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Khan AF, Muhammad F, Mohammadi E, O'Neal C, Haynes G, Hameed S, Walker B, Rohan ML, Yabluchanskiy A, Smith ZA. Beyond the aging spine - a systematic review of functional changes in the human brain in cervical spondylotic myelopathy. GeroScience 2024; 46:1421-1450. [PMID: 37801201 PMCID: PMC10828266 DOI: 10.1007/s11357-023-00954-8] [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: 07/21/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Abstract
Cervical Spondylotic Myelopathy (CSM) is a degenerative condition that leads to loss of cervical spinal cord integrity, typically affecting the aged population. Emerging fMRI-based evidence suggests that the brain is also affected by CSM. This systematic review aimed to understand the usefulness of brain fMRI in CSM. A comprehensive literature search was conducted until March 2023 according to PRISMA guidelines. The inclusion criteria included original research articles in English, primarily studying the human brain's functional changes in CSM using fMRI with at least 5 participants. The extracted data from each study included demographics, disease severity, MRI machine characteristics, affected brain areas, functional changes, and clinical utilities. A total of 30 studies met the inclusion criteria. Among the fMRI methods, resting-state fMRI was the most widely used experimental paradigm, followed by motor tasks. The brain areas associated with motor control were most affected in CSM, followed by the superior frontal gyrus and occipital cortex. Functional changes in the brain were correlated to clinical metrics showing clinical utility. However, the evidence that a specific fMRI metric correlating with a clinical metric was "very low" to "insufficient" due to a low number of studies and negative results. In conclusion, fMRI can potentially facilitate the diagnosis of CSM by quantitatively interrogating the functional changes of the brain, particularly areas of the brain associated with motor control. However, this field is in its early stages, and more studies are needed to establish the usefulness of brain fMRI in CSM.
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Affiliation(s)
- Ali Fahim Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA.
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Christen O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Brynden Walker
- College of Arts and Sciences, University of Oklahoma, Norman, OK, USA
| | | | - Andriy Yabluchanskiy
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zachary Adam Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
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Wu Z, Feng K, Huang J, Ye X, Yang R, Huang Q, Jiang Q. Brain region changes following a spinal cord injury. Neurochem Int 2024; 174:105696. [PMID: 38354751 DOI: 10.1016/j.neuint.2024.105696] [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: 08/11/2023] [Revised: 01/16/2024] [Accepted: 02/10/2024] [Indexed: 02/16/2024]
Abstract
Brain-related complications are common in clinical practice after spinal cord injury (SCI); however, the molecular mechanisms of these complications are still unclear. Here, we reviewed the changes in the brain regions caused by SCI from three perspectives: imaging, molecular analysis, and electrophysiology. Imaging studies revealed abnormal functional connectivity, gray matter volume atrophy, and metabolic abnormalities in brain regions after SCI, leading to changes in the structure and function of brain regions. At the molecular level, chemokines, inflammatory factors, and damage-associated molecular patterns produced in the injured area were retrogradely transmitted through the corticospinal tract, cerebrospinal fluid, or blood circulation to the specific brain area to cause pathologic changes. Electrophysiologic recordings also suggested abnormal changes in brain electrical activity after SCI. Transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation alleviated pain and improved motor function in patients with SCI; therefore, transcranial therapy may be a new strategy for the treatment of patients with SCI.
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Affiliation(s)
- Zhiwu Wu
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Kaiming Feng
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Jinqing Huang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Xinyun Ye
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Ruijin Yang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Qianliang Huang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China.
| | - Qiuhua Jiang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China.
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Calderone A, Cardile D, De Luca R, Quartarone A, Corallo F, Calabrò RS. Brain Plasticity in Patients with Spinal Cord Injuries: A Systematic Review. Int J Mol Sci 2024; 25:2224. [PMID: 38396902 PMCID: PMC10888628 DOI: 10.3390/ijms25042224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
A spinal cord injury (SCI) causes changes in brain structure and brain function due to the direct effects of nerve damage, secondary mechanisms, and long-term effects of the injury, such as paralysis and neuropathic pain (NP). Recovery takes place over weeks to months, which is a time frame well beyond the duration of spinal shock and is the phase in which the spinal cord remains unstimulated below the level of injury and is associated with adaptations occurring throughout the nervous system, often referred to as neuronal plasticity. Such changes occur at different anatomical sites and also at different physiological and molecular biological levels. This review aims to investigate brain plasticity in patients with SCIs and its influence on the rehabilitation process. Studies were identified from an online search of the PubMed, Web of Science, and Scopus databases. Studies published between 2013 and 2023 were selected. This review has been registered on OSF under (n) 9QP45. We found that neuroplasticity can affect the sensory-motor network, and different protocols or rehabilitation interventions can activate this process in different ways. Exercise rehabilitation training in humans with SCIs can elicit white matter plasticity in the form of increased myelin water content. This review has demonstrated that SCI patients may experience plastic changes either spontaneously or as a result of specific neurorehabilitation training, which may lead to positive outcomes in functional recovery. Clinical and experimental evidence convincingly displays that plasticity occurs in the adult CNS through a variety of events following traumatic or non-traumatic SCI. Furthermore, efficacy-based, pharmacological, and genetic approaches, alone or in combination, are increasingly effective in promoting plasticity.
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Affiliation(s)
- Andrea Calderone
- Graduate School of Health Psychology, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
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He LW, Guo XJ, Zhao C, Rao JS. Rehabilitation Training after Spinal Cord Injury Affects Brain Structure and Function: From Mechanisms to Methods. Biomedicines 2023; 12:41. [PMID: 38255148 PMCID: PMC10813763 DOI: 10.3390/biomedicines12010041] [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: 11/01/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Spinal cord injury (SCI) is a serious neurological insult that disrupts the ascending and descending neural pathways between the peripheral nerves and the brain, leading to not only functional deficits in the injured area and below the level of the lesion but also morphological, structural, and functional reorganization of the brain. These changes introduce new challenges and uncertainties into the treatment of SCI. Rehabilitation training, a clinical intervention designed to promote functional recovery after spinal cord and brain injuries, has been reported to promote activation and functional reorganization of the cerebral cortex through multiple physiological mechanisms. In this review, we evaluate the potential mechanisms of exercise that affect the brain structure and function, as well as the rehabilitation training process for the brain after SCI. Additionally, we compare and discuss the principles, effects, and future directions of several rehabilitation training methods that facilitate cerebral cortex activation and recovery after SCI. Understanding the regulatory role of rehabilitation training at the supraspinal center is of great significance for clinicians to develop SCI treatment strategies and optimize rehabilitation plans.
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Affiliation(s)
- Le-Wei He
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; (L.-W.H.); (X.-J.G.)
| | - Xiao-Jun Guo
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; (L.-W.H.); (X.-J.G.)
| | - Can Zhao
- Institute of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing 100068, China
| | - Jia-Sheng Rao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; (L.-W.H.); (X.-J.G.)
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Functional connectivity and amplitude of low-frequency fluctuations changes in people with complete subacute and chronic spinal cord injury. Sci Rep 2022; 12:20874. [PMID: 36463248 PMCID: PMC9719483 DOI: 10.1038/s41598-022-25345-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
After spinal cord injury (SCI), reorganization processes and changes in brain connectivity occur. Besides the sensorimotor cortex, the subcortical areas are strongly involved in motion and executive control. This exploratory study focusses on the cerebellum and vermis. Resting-state functional magnetic resonance imaging (fMRI) was performed. Between-group differences were computed using analysis of covariance and post-hoc tests for the seed-based connectivity measure with vermis and cerebellum as regions of interest. Twenty participants with complete SCI (five subacute SCI, 15 with chronic SCI) and 14 healthy controls (HC) were included. Functional connectivity (FC) was lower in all subjects with SCI compared with HC in vermis IX, right superior frontal gyrus (pFDR = 0.008) and right lateral occipital cortex (pFDR = 0.036). In addition, functional connectivity was lower in participants with chronic SCI compared with subacute SCI in bilateral cerebellar crus I, left precentral- and middle frontal gyrus (pFDR = 0.001). Furthermore, higher amplitude of low-frequency fluctuations (ALFF) was found in the left thalamus in individuals with subacute SCI (pFDR = 0.002). Reduced FC in SCI indicates adaptation with associated deficit in sensory and motor function. The increased ALFF in subacute SCI might reflect reorganization processes in the subacute phase.
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Kumari R, Jarjees M, Susnoschi-Luca I, Purcell M, Vučković A. Effective Connectivity in Spinal Cord Injury-Induced Neuropathic Pain. SENSORS (BASEL, SWITZERLAND) 2022; 22:6337. [PMID: 36080805 PMCID: PMC9460641 DOI: 10.3390/s22176337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
AIM The aim of this study was to differentiate the effects of spinal cord injury (SCI) and central neuropathic pain (CNP) on effective connectivity during motor imagery of legs, where CNP is typically experienced. METHODS Multichannel EEG was recorded during motor imagery of the legs in 3 groups of people: able-bodied (N = 10), SCI with existing CNP (N = 10), and SCI with no CNP (N = 20). The last group was followed up for 6 months to check for the onset of CNP. Source reconstruction was performed to obtain cortical activity in 17 areas spanning sensorimotor regions and pain matrix. Effective connectivity was calculated using the directed transfer function in 4 frequency bands and compared between groups. RESULTS A total of 50% of the SCI group with no CNP developed CNP later. Statistically significant differences in effective connectivity were found between all groups. The differences between groups were not dependent on the frequency band. Outflows from the supplementary motor area were greater for the able-bodied group while the outflows from the secondary somatosensory cortex were greater for the SCI groups. The group with existing CNP showed the least differences from the able-bodied group, appearing to reverse the effects of SCI. The connectivities involving the pain matrix were different between able-bodied and SCI groups irrespective of CNP status, indicating their involvement in motor networks generally. SIGNIFICANCE The study findings might help guide therapeutic interventions targeted at the brain for CNP alleviation as well as motor recovery post SCI.
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Affiliation(s)
- Radha Kumari
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
| | - Mohammed Jarjees
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
- Medical Instrumentation Techniques Engineering Department, Northern Technical University, Mosul 41002, Iraq
| | - Ioana Susnoschi-Luca
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
| | - Mariel Purcell
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Aleksandra Vučković
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
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Heled E, Tal K, Zeilig G. Does lack of brain injury mean lack of cognitive impairment in traumatic spinal cord injury? J Spinal Cord Med 2022; 45:373-380. [PMID: 33320804 PMCID: PMC9135427 DOI: 10.1080/10790268.2020.1847564] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Traumatic spinal cord injury (tSCI) has implications in many areas, including cognitive functioning. Findings regarding cognitive problems in people with SCI are inconsistent, presumably due to multiple variables than can affect performance, among them emotional variables. The purpose of the current study was to elucidate cognitive sequalae in some individuals with tSCI with no medical record of brain injury, while taking emotional variables into consideration. DESIGN Cross-sectional, with two groups. SETTING A public rehabilitation center. PARTICIPANTS Twenty participants with tSCI at least ten months post injury and twenty non-SCI controls, matched for sex, age, and education. INTERVENTION None. OUTCOME MEASURES A battery of neuropsychological tests tapping executive functions, memory, attention, and naming abilities, in addition to questionnaires assessing depression and distress. RESULTS When emotional variables were statistically controlled, participants with tSCI showed higher levels of depression and distress and scored lower than non-SCI control participants on all cognitive tests except naming. Executive functions were found to have the highest effect size, though no specific ability was sensitive enough to differentiate between the groups in a binary logistic regression analysis. CONCLUSION In some individuals with chronic tSCI, lower cognitive ability that is unrelated to emotional distress might result from spinal cord damage and its implications in a population who's medical records show no indication of brain injury. This highlights the importance of conducting cognitive evaluation following SCI, so that deficits can be effectively addressed during rehabilitation.
