted transcutaneous spinal cord stimulation promotes persistent recovery of upper limb strength and tactile sensation in spinal cord injury: a pilot study. Front Neurosci 2023; 17:1210328. [PMID: 37483349 PMCID: PMC10360050 DOI: 10.3389/fnins.2023.1210328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Long-term recovery of limb function is a significant unmet need in people with paralysis. Neuromodulation of the spinal cord through epidural stimulation, when paired with intense activity-based training, has shown promising results toward restoring volitional limb control in people with spinal cord injury. Non-invasive neuromodulation of the cervical spinal cord using transcutaneous spinal cord stimulation (tSCS) has shown similar improvements in upper-limb motor control rehabilitation. However, the motor and sensory rehabilitative effects of activating specific cervical spinal segments using tSCS have largely remained unexplored. We show in two individuals with motor-complete SCI that targeted stimulation of the cervical spinal cord resulted in up to a 1,136% increase in exerted force, with weekly activity-based training. Furthermore, this is the first study to document up to a 2-point improvement in clinical assessment of tactile sensation in SCI after receiving tSCS. Lastly, participant gains persisted after a one-month period void of stimulation, suggesting that targeted tSCS may lead to persistent recovery of motor and sensory function.
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Affiliation(s)
- Santosh Chandrasekaran
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Nikunj A. Bhagat
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, United States
| | - Richard Ramdeo
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Sadegh Ebrahimi
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Pawan D. Sharma
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Doug G. Griffin
- Northwell Health STARS Rehabilitation, East Meadow, NY, United States
| | - Adam Stein
- Department of Physical Medicine and Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, United States
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of Bioengineering, University of Louisville, Louisville, KY, United States
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Chad E. Bouton
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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Sharma P, Panta T, Ugiliweneza B, Bert RJ, Gerasimenko Y, Forrest G, Harkema S. Multi-Site Spinal Cord Transcutaneous Stimulation Facilitates Upper Limb Sensory and Motor Recovery in Severe Cervical Spinal Cord Injury: A Case Study. J Clin Med 2023; 12:4416. [PMID: 37445450 DOI: 10.3390/jcm12134416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Individuals with cervical spinal cord injury (SCI) rank regaining arm and hand function as their top rehabilitation priority post-injury. Cervical spinal cord transcutaneous stimulation (scTS) combined with activity-based recovery training (ABRT) is known to effectively facilitate upper extremity sensorimotor recovery in individuals with residual arm and hand function post SCI. However, scTS effectiveness in facilitating upper extremity recovery in individuals with severe SCI with minimal to no sensory and motor preservation below injury level remains largely unknown. We herein introduced a multimodal neuro-rehabilitative approach involving scTS targeting systematically identified various spinal segments combined with ABRT. We hypothesized that multi-site scTS combined with ABRT will effectively neuromodulate the spinal networks, resulting in improved integration of ascending and descending neural information required for sensory and motor recovery in individuals with severe cervical SCI. To test the hypothesis, a 53-year-old male (C2, AIS A, 8 years post-injury) received 60 ABRT sessions combined with continuous multi-site scTS. Post-training assessments revealed improved activation of previously paralyzed upper extremity muscles and sensory improvements over the dorsal and volar aspects of the hand. Most likely, altered spinal cord excitability and improved muscle activation and sensations resulted in observed sensorimotor recovery. However, despite promising neurophysiological evidence pertaining to motor re-activation, we did not observe visually appreciable functional recovery on obtained upper extremity motor assessments.
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Affiliation(s)
- Pawan Sharma
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
| | - Tudor Panta
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY 40202, USA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
- Department of Health Management and Systems Science, University of Louisville, Louisville, KY 40202, USA
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Robert J Bert
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Yury Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
- Department of Physiology, University of Louisville, Louisville, KY 40292, USA
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia
| | - Gail Forrest
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07052, USA
- Kessler Foundation, Newark, NJ 07052, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY 40202, USA
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, USA
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28
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Pinheiro DJLL, Faber J, Micera S, Shokur S. Human-machine interface for two-dimensional steering control with the auricular muscles. Front Neurorobot 2023; 17:1154427. [PMID: 37342389 PMCID: PMC10277645 DOI: 10.3389/fnbot.2023.1154427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
Human-machine interfaces (HMIs) can be used to decode a user's motor intention to control an external device. People that suffer from motor disabilities, such as spinal cord injury, can benefit from the uses of these interfaces. While many solutions can be found in this direction, there is still room for improvement both from a decoding, hardware, and subject-motor learning perspective. Here we show, in a series of experiments with non-disabled participants, a novel decoding and training paradigm allowing naïve participants to use their auricular muscles (AM) to control two degrees of freedom with a virtual cursor. AMs are particularly interesting because they are vestigial muscles and are often preserved after neurological diseases. Our method relies on the use of surface electromyographic records and the use of contraction levels of both AMs to modulate the velocity and direction of a cursor in a two-dimensional paradigm. We used a locking mechanism to fix the current position of each axis separately to enable the user to stop the cursor at a certain location. A five-session training procedure (20-30 min per session) with a 2D center-out task was performed by five volunteers. All participants increased their success rate (Initial: 52.78 ± 5.56%; Final: 72.22 ± 6.67%; median ± median absolute deviation) and their trajectory performances throughout the training. We implemented a dual task with visual distractors to assess the mental challenge of controlling while executing another task; our results suggest that the participants could perform the task in cognitively demanding conditions (success rate of 66.67 ± 5.56%). Finally, using the Nasa Task Load Index questionnaire, we found that participants reported lower mental demand and effort in the last two sessions. To summarize, all subjects could learn to control the movement of a cursor with two degrees of freedom using their AM, with a low impact on the cognitive load. Our study is a first step in developing AM-based decoders for HMIs for people with motor disabilities, such as spinal cord injury.
