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Craven BC, Souza WH, Jaglal S, Gibbs J, Wiest MJ, Sweet SN, Athanasopoulos P, Lamontagne ME, Boag L, Patsakos E, Wolfe D, Hicks A, Maltais DB, Best KL, Gagnon D. Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team. Disabil Rehabil 2024; 46:4835-4847. [PMID: 38018518 DOI: 10.1080/09638288.2023.2284223] [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: 04/29/2022] [Revised: 09/17/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.
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Affiliation(s)
- Beverley Catharine Craven
- Toronto Rehabilitation Institute, Lyndhurst Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wagner Henrique Souza
- Kite Research Institute, University Health Network, Lyndhurst Centre, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jenna Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | | | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, Canada
| | - Peter Athanasopoulos
- Senior Manager Public Policy and Government Relations, Spinal Cord Injury Ontario, Toronto, Canada
| | | | - Lynn Boag
- University of Guelph, Guelph, Canada
| | - Eleni Patsakos
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Dalton Wolfe
- Department of Physical Medicine and Rehabilitation, Western University, Parkwood Institute Research, London, Canada
| | - Audrey Hicks
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Désirée B Maltais
- Department of Rehabilitation, Physiotherapy Program, Laval University, Quebec City, Canada
| | - Krista Lynn Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Dany Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Canada
- Rehabilitation, Université de Montréal, École de Réadaptation, Montréal, Canada
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Hu Q, Li Y, Lin Z, Zhang H, Chen H, Chao C, Zhao C. The Molecular Biological Mechanism of Hydrogen Therapy and Its Application in Spinal Cord Injury. Drug Des Devel Ther 2024; 18:1399-1414. [PMID: 38707612 PMCID: PMC11068043 DOI: 10.2147/dddt.s463177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
Hydrogen, which is a novel biomedical molecule, is currently the subject of extensive research involving animal experiments and in vitro cell experiments, and it is gradually being applied in clinical settings. Hydrogen has been proven to possess anti-inflammatory, selective antioxidant, and antiapoptotic effects, thus exhibiting considerable protective effects in various diseases. In recent years, several studies have provided preliminary evidence for the protective effects of hydrogen on spinal cord injury (SCI). This paper provides a comprehensive review of the potential molecular biology mechanisms of hydrogen therapy and its application in treating SCI, with an aim to better explore the medical value of hydrogen and provide new avenues for the adjuvant treatment of SCI.
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Affiliation(s)
- Quan Hu
- Department of Neurosurgery, The Affiliated Taian City Central Hospital of Qingdao University, Tai’an City, Shandong, 271000, People’s Republic of China
| | - Yingxiao Li
- Department of Gynecology, The Affiliated Taian City Central Hospital of Qingdao University, Tai’an City, Shandong, 271000, People’s Republic of China
| | - Zhaochen Lin
- Hydrogen Medical Research Center, The Affiliated Taian City Central Hospital of Qingdao University, Tai’an City, Shandong, 271000, People’s Republic of China
| | - Hao Zhang
- Department of Rehabilitation Medical Center, The Affiliated Taian City Central Hospital of Qingdao University, Tai’an City, Shandong, 271000, People’s Republic of China
| | - Haoyue Chen
- Department of Rehabilitation Medical Center, The Affiliated Taian City Central Hospital of Qingdao University, Tai’an City, Shandong, 271000, People’s Republic of China
| | - Cui Chao
- Hydrogen Medical Research Center, The Affiliated Taian City Central Hospital of Qingdao University, Tai’an City, Shandong, 271000, People’s Republic of China
| | - Chuanliang Zhao
- Department of Orthopedics, the Affiliated Taian City Central Hospital of Qingdao University, Tai’an City, Shandong, 271000, People’s Republic of China
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3
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Tashiro S, Shibata S, Nagoshi N, Zhang L, Yamada S, Tsuji T, Nakamura M, Okano H. Do Pharmacological Treatments Act in Collaboration with Rehabilitation in Spinal Cord Injury Treatment? A Review of Preclinical Studies. Cells 2024; 13:412. [PMID: 38474376 DOI: 10.3390/cells13050412] [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: 01/17/2024] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
There is no choice other than rehabilitation as a practical medical treatment to restore impairments or improve activities after acute treatment in people with spinal cord injury (SCI); however, the effect is unremarkable. Therefore, researchers have been seeking effective pharmacological treatments. These will, hopefully, exert a greater effect when combined with rehabilitation. However, no review has specifically summarized the combinatorial effects of rehabilitation with various medical agents. In the current review, which included 43 articles, we summarized the combinatorial effects according to the properties of the medical agents, namely neuromodulation, neurotrophic factors, counteraction to inhibitory factors, and others. The recovery processes promoted by rehabilitation include the regeneration of tracts, neuroprotection, scar tissue reorganization, plasticity of spinal circuits, microenvironmental change in the spinal cord, and enforcement of the musculoskeletal system, which are additive, complementary, or even synergistic with medication in many cases. However, there are some cases that lack interaction or even demonstrate competition between medication and rehabilitation. A large fraction of the combinatorial mechanisms remains to be elucidated, and very few studies have investigated complex combinations of these agents or targeted chronically injured spinal cords.