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Affiliation(s)
- Eyal Heled
- Department of Psychology, Ariel University, Ariel, Israel,Department of Neurological Rehabilitation, Sheba Medical Center, Ramat-Gan, Israel,Correspondence to: Eyal Heled, Department of Psychology, Ariel University, Ariel, Israel; Ph: +972-502-310313; +972-3-9191437.
| | - Keren Tal
- Department of Psychology, Ariel University, Ariel, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Sheba Medical Center, Ramat-Gan, Israel,Department of Physical Medicine and Rehabilitation, Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Morita T, Hirose S, Kimura N, Takemura H, Asada M, Naito E. Hyper-Adaptation in the Human Brain: Functional and Structural Changes in the Foot Section of the Primary Motor Cortex in a Top Wheelchair Racing Paralympian. Front Syst Neurosci 2022; 16:780652. [PMID: 35498215 PMCID: PMC9039206 DOI: 10.3389/fnsys.2022.780652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/18/2022] [Indexed: 11/27/2022] Open
Abstract
The human brain has the capacity to drastically alter its somatotopic representations in response to congenital or acquired limb deficiencies and dysfunctions. The main purpose of the present study was to elucidate such extreme adaptability in the brain of an active top wheelchair racing Paralympian (participant P1) who has congenital paraplegia (dysfunction of bilateral lower limbs). Participant P1 has undergone long-term wheelchair racing training using bilateral upper limbs and has won a total of 19 medals in six consecutive summer Paralympic games as of 2021. We examined the functional and structural changes in the foot section of the primary motor cortex (M1) in participant P1 as compared to able-bodied control participants. We also examined the functional and structural changes in three other individuals (participants P2, P3, and P4) with acquired paraplegia, who also had long-term non-use period of the lower limbs and had undergone long-term training for wheelchair sports (but not top athletes at the level of participant P1). We measured brain activity in all the participants using functional magnetic resonance imaging (MRI) when bimanual wrist extension-flexion movement was performed, and the structural MRI images were collected. Compared to 37 control participants, participant P1 showed significantly greater activity in the M1 foot section during the bimanual task, and significant local GM expansion in this section. Significantly greater activity in the M1 foot section was also observed in participant P4, but not in P2 and P3, and the significant local GM expansion was observed in participant P2, but not in P3 and P4. Thus, functional or structural change was observed in an acquired paraplegic participant, but was not observed in all the paraplegic participants. The functional and structural changes typically observed in participant P1 may represent extreme adaptability of the human brain. We discuss the results in terms of a new idea of hyper-adaptation.
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Affiliation(s)
- Tomoyo Morita
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Osaka, Japan
- Graduate School of Frontier Biosciences, Osaka University, Osaka, Japan
| | - Satoshi Hirose
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Osaka, Japan
- Otemon Gakuin University, Faculty of Psychology, Osaka, Japan
| | - Nodoka Kimura
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Osaka, Japan
| | - Hiromasa Takemura
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Osaka, Japan
- Graduate School of Frontier Biosciences, Osaka University, Osaka, Japan
- Division of Sensory and Cognitive Brain Mapping, Department of System Neuroscience, National Institute for Physiological Sciences, Okazaki, Japan
- Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Kanagawa, Japan
| | - Minoru Asada
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Osaka, Japan
- Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Osaka, Japan
- International Professional University of Technology in Osaka, Osaka, Japan
| | - Eiichi Naito
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Osaka, Japan
- Graduate School of Frontier Biosciences, Osaka University, Osaka, Japan
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Differences in sensorimotor and functional recovery between the dominant and non-dominant upper extremity following cervical spinal cord injury. Spinal Cord 2022; 60:422-427. [PMID: 35273373 DOI: 10.1038/s41393-022-00782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Post hoc analysis of prospective multi-national, multi-centre cohort study. OBJECTIVE Determine whether cerebral dominance influences upper extremity recovery following cervical spinal cord injury (SCI). SETTING A multi-national subset of the longitudinal GRASSP dataset (n = 127). METHODS Secondary analysis of prospective, longitudinal multicenter study of individuals with cervical SCI (n = 73). Study participants were followed for up to 12 months after a cervical SCI, and the following outcome measures were serially assessed - the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) and the International Standards for the Neurological Classification of SCI (ISNCSCI), including upper extremity motor and sensory scores. Observed recovery and relative (percent) recovery were then determined for both the GRASSP and ISNCSCI, based on change from initial to last available assessment. RESULTS With the exception of prehension performance (quantitative grasping) following complete cervical SCI, there were no significant differences (p < 0.05) for observed and relative (percent) recovery, between the dominant and non-dominant upper extremities, as measured using GRASSP subtests, ISNCSCI motor scores and ISNCSCI sensory scores. CONCLUSION Despite well documented differences between the cerebral hemispheres, cerebral dominance appears to play a limited role in upper extremity recovery following acute cervical SCI.
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Leemhuis E, Giuffrida V, De Martino ML, Forte G, Pecchinenda A, De Gennaro L, Giannini AM, Pazzaglia M. Rethinking the Body in the Brain after Spinal Cord Injury. J Clin Med 2022; 11:jcm11020388. [PMID: 35054089 PMCID: PMC8780443 DOI: 10.3390/jcm11020388] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injuries (SCI) are disruptive neurological events that severly affect the body leading to the interruption of sensorimotor and autonomic pathways. Recent research highlighted SCI-related alterations extend beyond than the expected network, involving most of the central nervous system and goes far beyond primary sensorimotor cortices. The present perspective offers an alternative, useful way to interpret conflicting findings by focusing on the deafferented and deefferented body as the central object of interest. After an introduction to the main processes involved in reorganization according to SCI, we will focus separately on the body regions of the head, upper limbs, and lower limbs in complete, incomplete, and deafferent SCI participants. On one hand, the imprinting of the body’s spatial organization is entrenched in the brain such that its representation likely lasts for the entire lifetime of patients, independent of the severity of the SCI. However, neural activity is extremely adaptable, even over short time scales, and is modulated by changing conditions or different compensative strategies. Therefore, a better understanding of both aspects is an invaluable clinical resource for rehabilitation and the successful use of modern robotic technologies.
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Affiliation(s)
- Erik Leemhuis
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Valentina Giuffrida
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Maria Luisa De Martino
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Giuseppe Forte
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (M.P.); Tel.: +39-6-49917633 (M.P.)
| | - Anna Pecchinenda
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Anna Maria Giannini
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
| | - Mariella Pazzaglia
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (M.P.); Tel.: +39-6-49917633 (M.P.)
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11
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Tazoe T, Perez MA. Abnormal changes in motor cortical maps in humans with spinal cord injury. J Physiol 2021; 599:5031-5045. [PMID: 34192806 PMCID: PMC9109877 DOI: 10.1113/jp281430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The functional role of motor cortical reorganization following spinal cord injury (SCI) remains largely unknown. Here, we tested motor maps in a hand muscle at rest and during voluntary contraction of the hand with and without voluntary contraction of a proximal arm muscle. Motor map area in participants with SCI decreased during hand voluntary contraction and further decreased during additional contraction of a proximal arm muscle compared with rest. In contrast, motor map area in controls increased during the same motor tasks. Participants with SCI with more severe sensory deficits in the hand showed larger decreases in motor map area. Ten minutes of hand muscle-tendon vibration increased the motor map area during voluntary contraction in SCI participants. These novel findings suggest that abnormal changes in motor cortical maps during voluntary contraction after SCI can be reshaped by sensory input, knowledge that can have implications for rehabilitation. ABSTRACT Motor cortical representations reorganize following cervical spinal cord injury (SCI). The functional role of this reorganization remains largely unknown. Using neuronavigated transcranial magnetic stimulation, we examined motor cortical maps during voluntary contraction in humans with chronic cervical SCI and age-matched controls. We constructed motor maps in the first dorsal interosseous (FDI) muscle at rest and during voluntary contraction of the FDI with and without voluntary contraction of the biceps brachi (BB). The role of sensory input into this reorganization was examined by muscle-tendon vibration. We found that, at rest, motor maps were larger in SCI (22.3 cm2 ) compared with control (12.6 cm2 , P < 0.001) participants. Motor map area increased during voluntary contraction of the FDI (120.7%) and further increased during contraction of the BB (143.9%) compared with rest in control subjects; however, motor map area decreased during voluntary contraction of the FDI (69.5%) and further decreased during contraction of the BB (55.5%) in individuals with SCI. SCI participants with larger decreases in map area during voluntary contraction of the FDI were those with larger sensory deficits in the hand and 10 min of hand muscle-tendon vibration increased motor map area. These results provide the first evidence of abnormal changes in motor cortical maps in humans with chronic SCI during voluntary contraction, suggesting that sensory input can help to reshape this reorganization.
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Affiliation(s)
- Toshiki Tazoe
- Arms + Hands Lab, Shirley Ryan AbilityLab, Northwestern
University, Chicago, IL 60611 and Hines Veterans Affairs Medical Center, Chicago, IL
60141, USA
- Neural Prosthesis Project, Department of Brain and
Neurosciences, Tokyo Metropolitan Institute of Medial Science, Tokyo 156-8506,
Japan
| | - Monica A. Perez
- Arms + Hands Lab, Shirley Ryan AbilityLab, Northwestern
University, Chicago, IL 60611 and Hines Veterans Affairs Medical Center, Chicago, IL
60141, USA
- The Miami Project to Cure Paralysis, Department of
Neurological Surgery, University of Miami, Miami FL 33136 and Bruce W. Carter
Department of Veterans Affairs Medical Center, Miami, FL 33125, USA
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12
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Begenisic T, Pavese C, Aiachini B, Nardone A, Rossi D. Dynamics of biomarkers across the stages of traumatic spinal cord injury - implications for neural plasticity and repair. Restor Neurol Neurosci 2021; 39:339-366. [PMID: 34657853 DOI: 10.3233/rnn-211169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is a complex medical condition causing significant physical disability and psychological distress. While the adult spinal cord is characterized by poor regenerative potential, some recovery of neurological function is still possible through activation of neural plasticity mechanisms. We still have limited knowledge about the activation of these mechanisms in the different stages after human SCI. OBJECTIVE In this review, we discuss the potential role of biomarkers of SCI as indicators of the plasticity mechanisms at work during the different phases of SCI. METHODS An extensive review of literature related to SCI pathophysiology, neural plasticity and humoral biomarkers was conducted by consulting the PubMed database. Research and review articles from SCI animal models and SCI clinical trials published in English until January 2021 were reviewed. The selection of candidates for humoral biomarkers of plasticity after SCI was based on the following criteria: 1) strong evidence supporting involvement in neural plasticity (mandatory); 2) evidence supporting altered expression after SCI (optional). RESULTS Based on selected findings, we identified two main groups of potential humoral biomarkers of neural plasticity after SCI: 1) neurotrophic factors including: Brain derived neurotrophic factor (BDNF), Nerve growth factor (NGF), Neurotrofin-3 (NT-3), and Insulin-like growth factor 1 (IGF-1); 2) other factors including: Tumor necrosis factor-alpha (TNF-α), Matrix Metalloproteinases (MMPs), and MicroRNAs (miRNAs). Plasticity changes associated with these biomarkers often can be both adaptive (promoting functional improvement) and maladaptive. This dual role seems to be influenced by their concentrations and time-window during SCI. CONCLUSIONS Further studies of dynamics of biomarkers across the stages of SCI are necessary to elucidate the way in which they reflect the remodeling of neural pathways. A better knowledge about the mechanisms underlying plasticity could guide the selection of more appropriate therapeutic strategies to enhance positive spinal network reorganization.