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Affiliation(s)
- Daniel J. L. L. Pinheiro
- Division of Neuroscience, Department of Neurology and Neurosurgery, Neuroengineering and Neurocognition Laboratory, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Translational Neural Engineering Lab, Institute Neuro X, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jean Faber
- Division of Neuroscience, Department of Neurology and Neurosurgery, Neuroengineering and Neurocognition Laboratory, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Neuroengineering Laboratory, Division of Biomedical Engineering, Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, São José dos Campos, Brazil
| | - Silvestro Micera
- Translational Neural Engineering Lab, Institute Neuro X, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Department of Excellence in Robotics and AI, Institute of BioRobotics Interdisciplinary Health Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Solaiman Shokur
- Translational Neural Engineering Lab, Institute Neuro X, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
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Lorach H, Galvez A, Spagnolo V, Martel F, Karakas S, Intering N, Vat M, Faivre O, Harte C, Komi S, Ravier J, Collin T, Coquoz L, Sakr I, Baaklini E, Hernandez-Charpak SD, Dumont G, Buschman R, Buse N, Denison T, van Nes I, Asboth L, Watrin A, Struber L, Sauter-Starace F, Langar L, Auboiroux V, Carda S, Chabardes S, Aksenova T, Demesmaeker R, Charvet G, Bloch J, Courtine G. Walking naturally after spinal cord injury using a brain-spine interface. Nature 2023; 618:126-133. [PMID: 37225984 PMCID: PMC10232367 DOI: 10.1038/s41586-023-06094-5] [Citation(s) in RCA: 93] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023]
Abstract
A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis1,2. Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking4-6. A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.
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Affiliation(s)
- Henri Lorach
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Andrea Galvez
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Valeria Spagnolo
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Felix Martel
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, Grenoble, France
| | - Serpil Karakas
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, Grenoble, France
| | - Nadine Intering
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Molywan Vat
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Olivier Faivre
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, Grenoble, France
| | - Cathal Harte
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Salif Komi
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Jimmy Ravier
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Thibault Collin
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Laure Coquoz
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Icare Sakr
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Edeny Baaklini
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Sergio Daniel Hernandez-Charpak
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Gregory Dumont
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | | | | | - Tim Denison
- Medtronic, Minneapolis, MN, USA
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ilse van Nes
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Leonie Asboth
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | | | - Lucas Struber
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, Grenoble, France
| | | | - Lilia Langar
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Clinatec, Grenoble, France
| | | | - Stefano Carda
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stephan Chabardes
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, Grenoble, France
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Clinatec, Grenoble, France
| | | | - Robin Demesmaeker
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | | | - Jocelyne Bloch
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.
| | - Grégoire Courtine
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.
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30
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Tharu NS, Wong AYL, Zheng YP. Neuromodulation for recovery of trunk and sitting functions following spinal cord injury: a comprehensive review of the literature. Bioelectron Med 2023; 9:11. [PMID: 37246214 DOI: 10.1186/s42234-023-00113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023] Open
Abstract
Trunk stability is crucial for people with trunk paralysis resulting from spinal cord injuries (SCI), as it plays a significant role in performing daily life activities and preventing from fall-related accidents. Traditional therapy used assistive methods or seating modifications to provide passive assistance while restricting their daily functionality. The recent emergence of neuromodulation techniques has been reported as an alternative therapy that could improve trunk and sitting functions following SCI. The aim of this review was to provide a broad perspective on the existing studies using neuromodulation techniques and identify their potentials in terms of trunk recovery for people with SCI. Five databases were searched (PubMed, Embase, Science Direct, Medline-Ovid, and Web of Science) from inception to December 31, 2022 to identify relevant studies. A total of 21 studies, involving 117 participants with SCI, were included in this review. According to these studies, neuromodulation significantly improved the reaching ability, restored trunk stability and seated posture, increased sitting balance, as well as elevated activity of trunk and back muscles, which were considered early predictors of trunk recovery after SCI. However, there is limited evidence regarding neuromodulation techniques on the improvement of trunk and sitting functions. Therefore, future large-scale randomized controlled trials are warranted to validate these preliminary findings.
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Affiliation(s)
- Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China.
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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31
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Ciotti F, Cimolato A, Valle G, Raspopovic S. Design of an adaptable intrafascicular electrode (AIR) for selective nerve stimulation by model-based optimization. PLoS Comput Biol 2023; 19:e1011184. [PMID: 37228174 DOI: 10.1371/journal.pcbi.1011184] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Peripheral nerve stimulation is being investigated as a therapeutic tool in several clinical scenarios. However, the adopted devices have restricted ability to obtain desired outcomes with tolerable off-target effects. Recent promising solutions are not yet employed in clinical practice due to complex required surgeries, lack of long-term stability, and implant invasiveness. Here, we aimed to design a neural interface to address these issues, specifically dimensioned for pudendal and sacral nerves to potentially target sexual, bladder, or bowel dysfunctions. We designed the adaptable intrafascicular radial electrode (AIR) through realistic computational models. They account for detailed human anatomy, inhomogeneous anisotropic conductance, following the trajectories of axons along curving and branching fascicles, and detailed biophysics of axons. The model was validated against available experimental data. Thanks to computationally efficient geometry-based selectivity estimations we informed the electrode design, optimizing its dimensions to obtain the highest selectivity while maintaining low invasiveness. We then compared the AIR with state-of-the-art electrodes, namely InterStim leads, multipolar cuffs and transversal intrafascicular multichannel electrodes (TIME). AIR, comprising a flexible substrate, surface active sites, and radially inserted intrafascicular needles, is designed to be implanted in a few standard steps, potentially enabling fast implants. It holds potential for repeatable stimulation outcomes thanks to its radial structural symmetry. When compared in-silico, AIR consistently outperformed cuff electrodes and InterStim leads in terms of recruitment threshold and stimulation selectivity. AIR performed similarly or better than a TIME, with quantified less invasiveness. Finally, we showed how AIR can adapt to different nerve sizes and varying shapes while maintaining high selectivity. The AIR electrode shows the potential to fill a clinical need for an effective peripheral nerve interface. Its high predicted performance in all the identified requirements was enabled by a model-based approach, readily applicable for the optimization of electrode parameters in any peripheral nerve stimulation scenario.