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Affiliation(s)
- Syoichi Tashiro
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Faculty of Medicine, Kyorin University, Tokyo 181-8611, Japan
| | - Shinsuke Shibata
- Division of Microscopic Anatomy, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Liang Zhang
- Department of Rehabilitation Medicine, Faculty of Medicine, Kyorin University, Tokyo 181-8611, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Faculty of Medicine, Kyorin University, Tokyo 181-8611, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Hideyuki Okano
- Department of Physiology, School of Medicine, Keio University, Tokyo 160-8582, Japan
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4
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Clanchy K, Mitchell J, Mulholland K, Jurd E, Kendall E, Lloyd DG, Palipana D, Pizzolato C, Shirota C. Towards co-design of rehabilitation technologies: a collaborative approach to prioritize usability issues. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1302179. [PMID: 38450206 PMCID: PMC10915061 DOI: 10.3389/fresc.2024.1302179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024]
Abstract
Introduction Early stakeholder engagement is critical to the successful development and translation of rehabilitation technologies, a pivotal step of which is usability testing with intended end-users. To this end, several methods employ end-user feedback to identify usability and implementation issues. However, the process of prioritizing identified issues seldom leverages the knowledge and expertise of the range of stakeholders who will ultimately affect the demand and supply of a device. This paper describes a novel method to prioritize end-user feedback using transdisciplinary stakeholder consultation and address it in subsequent product development. The proposed approach was demonstrated using a case study relating to the development of a novel technology for neural recovery after spinal cord injury. Method Feedback from five individuals with chronic spinal cord injury was collected during two-hour usability evaluation sessions with a fully functional high-fidelity system prototype. A think-aloud and semi-structured interview protocol was used with each participant to identify usability and acceptability issues relating to the system in a 3-phase approach. Phase 1 involved extracting usability issues from think-aloud and semi-structured interview data. Phase 2 involved rating the usability issues based on their significance, technical feasibility, and implementation priority by relevant internal and external stakeholders. Finally, Phase 3 involved aggregating the usability issues according to design and implementation elements to facilitate solution generation, and these solutions were then raised as action tasks for future design iterations. Results Sixty usability issues representing nine facets of usability were rated. Eighty percent of issues were rated to be of moderate to high significance, 83% were rated as being feasible to address, and 75% were rated as addressable using existing project resources. Fifty percent of the issues were rated to be a high priority for implementation. Evaluation of the grouped issues identified 21 tasks which were mapped to the product roadmap for integration into future design iterations. Discussion This paper presents a method for meaningful transdisciplinary stakeholder engagement in rehabilitation technology development that can extended to other projects. Alongside a worked example, we offer practical considerations for others seeking to co-develop rehabilitation technologies.