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Affiliation(s)
- Tatjana Begenisic
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Pavese
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Beatrice Aiachini
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Antonio Nardone
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
| | - Daniela Rossi
- Laboratory for Research on Neurodegenerative Disorders, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
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13
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Vastano R, Costantini M, Widerstrom-Noga E. Maladaptive reorganization following SCI: The role of body representation and multisensory integration. Prog Neurobiol 2021; 208:102179. [PMID: 34600947 DOI: 10.1016/j.pneurobio.2021.102179] [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: 02/15/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
In this review we focus on maladaptive brain reorganization after spinal cord injury (SCI), including the development of neuropathic pain, and its relationship with impairments in body representation and multisensory integration. We will discuss the implications of altered sensorimotor interactions after SCI with and without neuropathic pain and possible deficits in multisensory integration and body representation. Within this framework we will examine published research findings focused on the use of bodily illusions to manipulate multisensory body representation to induce analgesic effects in heterogeneous chronic pain populations and in SCI-related neuropathic pain. We propose that the development and intensification of neuropathic pain after SCI is partly dependent on brain reorganization associated with dysfunctional multisensory integration processes and distorted body representation. We conclude this review by suggesting future research avenues that may lead to a better understanding of the complex mechanisms underlying the sense of the body after SCI, with a focus on cortical changes.
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Affiliation(s)
- Roberta Vastano
- University of Miami, Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL, USA.
| | - Marcello Costantini
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies, ITAB, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Eva Widerstrom-Noga
- University of Miami, Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL, USA.
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14
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Cronin AE, Detombe SA, Duggal CA, Duggal N, Bartha R. Spinal cord compression is associated with brain plasticity in degenerative cervical myelopathy. Brain Commun 2021; 3:fcab131. [PMID: 34396102 PMCID: PMC8361426 DOI: 10.1093/braincomms/fcab131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
The impact of spinal cord compression severity on brain plasticity and prognostic determinates is not yet fully understood. We investigated the association between the severity of spinal cord compression in patients with degenerative cervical myelopathy, a progressive disease of the spine, and functional plasticity in the motor cortex and subcortical areas using functional magnetic resonance imaging. A 3.0 T MRI scanner was used to acquire functional images of the brain in 23 degenerative cervical myelopathy patients. Patients were instructed to perform a structured finger-tapping task to activate the motor cortex to assess the extent of cortical activation. T2-weighted images of the brain and spine were also acquired to quantify the severity of spinal cord compression. The observed blood oxygen level-dependent signal increase in the contralateral primary motor cortex was associated with spinal cord compression severity when patients tapped with their left hand (r = 0.49, P = 0.02) and right hand (r = 0.56, P = 0.005). The volume of activation in the contralateral primary motor cortex also increased with spinal cord compression severity when patients tapped with their left hand (r = 0.55, P = 0.006) and right hand (r = 0.45, P = 0.03). The subcortical areas (cerebellum, putamen, caudate and thalamus) also demonstrated a significant relationship with compression severity. It was concluded that degenerative cervical myelopathy patients with severe spinal cord compression recruit larger regions of the motor cortex to perform finger-tapping tasks, which suggests that this adaptation is a compensatory response to neurological injury and tissue damage in the spinal cord.
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Affiliation(s)
- Alicia E Cronin
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada.,Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Sarah A Detombe
- Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario N6A 5A5, Canada
| | - Camille A Duggal
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Neil Duggal
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada.,Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario N6A 5A5, Canada
| | - Robert Bartha
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada.,Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canada
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15
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Chiaravalloti ND, Weber E, Wylie G, Dyson-Hudson T, Wecht JM. The impact of level of injury on patterns of cognitive dysfunction in individuals with spinal cord injury. J Spinal Cord Med 2020; 43:633-641. [PMID: 31859606 PMCID: PMC7534192 DOI: 10.1080/10790268.2019.1696076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context: While it is well recognized that physical and physiological changes are more prominent in individuals with higher neurologic levels of spinal cord injury (SCI), the impact of level of lesion on cognition is less clear. Design: Cross-sectional, 3-group. Setting: Non-profit rehabilitation research foundation. Participants: 59 individuals with SCI (30 with tetraplegia, 29 with paraplegia) and 30 age-matched healthy controls (HC). Interventions: None. Outcome Measures: Neuropsychological tests in the domains of attention, working memory, processing speed, executive control, and learning and memory. Results: Results indicated significantly lower test performance in individuals with paraplegia on new learning and memory testing compared to HC. In contrast, compared to HC the group with tetraplegia, showed a significantly impaired performance on a processing speed task, and both the tetraplegia and the paraplegia groups were similarly impaired on a verbal fluency measure. SCI groups did not differ on any cognitive measure. Conclusion: Individuals with SCI may display different patterns of cognitive performance based on their level of injury.
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Affiliation(s)
- Nancy D. Chiaravalloti
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - Erica Weber
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - Glenn Wylie
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - Trevor Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-NJ Medical School, Newark, New Jersey, USA
| | - Jill M. Wecht
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York, USA
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
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16
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Scandola M, Aglioti SM, Lazzeri G, Avesani R, Ionta S, Moro V. Visuo-motor and interoceptive influences on peripersonal space representation following spinal cord injury. Sci Rep 2020; 10:5162. [PMID: 32198431 PMCID: PMC7083926 DOI: 10.1038/s41598-020-62080-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
Peripersonal space (PPS) representation is modulated by information coming from the body. In paraplegic individuals, whose lower limb sensory-motor functions are impaired or completely lost, the representation of PPS around the feet is reduced. However, passive motion can have short-term restorative effects. What remains unclear is the mechanisms underlying this recovery, in particular with regard to the contribution of visual and motor feedback and of interoception. Using virtual reality technology, we dissociated the motor and visual feedback during passive motion in paraplegics with complete and incomplete lesions and in healthy controls. The results show that in the case of paraplegics, the presence of motor feedback was necessary for the recovery of PPS representation, both when the motor feedback was congruent and when it was incongruent with the visual feedback. In contrast, visuo-motor incongruence led to an inhibition of PPS representation in the control group. There were no differences in sympathetic responses between the three groups. Nevertheless, in individuals with incomplete lesions, greater interoceptive sensitivity was associated with a better representation of PPS around the feet in the visuo-motor incongruent conditions. These results shed new light on the modulation of PPS representation, and demonstrate the importance of residual motor feedback and its integration with other bodily information in maintaining space representation.
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Affiliation(s)
- Michele Scandola
- NPSY-Lab.VR, Department of Human Sciences, University of Verona, Verona, Italy. .,IRCCS, Fondazione Santa Lucia, Rome, Italy.
| | - Salvatore Maria Aglioti
- IRCCS, Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, University of Rome "Sapienza", Rome, Italy.,Istituto Italiano di Tecnologia, Rome, Italy
| | | | - Renato Avesani
- Department of Rehabilitation, IRCSS Sacro Cuore - Don Calabria Hospital, Verona, Italy
| | - Silvio Ionta
- Sensory-Motor Lab (SeMoLa), Department of Ophthalmology-University of Lausanne, Jules Gonin Eye; Hospital-Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Valentina Moro
- NPSY-Lab.VR, Department of Human Sciences, University of Verona, Verona, Italy
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17
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Abstract
A spinal cord injury (SCI) may result in impairments of motor, sensory, and autonomous functions below the injury level. Worldwide, the prevalence of SCI is 1:1000 and the incidence is between 4 and 9 new cases per 100,000 people per year. Most common causes for traumatic SCI are traffic accidents, falls, and violence. Nowadays, the proportion of patients with tetraplegia and paraplegia is equal. In industrialized countries, the percentage of nontraumatic injuries increases together with age. Most patients with initially preserved motor functions below the injury level show a substantial functional recovery, while three quarters of patients with initially complete SCI remain that way. In SCI, brain-computer interfaces (BCIs) may be used in the subacute phase as part of a restorative therapy program and, later, for control of assistive devices most needed by individuals with high cervical lesions. Research on structural and functional reorganization of the deefferented and deafferented brain after SCI is inconclusive mainly because of varying methods of analysis and the heterogeneity of the investigated populations. A better characterization of study participants with SCI together with documentation of confounding factors such as antispasticity medication or neuropathic pain is indicated.
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Affiliation(s)
- Rüdiger Rupp
- Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.
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18
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Leemhuis E, De Gennaro L, Pazzaglia M. Disconnected Body Representation: Neuroplasticity Following Spinal Cord Injury. J Clin Med 2019; 8:jcm8122144. [PMID: 31817187 PMCID: PMC6947607 DOI: 10.3390/jcm8122144] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023] Open
Abstract
Neuroplastic changes in somatotopic organization within the motor and somatosensory systems have long been observed. The interruption of afferent and efferent brain–body pathways promotes extensive cortical reorganization. Changes are majorly related to the typical homuncular organization of sensorimotor areas and specific “somatotopic interferences”. Recent findings revealed a relevant peripheral contribution to the plasticity of body representation in addition to the role of sensorimotor cortices. Here, we review the ways in which structures and brain mechanisms react to missing or critically altered sensory and motor peripheral signals. We suggest that these plastic events are: (i) variably affected across multiple timescales, (ii) age-dependent, (iii) strongly related to altered perceptual sensations during and after remapping of the deafferented peripheral area, and (iv) may contribute to the appearance of secondary pathological conditions, such as allodynia, hyperalgesia, and neuropathic pain. Understanding the considerable complexity of plastic reorganization processes will be a fundamental step in the formulation of theoretical and clinical models useful for maximizing rehabilitation programs and resulting recovery.
