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MacLellan MJ. Modular organization of muscle activity patterns in the leading and trailing limbs during obstacle clearance in healthy adults. Exp Brain Res 2017; 235:2011-2026. [PMID: 28343307 DOI: 10.1007/s00221-017-4946-z] [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: 08/02/2016] [Accepted: 03/16/2017] [Indexed: 12/24/2022]
Abstract
Human locomotor patterns require precise adjustments to successfully navigate complex environments. Studies suggest that the central nervous system may control such adjustments through supraspinal signals modifying a basic locomotor pattern at the spinal level. To explore this proposed control mechanism in the leading and trailing limbs during obstructed walking, healthy young adults stepped over obstacles measuring 0.1 and 0.2 m in height. Unobstructed walking with no obstacle present was also performed as a baseline. Full body three-dimensional kinematic data were recorded and electromyography (EMG) was collected from 14 lower limb muscles on each side of the body. EMG data were analyzed using two techniques: by mapping the EMG data to the approximate location of the motor neuron pools on the lumbosacral enlargement of the spinal cord and by applying a nonnegative matrix factorization algorithm to unilateral and bilateral muscle activations separately. Results showed that obstacle clearance may be achieved not only with the addition of a new activation pattern in the leading limb, but with a temporal shift of a pattern present during unobstructed walking in both the leading and trailing limbs. An investigation of the inter-limb coordination of these patterns suggested a strong bilateral linkage between lower limbs. These results highlight the modular organization of muscle activation in the leading and trailing limbs, as well as provide a mechanism of control when implementing a locomotor adjustment when stepping over an obstacle.
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Affiliation(s)
- Michael J MacLellan
- School of Kinesiology, College of Human Sciences and Education, Louisiana State University, 112 Huey P. Long Field House, Baton Rouge, LA, 70803, USA.
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202
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Chawla RS, Züchner M, Mastrangelopoulou M, Lambert FM, Glover JC, Boulland JL. Cellular reactions and compensatory tissue re-organization during spontaneous recovery after spinal cord injury in neonatal mice. Dev Neurobiol 2017; 77:928-946. [PMID: 28033684 DOI: 10.1002/dneu.22479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 11/08/2016] [Accepted: 12/06/2016] [Indexed: 01/23/2023]
Abstract
Following incomplete spinal cord injuries, neonatal mammals display a remarkable degree of behavioral recovery. Previously, we have demonstrated in neonatal mice a wholesale re-establishment and reorganization of synaptic connections from some descending axon tracts (Boulland et al.: PLoS One 8 (2013)). To assess the potential cellular mechanisms contributing to this recovery, we have here characterized a variety of cellular sequelae following thoracic compression injuries, focusing particularly on cell loss and proliferation, inflammation and reactive gliosis, and the dynamics of specific types of synaptic terminals. Early during the period of recovery, regressive events dominated. Tissue loss near the injury was severe, with about 80% loss of neurons and a similar loss of axons that later make up the white matter. There was no sign of neurogenesis, no substantial astroglial or microglial proliferation, no change in the ratio of M1 and M2 microglia and no appreciable generation of the terminal complement peptide C5a. One day after injury the number of synaptic terminals on lumbar motoneurons had dropped by a factor of 2, but normalized by 6 days. The ratio of VGLUT1/2+ to VGAT+ terminals remained similar in injured and uninjured spinal cords during this period. By 24 days after injury, when functional recovery is nearly complete, the density of 5-HT+ fibers below the injury site had increased by a factor of 2.5. Altogether this study shows that cellular reactions are diverse and dynamic. Pronounced recovery of both excitatory and inhibitory terminals and an increase in serotonergic innervation below the injury, coupled with a general lack of inflammation and reactive gliosis, are likely to contribute to the recovery. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 77: 928-946, 2017.