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Affiliation(s)
- K. Clanchy
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - J. Mitchell
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - K. Mulholland
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Advanced Design and Prototyping Technologies Institute, Menzies Health Institute Queensland, Southport, QLD, Australia
| | - E. Jurd
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Advanced Design and Prototyping Technologies Institute, Menzies Health Institute Queensland, Southport, QLD, Australia
| | - E. Kendall
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - D. G. Lloyd
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Advanced Design and Prototyping Technologies Institute, Menzies Health Institute Queensland, Southport, QLD, Australia
| | - D. Palipana
- Emergency Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - C. Pizzolato
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Advanced Design and Prototyping Technologies Institute, Menzies Health Institute Queensland, Southport, QLD, Australia
| | - C. Shirota
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
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Hao J, Li Z, Xie L, Yu B, Ma B, Yang Y, Ma X, Wang B, Zhou X. Syringaresinol promotes the recovery of spinal cord injury by inhibiting neuron apoptosis via activating the ubiquitination factor E4B/AKT Serine/Threonine kinase signal pathway. Brain Res 2024; 1824:148684. [PMID: 37992795 DOI: 10.1016/j.brainres.2023.148684] [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: 07/01/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023]
Abstract
Spinal cord injury (SCI) is a serious traumatic disease with no effective treatment. This study aimed to explore the therapeutic effect of syringaresinol on SCI. First, the potential targets and associated signaling pathways of syringaresinol were predicted by bioinformatics analysis and molecular docking. Second, MTT was employed to evaluate cell proliferation rate, Western blot was performed to detect protein expression, RT-qPCR was conducted to detect mRNA expression levels, flow cytometry and 5-ethynyl-2'-deoxyuridine (EDU) staining were used to determine cell apoptosis, and immunofluorescence and immunohistochemistry were used to estimate the expression of RNA binding fox-1 homolog 3 and clipped caspase 3. Basso-Beattie-Bresnahan scores and inclined plate tests were conducted to analyze hindlimb locomotor function. Results showed that syringaresinol could inhibit the apoptosis of glutamate-treated SHSY5Y cells by upregulating the expression of ubiquitination factor E4B (UBE4B) and activating the AKT serine/threonine kinase (AKT) signaling pathway. This effect can be rescued by UBE4B knockdown or AKT pathway inhibition. Syringaresinol remarkably improved locomotor function and increased neuronal survival in SCI rats. Our results suggested that syringaresinol could promote locomotor functional recovery by reducing neuronal apoptosis by activating the UBE4B/AKT signaling pathway.
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Affiliation(s)
- Jian Hao
- Orthopedic Department, The 2(nd) Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Zhenhan Li
- School of Clinical, Wannan Medical College, Wuhu, China
| | - Li Xie
- Department of Anesthesiology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Bingbing Yu
- Department of Orthopedics, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Boyuan Ma
- Orthopedic Department, The 2(nd) Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yubiao Yang
- Orthopedic Department, The 2(nd) Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuchen Ma
- Orthopedic Department, The 2(nd) Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bitao Wang
- Orthopedic Department, The 2(nd) Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xianhu Zhou
- Orthopedic Department, The 2(nd) Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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6
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More-Potdar S, Golowasch J. Oscillatory network spontaneously recovers both activity and robustness after prolonged removal of neuromodulators. Front Cell Neurosci 2023; 17:1280575. [PMID: 38162002 PMCID: PMC10757639 DOI: 10.3389/fncel.2023.1280575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024] Open
Abstract
Robustness of neuronal activity is a property necessary for a neuronal network to withstand perturbations, which may otherwise disrupt or destroy the system. The robustness of complex systems has been shown to depend on a number of features of the system, including morphology and heterogeneity of the activity of the component neurons, size of the networks, synaptic connectivity, and neuromodulation. The activity of small networks, such as the pyloric network of the crustacean stomatogastric nervous system, appears to be robust despite some of the factors not being consistent with the expected properties of complex systems, e.g., small size and homogeneity of the synaptic connections. The activity of the pyloric network has been shown to be stable and robust in a neuromodulatory state-dependent manner. When neuromodulatory inputs are severed, activity is initially disrupted, losing both stability and robustness. Over the long term, however, stable activity homeostatically recovers without the restoration of neuromodulatory input. The question we address in this study is whether robustness can also be restored as the network reorganizes itself to compensate for the loss of neuromodulatory input and recovers the lost activity. Here, we use temperature changes as a perturbation to probe the robustness of the network's activity. We develop a simple metric of robustness, i.e., the variances of the network phase relationships, and show that robustness is indeed restored simultaneously along with its stable network activity, indicating that, whatever the reorganization of the network entails, it is deep enough also to restore this important property.