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Affiliation(s)
- Federico Ciotti
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Andrea Cimolato
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Giacomo Valle
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Stanisa Raspopovic
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
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32
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Hu Y, Zhang H, Wei H, Liao M, Chen X, Xing J, Duan L, Cheng C, Lu W, Yang X, Wu P, Wang H, Xie J, Chai R. Conductive PS inverse opals for regulating proliferation and differentiation of neural stem cells. ENGINEERED REGENERATION 2023. [DOI: 10.1016/j.engreg.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
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33
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Powell MP, Verma N, Sorensen E, Carranza E, Boos A, Fields DP, Roy S, Ensel S, Barra B, Balzer J, Goldsmith J, Friedlander RM, Wittenberg GF, Fisher LE, Krakauer JW, Gerszten PC, Pirondini E, Weber DJ, Capogrosso M. Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis. Nat Med 2023; 29:689-699. [PMID: 36807682 DOI: 10.1038/s41591-022-02202-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/22/2022] [Indexed: 02/22/2023]
Abstract
Cerebral strokes can disrupt descending commands from motor cortical areas to the spinal cord, which can result in permanent motor deficits of the arm and hand. However, below the lesion, the spinal circuits that control movement remain intact and could be targeted by neurotechnologies to restore movement. Here we report results from two participants in a first-in-human study using electrical stimulation of cervical spinal circuits to facilitate arm and hand motor control in chronic post-stroke hemiparesis ( NCT04512690 ). Participants were implanted for 29 d with two linear leads in the dorsolateral epidural space targeting spinal roots C3 to T1 to increase excitation of arm and hand motoneurons. We found that continuous stimulation through selected contacts improved strength (for example, grip force +40% SCS01; +108% SCS02), kinematics (for example, +30% to +40% speed) and functional movements, thereby enabling participants to perform movements that they could not perform without spinal cord stimulation. Both participants retained some of these improvements even without stimulation and no serious adverse events were reported. While we cannot conclusively evaluate safety and efficacy from two participants, our data provide promising, albeit preliminary, evidence that spinal cord stimulation could be an assistive as well as a restorative approach for upper-limb recovery after stroke.
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Affiliation(s)
- Marc P Powell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nikhil Verma
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Erynn Sorensen
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Carranza
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Boos
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daryl P Fields
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Souvik Roy
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Ensel
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatrice Barra
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey Balzer
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - George F Wittenberg
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Veterans Affairs HS, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - John W Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
- The Santa Fe Institute, Santa Fe, NM, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA
- The Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Dorrian RM, Berryman CF, Lauto A, Leonard AV. Electrical stimulation for the treatment of spinal cord injuries: A review of the cellular and molecular mechanisms that drive functional improvements. Front Cell Neurosci 2023; 17:1095259. [PMID: 36816852 PMCID: PMC9936196 DOI: 10.3389/fncel.2023.1095259] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that causes severe loss of motor, sensory and autonomic functions. Additionally, many individuals experience chronic neuropathic pain that is often refractory to interventions. While treatment options to improve outcomes for individuals with SCI remain limited, significant research efforts in the field of electrical stimulation have made promising advancements. Epidural electrical stimulation, peripheral nerve stimulation, and functional electrical stimulation have shown promising improvements for individuals with SCI, ranging from complete weight-bearing locomotion to the recovery of sexual function. Despite this, there is a paucity of mechanistic understanding, limiting our ability to optimize stimulation devices and parameters, or utilize combinatorial treatments to maximize efficacy. This review provides a background into SCI pathophysiology and electrical stimulation methods, before exploring cellular and molecular mechanisms suggested in the literature. We highlight several key mechanisms that contribute to functional improvements from electrical stimulation, identify gaps in current knowledge and highlight potential research avenues for future studies.
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Affiliation(s)
- Ryan M. Dorrian
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia,*Correspondence: Ryan M. Dorrian,
| | | | - Antonio Lauto
- School of Science, Western Sydney University, Penrith, NSW, Australia
| | - Anna V. Leonard
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
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Morphological changes of large layer V pyramidal neurons in cortical motor-related areas after spinal cord injury in macaque monkeys. Sci Rep 2023; 13:82. [PMID: 36596827 PMCID: PMC9810718 DOI: 10.1038/s41598-022-26931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
In primates, neurons giving rise to the corticospinal tract (CST) are distributed in several motor-related areas of the frontal lobe, such as the primary motor cortex (M1), the supplementary motor area (SMA), and the dorsal and ventral divisions of the premotor cortex (PMd, PMv). Recently, we have shown in macaque monkeys that the morphology of basal dendrites of CST neurons, i.e., large layer V pyramidal neurons, varies among the digit regions of the motor-related areas. Here, we investigated the alterations in basal dendrite morphology of CST neurons after spinal cord injury (SCI). In our monkey model, both the complexity and the spine density of basal dendrites were highly decreased throughout the areas. Notably, these events were less prominent for the PMd than for the M1, SMA, and PMv. In analyzing the density changes post-SCI of the filopodia-, thin-, stubby-, and mushroom-type spines, it was found that the density of filopodia-type spines was increased for all areas, whereas the other types of spines exhibited density decreases. Such spine density reductions were so limited for the PMd as compared to the other areas. The observed plastic changes of CST neurons may contribute to the recovery from impaired motor functions caused by SCI.
