Interfering with inhibition may improve motor function

Changes in intra- and interlimb reflexes from hindlimb cutaneous afferents after staggered thoracic lateral hemisections during locomotion in cats

When the foot dorsum contacts an obstacle during locomotion, cutaneous afferents signal central circuits to coordinate muscle activity in the four limbs. Spinal cord injury disrupts these interactions, impairing balance and interlimb coordination. We evoked cutaneous reflexes by electrically stimulating left and right superficial peroneal nerves before and after two thoracic lateral hemisections placed on opposite sides of the cord at 9- to 13-week interval in seven adult cats (4 males and 3 females). We recorded reflex responses in ten hindlimb and five forelimb muscles bilaterally. After the first (right T5-T6) and second (left T10-T11) hemisections, coordination of the fore- and hindlimbs was altered and/or became less consistent. After the second hemisection, cats required balance assistance to perform quadrupedal locomotion. Short-latency reflex responses in homonymous and crossed hindlimb muscles largely remained unaffected after staggered hemisections. However, mid- and long-latency homonymous and crossed responses in both hindlimbs occurred less frequently after staggered hemisections. In forelimb muscles, homolateral and diagonal mid- and long-latency response occurrence significantly decreased after the first and second hemisections. In all four limbs, however, when present, short-, mid- and long-latency responses maintained their phase-dependent modulation. We also observed reduced durations of short-latency inhibitory homonymous responses in left hindlimb extensors early after the first hemisection and delayed short-latency responses in the right ipsilesional hindlimb after the first hemisection. Therefore, changes in cutaneous reflex responses correlated with impaired balance/stability and interlimb coordination during locomotion after spinal cord injury. Restoring reflex transmission could be used as a biomarker to facilitate locomotor recovery. KEY POINTS: Cutaneous afferent inputs coordinate muscle activity in the four limbs during locomotion when the foot dorsum contacts an obstacle. Thoracic spinal cord injury disrupts communication between spinal locomotor centres located at cervical and lumbar levels, impairing balance and limb coordination. We investigated cutaneous reflexes during quadrupedal locomotion by electrically stimulating the superficial peroneal nerve bilaterally, before and after staggered lateral thoracic hemisections of the spinal cord in cats. We showed a loss/reduction of mid- and long-latency responses in all four limbs after staggered hemisections, which correlated with altered coordination of the fore- and hindlimbs and impaired balance. Targeting cutaneous reflex pathways projecting to the four limbs could help develop therapeutic approaches aimed at restoring transmission in ascending and descending spinal pathways.

Changes in intra- and interlimb reflexes from hindlimb cutaneous afferents after staggered thoracic lateral hemisections during locomotion in cats

When the foot dorsum contacts an obstacle during locomotion, cutaneous afferents signal central circuits to coordinate muscle activity in the four limbs. Spinal cord injury disrupts these interactions, impairing balance and interlimb coordination. We evoked cutaneous reflexes by electrically stimulating left and right superficial peroneal nerves before and after two thoracic lateral hemisections placed on opposite sides of the cord at 9-13 weeks interval in seven adult cats (4 males and 3 females). We recorded reflex responses in ten hindlimb and five forelimb muscles bilaterally. After the first (right T5-T6) and second (left T10-T11) hemisections, coordination of the fore- and hindlimbs was altered and/or became less consistent. After the second hemisection, cats required balance assistance to perform quadrupedal locomotion. Short-latency reflex responses in homonymous and crossed hindlimb muscles largely remained unaffected after staggered hemisections. However, mid- and long-latency homonymous and crossed responses in both hindlimbs occurred less frequently after staggered hemisections. In forelimb muscles, homolateral and diagonal mid- and long-latency response occurrence significantly decreased after the first and second hemisections. In all four limbs, however, when present, short-, mid- and long-latency responses maintained their phase-dependent modulation. We also observed reduced durations of short-latency inhibitory homonymous responses in left hindlimb extensors early after the first hemisection and delayed short-latency responses in the right ipsilesional hindlimb after the first hemisection. Therefore, changes in cutaneous reflex responses correlated with impaired balance/stability and interlimb coordination during locomotion after spinal cord injury. Restoring reflex transmission could be used as a biomarker to facilitate locomotor recovery.