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Affiliation(s)
| | - Jorge Golowasch
- Department of Biological Sciences, New Jersey Institute of Technology, Newark, NJ, United States
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7
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Yu D, Zeng X, Aljuboori ZS, Dennison R, Wu L, Anderson JA, Teng YD. T12-L3 Nerve Transfer-Induced Locomotor Recovery in Rats with Thoracolumbar Contusion: Essential Roles of Sensory Input Rerouting and Central Neuroplasticity. Cells 2023; 12:2804. [PMID: 38132124 PMCID: PMC10741684 DOI: 10.3390/cells12242804] [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: 10/09/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Locomotor recovery after spinal cord injury (SCI) remains an unmet challenge. Nerve transfer (NT), the connection of a functional/expendable peripheral nerve to a paralyzed nerve root, has long been clinically applied, aiming to restore motor control. However, outcomes have been inconsistent, suggesting that NT-induced neurological reinstatement may require activation of mechanisms beyond motor axon reinnervation (our hypothesis). We previously reported that to enhance rat locomotion following T13-L1 hemisection, T12-L3 NT must be performed within timeframes optimal for sensory nerve regrowth. Here, T12-L3 NT was performed for adult female rats with subacute (7-9 days) or chronic (8 weeks) mild (SCImi: 10 g × 12.5 mm) or moderate (SCImo: 10 g × 25 mm) T13-L1 thoracolumbar contusion. For chronic injuries, T11-12 implantation of adult hMSCs (1-week before NT), post-NT intramuscular delivery of FGF2, and environmentally enriched/enlarged (EEE) housing were provided. NT, not control procedures, qualitatively improved locomotion in both SCImi groups and animals with subacute SCImo. However, delayed NT did not produce neurological scale upgrading conversion for SCImo rats. Ablation of the T12 ventral/motor or dorsal/sensory root determined that the T12-L3 sensory input played a key role in hindlimb reanimation. Pharmacological, electrophysiological, and trans-synaptic tracing assays revealed that NT strengthened integrity of the propriospinal network, serotonergic neuromodulation, and the neuromuscular junction. Besides key outcomes of thoracolumbar contusion modeling, the data provides the first evidence that mixed NT-induced locomotor efficacy may rely pivotally on sensory rerouting and pro-repair neuroplasticity to reactivate neurocircuits/central pattern generators. The finding describes a novel neurobiology mechanism underlying NT, which can be targeted for development of innovative neurotization therapies.
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Affiliation(s)
- Dou Yu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
- Laboratory of SCI, Stem Cell and Recovery Neurobiology Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02129, USA
| | - Xiang Zeng
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
- Laboratory of SCI, Stem Cell and Recovery Neurobiology Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02129, USA
| | - Zaid S. Aljuboori
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
- Laboratory of SCI, Stem Cell and Recovery Neurobiology Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02129, USA
| | - Rachel Dennison
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
- Laboratory of SCI, Stem Cell and Recovery Neurobiology Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02129, USA
| | - Liquan Wu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
- Laboratory of SCI, Stem Cell and Recovery Neurobiology Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02129, USA
| | - Jamie A. Anderson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
- Laboratory of SCI, Stem Cell and Recovery Neurobiology Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02129, USA
| | - Yang D. Teng
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA 02115, USA
- Laboratory of SCI, Stem Cell and Recovery Neurobiology Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02129, USA
- Neurotrauma Recovery Research, Spaulding Rehabilitation Hospital Network, Mass General Brigham, Harvard Medical School, Boston, MA 02129, USA
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8
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Saxby DJ, Pizzolato C, Diamond LE. A Digital Twin Framework for Precision Neuromusculoskeletal Health Care: Extension Upon Industrial Standards. J Appl Biomech 2023; 39:347-354. [PMID: 37567581 DOI: 10.1123/jab.2023-0114] [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: 04/29/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
There is a powerful global trend toward deeper integration of digital twins into modern life driven by Industry 4.0 and 5.0. Defense, agriculture, engineering, manufacturing, and urban planning sectors have thoroughly incorporated digital twins to great benefit across their respective product lifecycles. Despite clear benefits, a digital twin framework for health and medical sectors is yet to emerge. This paper proposes a digital twin framework for precision neuromusculoskeletal health care. We build upon the International Standards Organization framework for digital twins for manufacturing by presenting best available computational models within a digital twin framework for clinical application. We map a use case for modeling Achilles tendon mechanobiology, highlighting how current modeling practices align with our proposed digital twin framework. Similarly, we map a use case for advanced neurorehabilitation technology, highlighting the role of a digital twin in control of systems where human and machine are interfaced. Future work must now focus on creating an informatic representation to govern how digital data are passed to, from, and within the digital twin, as well as specific standards to declare which measurement systems and modeling methods are acceptable to move toward widespread use of the digital twin framework for precision neuromusculoskeletal health care.