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Affiliation(s)
- Erik Leemhuis
- Department of Psychology, University of Rome “La Sapienza”, Via dei Marsi 78, 00185 Rome, Italy;
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (E.L.); (M.P.)
| | - Luigi De Gennaro
- Department of Psychology, University of Rome “La Sapienza”, Via dei Marsi 78, 00185 Rome, Italy;
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Mariella Pazzaglia
- Department of Psychology, University of Rome “La Sapienza”, Via dei Marsi 78, 00185 Rome, Italy;
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (E.L.); (M.P.)
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19
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miR-21 deficiency contributes to the impaired protective effects of obese rat mesenchymal stem cell-derived exosomes against spinal cord injury. Biochimie 2019; 167:171-178. [PMID: 31605737 DOI: 10.1016/j.biochi.2019.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
Abstract
The therapeutic effect of stem cell transplantation in traumatic spinal cord injury (SCI) has been extensively studied these days, and evidence has shown that stem cell-derived exosomes and exosome-shuttled miRNA (e.g. miR-21) contribute to the protective effects of stem cell transplantation against SCI. It has been reported that obesity, a prevalent metabolic disorder, reshapes stem cells and their extracellular vesicles. However, the effects of exosomes derived from obese rat stem cells on SCI and its underlying mechanism remain unknown. Here, we examined the effects of exosomes derived from obese rat mesenchymal stem cells (MSCs) on SCI, and tested the role of miR-21 in their effects. We found that exosomes derived from obese rat MSCs showed decreased miR-21 levels and did not exert protective effects against SCI. Overexpression of miR-21 in obese rat MSCs restored the protective effects of exosomes purified from obese rat MSCs against SCI. In addition, obese rat MSCs showed insulin resistance, and MSC insulin resistance decreased miR-21 levels in its secreted exosomes. These results suggested that miR-21 deficiency in obese rat MSCs contributes to the impaired protective effects of obese rat MSCs-derived exosomes against SCI, and further reinforced the notion that miR-21 is a potential molecule for treatment of SCI.
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20
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Costa-García A, Iáñez E, del-Ama A, Gil-Agudo A, Azorín J. EEG model stability and online decoding of attentional demand during gait using gamma band features. Neurocomputing 2019. [DOI: 10.1016/j.neucom.2019.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression. Eur Radiol 2019; 30:357-369. [DOI: 10.1007/s00330-019-06352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
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22
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Galli G, Lenggenhager B, Scivoletto G, Giannini AM, Pazzaglia M. "My friend, the pain": does altered body awareness affect the valence of pain descriptors? J Pain Res 2019; 12:1721-1732. [PMID: 31213884 PMCID: PMC6549758 DOI: 10.2147/jpr.s191548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Pain is a marker of bodily status, that despite being aversive under most conditions, may also be perceived as a positive experience. However, how bodily states represent, define, and interpret pain signals, and how these processes might be reflected in common language, remains unclear. Methods: Qualitative and quantitative methods were used to explore the relationship between bodily awareness, pain reactions, and descriptions. A list of pain-related terms was generated from open-ended interviews with persons with spinal cord injury (SCI), and 138 participants (persons with SCI, health professionals, and a healthy control group) rated each descriptor as representative of pain on a gradated scale. A lexical decision task was used to test the strength of the automatic association of the word “pain” with positive and negative concepts. The behavioral results were related to body awareness, experience of pain, and exposure to pain, by comparing the three groups. Results: Higher positive and lower negative pain descriptors, as well as slower response times when categorizing pain as an unpleasant experience were found in the SCI group. The effect was not modulated by either the time since the injury or the present pain intensity, but it was linked to the level of subjective bodily awareness. Compared with the SCI group, health experts and non-experts both associated more quickly the word “pain” and unpleasant in the lexical decision task. However, while health professionals attributed positive linguistic qualities to pain, pain was exclusively associated with negative descriptors in healthy controls group. Conclusions: These findings are discussed in terms of their theoretical and clinical implications. An awareness of bodily signals prominently affects both the sensory and linguistic responses in persons with SCI. Pain should be evaluated more broadly to understand and, by extension, to manage, experiences beyond its adverse side.
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Affiliation(s)
- G Galli
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - B Lenggenhager
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - A M Giannini
- Dipartimento di Psicologia, University of Rome 'La Sapienza', Rome, Italy
| | - M Pazzaglia
- IRCCS Fondazione Santa Lucia, Rome, Italy.,Dipartimento di Psicologia, University of Rome 'La Sapienza', Rome, Italy
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23
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Wang W, Tang S, Li C, Chen J, Li H, Su Y, Ning B. Specific Brain Morphometric Changes in Spinal Cord Injury: A Voxel-Based Meta-Analysis of White and Gray Matter Volume. J Neurotrauma 2019; 36:2348-2357. [PMID: 30794041 DOI: 10.1089/neu.2018.6205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The objective of the study was to investigate degenerative changes of white matter volume (WMV) and gray matter volume (GMV) in individuals after a spinal cord injury (SCI). Published studies of whole-brain voxel-based morphometry (VBM) published between January 1, 2006 and March 1, 2018 comparing SCI patients with controls were collected by searching PubMed, Web of Science, and EMBASE databases. Voxel-wise meta-analyses of GMV and WMV differences between SCI patients and controls were performed separately using seed-based d mapping. Twelve studies with 12 GMV data sets and 9 WMV data sets yielded a total of 466 individuals (190 SCI patients and 276 controls) who were included in this meta-analysis. Compared with controls, SCI patients showed GMV atrophy in sensorimotor system regions including the bilateral sensorimotor cortex (S1 and M1), the supplementary motor area (SMA), paracentral gyrus, thalamus, and basal ganglia, as well as WMV loss in the corticospinal tract.GMV aberrancies were also demonstrated in brain regions responsible for cognition and emotion, such as the orbitofrontal cortex (OFC) and the left insula. Additionally, GMV in both the bilateral S1 and the left SMA was positively correlated with the time span after the injury. In conclusion, anatomical atrophy in cortical-thalamic-spinal pathways suggested that SCIs may result in degenerative changes of the sensorimotor system. Further, OFC and insula GMV abnormalities may explain symptoms such as neuropathic pain and potential cognitive-emotional impairments in chronic SCI patients. These findings indicate that anatomical brain magnetic resonance imaging (MRI) protocols could be neuroimaging biomarkers for interventional studies and treatments.
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Affiliation(s)
- Wenzhao Wang
- 1Department of Orthopedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China.,2Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Tang
- 3Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Cong Li
- 4Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jianan Chen
- 1Department of Orthopedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Hongfei Li
- 1Department of Orthopedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Yanlin Su
- 1Department of Orthopedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Bin Ning
- 1Department of Orthopedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
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24
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Karunakaran KD, He J, Zhao J, Cui JL, Zang YF, Zhang Z, Biswal BB. Differences in Cortical Gray Matter Atrophy of Paraplegia and Tetraplegia after Complete Spinal Cord Injury. J Neurotrauma 2019; 36:2045-2051. [PMID: 30430910 DOI: 10.1089/neu.2018.6040] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Anatomical studies of spinal cord injury (SCI) using magnetic resonance imaging (MRI) report diverging observations, from "no changes" to "tissue atrophy in motor and non-motor regions." These discrepancies among studies can be attributed to heterogeneity in extent, level, and post-injury duration observed within the SCI population. But, no studies have investigated structural changes associated with different levels of injury (paraplegia vs. tetraplegia). High-resolution MRI images were processed using a voxel-based morphometry technique to compare regional gray matter volume (GMV) between 16 complete paraplegia and 7 complete tetraplegia SCI subjects scanned within 2 years of injury when compared to 22 age-matched healthy controls using one-way analysis of covariance (ANCOVA). A post-hoc analysis using a region of interest-based approach was utilized to quantify GMV differences between healthy controls and subgroups of SCI. A voxel-wise one-sample t-test was also performed to evaluate the mean effect of post-injury duration on GMV of the SCI group. ANCOVA resulted in altered GMV in inferior frontal gyrus, bilateral mid orbital gyrus extending to rectal gyrus, and anterior cingulate cortex. Post-hoc analysis, in general, indicated GM atrophy after SCI, but tetraplegia showed a greater decrease in GMV when compared to paraplegia and healthy controls. Further, the GMV of the middle frontal gyrus, superior frontal gyrus, inferior frontal gyrus, insula, mid-orbital gyrus, and middle temporal gyrus was positively correlated with post-injury duration in both paraplegia and tetraplegia groups. GM atrophy after SCI is affected by level of cord injury, with higher levels of injury resulting in greater loss of GMV. Magnitude of GMV loss in the frontal cortex after SCI also appears to be dynamic within the first 2 years of injury. Understanding the effect of injury level and injury duration on structural changes after SCI can help to better understand the mechanisms leading to positive and negative clinical outcome in SCI patients.
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Affiliation(s)
| | - Jie He
- 2 Hebei Medical University, Third Affiliated Hospital, Shijiazhuang, China
| | - Jian Zhao
- 3 Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan, China
| | - Jian-Ling Cui
- 2 Hebei Medical University, Third Affiliated Hospital, Shijiazhuang, China
| | - Yu-Feng Zang
- 4 Hangzhou Normal University Affiliated Hospital, Center for Cognition and Brain Disorders, Hangzhou, China
| | - Zhong Zhang
- 2 Hebei Medical University, Third Affiliated Hospital, Shijiazhuang, China
| | - Bharat B Biswal
- 1 Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
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25
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Keyl P, Schneiders M, Schuld C, Franz S, Hommelsen M, Weidner N, Rupp R. Differences in Characteristics of Error-Related Potentials Between Individuals With Spinal Cord Injury and Age- and Sex-Matched Able-Bodied Controls. Front Neurol 2019; 9:1192. [PMID: 30766510 PMCID: PMC6365444 DOI: 10.3389/fneur.2018.01192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Non-invasive brain-computer interfaces (BCI) represent an emerging technology for enabling persons with impaired or lost grasping and reaching functions due to high spinal cord injury (SCI) to control assistive devices. A major drawback of BCIs is a high rate of false classifications. The robustness and performance of BCIs might be improved using cerebral electrophysiological correlates of error recognition (error-related potentials, ErrPs). As ErrPs have never been systematically examined in subjects with SCI, this study compares the characteristics of ErrPs in individuals with SCI with those of able-bodied control subjects. Methods: ErrPs at FCz and Cz were analyzed in 11 subjects with SCI (9 male, median age 28 y) and in 11 sex- and age-matched controls. Moving a shoulder joystick according to a visual cue, subjects received feedback about the match/mismatch of the performed movement. ErrPs occurring after "error"-feedback were evaluated by comparing means of voltage values within three consecutive time windows after feedback (wP1, wN1, wP2 containing peak voltages P1, N1, P2) using repeated-measurement analysis of variance. Results: In the control group, mean voltage values for the "error" and "correct" feedback condition differed significantly around N1 (FCz: 254 ms, Cz: 252 ms) and P2 (FCz: 347 ms, Cz: 345 ms), but not around P1 (FCz: 181 ms, Cz: 179 ms). ErrPs of the control and the SCI group showed similar morphology, however mean amplitudes of ErrPs were significantly smaller in individuals with SCI compared to controls for wN1 (FCz: control = -1.55 μV, SCI = -0.27 μV, p = 0.02; Cz: control = -1.03 μV, SCI = 0.11 μV, p = 0.04) and wP2 (FCz: control = 2.79 μV, SCI = 1.29 μV, p = 0.011; Cz: control = 2.12 μV, SCI = 0.81 μV, p = 0.003). Mean voltage values in wP1, wN1, and wP2 did not correlate significantly with either chronicity after or level of injury. Conclusion: The morphology of ErrPs in subjects with and without SCI is comparable, however, with reduced mean amplitude in wN1 and wP2 in the SCI group. Further studies should evaluate whether ErrP-classification can be used for online correction of false BCI-commands in individuals with SCI.