Neurotransmitter phenotype switching by spinal excitatory interneurons regulates locomotor recovery after spinal cord injury

Severe spinal cord injury in adults leads to irreversible paralysis below the lesion. However, adult rodents that received a complete thoracic lesion just after birth demonstrate proficient hindlimb locomotion without input from the brain. How the spinal cord achieves such striking plasticity remains unknown. In this study, we found that adult spinal cord injury prompts neurotransmitter switching of spatially defined excitatory interneurons to an inhibitory phenotype, promoting inhibition at synapses contacting motor neurons. In contrast, neonatal spinal cord injury maintains the excitatory phenotype of glutamatergic interneurons and causes synaptic sprouting to facilitate excitation. Furthermore, genetic manipulation to mimic the inhibitory phenotype observed in excitatory interneurons after adult spinal cord injury abrogates autonomous locomotor functionality in neonatally injured mice. In comparison, attenuating this inhibitory phenotype improves locomotor capacity after adult injury. Together, these data demonstrate that neurotransmitter phenotype of defined excitatory interneurons steers locomotor recovery after spinal cord injury.

Myoelectric evoked potentials versus locomotor recovery in chronic spinal cord injured rats

The purpose of this study was to determine the utility of descending evoked potentials in evaluating functional recovery in rats after spinal cord contusion injury. Rats received thoracic contusions at T9 using a controlled-displacement impactor. They were evaluated for 5 weeks postinjury using auditory startle responses (ASR) while alert, or by cerebellar motor evoked potentials (CMEP) while anesthetized. ASR and CMEP were recorded electromyographically from forelimb and hindlimb muscles. Open field locomotor performance was also assessed and recovered to almost normal levels by 3 weeks postinjury. Histologic analysis of the injury site indicated that the contusions destroyed approximately 70% of the cross-sectional area of the cord. Although the remaining 30% was sufficient to preserve nearly normal locomotor behavior, ASR and CMEP amplitudes in hindlimb flexors and extensors were reduced by 90% or more after injury and showed virtually no recovery. Significant ASR and CMEP responses were present in the cutaneous trunk muscles of the lower torso after injury. These muscles are innervated via peripheral nerves originating at cord levels above the injury. Multi-wave field potentials normally recorded from the dorsal cord surface in response to cerebellar stimulation were absent in injured rats, suggesting minimal if any activation of segmental neurons via the pathways normally mediating CMEP. The tracts mediating ASR and CMEP thus appear to be highly sensitive to mild spinal cord trauma but are evidently not essential for support or walking.

Functional recovery after limbic lesions in monkeys

Ten monkeys received lesions of either the hippocampus, or the amygdala and hippocampus, or the anterior and medial thalamus (each group with two monkeys), or of all these structures together with additional septal lesions (four monkeys). Postoperatively, the monkeys were trained in tasks of visual and spatial reversal, several concurrent object discriminations, delayed nonmatch-to-sample, and in an angle threshold discrimination task. Their performance was compared to that of five healthy or sham-operated control monkeys. The single- or double-lesioned monkeys were impaired in the delayed nonmatch-to-sample task and the angle threshold discrimination, whereas monkeys with five-fold lesions were unimpaired in these tasks. Correlations between brain volume loss and behavioral performance indicated negative coefficients for the delayed nonmatch-to-sample task ("delays": rs = -.59, "lists": rs = -.20) and the angle threshold discrimination (rs = -.60). It is concluded that monkeys with massive limbic lesions display a more effective postlesion reorganization than monkeys with smaller limbic lesions; however, reliability of this effect must be proved by future work with a larger sample. Furthermore, the missing impairments of massively lesioned monkeys especially in the delayed nonmatch-to-sample task also indicate that the limbic targets lesioned here may not be as exclusively involved in mnemonic information processing as suggested earlier.

Motor recovery in the absence of segmental afferents: a case study of incomplete spinal cord injury

A 41-year-old male with a prior left L-5/S-1 radiculopathy developed complete quadriplegia following a gunshot wound to the left anterior neck. He subsequently recovered pinprick sensation over the left side of the trunk and lower extremity; and a right peroneal SEP, suggested sparing of long tracts on the right side. Voluntary motor strength gradually recovered more on the left than right for the L-5/S-1 segments, where tendon reflexes were absent. This unique case is discussed with respect to the effect of absent segmental afferents on suprasegmental recovery.