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Obara K, Kaneshige M, Suzuki M, Yokoyama O, Tazoe T, Nishimura Y. Corticospinal interface to restore voluntary control of joint torque in a paralyzed forearm following spinal cord injury in non-human primates. Front Neurosci 2023; 17:1127095. [PMID: 36960166 PMCID: PMC10028188 DOI: 10.3389/fnins.2023.1127095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 03/09/2023] Open
Abstract
The corticospinal tract plays a major role in the control of voluntary limb movements, and its damage impedes voluntary limb control. We investigated the feasibility of closed-loop brain-controlled subdural spinal stimulation through a corticospinal interface for the modulation of wrist torque in the paralyzed forearm of monkeys with spinal cord injury at C4/C5. Subdural spinal stimulation of the preserved cervical enlargement activated multiple muscles on the paralyzed forearm and wrist torque in the range from flexion to ulnar-flexion. The magnitude of the evoked torque could be modulated by changing current intensity. We then employed the corticospinal interface designed to detect the firing rate of an arbitrarily selected "linked neuron" in the forearm territory of the primary motor cortex (M1) and convert it in real time to activity-contingent electrical stimulation of a spinal site caudal to the lesion. Linked neurons showed task-related activity that modulated the magnitude of the evoked torque and the activation of multiple muscles depending on the required torque. Unlinked neurons, which were independent of spinal stimulation and located in the vicinity of the linked neurons, exhibited task-related or -unrelated activity. Thus, monkeys were able to modulate the wrist torque of the paralyzed forearm by modulating the firing rate of M1 neurons including unlinked and linked neurons via the corticospinal interface. These results suggest that the corticospinal interface can replace the function of the corticospinal tract after spinal cord injury.
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Affiliation(s)
- Kei Obara
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Division of Neural Engineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Miki Kaneshige
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Michiaki Suzuki
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Osamu Yokoyama
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Toshiki Tazoe
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yukio Nishimura
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Division of Neural Engineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- *Correspondence: Yukio Nishimura,
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Ahmed RU, Knibbe CA, Wilkins F, Sherwood LC, Howland DR, Boakye M. Porcine spinal cord injury model for translational research across multiple functional systems. Exp Neurol 2023; 359:114267. [PMID: 36356636 DOI: 10.1016/j.expneurol.2022.114267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
Animal models are necessary to identify pathological changes and help assess therapeutic outcomes following spinal cord injury (SCI). Small animal models offer value in research in terms of their easily managed size, minimal maintenance requirements, lower cost, well-characterized genomes, and ability to power research studies. However, despite these benefits, small animal models have neurologic and anatomical differences that may influence translation of results to humans and thus limiting the success of their use in preclinical studies as a direct pipeline to clinical studies. Large animal models, offer an attractive intermediary translation model that may be more successful in translating to the clinic for SCI research. This is largely due to their greater neurologic and anatomical similarities to humans. The physical characteristics of pig spinal cord, gut microbiome, metabolism, proportions of white to grey matter, bowel anatomy and function, and urinary system are strikingly similar and provide great insight into human SCI conditions. In this review, we address the variety of existing porcine injury models and their translational relevance, benefits, and drawbacks in modeling human systems and functions for neurophysiology, cardiovascular, gastrointestinal and urodynamic functions.
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Affiliation(s)
- Rakib Uddin Ahmed
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
| | - Chase A Knibbe
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Felicia Wilkins
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Leslie C Sherwood
- Comparative Medicine Research Unit, University of Louisville, Louisville, KY, USA
| | - Dena R Howland
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Robley Rex VA Medical Center, Louisville, KY 40202, USA
| | - Maxwell Boakye
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
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McIntosh JR, Joiner EF, Goldberg JL, Murray LM, Yasin B, Mendiratta A, Karceski SC, Thuet E, Modik O, Shelkov E, Lombardi JM, Sardar ZM, Lehman RA, Mandigo C, Riew KD, Harel NY, Virk MS, Carmel JB. Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses. J Neurophysiol 2023; 129:66-82. [PMID: 36417309 PMCID: PMC9799146 DOI: 10.1152/jn.00235.2022] [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: 06/01/2022] [Revised: 09/18/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Although epidural stimulation of the lumbar spinal cord has emerged as a powerful modality for recovery of movement, how it should be targeted to the cervical spinal cord to activate arm and hand muscles is not well understood, particularly in humans. We sought to map muscle responses to posterior epidural cervical spinal cord stimulation in humans. We hypothesized that lateral stimulation over the dorsal root entry zone would be most effective and responses would be strongest in the muscles innervated by the stimulated segment. Twenty-six people undergoing clinically indicated cervical spine surgery consented to mapping of motor responses. During surgery, stimulation was performed in midline and lateral positions at multiple exposed segments; six arm and three leg muscles were recorded on each side of the body. Across all segments and muscles tested, lateral stimulation produced stronger muscle responses than midline despite similar latency and shape of responses. Muscles innervated at a cervical segment had the largest responses from stimulation at that segment, but responses were also observed in muscles innervated at other cervical segments and in leg muscles. The cervical responses were clustered in rostral (C4-C6) and caudal (C7-T1) cervical segments. Strong responses to lateral stimulation are likely due to the proximity of stimulation to afferent axons. Small changes in response sizes to stimulation of adjacent cervical segments argue for local circuit integration, and distant muscle responses suggest activation of long propriospinal connections. This map can help guide cervical stimulation to improve arm and hand function.NEW & NOTEWORTHY A map of muscle responses to cervical epidural stimulation during clinically indicated surgery revealed strongest activation when stimulating laterally compared to midline and revealed differences to be weaker than expected across different segments. In contrast, waveform shapes and latencies were most similar when stimulating midline and laterally, indicating activation of overlapping circuitry. Thus, a map of the cervical spinal cord reveals organization and may help guide stimulation to activate arm and hand muscles strongly and selectively.