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Affiliation(s)
- David J Saxby
- Giffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Parklands,Australia
- School of Health Sciences and Social Work, Griffith University, Parklands,Australia
| | - Claudio Pizzolato
- Giffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Parklands,Australia
- School of Health Sciences and Social Work, Griffith University, Parklands,Australia
| | - Laura E Diamond
- Giffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Parklands,Australia
- School of Health Sciences and Social Work, Griffith University, Parklands,Australia
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9
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Mitchell J, Clanchy K, Shirota C. Towards Translation of Novel Neurorehabilitation Systems: A Practical Approach to Usability Testing. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941179 DOI: 10.1109/icorr58425.2023.10304770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Usability testing is important for the effective translation of neurorehabilitation technologies but is often overlooked and under-reported. The aim of this paper is to present a method of collecting and analyzing usability data, using a think-aloud and semi-structured interview protocol and qualitative analysis techniques. We present a worked case study of this method with a novel neurorehabilitation system that utilizes thought-controlled robotics to partially restore lower-limb function of people with spinal cord injury (SCI). Five male participants (mean age = 32.6 years) with SCI who identified as users of related neurorehabilitation technologies completed the usability study. Video-recorded usability sessions utilized a combination of concurrent and retrospective think-aloud methods as well as semi-structured interviews. Recordings were analyzed to identify verbal and behavioral feedback from participants regarding system performance and acceptability. In total, 538 data points were logged, which were aggregated into 60 usability issues, 44 positive evaluations, and 31 strategies for improvement. The approach undertaken was novel in that we sought to not only capture usability issues but also system elements that were positively evaluated by intended users and strategies for improvement from the perspective of intended users. These observations will be used to inform the further development of the neurorehabilitation system.
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10
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Lloyd DG, Saxby DJ, Pizzolato C, Worsey M, Diamond LE, Palipana D, Bourne M, de Sousa AC, Mannan MMN, Nasseri A, Perevoshchikova N, Maharaj J, Crossley C, Quinn A, Mulholland K, Collings T, Xia Z, Cornish B, Devaprakash D, Lenton G, Barrett RS. Maintaining soldier musculoskeletal health using personalised digital humans, wearables and/or computer vision. J Sci Med Sport 2023:S1440-2440(23)00070-1. [PMID: 37149408 DOI: 10.1016/j.jsams.2023.04.001] [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: 05/31/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES The physical demands of military service place soldiers at risk of musculoskeletal injuries and are major concerns for military capability. This paper outlines the development new training technologies to prevent and manage these injuries. DESIGN Narrative review. METHODS Technologies suitable for integration into next-generation training devices were examined. We considered the capability of technologies to target tissue level mechanics, provide appropriate real-time feedback, and their useability in-the-field. RESULTS Musculoskeletal tissues' health depends on their functional mechanical environment experienced in military activities, training and rehabilitation. These environments result from the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing joint tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and strain), which may be enabled by real-time biofeedback. Recent research has shown that these biofeedback technologies are possible by integrating a patient's personalised digital twin and wireless wearable devices. Personalised digital twins are personalised neuromusculoskeletal rigid body and finite element models that work in real-time by code optimisation and artificial intelligence. Model personalisation is crucial in obtaining physically and physiologically valid predictions. CONCLUSIONS Recent work has shown that laboratory-quality biomechanical measurements and modelling can be performed outside the laboratory with a small number of wearable sensors or computer vision methods. The next stage is to combine these technologies into well-designed easy to use products.
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Affiliation(s)
- David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia.