Neuromuscular patterns of stereotypic hindlimb behaviors in the first two postnatal months. I. Stepping in normal kittens

Neuromuscular patterns associated with the development of hindlimb stepping behaviors were studied from birth to postnatal day 60 in normal kittens. Hindlimb muscles were chronically implanted with EMG electrodes at birth to characterize interlimb coordination and intralimb synergies during development of overground and treadmill stepping. Airstepping was also examined but seldom occurred after the second postnatal week. All kittens performed stepping under each condition, including weight-supported stepping, by postnatal day 3. The number of sequential steps on the treadmill and overground increased with age and cycle periods decreased. At onset, stepping behaviors were characterized by adult-like EMG patterns. Interlimb coordination was typified by alternating extensor bursts of similar duration. Extensors at the knee and ankle were coactive during the stance phase, and extensor burst durations were strongly correlated with the cycle periods over a wide range of stepping frequency. Ankle flexor and extensor muscles were reciprocally active during postural tremor, bouts of airstepping, and weight-supported steps on the treadmill and overground. The duration of the reciprocal flexor bust did not vary with cycle period or age. Observations of stepping behaviors and adult-like EMG patterns during initial postnatal development were contingent on optimal testing conditions. Taken together, the data suggest that pattern-generating circuits for regulating interlimb coordination and intralimb muscle synergies are potentially functional prior to the normal ontogenetic onset of locomotion. Perhaps the prolonged postnatal development of locomotion reflects the time required to establish adaptive mechanisms, such as postural control and agility, rather than spinal pattern-generating circuits for locomotion.

Neuromuscular patterns of stereotypic hindlimb behaviors in the first two postnatal months. II. Stepping in spinal kittens

From birth to postnatal day 60, neuromuscular patterns for airstepping and treadmill stepping were assessed in kittens spinalized (T12) at birth (Day-1) or at the end of the second postnatal week (Day-14). Within 72 h after spinalization, all kittens displayed stepping motions, but exteroceptive facilitation (e.g. tail pinch) was required to initiate and sustain both behaviors. In Day-14 spinal kittens, the hindlimbs spontaneously and alternately airstepped, but in Day-1 spinal kittens exteroceptive stimulation was usually necessary to evoke airstepping, and the hindlimbs stepped synchronously. Kittens in both groups developed atypical neuromuscular patterns; flexor bursts were nearly twice as long in duration as extensor bursts. Development of bipedal treadmill stepping was similar for Day-1 and Day-14 spinal kittens, but differed from that for normal kittens. Tested at the same belt speeds, stepping was more easily elicited in spinal kittens, bouts of repetitive stepping were longer, and cycle periods were shorter than in normal kittens until postnatal week 6. Spinal kittens, however, seldom exhibited adequate weight support during hindlimbs stepping, and the neuromuscular patterns associated with bipedal stepping were atypical. For spinal kittens, the relationship between the extensor burst duration and the cycle period was reduced substantially, and flexor activity was initiated earlier in the step cycle and was longer in duration than that for normal kittens. These atypical intralimb synergies may have been the consequence of altered lumbosacral circuits produced by the spinal transection. It is also possible that these spinal circuits, lacking rostral input, were particularly susceptible to abnormal motion-dependent feedback resulting from reduced hindlimb weight support.

Development of serotonin immunoreactivity in the rat spinal cord and its plasticity after neonatal spinal cord lesions