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Affiliation(s)
- James R McIntosh
- Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York
- Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Evan F Joiner
- Department of Neurological Surgery, Columbia University, New York, New York
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Lynda M Murray
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Bushra Yasin
- Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York
- Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Anil Mendiratta
- Department of Neurology, Columbia University, New York, New York
| | - Steven C Karceski
- Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Earl Thuet
- New York Presbyterian, Och Spine Hospital, New York, New York
| | - Oleg Modik
- Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Evgeny Shelkov
- Department of Neurology, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Joseph M Lombardi
- Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York
- New York Presbyterian, Och Spine Hospital, New York, New York
| | - Zeeshan M Sardar
- Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York
- New York Presbyterian, Och Spine Hospital, New York, New York
| | - Ronald A Lehman
- Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York
- New York Presbyterian, Och Spine Hospital, New York, New York
| | - Christopher Mandigo
- Department of Neurological Surgery, Columbia University, New York, New York
- New York Presbyterian, Och Spine Hospital, New York, New York
| | - K Daniel Riew
- Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York
- Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
- New York Presbyterian, Och Spine Hospital, New York, New York
| | - Noam Y Harel
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
| | - Jason B Carmel
- Department of Orthopedic Surgery, https://ror.org/00hj8s172Columbia University, New York, New York
- Department of Neurology, Columbia University, New York, New York
- Department of Neurological Surgery, Weill Cornell Medicine-New York Presbyterian, Och Spine Hospital, New York, New York
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Jantz MK, Gopinath C, Kumar R, Chin C, Wong L, Ogren JI, Fisher LE, McLaughlin BL, Gaunt RA. High-density spinal cord stimulation selectively activates lower urinary tract nerves. J Neural Eng 2022; 19:066014. [PMID: 36343359 PMCID: PMC9855651 DOI: 10.1088/1741-2552/aca0c2] [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: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022]
Abstract
Objective.Epidural spinal cord stimulation (SCS) is a potential intervention to improve limb and autonomic functions, with lumbar stimulation improving locomotion and thoracic stimulation regulating blood pressure. Here, we asked whether sacral SCS could be used to target the lower urinary tract (LUT) and used a high-density epidural electrode array to test whether individual electrodes could selectively recruit LUT nerves.Approach. We placed a high-density epidural SCS array on the dorsal surface of the sacral spinal cord and cauda equina of anesthetized cats and recorded the stimulation-evoked activity from nerve cuffs on the pelvic, pudendal and sciatic nerves.Main results. Here we show that sacral SCS evokes responses in nerves innervating the bladder and urethra and that these nerves can be activated selectively. Sacral SCS always recruited the pelvic and pudendal nerves and selectively recruited both of these nerves in all but one animal. Individual branches of the pudendal nerve were always recruited as well. Electrodes that selectively recruited specific peripheral nerves were spatially clustered on the arrays, suggesting anatomically organized sensory pathways.Significance.This selective recruitment demonstrates a mechanism to directly modulate bladder and urethral function through known reflex pathways, which could be used to restore bladder and urethral function after injury or disease.
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Affiliation(s)
- Maria K Jantz
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, PA, United States of America
| | - Chaitanya Gopinath
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Ritesh Kumar
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, PA, United States of America
| | - Celine Chin
- Micro-Leads Inc., Somerville, MA, United States of America
| | - Liane Wong
- Micro-Leads Inc., Somerville, MA, United States of America
| | - John I Ogren
- Micro-Leads Inc., Somerville, MA, United States of America
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, PA, United States of America
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
- Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | | | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for the Neural Basis of Cognition, Pittsburgh, PA, United States of America
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
- Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
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40
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Insausti-Delgado A, López-Larraz E, Nishimura Y, Ziemann U, Ramos-Murguialday A. Non-invasive brain-spine interface: Continuous control of trans-spinal magnetic stimulation using EEG. Front Bioeng Biotechnol 2022; 10:975037. [PMID: 36394044 PMCID: PMC9659618 DOI: 10.3389/fbioe.2022.975037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/23/2022] [Indexed: 08/22/2023] Open
Abstract
Brain-controlled neuromodulation has emerged as a promising tool to promote functional recovery in patients with motor disorders. Brain-machine interfaces exploit this neuromodulatory strategy and could be used for restoring voluntary control of lower limbs. In this work, we propose a non-invasive brain-spine interface (BSI) that processes electroencephalographic (EEG) activity to volitionally control trans-spinal magnetic stimulation (ts-MS), as an approach for lower-limb neurorehabilitation. This novel platform allows to contingently connect motor cortical activation during leg motor imagery with the activation of leg muscles via ts-MS. We tested this closed-loop system in 10 healthy participants using different stimulation conditions. This BSI efficiently removed stimulation artifacts from EEG regardless of ts-MS intensity used, allowing continuous monitoring of cortical activity and real-time closed-loop control of ts-MS. Our BSI induced afferent and efferent evoked responses, being this activation ts-MS intensity-dependent. We demonstrated the feasibility, safety and usability of this non-invasive BSI. The presented system represents a novel non-invasive means of brain-controlled neuromodulation and opens the door towards its integration as a therapeutic tool for lower-limb rehabilitation.