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Affiliation(s)
- Philipp Keyl
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Schneiders
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Nobert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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26
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Filipp ME, Travis BJ, Henry SS, Idzikowski EC, Magnuson SA, Loh MY, Hellenbrand DJ, Hanna AS. Differences in neuroplasticity after spinal cord injury in varying animal models and humans. Neural Regen Res 2019; 14:7-19. [PMID: 30531063 PMCID: PMC6263009 DOI: 10.4103/1673-5374.243694] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rats have been the primary model to study the process and underlying mechanisms of recovery after spinal cord injury. Two weeks after a severe spinal cord contusion, rats can regain weight-bearing abilities without therapeutic interventions, as assessed by the Basso, Beattie and Bresnahan locomotor scale. However, many human patients suffer from permanent loss of motor function following spinal cord injury. While rats are the most understood animal model, major differences in sensorimotor pathways between quadrupeds and bipeds need to be considered. Understanding the major differences between the sensorimotor pathways of rats, non-human primates, and humans is a start to improving targets for treatments of human spinal cord injury. This review will discuss the neuroplasticity of the brain and spinal cord after spinal cord injury in rats, non-human primates, and humans. A brief overview of emerging interventions to induce plasticity in humans with spinal cord injury will also be discussed.
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Affiliation(s)
- Mallory E Filipp
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Benjamin J Travis
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Stefanie S Henry
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Emma C Idzikowski
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Sarah A Magnuson
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Megan Yf Loh
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | | | - Amgad S Hanna
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
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27
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Fassett HJ, Turco CV, El-Sayes J, Nelson AJ. Alterations in Motor Cortical Representation of Muscles Following Incomplete Spinal Cord Injury in Humans. Brain Sci 2018; 8:E225. [PMID: 30558361 PMCID: PMC6316395 DOI: 10.3390/brainsci8120225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 12/03/2022] Open
Abstract
(1) Background: The primary motor cortex (M1) experiences reorganization following spinal cord injury (SCI). However, there is a paucity of research comparing bilateral M1 organization in SCI and questions remain to be answered. We explored the presence of somatotopy within the M1 representation of arm muscles, and determined whether anatomical shifts in these representations occur, and investigated the symmetry in organization between the two hemispheres.; (2) Methods: Transcranial magnetic stimulation (TMS) was used to map the representation of the biceps, flexor carpi radialis and abductor pollicis brevis (APB) bilaterally in nine individuals with chronic incomplete cervical spinal cord injury and nine aged- and handed-matched uninjured controls. TMS was delivered over a 6 × 5 point grid that encompassed M1 using an intensity specific to the resting motor threshold for each muscle tested.; (3) Results: Results indicate that, compared to controls, muscle representations in SCI are shifted medially but preserve a general somatotopic arrangement, and that territory dedicated to the APB muscle is greater.; (4) Conclusions: These findings demonstrate differences in the organization of M1 between able-bodied controls and those with incomplete cervical SCI. This altered organization may have future implications in understanding the functional deficits observed in SCI and rehabilitation techniques aimed at restoring function.
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Affiliation(s)
- Hunter J Fassett
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Claudia V Turco
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Jenin El-Sayes
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.
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28
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Gant K, Guerra S, Zimmerman L, Parks BA, Prins NW, Prasad A. EEG-controlled functional electrical stimulation for hand opening and closing in chronic complete cervical spinal cord injury. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aabb13] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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29
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Chao ZC, Sawada M, Isa T, Nishimura Y. Dynamic Reorganization of Motor Networks During Recovery from Partial Spinal Cord Injury in Monkeys. Cereb Cortex 2018; 29:3059-3073. [DOI: 10.1093/cercor/bhy172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/28/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
After spinal cord injury (SCI), the motor-related cortical areas can be a potential substrate for functional recovery in addition to the spinal cord. However, a dynamic description of how motor cortical circuits reorganize after SCI is lacking. Here, we captured the comprehensive dynamics of motor networks across SCI in a nonhuman primate model. Using electrocorticography over the sensorimotor areas in monkeys, we collected broadband neuronal signals during a reaching-and-grasping task at different stages of recovery of dexterous finger movements after a partial SCI at the cervical levels. We identified two distinct network dynamics: grasping-related intrahemispheric interactions from the contralesional premotor cortex (PM) to the contralesional primary motor cortex (M1) in the high-γ band (>70 Hz), and motor-preparation-related interhemispheric interactions from the contralesional to ipsilesional PM in the α and low-β bands (10–15 Hz). The strengths of these networks correlated to the time course of behavioral recovery. The grasping-related network showed enhanced activation immediately after the injury, but gradually returned to normal while the strength of the motor-preparation-related network gradually increased. Our findings suggest a cortical compensatory mechanism after SCI, where two interdependent motor networks redirect activity from the contralesional hemisphere to the other hemisphere to facilitate functional recovery.
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Affiliation(s)
- Zenas C Chao
- Department of Neuroscience, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Developmental Physiology, National Institute for Physiological Sciences, Okazaki, Japan
| | - Masahiro Sawada
- Department of Developmental Physiology, National Institute for Physiological Sciences, Okazaki, Japan
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadashi Isa
- Department of Neuroscience, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Developmental Physiology, National Institute for Physiological Sciences, Okazaki, Japan
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukio Nishimura
- Department of Neuroscience, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Developmental Physiology, National Institute for Physiological Sciences, Okazaki, Japan
- Neural Prosthesis Project, Department of Dementia and Higher Brain Function, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
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30
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Mohammed H, Hollis ER. Cortical Reorganization of Sensorimotor Systems and the Role of Intracortical Circuits After Spinal Cord Injury. Neurotherapeutics 2018; 15:588-603. [PMID: 29882081 PMCID: PMC6095783 DOI: 10.1007/s13311-018-0638-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The plasticity of sensorimotor systems in mammals underlies the capacity for motor learning as well as the ability to relearn following injury. Spinal cord injury, which both deprives afferent input and interrupts efferent output, results in a disruption of cortical somatotopy. While changes in corticospinal axons proximal to the lesion are proposed to support the reorganization of cortical motor maps after spinal cord injury, intracortical horizontal connections are also likely to be critical substrates for rehabilitation-mediated recovery. Intrinsic connections have been shown to dictate the reorganization of cortical maps that occurs in response to skilled motor learning as well as after peripheral injury. Cortical networks incorporate changes in motor and sensory circuits at subcortical or spinal levels to induce map remodeling in the neocortex. This review focuses on the reorganization of cortical networks observed after injury and posits a role of intracortical circuits in recovery.
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Affiliation(s)
- Hisham Mohammed
- Burke Neurological Institute, 785 Mamaroneck Avenue, White Plains, NY, 10605, USA
| | - Edmund R Hollis
- Burke Neurological Institute, 785 Mamaroneck Avenue, White Plains, NY, 10605, USA.
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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31
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Solstrand Dahlberg L, Becerra L, Borsook D, Linnman C. Brain changes after spinal cord injury, a quantitative meta-analysis and review. Neurosci Biobehav Rev 2018; 90:272-293. [DOI: 10.1016/j.neubiorev.2018.04.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/21/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022]
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32
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Rocca MA, Savoldi F, Valsasina P, Radaelli M, Preziosa P, Comi G, Falini A, Filippi M. Cross-modal plasticity among sensory networks in neuromyelitis optica spectrum disorders. Mult Scler 2018; 25:968-979. [PMID: 29771186 DOI: 10.1177/1352458518778008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore resting-state (RS) functional connectivity (FC) of the main sensory/motor networks of patients with neuromyelitis optica spectrum disorders (NMOSDs), clinically isolated optic neuritis (ON), and myelitis. METHODS Clinical evaluation and RS fMRI were obtained from 28 NMOSD, 11 recurrent ON, and 12 recurrent myelitis patients and 30 healthy controls. Between-group RS FC comparisons and correlations with motor performance were assessed (SPM12) on the main sensory/motor RS networks (RSNs) identified by independent component analysis. Functional network connectivity analysis estimated inter-network connectivity. RESULTS Intra- and inter-network RS FCs were reduced in RSNs associated to somatosensory modalities affected by pathology: regions of the primary visual network in ON patients, of the sensorimotor networks in myelitis patients, and of the sensorimotor and secondary visual networks in NMOSD patients. The opposite trend was observed in regions of RSNs spared by pathology: the auditory and part of visual networks in NMOSD, the secondary visual and sensorimotor networks in ON, and the primary visual network in myelitis patients. Better motor performance correlated with higher RS FC of spared RSNs. CONCLUSION Sensory and motor RSN abnormalities occur in NMOSD. Loss of function within disease-target networks may elicit cross-modal plasticity across sensory networks potentially preserving clinical function.
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Affiliation(s)
- Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Savoldi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Radaelli
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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33
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Pazzaglia M, Haggard P, Scivoletto G, Molinari M, Lenggenhager B. Pain and somatic sensation are transiently normalized by illusory body ownership in a patient with spinal cord injury. Restor Neurol Neurosci 2018; 34:603-13. [PMID: 27080071 DOI: 10.3233/rnn-150611] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Spinal cord injury (SCI), a profound impairment of sensorimotor functions, is often associated with pain related phenomena, including mechanical allodynia, a condition in which non-painful tactile sensation is perceived as pain. Pain and somatic sensation are undeniable markers of normal bodily awareness. However, the mechanism by which they are integrated into a coherent sense of the bodily self remains largely unclear. In this study, we investigated the effect of high-level multisensory manipulation on subjective experiences of pain, touch, and body-ownership. METHODS We administered visuo-tactile stimulation based on the rubber hand illusion. In a longitudinal study, we compared the strength of the illusion in a male with SCI, who initially had lost somatosensation in all his fingers, but a few months later reported signs of tactile allodynia restricted to the left C6-dermatome. RESULTS After the restoration of some somatosensation, even if it were painful, synchronous but not asynchronous visuo-tactile stimulation induced body illusion. Previously painful stimuli were temporarily perceived as less painful, and the patient further regained tactile sensations in adjacent numb areas. CONCLUSIONS The sensations of touch and pain are mutually influenced and inextricably linked to a coherent representation of one's own body. Multisensory manipulations affecting the perception and representation of the body might thus offer a powerful opportunity to mitigate nociceptive and somatic abnormalities.