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Affiliation(s)
- Rishab S Chawla
- Laboratory of Neural Development and Optical Recording (NDEVOR), Division of Physiology, Department of Molecular Medicine, University of Oslo
| | - Mark Züchner
- Norwegian Center for Stem Cell Research, Oslo University Hospital.,Department of Neurosurgery, Oslo University Hospital
| | - Maria Mastrangelopoulou
- Laboratory of Neural Development and Optical Recording (NDEVOR), Division of Physiology, Department of Molecular Medicine, University of Oslo
| | - François M Lambert
- Laboratory of Neural Development and Optical Recording (NDEVOR), Division of Physiology, Department of Molecular Medicine, University of Oslo.,INCIA CNRS UMR 5287 Université de Bordeaux, Bordeaux, France
| | - Joel C Glover
- Laboratory of Neural Development and Optical Recording (NDEVOR), Division of Physiology, Department of Molecular Medicine, University of Oslo.,Norwegian Center for Stem Cell Research, Oslo University Hospital
| | - Jean-Luc Boulland
- Laboratory of Neural Development and Optical Recording (NDEVOR), Division of Physiology, Department of Molecular Medicine, University of Oslo.,Norwegian Center for Stem Cell Research, Oslo University Hospital
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203
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Alam M, Garcia-Alias G, Jin B, Keyes J, Zhong H, Roy RR, Gerasimenko Y, Lu DC, Edgerton VR. Electrical neuromodulation of the cervical spinal cord facilitates forelimb skilled function recovery in spinal cord injured rats. Exp Neurol 2017; 291:141-150. [PMID: 28192079 DOI: 10.1016/j.expneurol.2017.02.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/21/2017] [Accepted: 02/01/2017] [Indexed: 01/03/2023]
Abstract
Enabling motor control by epidural electrical stimulation of the spinal cord is a promising therapeutic technique for the recovery of motor function after a spinal cord injury (SCI). Although epidural electrical stimulation has resulted in improvement in hindlimb motor function, it is unknown whether it has any therapeutic benefit for improving forelimb fine motor function after a cervical SCI. We tested whether trains of pulses delivered at spinal cord segments C6 and C8 would facilitate the recovery of forelimb fine motor control after a cervical SCI in rats. Rats were trained to reach and grasp sugar pellets. Immediately after a dorsal funiculus crush at C4, the rats showed significant deficits in forelimb fine motor control. The rats were tested to reach and grasp with and without cervical epidural stimulation for 10weeks post-injury. To determine the best stimulation parameters to activate the cervical spinal networks involved in forelimb motor function, monopolar and bipolar currents were delivered at varying frequencies (20, 40, and 60Hz) concomitant with the reaching and grasping task. We found that cervical epidural stimulation increased reaching and grasping success rates compared to the no stimulation condition. Bipolar stimulation (C6- C8+ and C6+ C8-) produced the largest spinal motor-evoked potentials (sMEPs) and resulted in higher reaching and grasping success rates compared with monopolar stimulation (C6- Ref+ and C8- Ref+). Forelimb performance was similar when tested at stimulation frequencies of 20, 40, and 60Hz. We also found that the EMG activity in most forelimb muscles as well as the co-activation between flexor and extensor muscles increased post-injury. With epidural stimulation, however, this trend was reversed indicating that cervical epidural spinal cord stimulation has therapeutic potential for rehabilitation after a cervical SCI.
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Affiliation(s)
- Monzurul Alam
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095, United States
| | - Guillermo Garcia-Alias
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095, United States
| | - Benita Jin
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095, United States
| | - Jonathan Keyes
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095, United States
| | - Hui Zhong
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095, United States
| | - Roland R Roy
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095, United States; Brain Research Institute, University of California, Los Angeles, CA 90095, United States
| | - Yury Gerasimenko
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095, United States; Pavlov Institute of Physiology, St. Petersburg 199034, Russia; Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420006, Russia
| | - Daniel C Lu
- Departments of Neurosurgery, University of California, Los Angeles, CA 90095, United States
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA 90095, United States; Brain Research Institute, University of California, Los Angeles, CA 90095, United States; Departments of Neurobiology, University of California, Los Angeles, CA 90095, United States; Departments of Neuroscience, University of California, Los Angeles, CA 90095, United States.