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Affiliation(s)
- Ainhoa Insausti-Delgado
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- International Max Planck Research School (IMPRS) for Cognitive and Systems Neuroscience, Tübingen, Germany
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain, Zaragoza, Spain
| | - Yukio Nishimura
- Neural Prosthetics Project, Department of Brain and Neuroscience, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia-San Sebastián, Spain
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Oh J, Steele AG, Varghese B, Martin CA, Scheffler MS, Markley RL, Lo YK, Sayenko DG. Cervical transcutaneous spinal stimulation for spinal motor mapping. iScience 2022; 25:105037. [PMID: 36147963 PMCID: PMC9485062 DOI: 10.1016/j.isci.2022.105037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Transcutaneous spinal stimulation (TSS) is a promising approach to restore upper-limb (UL) functions after spinal cord injury (SCI) in humans. We sought to demonstrate the selectivity of recruitment of individual UL motor pools during cervical TSS using different electrode placements. We demonstrated that TSS delivered over the rostrocaudal and mediolateral axes of the cervical spine resulted in a preferential activation of proximal, distal, and ipsilateral UL muscles. This was revealed by changes in motor threshold intensity, maximum amplitude, and the amount of post-activation depression of the evoked responses. We propose that an arrangement of electrodes targeting specific UL motor pools may result in superior efficacy, restoring more diverse motor activities after neurological injuries and disorders, including severe SCI.
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Affiliation(s)
- Jeonghoon Oh
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Alexander G. Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
- Department of Electrical and Computer Engineering, University of Houston, N308 Engineering Bldg 1, 4726 Calhoun Rd., Houston, TX 77204, USA
| | - Blesson Varghese
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Catherine A. Martin
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Michelle S. Scheffler
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | - Rachel L. Markley
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
| | | | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX 77030, USA
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Pirondini E, Carranza E, Balaguer JM, Sorensen E, Weber DJ, Krakauer JW, Capogrosso M. Poststroke arm and hand paresis: should we target the cervical spinal cord? Trends Neurosci 2022; 45:568-578. [PMID: 35659414 DOI: 10.1016/j.tins.2022.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/18/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have limited efficacy at the level of impairment. To address this problem, we make the conceptual case for a new treatment approach. We first summarize current understanding of motor control deficits in the arm and hand after stroke and their shared physiological mechanisms with spinal cord injury (SCI). We then review studies of spinal cord stimulation (SCS) for recovery of locomotion after SCI, which provide convincing evidence for enhancement of residual corticospinal function. By extrapolation, we argue for using cervical SCS to restore upper limb motor control after stroke.
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Affiliation(s)
- Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Erick Carranza
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erynn Sorensen
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA; Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - John W Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; The Santa Fe Institute, Santa Fe, CA, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA.
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Yang H, Su Y, Sun Z, Ma B, Liu F, Kong Y, Sun C, Li B, Sang Y, Wang S, Li G, Qiu J, Liu C, Geng Z, Liu H. Gold Nanostrip Array-Mediated Wireless Electrical Stimulation for Accelerating Functional Neuronal Differentiation. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2202376. [PMID: 35618610 PMCID: PMC9353484 DOI: 10.1002/advs.202202376] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Indexed: 05/27/2023]
Abstract
Neural stem cell (NSC)-based therapy holds great promise for the treatment of neurodegenerative diseases. Presently, however, it is hindered by poor functional neuronal differentiation. Electrical stimulation is considered one of the most effective ways to promote neuronal differentiation of NSCs. In addition to surgically implanted electrodes, traditional electrical stimulation includes wires connected to the external power supply, and an additional surgery is required to remove the electrodes or wires following stimulation, which may cause secondary injuries and infections. Herein, a novel method is reported for generation of wireless electrical signals on an Au nanostrip array by leveraging the effect of electromagnetic induction under a rotating magnetic field. The intensity of the generated electrical signals depends on the rotation speed and magnetic field strength. The Au nanostrip array-mediated electric stimulation promotes NSC differentiation into mature neurons within 5 days, at the mRNA, protein, and function levels. The rate of differentiation is faster by at least 5 days than that in cells without treatment. The Au nanostrip array-based wireless device also accelerates neuronal differentiation of NSCs in vivo. The novel method to accelerate the neuronal differentiation of NSCs has the advantages of wireless, timely, localized and precise controllability, and noninvasive power supplementation.
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Affiliation(s)
- Hongru Yang
- State Key Laboratory of Crystal MaterialsShandong UniversityJinanShandong250100P. R. China
| | - Yue Su
- State Key Laboratory of Integrated OptoelectronicsInstitute of SemiconductorsChinese Academy of SciencesBeijing100083P. R. China
| | - Zhaoyang Sun
- Department of Oral and Maxillofacial SurgeryQilu Hospital of Shandong UniversityJinanShandong250012P. R. China
| | - Baojin Ma
- State Key Laboratory of Crystal MaterialsShandong UniversityJinanShandong250100P. R. China
| | - Feng Liu
- State Key Laboratory of Crystal MaterialsShandong UniversityJinanShandong250100P. R. China
| | - Ying Kong
- State Key Laboratory of Crystal MaterialsShandong UniversityJinanShandong250100P. R. China
| | - Chunhui Sun
- Institute for Advanced Interdisciplinary ResearchUniversity of JinanJinanShandong250022P. R. China
| | - Boyan Li
- Department of Neurosurgery Qilu HospitalCheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanShandong250012P. R. China
| | - Yuanhua Sang
- State Key Laboratory of Crystal MaterialsShandong UniversityJinanShandong250100P. R. China
| | - Shuhua Wang
- State Key Laboratory of Crystal MaterialsShandong UniversityJinanShandong250100P. R. China
| | - Gang Li
- Department of Neurosurgery Qilu HospitalCheeloo College of Medicine and Institute of Brain and Brain‐Inspired ScienceShandong UniversityJinanShandong250012P. R. China