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Matthew Worsey
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Dinesh Palipana
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Medicine, Dentistry and Health, Griffith University, Australia
| | - Matthew Bourne
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Ana Cardoso de Sousa
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Malik Muhammad Naeem Mannan
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Azadeh Nasseri
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Nataliya Perevoshchikova
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Jayishni Maharaj
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Claire Crossley
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Alastair Quinn
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Kyle Mulholland
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Tyler Collings
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Zhengliang Xia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia
| | - Bradley Cornish
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
| | - Daniel Devaprakash
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; VALD Performance, Australia
| | | | - Rodney S Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Australia; School of Health Sciences and Social Work, Griffith University, Australia
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11
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Arora T, Desai N, Kirshblum S, Chen R. Utility of transcranial magnetic stimulation in the assessment of spinal cord injury: Current status and future directions. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005111. [PMID: 36275924 PMCID: PMC9581184 DOI: 10.3389/fresc.2022.1005111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
Comprehensive assessment following traumatic spinal cord injury (SCI) is needed to improve prognostication, advance the understanding of the neurophysiology and better targeting of clinical interventions. The International Standards for Neurological Classification of Spinal Cord Injury is the most common clinical examination recommended for use after a SCI. In addition, there are over 30 clinical assessment tools spanning across different domains of the International Classification of Functioning, Disability, and Health that have been validated and recommended for use in SCI. Most of these tools are subjective in nature, have limited value in predicting neurologic recovery, and do not provide insights into neurophysiological mechanisms. Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiology technique that can supplement the clinical assessment in the domain of body structure and function during acute and chronic stages of SCI. TMS offers a better insight into neurophysiology and help in better detection of residual corticomotor connectivity following SCI compared to clinical assessment alone. TMS-based motor evoked potential and silent period duration allow study of excitatory and inhibitory mechanisms following SCI. Changes in muscle representations in form of displacement of TMS-based motor map center of gravity or changes in the map area can capture neuroplastic changes resulting from SCI or following rehabilitation. Paired-pulse TMS measures help understand the compensatory reorganization of the cortical circuits following SCI. In combination with peripheral stimulation, TMS can be used to study central motor conduction time and modulation of spinal reflexes, which can be used for advanced diagnostic and treatment purposes. To strengthen the utility of TMS in SCI assessment, future studies will need to standardize the assessment protocols, address population-specific concerns, and establish the psychometric properties of TMS-based measurements in the SCI population.
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Affiliation(s)
- Tarun Arora
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Correspondence: Tarun Arora Robert Chen
| | - Naaz Desai
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States,Kessler Institute for Rehabilitation, West Orange, NJ, United States,Kessler Foundation, West Orange, NJ, United States,Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada,Division of Neurology, University of Toronto, Toronto, ON, Canada,Correspondence: Tarun Arora Robert Chen
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12
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Kobayashi RO, Gogeascoechea A, Tomy LJ, Asseldonk EV, Sartori M. Neural data-driven model of spinal excitability changes induced by transcutaneous electrical stimulation in spinal cord injury subjects. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176142 DOI: 10.1109/icorr55369.2022.9896517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The efficacy of trans-spinal direct current stimulation (tsDCS) as neurorehabilitation technology remains sub-optimal, partly due to the variability introduced by subject-specific neurophysiological features and stimulation conditions (e.g. electrode placement, stimulating amplitude, polarity, etc.) Hence, current therapies apply tsDCS in an open-loop fashion, resulting in a lack of standardized protocols for controlling elicited neuronal adaptations in closed-loop. Through the combination of high-density electromyogram (HD-EMG) decomposition, biophysical neuronal modelling and metaheuristic optimization, this work presents a novel neural data-driven framework for estimating subject-specific features and quantifying acute neuronal adaptations elicited by tsDCS on incomplete spinal cord injury subjects. This approach consists of calibrating the anatomical parameters (e.g. soma diameter) of in silico $\alpha-$motoneuron (MN) models for firing similarly to in vivo MNs decoded from HD-EMG. Assuming that cathodal-tsDCS elicits excitability changes in the MN pool, while preserving their anatomical parameters, optimization of an excitability gain common to the entire pool was performed to minimize discrepancies in firing rate and recruitment time between in vivo and in silico MNs after cathodal-tsDCS. This quantification of excitability changes on MN models calibrated in a person specific way enables closing the loop with neuro-modulation devices to tailor neurorehabilitation therapies. Clinical Relevance - This framework addresses a key limitation in non-invasive neuro-modulative technologies via a novel model-assisted framework that enables quantifying acute excitability changes induced on a person-specific in silico MN pool calibrated using in vivo neural data. This will enable the development of advanced controllers for modulating targeted neuronal adaptations in closed-loop.