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204
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Hormigo KM, Zholudeva LV, Spruance VM, Marchenko V, Cote MP, Vinit S, Giszter S, Bezdudnaya T, Lane MA. Enhancing neural activity to drive respiratory plasticity following cervical spinal cord injury. Exp Neurol 2017; 287:276-287. [PMID: 27582085 PMCID: PMC5121051 DOI: 10.1016/j.expneurol.2016.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/20/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
Cervical spinal cord injury (SCI) results in permanent life-altering sensorimotor deficits, among which impaired breathing is one of the most devastating and life-threatening. While clinical and experimental research has revealed that some spontaneous respiratory improvement (functional plasticity) can occur post-SCI, the extent of the recovery is limited and significant deficits persist. Thus, increasing effort is being made to develop therapies that harness and enhance this neuroplastic potential to optimize long-term recovery of breathing in injured individuals. One strategy with demonstrated therapeutic potential is the use of treatments that increase neural and muscular activity (e.g. locomotor training, neural and muscular stimulation) and promote plasticity. With a focus on respiratory function post-SCI, this review will discuss advances in the use of neural interfacing strategies and activity-based treatments, and highlights some recent results from our own research.
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Affiliation(s)
- Kristiina M Hormigo
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, College of Medicine, Drexel University, 2900 W Queen Lane, Philadelphia, PA, USA
| | - Lyandysha V Zholudeva
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, College of Medicine, Drexel University, 2900 W Queen Lane, Philadelphia, PA, USA
| | - Victoria M Spruance
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, College of Medicine, Drexel University, 2900 W Queen Lane, Philadelphia, PA, USA
| | - Vitaliy Marchenko
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, College of Medicine, Drexel University, 2900 W Queen Lane, Philadelphia, PA, USA
| | - Marie-Pascale Cote
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, College of Medicine, Drexel University, 2900 W Queen Lane, Philadelphia, PA, USA
| | - Stephane Vinit
- Université de Versailles Saint-Quentin-en-Yvelines, INSERM U1179 End:icap, UFR des Sciences de la Santé - Simone Veil, Montigny-le-Bretonneux, France
| | - Simon Giszter
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, College of Medicine, Drexel University, 2900 W Queen Lane, Philadelphia, PA, USA
| | - Tatiana Bezdudnaya
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, College of Medicine, Drexel University, 2900 W Queen Lane, Philadelphia, PA, USA
| | - Michael A Lane
- Spinal Cord Research Center, Department of Neurobiology and Anatomy, College of Medicine, Drexel University, 2900 W Queen Lane, Philadelphia, PA, USA.
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205
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Capogrosso M, Milekovic T, Borton D, Wagner F, Moraud EM, Mignardot JB, Buse N, Gandar J, Barraud Q, Xing D, Rey E, Duis S, Jianzhong Y, Ko WKD, Li Q, Detemple P, Denison T, Micera S, Bezard E, Bloch J, Courtine G. A brain-spine interface alleviating gait deficits after spinal cord injury in primates. Nature 2016; 539:284-288. [PMID: 27830790 PMCID: PMC5108412 DOI: 10.1038/nature20118] [Citation(s) in RCA: 349] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022]
Abstract
Spinal cord injury disrupts the communication between the brain and the spinal circuits that orchestrate movement. To bypass the lesion, brain–computer interfaces1–3 have directly linked cortical activity to electrical stimulation of muscles, which have restored grasping abilities after hand paralysis1,4. Theoretically, this strategy could also restore control over leg muscle activity for walking5. However, replicating the complex sequence of individual muscle activation patterns underlying natural and adaptive locomotor movements poses formidable conceptual and technological challenges6,7. Recently, we showed in rats that epidural electrical stimulation of the lumbar spinal cord can reproduce the natural activation of synergistic muscle groups producing locomotion8–10. Here, we interfaced leg motor cortex activity with epidural electrical stimulation protocols to establish a brain–spinal interface that alleviated gait deficits after a spinal cord injury in nonhuman primates. Rhesus monkeys were implanted with an intracortical microelectrode array into the leg area of motor cortex; and a spinal cord stimulation system composed of a spatially selective epidural implant and a pulse generator with real-time triggering capabilities. We designed and implemented wireless control systems that linked online neural decoding of extension and flexion motor states with stimulation protocols promoting these movements. These systems allowed the monkeys to behave freely without any restrictions or constraining tethered electronics. After validation of the brain–spinal interface in intact monkeys, we performed a unilateral corticospinal tract lesion at the thoracic level. As early as six days post-injury and without prior training of the monkeys, the brain–spinal interface restored weight-bearing locomotion of the paralyzed leg on a treadmill and overground. The implantable components integrated in the brain–spinal interface have all been approved for investigational applications in similar human research, suggesting a practical translational pathway for proof-of-concept studies in people with spinal cord injury.