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Affiliation(s)
- Mariella Pazzaglia
- Department of Psychology, University of Rome "La Sapienza, " Via dei Marsi, Rome, Italy.,IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK
| | | | - Marco Molinari
- IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy
| | - Bigna Lenggenhager
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Switzerland
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34
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Nardone R, Höller Y, Sebastianelli L, Versace V, Saltuari L, Brigo F, Lochner P, Trinka E. Cortical morphometric changes after spinal cord injury. Brain Res Bull 2017; 137:107-119. [PMID: 29175055 DOI: 10.1016/j.brainresbull.2017.11.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/04/2017] [Accepted: 11/21/2017] [Indexed: 01/18/2023]
Abstract
Neuroimaging studies suggest that spinal cord injury (SCI) may lead to significant anatomical alterations in the human sensorimotor system. In particular, voxel-based morphometry (VBM) of cortical volume has revealed a significant gray and white matter atrophy bilaterally in the primary sensory cortex (S1). By contrast, some structural studies failed to detect changes in gray matter volume (GMV) in the primary motor cortex (M1) following SCI, whereas others have reported a substantial decrease of GMV also in M1. In addition to direct degeneration of the sensorimotor cortex, SCI can also lead to atrophy of the non-sensorimotor cortex, such as anterior cingulate cortex, insular cortex, middle frontal gyrus and supplementary motor area. These findings suggest that SCI can cause remote atrophy of brain gray matter in the salient network. Furthermore, pain-related remodelling may occur in SCI. In fact, structural changes in SCI are also related to the presence and degree of below-level pain. We performed a systematic review of the neuroimaging studies showing morphometric cortical changes and subsequent functional reorganization in humans with SCI. Literature search was conducted using PubMed and Embase. We identified 12 articles matching the inclusion criteria and 195 patients were included in these studies. The wide range of disease duration, rehabilitation training, drug intervention, and different research methodology, especially the identification of region of interest and the statistical approach to correct for multiple comparisons, may have contributed to some inconsistencies between the reviewed studies. Nevertheless, neuroimaging biomarkers can assess the extent of neural damage, elucidate the mechanisms of neural repair, and predict clinical outcome. A better understanding of the structural and functional changes that occur at cortical level following SCI may be useful in tracking potential treatment induced changes and identifying potential therapeutic targets, thus developing evidence-based rehabilitation therapies.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria.
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno and Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno and Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno and Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | | | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
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35
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Foldes ST, Weber DJ, Collinger JL. Altered modulation of sensorimotor rhythms with chronic paralysis. J Neurophysiol 2017; 118:2412-2420. [PMID: 28768745 DOI: 10.1152/jn.00878.2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 02/06/2023] Open
Abstract
After paralysis, the disconnection between the cortex and its peripheral targets leads to neuroplasticity throughout the nervous system. However, it is unclear how chronic paralysis specifically impacts cortical oscillations associated with attempted movement of impaired limbs. We hypothesized that μ- (8-13 Hz) and β- (15-30 Hz) event-related desynchronization (ERD) would be less modulated for individuals with hand paralysis due to cervical spinal cord injury (SCI). To test this, we compared the modulation of ERD from magnetoencephalography (MEG) during attempted and imagined grasping performed by participants with cervical SCI (n = 12) and able-bodied controls (n = 13). Seven participants with tetraplegia were able to generate some electromyography (EMG) activity during attempted grasping, whereas the other five were not. The peak and area of ERD were significantly decreased for individuals without volitional muscle activity when they attempted to grasp compared with able-bodied subjects and participants with SCI,with some residual EMG activity. However, no significant differences were found between subject groups during mentally simulated tasks (i.e., motor imagery) where no muscle activity or somatosensory consequences were expected. These findings suggest that individuals who are unable to produce muscle activity are capable of generating ERD when attempting to move, but the characteristics of this ERD are altered. However, for people who maintain volitional muscle activity after SCI, there are no significant differences in ERD characteristics compared with able-bodied controls. These results provide evidence that ERD is dependent on the level of intact muscle activity after SCI.NEW & NOTEWORTHY Source space MEG was used to investigate sensorimotor cortical oscillations in individuals with SCI. This study provides evidence that individuals with cervical SCI exhibit decreased ERD when they attempt to grasp if they are incapable of generating muscle activity. However, there were no significant differences in ERD between paralyzed and able-bodied participants during motor imagery. These results have important implications for the design and evaluation of new therapies, such as motor imagery and neurofeedback interventions.
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Affiliation(s)
- Stephen T Foldes
- Veterans Affairs Pittsburgh Healthcare System, Department of Veterans Affairs, Pittsburgh, Pennsylvania.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, Pennsylvania.,Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Douglas J Weber
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, Pennsylvania.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer L Collinger
- Veterans Affairs Pittsburgh Healthcare System, Department of Veterans Affairs, Pittsburgh, Pennsylvania; .,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, Pennsylvania.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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36
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Ozdemir RA, Perez MA. Afferent input and sensory function after human spinal cord injury. J Neurophysiol 2017; 119:134-144. [PMID: 28701541 DOI: 10.1152/jn.00354.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) often disrupts the integrity of afferent (sensory) axons projecting through the spinal cord dorsal columns to the brain. Examinations of ascending sensory tracts, therefore, are critical for monitoring the extent of SCI and recovery processes. In this review, we discuss the most common electrophysiological techniques used to assess transmission of afferent inputs to the primary motor cortex (i.e., afferent input-induced facilitation and inhibition) and the somatosensory cortex [i.e., somatosensory evoked potentials (SSEPs), dermatomal SSEPs, and electrical perceptual thresholds] following human SCI. We discuss how afferent input modulates corticospinal excitability by involving cortical and spinal mechanisms depending on the timing of the effects, which need to be considered separately for upper and lower limb muscles. We argue that the time of arrival of afferent input onto the sensory and motor cortex is critical to consider in plasticity-induced protocols in humans with SCI. We also discuss how current sensory exams have been used to detect differences between control and SCI participants but might be less optimal to characterize the level and severity of injury. There is a need to conduct some of these electrophysiological examinations during functionally relevant behaviors to understand the contribution of impaired afferent inputs to the control, or lack of control, of movement. Thus the effects of transmission of afferent inputs to the brain need to be considered on multiple functions following human SCI.
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Affiliation(s)
- Recep A Ozdemir
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami , Miami, Florida.,Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida
| | - Monica A Perez
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami , Miami, Florida.,Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida
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Thomschewski A, Höller Y, Höller P, Leis S, Trinka E. High Amplitude EEG Motor Potential during Repetitive Foot Movement: Possible Use and Challenges for Futuristic BCIs That Restore Mobility after Spinal Cord Injury. Front Neurosci 2017; 11:362. [PMID: 28690497 PMCID: PMC5481367 DOI: 10.3389/fnins.2017.00362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/09/2017] [Indexed: 11/23/2022] Open
Abstract
Recent advances in neuroprostheses provide us with promising ideas of how to improve the quality of life in people suffering from impaired motor functioning of upper and lower limbs. Especially for patients after spinal cord injury (SCI), futuristic devices that are controlled by thought via brain-computer interfaces (BCIs) might be of tremendous help in managing daily tasks and restoring at least some mobility. However, there are certain problems arising when trying to implement BCI technology especially in such a heterogenous patient group. A plethora of processes occurring after the injuries change the brain's structure as well as its functionality collectively referred to as neuroplasticity. These changes are very different between individuals, leading to an increasing interest to reveal the exact changes occurring after SCI. In this study we investigated event-related potentials (ERPs) derived from electroencephalography (EEG) signals recorded during the (attempted) execution and imagination of hand and foot movements in healthy subjects and patients with SCI. As ERPs and especially early components are of interest for BCI research we aimed to investigate differences between 22 healthy volunteers and 7 patients (mean age = 51.86, SD = 15.49) suffering from traumatic or non-traumatic SCI since 2–314 months (mean = 116,57, SD = 125,55). We aimed to explore differences in ERP responses as well as the general presence of component that might be of interest to further consider for incorporation into BCI research. In order to match the real-life situation of BCIs for controlling neuroprostheses, we worked on small trial numbers (<25), only. We obtained a focal potential over Pz in ten healthy participants but in none of the patients after lenient artifact rejection. The potential was characterized by a high amplitude, it correlated with the repeated movements (6 times in 6 s) and in nine subjects it significantly differed from a resting condition. Furthermore, there are strong arguments against possible confounding factors leading to the potential's appearance. This phenomenon, occurring when movements are repeatedly conducted, might represent a possible potential to be used in futuristic BCIs and further studies should try to investigate the replicability of its appearance.
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Affiliation(s)
- Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center SalzburgSalzburg, Austria.,Department of Psychology, Paris-Lodron University of SalzburgSalzburg, Austria
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Department of Psychology, Paris-Lodron University of SalzburgSalzburg, Austria.,Center for Cognitive Neuroscience SalzburgSalzburg, Austria
| | - Peter Höller
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center SalzburgSalzburg, Austria
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center SalzburgSalzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical UniversitySalzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center SalzburgSalzburg, Austria.,Center for Cognitive Neuroscience SalzburgSalzburg, Austria
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Iamsakul K, Pavlovcik AV, Calderon JI, Sanderson LM. PROJECT HEAVEN: Preoperative Training in Virtual Reality. Surg Neurol Int 2017; 8:59. [PMID: 28540125 PMCID: PMC5421260 DOI: 10.4103/sni.sni_371_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/10/2017] [Indexed: 01/05/2023] Open
Abstract
A cephalosomatic anastomosis (CSA; also called HEAVEN: head anastomosis venture) has been proposed as an option for patients with neurological impairments, such as spinal cord injury (SCI), and terminal medical illnesses, for which medicine is currently powerless. Protocols to prepare a patient for life after CSA do not currently exist. However, methods used in conventional neurorehabilitation can be used as a reference for developing preparatory training. Studies on virtual reality (VR) technologies have documented VR's ability to enhance rehabilitation and improve the quality of recovery in patients with neurological disabilities. VR-augmented rehabilitation resulted in increased motivation towards performing functional training and improved the biopsychosocial state of patients. In addition, VR experiences coupled with haptic feedback promote neuroplasticity, resulting in the recovery of motor functions in neurologically-impaired individuals. To prepare the recipient psychologically for life after CSA, the development of VR experiences paired with haptic feedback is proposed. This proposal aims to innovate techniques in conventional neurorehabilitation to implement preoperative psychological training for the recipient of HEAVEN. Recipient's familiarity to body movements will prevent unexpected psychological reactions from occurring after the HEAVEN procedure.