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13
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Advanced Equipment Development and Clinical Application in Neurorehabilitation for Spinal Cord Injury: Historical Perspectives and Future Directions. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Partial to complete paralysis following spinal cord injury (SCI) causes deterioration in health and has severe effects on the ability to perform activities of daily living. Following the discovery of neural plasticity, neurorehabilitation therapies have emerged that aim to reconstruct the motor circuit of the damaged spinal cord. Functional electrical stimulation (FES) has been incorporated into devices that reconstruct purposeful motions in the upper and lower limbs, the most recent of which do not require percutaneous electrode placement surgery and thus enable early rehabilitation after injury. FES-based devices have shown promising results for improving upper limb movement, including gripping and finger function, and for lower limb function such as the ability to stand and walk. FES has also been employed in hybrid cycling and rowing to increase total body fitness. Training using rehabilitation robots is advantageous in terms of consistency of quality and quantity of movements and is particularly applicable to walking training. Initiation of motor reconstruction at the early stage following SCI is likely to advance rapidly in the future, with the combined use of technologies such as regenerative medicine, brain machine interfaces, and rehabilitation robots with FES showing great promise.
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14
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Bajjig A, Cayetanot F, Taylor JA, Bodineau L, Vivodtzev I. Serotonin 1A Receptor Pharmacotherapy and Neuroplasticity in Spinal Cord Injury. Pharmaceuticals (Basel) 2022; 15:ph15040460. [PMID: 35455457 PMCID: PMC9025596 DOI: 10.3390/ph15040460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022] Open
Abstract
Spinal cord injury is associated with damage in descending and ascending pathways between brainstem/cortex and spinal neurons, leading to loss in sensory-motor functions. This leads not only to locomotor reduction but also to important respiratory impairments, both reducing cardiorespiratory engagement, and increasing cardiovascular risk and mortality. Moreover, individuals with high-level injuries suffer from sleep-disordered breathing in a greater proportion than the general population. Although no current treatments exist to restore motor function in spinal cord injury (SCI), serotoninergic (5-HT) 1A receptor agonists appear as pharmacologic neuromodulators that could be important players in inducing functional improvements by increasing the activation of spared motoneurons. Indeed, single therapies of serotoninergic 1A (5-HT1A) agonists allow for acute and temporary recovery of locomotor function. Moreover, the 5-HT1A agonist could be even more promising when combined with other pharmacotherapies, exercise training, and/or spinal stimulation, rather than administered alone. In this review, we discuss previous and emerging evidence showing the value of the 5HT1A receptor agonist therapies for motor and respiratory limitations in SCI. Moreover, we provide mechanistic hypotheses and clinical impact for the potential benefit of 5-HT1A agonist pharmacology in inducing neuroplasticity and improving locomotor and respiratory functions in SCI.
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Affiliation(s)
- Afaf Bajjig
- Sorbonne Université, Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; (A.B.); (F.C.); (L.B.)
| | - Florence Cayetanot
- Sorbonne Université, Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; (A.B.); (F.C.); (L.B.)
| | - J. Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA 02139, USA;
| | - Laurence Bodineau
- Sorbonne Université, Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; (A.B.); (F.C.); (L.B.)
| | - Isabelle Vivodtzev
- Sorbonne Université, Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; (A.B.); (F.C.); (L.B.)