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Affiliation(s)
- Marco Capogrosso
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland
| | - Tomislav Milekovic
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - David Borton
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,School of Engineering, Brown University, Providence, Rhode Island, USA
| | - Fabien Wagner
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Eduardo Martin Moraud
- Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland
| | - Jean-Baptiste Mignardot
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | | | - Jerome Gandar
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - David Xing
- School of Engineering, Brown University, Providence, Rhode Island, USA
| | - Elodie Rey
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Simone Duis
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | | | | | - Qin Li
- Motac Neuroscience Ltd, Manchester, UK.,Institute of Lab Animal Sciences, China Academy of Medical Sciences, Beijing, China
| | - Peter Detemple
- Mainz Institute for Microtechnology, Fraunhofer Institute for Chemical Technology (ICT-IMM), Mainz, Germany
| | | | - Silvestro Micera
- Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Erwan Bezard
- Motac Neuroscience Ltd, Manchester, UK.,Institute of Lab Animal Sciences, China Academy of Medical Sciences, Beijing, China.,Institut des Maladies Neurodégénératives, University of Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Jocelyne Bloch
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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206
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Borrell JA, Frost SB, Peterson J, Nudo RJ. A 3D map of the hindlimb motor representation in the lumbar spinal cord in Sprague Dawley rats. J Neural Eng 2016; 14:016007. [PMID: 27934789 DOI: 10.1088/1741-2552/14/1/016007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Spinal cord injury (SCI) is a devastating neurological trauma with a prevalence of about 282 000 people living with an SCI in the United States in 2016. Advances in neuromodulatory devices hold promise for restoring function by incorporating the delivery of electrical current directly into the spinal cord grey matter via intraspinal microstimulation (ISMS). In such designs, detailed topographic maps of spinal cord outputs are needed to determine ISMS locations for eliciting hindlimb movements. The primary goal of the present study was to derive a topographic map of functional motor outputs in the lumbar spinal cord to hindlimb skeletal muscles as defined by ISMS in a rat model. APPROACH Experiments were carried out in nine healthy, adult, male, Sprague Dawley rats. After a laminectomy of the T13-L1 vertebrae and removal of the dura mater, a four-shank, 16-channel microelectrode array was inserted along a 3D (200 µm) stimulation grid. Trains of three biphasic current pulses were used to determine evoked movements and electromyographic (EMG) activity. Via fine wire EMG electrodes, stimulus-triggered averaging (StTA) was used on rectified EMG data to determine response latency. MAIN RESULTS Hindlimb movements were elicited at a median current intensity of 6 µA, and thresholds were significantly lower in ventrolateral sites. Movements typically consisted of whole leg, hip, knee, ankle, toe, and trunk movements. Hip movements dominated rostral to the T13 vertebral segment, knee movements were evoked at the T13-L1 vertebral junction, while ankle and digit movements were found near the rostral L1 vertebra. Whole leg movements spanned the entire rostrocaudal region explored, while trunk movements dominated medially. StTAs of EMG activity demonstrated a latency of ~4 ms. SIGNIFICANCE The derived motor map provides insight into the parameters needed for future neuromodulatory devices.