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Affiliation(s)
- Kiratipath Iamsakul
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Alexander V Pavlovcik
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Jesus I Calderon
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Lance M Sanderson
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
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Diffusion Assessment of Cortical Changes, Induced by Traumatic Spinal Cord Injury. Brain Sci 2017; 7:brainsci7020021. [PMID: 28218643 PMCID: PMC5332964 DOI: 10.3390/brainsci7020021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/14/2016] [Accepted: 02/14/2017] [Indexed: 01/21/2023] Open
Abstract
Promising treatments are being developed to promote functional recovery after spinal cord injury (SCI). Magnetic resonance imaging, specifically Diffusion Tensor Imaging (DTI) has been shown to non-invasively measure both axonal and myelin integrity following traumatic brain and SCI. A novel data-driven model-selection algorithm known as Diffusion Basis Spectrum Imaging (DBSI) has been proposed to more accurately delineate white matter injury. The objective of this study was to investigate whether DTI/DBSI changes that extend to level of the cerebral peduncle and internal capsule following a SCI could be correlated with clinical function. A prospective non-randomized cohort of 23 patients with chronic spinal cord injuries and 17 control subjects underwent cranial diffusion weighted imaging, followed by whole brain DTI and DBSI computations. Region-based analyses were performed on cerebral peduncle and internal capsule. Three subgroups of patients were included in the region-based analysis. Tract-Based Spatial Statistics (TBSS) was also applied to allow whole-brain white matter analysis between controls and all patients. Functional assessments were made using International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) as modified by the American Spinal Injury Association (ASIA) Scale. Whole brain white matter analysis using TBSS finds no statistical difference between controls and all patients. Only cervical ASIA A/B patients in cerebral peduncle showed differences from controls in DTI and DBSI results with region-based analysis. Cervical ASIA A/B SCI patients had higher levels of axonal injury and edema/tissue loss as measured by DBSI at the level of the cerebral peduncle. DTI Fractional Anisotropy (FA), Axial Diffusivity (AD) and Radial Diffusivity (RD) was able to detect differences in cervical ASIA A/B patients, but were non-specific to pathologies. Increased water fraction indicated by DBSI non-restricted isotropic diffusion fraction in the cerebral peduncle, explains the simultaneously increased DTI AD and DTI RD values. Our results further demonstrate the utility of DTI to detect disruption in axonal integrity in white matter, yet a clear shortcoming in differentiating true axonal injury from inflammation/tissue loss. Our results suggest a preservation of axonal integrity at the cortical level and has implications for future regenerative clinical trials.
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Brain White Matter Impairment in Patients with Spinal Cord Injury. Neural Plast 2017; 2017:4671607. [PMID: 28255458 PMCID: PMC5309430 DOI: 10.1155/2017/4671607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/12/2017] [Indexed: 02/08/2023] Open
Abstract
It remains unknown whether spinal cord injury (SCI) could indirectly impair or reshape the white matter (WM) of human brain and whether these changes are correlated with injury severity, duration, or clinical performance. We choose tract-based spatial statistics (TBSS) to investigate the possible changes in whole-brain white matter integrity and their associations with clinical variables in fifteen patients with SCI. Compared with the healthy controls, the patients exhibited significant decreases in WM fractional anisotropy (FA) in the left angular gyrus (AG), right cerebellum (CB), left precentral gyrus (PreCG), left lateral occipital region (LOC), left superior longitudinal fasciculus (SLF), left supramarginal gyrus (SMG), and left postcentral gyrus (PostCG) (p < 0.01, TFCE corrected). No significant differences were found in all diffusion indices between the complete and incomplete SCI. However, significantly negative correlation was shown between the increased radial diffusivity (RD) of left AG and total motor scores (uncorrected p < 0.05). Our findings provide evidence that SCI can cause not only direct degeneration but also transneuronal degeneration of brain WM, and these changes may be irrespective of the injury severity. The affection of left AG on rehabilitation therapies need to be further researched in the future.
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Zantedeschi M, Pazzaglia M. Commentary: Non-invasive Brain Stimulation, a Tool to Revert Maladaptive Plasticity in Neuropathic Pain. Front Hum Neurosci 2016; 10:544. [PMID: 27833544 PMCID: PMC5081357 DOI: 10.3389/fnhum.2016.00544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/13/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Marta Zantedeschi
- Department of Psychology, University of Rome “La Sapienza”Rome, Italy
| | - Mariella Pazzaglia
- Department of Psychology, University of Rome “La Sapienza”Rome, Italy
- IRCCS Santa Lucia FoundationRome, Italy
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Recruitment of Polysynaptic Connections Underlies Functional Recovery of a Neural Circuit after Lesion. eNeuro 2016; 3:eN-NWR-0056-16. [PMID: 27570828 PMCID: PMC4999536 DOI: 10.1523/eneuro.0056-16.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 11/21/2022] Open
Abstract
The recruitment of additional neurons to neural circuits often occurs in accordance with changing functional demands. Here we found that synaptic recruitment plays a key role in functional recovery after neural injury. Disconnection of a brain commissure in the nudibranch mollusc, Tritonia diomedea, impairs swimming behavior by eliminating particular synapses in the central pattern generator (CPG) underlying the rhythmic swim motor pattern. However, the CPG functionally recovers within a day after the lesion. The strength of a spared inhibitory synapse within the CPG from Cerebral Neuron 2 (C2) to Ventral Swim Interneuron B (VSI) determines the level of impairment caused by the lesion, which varies among individuals. In addition to this direct synaptic connection, there are polysynaptic connections from C2 and Dorsal Swim Interneurons to VSI that provide indirect excitatory drive but play only minor roles under normal conditions. After disconnecting the pedal commissure (Pedal Nerve 6), the recruitment of polysynaptic excitation became a major source of the excitatory drive to VSI. Moreover, the amount of polysynaptic recruitment, which changed over time, differed among individuals and correlated with the degree of recovery of the swim motor pattern. Thus, functional recovery was mediated by an increase in the magnitude of polysynaptic excitatory drive, compensating for the loss of direct excitation. Since the degree of susceptibility to injury corresponds to existing individual variation in the C2 to VSI synapse, the recovery relied upon the extent to which the network reorganized to incorporate additional synapses.
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Kim JH, Kim SH, Cho SR, Lee JY, Kim JH, Baek A, Jung HS. The Modulation of Neurotrophin and Epigenetic Regulators: Implication for Astrocyte Proliferation and Neuronal Cell Apoptosis After Spinal Cord Injury. Ann Rehabil Med 2016; 40:559-67. [PMID: 27606261 PMCID: PMC5012966 DOI: 10.5535/arm.2016.40.4.559] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/22/2015] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate alterations in the expression of the main regulators of neuronal survival and death related to astrocytes and neuronal cells in the brain in a mouse model of spinal cord injury (SCI). Methods Eight-week-old male imprinting control region mice (n=36; 30–35 g) were used in this study and randomly assigned to two groups: the naïve control group (n=18) and SCI group (n=18). The mice in both groups were randomly allocated to the following three time points: 3 days, 1 week, and 2 weeks (n=6 each). The expression levels of regulators such as brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), histone deacetylase 1 (HDAC1), and methyl-CpG-binding protein 2 (MeCP 2) in the brain were evaluated following thoracic contusive SCI. In addition, the number of neuronal cells in the motor cortex (M1 and M2 areas) and the number of astrocytes in the hippocampus were determined by immunohistochemistry. Results BDNF expression was significantly elevated at 2 weeks after injury (p=0.024). The GDNF level was significantly elevated at 3 days (p=0.042). The expression of HDAC1 was significantly elevated at 1 week (p=0.026). Following SCI, compared with the control the number of NeuN-positive cells in the M1 and M2 areas gradually and consistently decreased at 2 weeks after injury. In contrast, the number of astrocytes was significantly increased at 1 week (p=0.029). Conclusion These results demonstrate that the upregulation of BDNF, GDNF and HDAC1 might play on important role in brain reorganization after SCI.
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Affiliation(s)
- Jong Heon Kim
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung-Hoon Kim
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung-Rae Cho
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yong Lee
- Department of Rehabilitation Medicine, The Graduate School of Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hyun Kim
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ahreum Baek
- Department of Rehabilitation Medicine, The Graduate School of Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hong Sun Jung
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Dhillon RS, Parker J, Syed YA, Edgley S, Young A, Fawcett JW, Jeffery ND, Franklin RJM, Kotter MRN. Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy. Acta Neuropathol Commun 2016; 4:89. [PMID: 27552807 PMCID: PMC4994254 DOI: 10.1186/s40478-016-0359-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/01/2016] [Indexed: 02/02/2023] Open
Abstract
Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder and a major cause of disability in adults. Improvements following surgical decompression are limited and patients often remain severely disabled. Post mortem studies indicate that CSM is associated with profound axonal loss. However, our understanding of the pathophysiology of CSM remains limited.To investigate the hypothesis that axonal plasticity plays a role in the recovery following surgical decompression, we adopted a novel preclinical model of mild to moderate CSM. Spinal cord compression resulted in significant locomotor deterioration, increased expression of the axonal injury marker APP, and loss of serotonergic fibres. Surgical decompression partially reversed the deficits and attenuated APP expression. Decompression was also associated with axonal sprouting, reflected in the restoration of serotonergic fibres and an increase of GAP43 expression. The re-expression of synaptophysin indicated the restoration of functional synapses following decompression. Promoting axonal plasticity may therefore be a therapeutic strategy for promoting neurological recovery in CSM.
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Affiliation(s)
- Rana S. Dhillon
- Department of Clinical Neurosciences, Anne McLaren Laboratory, Wellcome Trust-MRC Cambridge Stem Cell Institute, John van Geest Centre for Brain Repair, Academic Neurosurgery Unit, University of Cambridge, Cambridge Biomedical Campus, West Forvie Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK
| | - John Parker
- Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH UK
| | - Yasir A. Syed
- Department of Clinical Neurosciences, Anne McLaren Laboratory, Wellcome Trust-MRC Cambridge Stem Cell Institute, John van Geest Centre for Brain Repair, Academic Neurosurgery Unit, University of Cambridge, Cambridge Biomedical Campus, West Forvie Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK
| | - Steve Edgley
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3DY UK
| | - Adam Young
- Department of Clinical Neurosciences, Anne McLaren Laboratory, Wellcome Trust-MRC Cambridge Stem Cell Institute, John van Geest Centre for Brain Repair, Academic Neurosurgery Unit, University of Cambridge, Cambridge Biomedical Campus, West Forvie Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK
| | - James W. Fawcett
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, E.D. Adrian Building, Forvie Site, Robinson Way, Cambridge, CB2 0PY UK
| | - Nick D. Jeffery
- College of Veterinary Medicine, Iowa State University, 1800 Christensen Drive, Ames, IA 50011-1134 USA
| | - Robin J. M. Franklin
- Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH UK
| | - Mark R. N. Kotter
- Department of Clinical Neurosciences, Anne McLaren Laboratory, Wellcome Trust-MRC Cambridge Stem Cell Institute, John van Geest Centre for Brain Repair, Academic Neurosurgery Unit, University of Cambridge, Cambridge Biomedical Campus, West Forvie Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK
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Beekhuizen KS, Field-Fote EC. Massed Practice versus Massed Practice with Stimulation: Effects on Upper Extremity Function and Cortical Plasticity in Individuals with Incomplete Cervical Spinal Cord Injury. Neurorehabil Neural Repair 2016; 19:33-45. [PMID: 15673842 DOI: 10.1177/1545968305274517] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To determine the effect of massed practice (MP) versus massed practice combined with somatosensory stimulation (MP+SS) on cortical plasticity and function in persons with incomplete tetraplegia. Methods. Ten subjects were assigned to either MP or MP+SS. Median nerve stimulation (500 ms train, 10 Hz, 1 ms pulse duration) was delivered at the intensity eliciting a motor threshold response. Training sessions were 5 d/week for 3 weeks at 2 h/session. Outcome measures included 1) motor-evoked potentials (MEPs) elicited via transcranial magnetic stimulation (TMS), motor threshold (MT) and MEP amplitude at 1.2 MT; 2) maximal pinch grip force; 3) Wolf Motor Function Test (WMFT) and Jebsen Hand Function Test. Results. The MP+SS group demonstrated significant improvements (P < 0.05) in pinch grip strength (190%), WMFT scores (52%), and Jebsen test scores (33%), whereas the MP group demonstrated significant improvement (P < 0.05) only in Jebsen test scores (11%). No significant changes were detected in cortical excitability in the MP+SS or MP group. Conclusions. The findings of this preliminary study suggest that MP+SS results in greater increases in pinch strength and timed functional test scores than MP. Optimal stimulation paradigms and training methods are needed to further test this strategy.