The postnatal maturation of spinal pathways may account for the gradual time course of postnatal development of behavior and also account for the greater anatomical reorganization which often follows damage to the developing CNS compared to the mature CNS. The purpose of the current study was to examine (1) the prenatal and postnatal development of the descending serotonergic (5-HT) projection to the spinal cord and (2) the effects of a neonatal spinal cord lesion on this development. In addition, we wished to determine (3) whether transplants of fetal spinal cord tissue placed into the neonatal lesion site alter the plasticity of the 5-HT projection to the cord. Peroxidase-antiperoxidase immunocytochemical techniques were used. At embryonic day 14 (E14), no 5-HT immunoreactive fibers could be identified at any spinal cord level. By E18 the first axons were identified in the white matter only at all spinal cord levels. At birth, 5-HT immunoreactive fibers were present both in the white matter and in the gray matter at all cord levels. The projection within the gray matter was diffuse and considerably less dense than in the adult. The postnatal maturation of the 5-HT projection within the gray matter of the spinal cord followed rostral to caudal and ventral to dorsal gradients. During the first weeks postnatal, the 5-HT immunoreactivity within the cord increased to attain an adult pattern and density by 14 days in the cervical cord and 21 days in the thoracic and lumbar cord. The effect of a spinal cord hemisection at birth on the anatomical reorganization of the descending serotonergic innervation of the cord was compared with the effect of the same lesion in the adult. In the adult animal, mid-thoracic hemisection decreased the 5-HT content of the ventral horn of the lumbar spinal cord caudal and ipsilateral to the lesion to 8% of that on the intact side. When this same lesion was made in the newborn animal, the innervation was 43% of that on the intact side. When a transplant of fetal spinal cord tissue was inserted into the lesion site in the newborn animals, there was even greater 5-HT innervation caudal to the lesion, 83% of that on the intact side. These results indicate that there is considerable postnatal development and plasticity of the descending serotonergic projection to the spinal cord, and this plasticity is enhanced by the presence of a spinal cord transplant at the site of the lesion.

Lesion size and recovery of function: some new perspectives

The present article discusses the possibility that functional recovery following brain damage may be to a large degree dependent on the amount of nervous tissue destroyed, such that more neuronal destruction may lead to more and not (as commonly suggested) to less recovery. This assumption may derive from the neuropsychological and neurological literature: many cases with circumscribed brain lesions are implicated with severe functional losses. However, patients with dramatic and severe brain destructions often show astonishingly normal behavior regarding cognition, speech, visuospatial, motor and sensory functions. Animal experimentation as well shows that an extensive lesion of a brain area may be associated with equal or less functional detriment than a small lesion of the same area. Along with the well-known variables of age, lesion growth, or personality and environmental factors, the amount of tissue destroyed should be considered as a potent mediator of functional recovery. At least for some functions and brain regions, the likeliness of recovery may increase with the extent of the lesion and thus the necessity of the brain to fulfill plastic changes.

Mechanisms contributing to sparing of function following neonatal damage to spinal pathways

When spinal pathways are damaged in newborn animals and their behavior is examined in adulthood, motor function is superior to that seen in animals in which the same lesion was made in adulthood. This is the infant lesion effect. After neonatal sensorimotor cortex ablation, spinal hemisection, or spinal transection, sparing of contact placing is observed; in adults, all three lesions abolish contact placing permanently. The anatomical correlates of the infant lesion effect are different in each case. After neonatal unilateral cortical ablation, an exuberant crossed corticorubral pathway from the other cortex fails to retract (as it does normally), giving the remaining cortex a path for mediating contact placing. After neonatal spinal hemisection, late-developing corticospinal axons take an aberrant course around the lesion and mediate contact placing. After neonatal transection, the spinal inhibitory GABA-ergic system fails to develop to a normal extent. This may result in abnormal enhancement of spinal reflex pathways, especially since some dorsal roots increase their input after that lesion. Thus, a number of factors may influence the outcome of damage to the developing nervous system.

Voluntary supraspinal suppression of spinal reflex activity in paralyzed muscles of spinal cord injury patients

Having previously demonstrated that residual facilitatory brain influence on segmental structures occurs in paralyzed spinal cord injury patients, we sought evidence of suprasegmental suppression in such patients. By recording EMG activity from leg muscles, we studied changes in segmental excitability of the plantar reflex elicited by cutaneous stimulation of the plantar surface. Using surface EMG recordings, 50 paralyzed spinal cord injury patients were examined for their ability to volitionally suppress the plantar reflex on three repeated trials after three baseline trials. The patients, who had no voluntary EMG activity in the monitored muscles, were able to volitionally suppress the plantar reflex responses by 45% in the tibialis anterior, hamstring, and triceps surae muscles and to suppress the quadriceps response by 72%. In this patient group, 73 of 100 tibialis anterior muscle groups showed suppression of more than 20% compared with the control response. On reexamination, these findings were consistent during a period of 2 years in six patients. We conclude that suprasegmental suppression of segmental activity does occur in paralyzed spinal cord injury patients, and that in clinically complete patients, neurological evaluation should include assessment of the degree of preservation of suprasegmental neurocontrol on segmental activity below the lesion.