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Affiliation(s)
- Jordan A Borrell
- Bioengineering Program, University of Kansas, Lawrence, KS, USA. Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS, USA
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207
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O'Donovan KJ. Intrinsic Axonal Growth and the Drive for Regeneration. Front Neurosci 2016; 10:486. [PMID: 27833527 PMCID: PMC5081384 DOI: 10.3389/fnins.2016.00486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/10/2016] [Indexed: 02/01/2023] Open
Abstract
Following damage to the adult nervous system in conditions like stroke, spinal cord injury, or traumatic brain injury, many neurons die and most of the remaining spared neurons fail to regenerate. Injured neurons fail to regrow both because of the inhibitory milieu in which they reside as well as a loss of the intrinsic growth capacity of the neurons. If we are to develop effective therapeutic interventions that promote functional recovery for the devastating injuries described above, we must not only better understand the molecular mechanisms of developmental axonal growth in hopes of re-activating these pathways in the adult, but at the same time be aware that re-activation of adult axonal growth may proceed via distinct mechanisms. With this knowledge in hand, promoting adult regeneration of central nervous system neurons can become a more tractable and realistic therapeutic endeavor.
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Affiliation(s)
- Kevin J O'Donovan
- Department of Chemistry and Life Science, United States Military Academy West Point, NY, USA
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208
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Cappellini G, Ivanenko YP, Martino G, MacLellan MJ, Sacco A, Morelli D, Lacquaniti F. Immature Spinal Locomotor Output in Children with Cerebral Palsy. Front Physiol 2016; 7:478. [PMID: 27826251 PMCID: PMC5078720 DOI: 10.3389/fphys.2016.00478] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/05/2016] [Indexed: 12/29/2022] Open
Abstract
Detailed descriptions of gait impairments have been reported in cerebral palsy (CP), but it is still unclear how maturation of the spinal motoneuron output is affected. Spatiotemporal alpha-motoneuron activation during walking can be assessed by mapping the electromyographic activity profiles from several, simultaneously recorded muscles onto the anatomical rostrocaudal location of the motoneuron pools in the spinal cord, and by means of factor analysis of the muscle activity profiles. Here, we analyzed gait kinematics and EMG activity of 11 pairs of bilateral muscles with lumbosacral innervation in 35 children with CP (19 diplegic, 16 hemiplegic, 2-12 years) and 33 typically developing (TD) children (1-12 years). TD children showed a progressive reduction of EMG burst durations and a gradual reorganization of the spatiotemporal motoneuron output with increasing age. By contrast, children with CP showed very limited age-related changes of EMG durations and motoneuron output, as well as of limb intersegmental coordination and foot trajectory control (on both sides for diplegic children and the affected side for hemiplegic children). Factorization of the EMG signals revealed a comparable structure of the motor output in children with CP and TD children, but significantly wider temporal activation patterns in children with CP, resembling the patterns of much younger TD infants. A similar picture emerged when considering the spatiotemporal maps of alpha-motoneuron activation. Overall, the results are consistent with the idea that early injuries to developing motor regions of the brain substantially affect the maturation of the spinal locomotor output and consequently the future locomotor behavior.
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Affiliation(s)
- Germana Cappellini
- Centre of Space Bio-medicine, University of Rome Tor Vergata Rome, Italy
| | - Yury P Ivanenko
- Laboratory of Neuromotor Physiology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation Rome, Italy
| | - Giovanni Martino
- Centre of Space Bio-medicine, University of Rome Tor Vergata Rome, Italy
| | | | - Annalisa Sacco
- Department of Pediatric Neurorehabilitation, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation Rome, Italy
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation Rome, Italy
| | - Francesco Lacquaniti
- Centre of Space Bio-medicine, University of Rome Tor VergataRome, Italy; Laboratory of Neuromotor Physiology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia FoundationRome, Italy; Department of Systems Medicine, University of Rome Tor VergataRome, Italy
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209
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Torregrosa T, Koppes RA. Bioelectric Medicine and Devices for the Treatment of Spinal Cord Injury. Cells Tissues Organs 2016; 202:6-22. [PMID: 27701161 DOI: 10.1159/000446698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
Recovery of motor control is paramount for patients living with paralysis following spinal cord injury (SCI). While a cure or regenerative intervention remains on the horizon for the treatment of SCI, a number of neuroprosthetic devices have been employed to treat and mitigate the symptoms of paralysis associated with injuries to the spinal column and associated comorbidities. The recent success of epidural stimulation to restore voluntary motor function in the lower limbs of a small cohort of patients has breathed new life into the promise of electric-based medicine. Recently, a number of new organic and inorganic electronic devices have been developed for brain-computer interfaces to bypass the injury, for neurorehabilitation, bladder and bowel control, and the restoration of motor or sensory control. Herein, we discuss the recent advances in neuroprosthetic devices for treating SCI and highlight future design needs for closed-loop device systems.