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Affiliation(s)
- Kristina S Beekhuizen
- The Miami Project to Cure Paralysis, University of Miami School of Medicine, Miami, FL 33136, USA
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Dobkin BH. An Overview of Treadmill Locomotor Training with Partial Body Weight Support: A Neurophysiologically Sound Approach Whose Time Has Come for Randomized Clinical Trials. Neurorehabil Neural Repair 2016. [DOI: 10.1177/154596839901300301] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Much of the rehabilitation team's effort during inpatient and outpatient therapy for disabling neurologic diseases aims to restore the ability to walk with as little human assistance as possible. Although the use of treadmill (TM) training with partial body weight support has a strong underpinning from basic and clinical neuroscience stud ies and small clinical trials, the technique still lacks the reproducible results that make for an evidence-based practice. Therapists will have to learn how to employ body weight-supported treadmill training (BWSTT) so that they optimize the segmental sensory inputs that best facilitate spinal and supraspinal locomotor networks. Ran domized clinical trials must be undertaken using scientific expertmental designs that measure the impact of BSWTT on the lives of hemiparetic and paraparetic people. Outcomes specific to a locomotor intervention might include functional independence for walking and for mobility-related self-care and community activities, walking speed, endurance for walking distances, and the perceptions of subjects about health-related quality of life. Features of training and trial design are discussed in relation to reported basic and clinical research.
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Bloch A, Tamir D, Vakil E, Zeilig G. Specific Deficit in Implicit Motor Sequence Learning following Spinal Cord Injury. PLoS One 2016; 11:e0158396. [PMID: 27355834 PMCID: PMC4927174 DOI: 10.1371/journal.pone.0158396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/15/2016] [Indexed: 12/04/2022] Open
Abstract
Background Physical and psychosocial rehabilitation following spinal cord injury (SCI) leans heavily on learning and practicing new skills. However, despite research relating motor sequence learning to spinal cord activity and clinical observations of impeded skill-learning after SCI, implicit procedural learning following spinal cord damage has not been examined. Objective To test the hypothesis that spinal cord injury (SCI) in the absence of concomitant brain injury is associated with a specific implicit motor sequence learning deficit that cannot be explained by depression or impairments in other cognitive measures. Methods Ten participants with SCI in T1-T11, unharmed upper limb motor and sensory functioning, and no concomitant brain injury were compared to ten matched control participants on measures derived from the serial reaction time (SRT) task, which was used to assess implicit motor sequence learning. Explicit generation of the SRT sequence, depression, and additional measures of learning, memory, and intelligence were included to explore the source and specificity of potential learning deficits. Results There was no between-group difference in baseline reaction time, indicating that potential differences between the learning curves of the two groups could not be attributed to an overall reduction in response speed in the SCI group. Unlike controls, the SCI group showed no decline in reaction time over the first six blocks of the SRT task and no advantage for the initially presented sequence over the novel interference sequence. Meanwhile, no group differences were found in explicit learning, depression, or any additional cognitive measures. Conclusions The dissociation between impaired implicit learning and intact declarative memory represents novel empirical evidence of a specific implicit procedural learning deficit following SCI, with broad implications for rehabilitation and adjustment.
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Affiliation(s)
- Ayala Bloch
- The National Institute for the Rehabilitation of the Brain Injured, Tel Aviv, Israel
- * E-mail:
| | - Dror Tamir
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eli Vakil
- Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Costa Á, Iáñez E, Úbeda A, Hortal E, Del-Ama AJ, Gil-Agudo Á, Azorín JM. Decoding the Attentional Demands of Gait through EEG Gamma Band Features. PLoS One 2016; 11:e0154136. [PMID: 27115740 PMCID: PMC4846000 DOI: 10.1371/journal.pone.0154136] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/08/2016] [Indexed: 12/03/2022] Open
Abstract
Rehabilitation techniques are evolving focused on improving their performance in terms of duration and level of recovery. Current studies encourage the patient’s involvement in their rehabilitation. Brain-Computer Interfaces are capable of decoding the cognitive state of users to provide feedback to an external device. On this paper, cortical information obtained from the scalp is acquired with the goal of studying the cognitive mechanisms related to the users’ attention to the gait. Data from 10 healthy users and 3 incomplete Spinal Cord Injury patients are acquired during treadmill walking. During gait, users are asked to perform 4 attentional tasks. Data obtained are treated to reduce movement artifacts. Features from δ(1 − 4Hz), θ(4 − 8Hz), α(8 − 12Hz), β(12 − 30Hz), γlow(30 − 50Hz), γhigh(50 − 90Hz) frequency bands are extracted and analyzed to find which ones provide more information related to attention. The selected bands are tested with 5 classifiers to distinguish between tasks. Classification results are also compared with chance levels to evaluate performance. Results show success rates of ∼67% for healthy users and ∼59% for patients. These values are obtained using features from γ band suggesting that the attention mechanisms are related to selective attention mechanisms, meaning that, while the attention on gait decreases the level of attention on the environment and external visual information increases. Linear Discriminant Analysis, K-Nearest Neighbors and Support Vector Machine classifiers provide the best results for all users. Results from patients are slightly lower, but significantly different, than those obtained from healthy users supporting the idea that the patients pay more attention to gait during non-attentional tasks due to the inherent difficulties they have during normal gait. This study provides evidence of the existence of classifiable cortical information related to the attention level on the gait. This fact could allow the development of a real-time system that obtains the attention level during lower limb rehabilitation. This information could be used as feedback to adapt the rehabilitation strategy.
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Affiliation(s)
- Álvaro Costa
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
- * E-mail:
| | - Eduardo Iáñez
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
| | - Andrés Úbeda
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
| | - Enrique Hortal
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
| | - Antonio J. Del-Ama
- Biomechanics and Technical Aids Units, Physical Medicine and Rehabilitation Department, National Hospital for Spinal Cord Injury, SESCAM, Finca de la Peraleda S/N, 45071, Toledo, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Units, Physical Medicine and Rehabilitation Department, National Hospital for Spinal Cord Injury, SESCAM, Finca de la Peraleda S/N, 45071, Toledo, Spain
| | - José M. Azorín
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
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Scandola M, Aglioti SM, Bonente C, Avesani R, Moro V. Spinal cord lesions shrink peripersonal space around the feet, passive mobilization of paraplegic limbs restores it. Sci Rep 2016; 6:24126. [PMID: 27049439 PMCID: PMC4822176 DOI: 10.1038/srep24126] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/18/2016] [Indexed: 12/02/2022] Open
Abstract
Peripersonal space (PPS) is the space surrounding us within which we interact with objects. PPS may be modulated by actions (e.g. when using tools) or sense of ownership (e.g. over a rubber hand). Indeed, intense and/or prolonged use of a tool may induce a sense of ownership over it. Conversely, inducing ownership over a rubber hand may activate brain regions involved in motor control. However, the extent to which PPS is modulated by action-dependent or ownership-dependent mechanisms remains unclear. Here, we explored the PPS around the feet and the sense of ownership over lower limbs in people with Paraplegia following Complete spinal cord Lesions (PCL) and in healthy subjects. PCL people can move their upper body but have lost all sensory-motor functions in their lower body (e.g. lower limbs). We tested whether PPS alterations reflect the topographical representations of various body parts. We found that the PPS around the feet was impaired in PCL who however had a normal representation of the PPS around the hands. Significantly, passive mobilization of paraplegic limbs restored the PPS around the feet suggesting that activating action representations in PCL brings about short-term changes of PPS that may thus be more plastic than previously believed.
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Affiliation(s)
- Michele Scandola
- NPSY-Lab.VR, Department of Human Sciences, University of Verona, Verona I-37129, Italy.,IRCCS, Fondazione Santa Lucia, Rome I-00179, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, University of Rome "Sapienza", Rome I-00185, Italy.,IRCCS, Fondazione Santa Lucia, Rome I-00179, Italy
| | - Claudio Bonente
- NPSY-Lab.VR, Department of Human Sciences, University of Verona, Verona I-37129, Italy
| | - Renato Avesani
- Department of Rehabilitation, Sacro Cuore - Don Calabria Hospital, Negrar I-37024, Verona, Italy
| | - Valentina Moro
- NPSY-Lab.VR, Department of Human Sciences, University of Verona, Verona I-37129, Italy
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Alterations in Cortical Sensorimotor Connectivity following Complete Cervical Spinal Cord Injury: A Prospective Resting-State fMRI Study. PLoS One 2016; 11:e0150351. [PMID: 26954693 PMCID: PMC4783046 DOI: 10.1371/journal.pone.0150351] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/12/2016] [Indexed: 12/14/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) studies have demonstrated alterations during task-induced brain activation in spinal cord injury (SCI) patients. The interruption to structural integrity of the spinal cord and the resultant disrupted flow of bidirectional communication between the brain and the spinal cord might contribute to the observed dynamic reorganization (neural plasticity). However, the effect of SCI on brain resting-state connectivity patterns remains unclear. We undertook a prospective resting-state fMRI (rs-fMRI) study to explore changes to cortical activation patterns following SCI. With institutional review board approval, rs-fMRI data was obtained in eleven patients with complete cervical SCI (>2 years post injury) and nine age-matched controls. The data was processed using the Analysis of Functional Neuroimages software. Region of interest (ROI) based analysis was performed to study changes in the sensorimotor network using pre- and post-central gyri as seed regions. Two-sampled t-test was carried out to check for significant differences between the two groups. SCI patients showed decreased functional connectivity in motor and sensory cortical regions when compared to controls. The decrease was noted in ipsilateral, contralateral, and interhemispheric regions for left and right precentral ROIs. Additionally, the left postcentral ROI demonstrated increased connectivity with the thalamus bilaterally in SCI patients. Our results suggest that cortical activation patterns in the sensorimotor network undergo dynamic reorganization following SCI. The presence of these changes in chronic spinal cord injury patients is suggestive of the inherent neural plasticity within the central nervous system.
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