| | - Jichuan Qiu
- State Key Laboratory of Crystal MaterialsShandong UniversityJinanShandong250100P. R. China
| | - Chao Liu
- Department of Oral and Maxillofacial SurgeryQilu Hospital of Shandong UniversityJinanShandong250012P. R. China
| | - Zhaoxin Geng
- School of Information EngineeringMinzu University of ChinaBeijing100081P. R. China
| | - Hong Liu
- State Key Laboratory of Crystal MaterialsShandong UniversityJinanShandong250100P. R. China
- Institute for Advanced Interdisciplinary ResearchUniversity of JinanJinanShandong250022P. R. China
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Fang X, Collins S, Nanivadekar AC, Jantz M, Gaunt RA, Capogrosso M. An Open-source Computational Model of Neurostimulation of the Spinal Pudendo-Vesical Reflex for the Recovery of Bladder Control After Spinal Cord Injury. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1607-1610. [PMID: 36086204 DOI: 10.1109/embc48229.2022.9871195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Spinal cord stimulation (SCS) could be used to restore control of the bladder after spinal cord injury, but substantial development is still required to tailor this technology for bladder function. Computational models could be utilized to accelerate these efforts enabling in-silico optimization of stimulation parameters. However, no model of the spinal pudendo-vesical reflex can simulate the effect of stimulation amplitude on neuron recruitment. This limitation hinders accurate prediction of bladder pressure changes for different stimulation configurations. Here., we implemented an open-source realistic spiking neural network model of the pudendo-vesical reflex enabling exploration of the impact of stimulation amplitude and frequency on bladder pressure changes. We used the o2S2 PARC platform to design a parallel implementation of the bladder reflex circuits with NEURON. Our model successfully reproduced and expanded previous studies., producing a decrease in bladder pressure at low stimulation frequency (10 Hz) and excitation at high stimulation frequency (≥33 Hz) in isovolumetric experiments. We then explored the effect of mixed nerve recruitment., simulating a common case of poorly selective spinal cord stimulation. We found that high recruitments of pudendal nerve axons are necessary to maintain this bi-modal behavior., regardless of stimulation specificity. Our framework is fully open-source and can be used to simulate any type of axon stimulations such as SCS and peripheral nerve stimulation.
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Barra B, Conti S, Perich MG, Zhuang K, Schiavone G, Fallegger F, Galan K, James ND, Barraud Q, Delacombaz M, Kaeser M, Rouiller EM, Milekovic T, Lacour S, Bloch J, Courtine G, Capogrosso M. Epidural electrical stimulation of the cervical dorsal roots restores voluntary upper limb control in paralyzed monkeys. Nat Neurosci 2022; 25:924-934. [PMID: 35773543 DOI: 10.1038/s41593-022-01106-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022]
Abstract
Regaining arm control is a top priority for people with paralysis. Unfortunately, the complexity of the neural mechanisms underlying arm control has limited the effectiveness of neurotechnology approaches. Here, we exploited the neural function of surviving spinal circuits to restore voluntary arm and hand control in three monkeys with spinal cord injury, using spinal cord stimulation. Our neural interface leverages the functional organization of the dorsal roots to convey artificial excitation via electrical stimulation to relevant spinal segments at appropriate movement phases. Stimulation bursts targeting specific spinal segments produced sustained arm movements, enabling monkeys with arm paralysis to perform an unconstrained reach-and-grasp task. Stimulation specifically improved strength, task performances and movement quality. Electrophysiology suggested that residual descending inputs were necessary to produce coordinated movements. The efficacy and reliability of our approach hold realistic promises of clinical translation.
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Affiliation(s)
- Beatrice Barra
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara Conti
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Matthew G Perich
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Katie Zhuang
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Katia Galan
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicholas D James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maude Delacombaz
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mélanie Kaeser
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Eric M Rouiller
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Tomislav Milekovic
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Stephanie Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Marco Capogrosso
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland. .,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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46
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Hasse BA, Sheets DEG, Holly NL, Gothard KM, Fuglevand AJ. Restoration of complex movement in the paralyzed upper limb. J Neural Eng 2022; 19. [PMID: 35728568 DOI: 10.1088/1741-2552/ac7ad7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Functional electrical stimulation (FES) involves artificial activation of skeletal muscles to reinstate motor function in paralyzed individuals. While FES applied to the upper limb has improved the ability of tetraplegics to perform activities of daily living, there are key shortcomings impeding its widespread use. One major limitation is that the range of motor behaviors that can be generated is restricted to a small set of simple, preprogrammed movements. This limitation stems from the substantial difficulty in determining the patterns of stimulation across many muscles required to produce more complex movements. Therefore, the objective of this study was to use machine learning to flexibly identify patterns of muscle stimulation needed to evoke a wide array of multi-joint arm movements. APPROACH Arm kinematics and electromyographic activity from 29 muscles were recorded while a 'trainer' monkey made an extensive range of arm movements. Those data were used to train an artificial neural network that predicted patterns of muscle activity associated with a new set of movements. Those patterns were converted into trains of stimulus pulses that were delivered to upper limb muscles in two other temporarily paralyzed monkeys. RESULTS Machine-learning based prediction of EMG was good for within-subject predictions but appreciably poorer for across-subject predictions. Evoked responses matched the desired movements with good fidelity only in some cases. Means to mitigate errors associated with FES-evoked movements are discussed. SIGNIFICANCE Because the range of movements that can be produced with our approach is virtually unlimited, this system could greatly expand the repertoire of movements available to individuals with high level paralysis.