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210
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Rejc E, Angeli CA, Bryant N, Harkema SJ. Effects of Stand and Step Training with Epidural Stimulation on Motor Function for Standing in Chronic Complete Paraplegics. J Neurotrauma 2016; 34:1787-1802. [PMID: 27566051 DOI: 10.1089/neu.2016.4516] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Individuals affected by motor complete spinal cord injury are unable to stand, walk, or move their lower limbs voluntarily; this diagnosis normally implies severe limitations for functional recovery. We have recently shown that the appropriate selection of epidural stimulation parameters was critical to promoting full-body, weight-bearing standing with independent knee extension in four individuals with chronic clinically complete paralysis. In the current study, we examined the effects of stand training and subsequent step training with epidural stimulation on motor function for standing in the same four individuals. After stand training, the ability to stand improved to different extents in the four participants. Step training performed afterwards substantially impaired standing ability in three of the four individuals. Improved standing ability generally coincided with continuous electromyography (EMG) patterns with constant levels of ground reaction forces. Conversely, poorer standing ability was associated with more variable EMG patterns that alternated EMG bursts and longer periods of negligible activity in most of the muscles. Stand and step training also differentially affected the evoked potentials amplitude modulation induced by sitting-to-standing transition. Finally, stand and step training with epidural stimulation were not sufficient to improve motor function for standing without stimulation. These findings show that the spinal circuitry of motor complete paraplegics can generate motor patterns effective for standing in response to task-specific training with optimized stimulation parameters. Conversely, step training can lead to neural adaptations resulting in impaired motor function for standing.
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Affiliation(s)
- Enrico Rejc
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville , Louisville, Kentucky
| | - Claudia A Angeli
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,3 Frazier Rehab Institute , Kentucky One Health, Louisville, Kentucky
| | - Nicole Bryant
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky
| | - Susan J Harkema
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville , Louisville, Kentucky.,3 Frazier Rehab Institute , Kentucky One Health, Louisville, Kentucky
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211
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Canavero S, Ren X, Kim CY, Rosati E. Neurologic foundations of spinal cord fusion (GEMINI). Surgery 2016; 160:11-19. [PMID: 27180142 DOI: 10.1016/j.surg.2016.01.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/08/2016] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Abstract
Cephalosomatic anastomosis has been carried out in both monkeys and mice with preservation of brain function. Nonetheless the spinal cord was not reconstructed, leaving the animals unable to move voluntarily. Here we review the details of the GEMINI spinal cord fusion protocol, which aims at restoring electrophysiologic conduction across an acutely transected spinal cord. The existence of the cortico-truncoreticulo-propriospinal pathway, a little-known anatomic entity, is described, and its importance concerning spinal cord fusion emphasized. The use of fusogens and electrical stimulation as adjuvants for nerve fusion is addressed. The possibility of achieving cephalosomatic anastomosis in humans has become reality in principle.
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Affiliation(s)
| | - XiaoPing Ren
- Hand and Microsurgical Center, the Second Affiliated Hospital of Harbin Medical University; State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China; Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - C-Yoon Kim
- Department of Bioengineering, College of Life Science, CHA University, Seoul, Korea; Department of Laboratory Animal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Korea
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