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Affiliation(s)
- Brady A Hasse
- Department of Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Avenue, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Drew E G Sheets
- Department of Organismal Biology & Anatomy, University of Chicago Biological Sciences Division, Anatomy, 1027 E 57th Street Chicago, IL 60637, Chicago, Illinois, 60637-5416, UNITED STATES
| | - Nicole L Holly
- Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Avenue, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Katalin M Gothard
- Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Ave, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Andrew J Fuglevand
- Department of Physiology, University of Arizona, Arizona Health Sciences Center, 1501 N. Campbell Ave, Tucson, Arizona, 85724-5051, UNITED STATES
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47
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Kapardi M, Pithapuram MV, Rangayyan YM, Iyengar RS, Singh AK, Sripada S, Raghavan M. In-silico neuro musculoskeletal model reproduces the movement types obtained by spinal micro stimulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 220:106804. [PMID: 35436659 DOI: 10.1016/j.cmpb.2022.106804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Virtual patients and physiologies allow experimentation, design, and early-stage clinical trials in-silico. Virtual patient technology for human movement systems that encompasses musculoskeleton and its neural control are few and far in between. Our major goal is to create a neuro- musculoskeletal upper limb in-silico model, which is modular in architecture and generates movement as an emergent phenomenon out of a multiscale co-simulation of spinal cord neural control and musculoskeletal dynamics. METHODS The model is developed on the NEUROiD movement simulation platform that enables a co-simulation of popular neural simulator NEURON and the musculoskeletal simulator OpenSim. We further characterized and demonstrated the use of this model in generating a range of commonly observed upper limb movements by means of a spatio-temporal stimulation pattern delivered to the cervical spinal cord. RESULTS We were able to characterize the model based on proprioception (Ia, Ib and II fibers), afferent conduction delay and inital postures of the musculoskeletal system. A smooth movement was achieved in all the considered experiments. The generated movements in all degrees of freedom were reproduced in accordance with the previous experimental studies. CONCLUSION In this work, design and development of the upper limb model was described in a modular fashion, while reusing existing models and modules. We believe this work enables a first and small step towards an in-silico paradigms for understanding upper limb movement, disease pathology, medication, and rehabilitation.
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48
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Stochastic spinal neuromodulation tunes the intrinsic logic of spinal neural networks. Exp Neurol 2022; 355:114138. [DOI: 10.1016/j.expneurol.2022.114138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022]
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de Freitas RM, Capogrosso M, Nomura T, Milosevic M. Optimizing sensory fiber activation during cervical transcutaneous spinal stimulation using different electrode configurations: A computational analysis. Artif Organs 2022; 46:2015-2026. [PMID: 35642297 DOI: 10.1111/aor.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cervical transcutaneous spinal cord stimulation (tSCS) is a rehabilitation tool which has been used to promote upper-limb motor recovery after spinal cord injury. Importantly, optimizing sensory fiber activation at specific spinal segments could enable activity-dependent neuromodulation during rehabilitation. METHODS An anatomically realistic cervical tSCS computational model was used to analyze the activation of α-motor and Aα-sensory fibers at C7 and C8 spinal segments using nine cathode electrode configurations. Specifically, the cathode was simulated at three vertebral level positions: C6, C7, and T1; and in three sizes: 5.0 x 5.0, 3.5 x 3.5; and 2.5 x 2.5 cm2 , while the anode was on the anterior neck. Finite element method was used to estimate the electric potential distribution along α-motor and Aα-sensory fibers, and computational models were applied to simulate the fiber membrane dynamics during tSCS. The minimum stimulation intensity necessary to activate the fibers (activation threshold) was estimated and compared across cathode configurations in an effort to optimize sensory fiber activation. RESULTS Our results showed that nerve fibers at both C7 and C8 spinal segments were recruited at lower stimulation intensities when the cathode was positioned over the C7 or T1 vertebra compared with the C6 position. Sensory fibers were activated at lower stimulation intensities using smaller electrodes, which could also affect the degree of nerve fiber activation across different positions. Importantly, Aα-sensory fibers were consistently recruited before α-motor fibers. CONCLUSIONS These results imply that cathode positioning could help optimize preferential activation of hand muscles during cervical tSCS.
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Affiliation(s)
- Roberto M de Freitas
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Japan
| | - Marco Capogrosso
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA.,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Japan
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50
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Zhang X, Zhang S, Lu B, Wang Y, Li N, Peng Y, Hou J, Qiu J, Li F, Yao D, Xu P. Dynamic corticomuscular multi-regional modulations during finger movement revealed by time-varying network analysis. J Neural Eng 2022; 19. [PMID: 35523144 DOI: 10.1088/1741-2552/ac6d7c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 05/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A body movement involves the complicated information exchange between the central and peripheral systems, which is characterized by the dynamical coupling patterns between the multiple brain areas and multiple muscle units. How the central and peripheral nerves coordinate multiple internal brain regions and muscle groups is very important when accomplishing the action. APPROACH In this study, we extend the adaptive directed transfer function to construct the time-varying networks between multiple corticomuscular regions and divide the movement duration into different stages by the time-varying corticomuscular network patterns. MAIN RESULTS The inter dynamical corticomuscular network demonstrated the different interaction patterns between the central and peripheral systems during the different hand movement stages. The muscles transmit bottom-up movement information in the preparation stage, but the brain issues top-down control commands and dominates in the execution stage, and finally, the brain's dominant advantage gradually weakens in the relaxation stage. When classifying the different movement stages based on time-varying corticomuscular network indicators, an average accuracy above 74% could be reliably achieved. SIGNIFICANCE The findings of this study help deepen our knowledge of central-peripheral nerve pathways and coordination mechanisms, and also provide opportunities for monitoring and regulating movement disorders.
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Affiliation(s)
- Xiabing Zhang
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Shu Zhang
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Bin Lu
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Yifeng Wang
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Ning Li
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Yueheng Peng
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Jingming Hou
- Third Military Medical University Southwest Hospital, No. 30, Gaotanyanzheng Street, Shapingba District, Chongqing, 400038, CHINA
| | - Jing Qiu
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Fali Li
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Dezhong Yao
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
| | - Peng Xu
- University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, Chengdu, 610054, CHINA
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