- Correspondence:
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15
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Bajjig A, Michel-Flutot P, Migevent T, Cayetanot F, Bodineau L, Vinit S, Vivodtzev I. Diaphragmatic Activity and Respiratory Function Following C3 or C6 Unilateral Spinal Cord Contusion in Mice. BIOLOGY 2022; 11:biology11040558. [PMID: 35453757 PMCID: PMC9031817 DOI: 10.3390/biology11040558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 06/12/2023]
Abstract
The majority of spinal cord injuries (SCIs) are cervical (cSCI), leading to a marked reduction in respiratory capacity. We aimed to investigate the effect of hemicontusion models of cSCI on both diaphragm activity and respiratory function to serve as preclinical models of cervical SCI. Since phrenic motoneuron pools are located at the C3-C5 spinal level, we investigated two models of preclinical cSCI mimicking human forms of injury, namely, one above (C3 hemicontusion-C3HC) and one below phrenic motoneuron pools (C6HC) in wild-type swiss OF-1 mice, and we compared their effects on respiratory function using whole-body plethysmography and on diaphragm activity using electromyography (EMG). At 7 days post-surgery, both C3HC and C6HC damaged spinal cord integrity above the lesion level, suggesting that C6HC potentially alters C5 motoneurons. Although both models led to decreased diaphragmatic EMG activity in the injured hemidiaphragm compared to the intact one (-46% and -26% in C3HC and C6HC, respectively, both p = 0.02), only C3HC led to a significant reduction in tidal volume and minute ventilation compared to sham surgery (-25% and -20% vs. baseline). Moreover, changes in EMG amplitude between respiratory bursts were observed post-C3HC, reflecting a change in phrenic motoneuronal excitability. Hence, C3HC and C6HC models induced alteration in respiratory function proportionally to injury level, and the C3HC model is a more appropriate model for interventional studies aiming to restore respiratory function in cSCI.
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Affiliation(s)
- Afaf Bajjig
- Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75013 Paris, France; (A.B.); (T.M.); (F.C.); (L.B.)
| | - Pauline Michel-Flutot
- Inserm, END-ICAP, Université Paris-Saclay, UVSQ, 78000 Versailles, France; (P.M.-F.); (S.V.)
| | - Tiffany Migevent
- Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75013 Paris, France; (A.B.); (T.M.); (F.C.); (L.B.)
| | - Florence Cayetanot
- Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75013 Paris, France; (A.B.); (T.M.); (F.C.); (L.B.)
| | - Laurence Bodineau
- Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75013 Paris, France; (A.B.); (T.M.); (F.C.); (L.B.)
| | - Stéphane Vinit
- Inserm, END-ICAP, Université Paris-Saclay, UVSQ, 78000 Versailles, France; (P.M.-F.); (S.V.)
| | - Isabelle Vivodtzev
- Inserm, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75013 Paris, France; (A.B.); (T.M.); (F.C.); (L.B.)
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16
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Cerone GL, Giangrande A, Ghislieri M, Gazzoni M, Piitulainen H, Botter A. Design and validation of a wireless Body Sensor Network for integrated EEG and HD-sEMG acquisitions. IEEE Trans Neural Syst Rehabil Eng 2022; 30:61-71. [PMID: 34982687 DOI: 10.1109/tnsre.2022.3140220] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sensorimotor integration is the process through which the human brain plans the motor program execution according to external sources. Within this context, corticomuscular and corticokinematic coherence analyses are common methods to investigate the mechanism underlying the central control of muscle activation. This requires the synchronous acquisition of several physiological signals, including EEG and sEMG. Nevertheless, physical constraints of the current, mostly wired, technologies limit their application in dynamic and naturalistic contexts. In fact, although many efforts were made in the development of biomedical instrumentation for EEG and HD-sEMG signal acquisition, the need for an integrated wireless system is emerging. We hereby describe the design and validation of a new fully wireless body sensor network for the integrated acquisition of EEG and HD-sEMG signals. This Body Sensor Network is composed of wireless bio-signal acquisition modules, named sensor units, and a set of synchronization modules used as a general-purpose system for time-locked recordings. The system was characterized in terms of accuracy of the synchronization and quality of the collected signals. An in-depth characterization of the entire system and an end-to-end comparison of the wireless EEG sensor unit with a wired benchmark EEG device were performed. The proposed device represents an advancement of the State-of-the-Art technology allowing the integrated acquisition of EEG and HD-sEMG signals for the study of sensorimotor integration.
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17
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Noga BR, Guest JD. Combined neuromodulatory approaches in the central nervous system for treatment of spinal cord injury. Curr Opin Neurol 2021; 34:804-811. [PMID: 34593718 PMCID: PMC8595808 DOI: 10.1097/wco.0000000000000999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW To report progress in neuromodulation following spinal cord injury (SCI) using combined brain and spinal neuromodulation.Neuromodulation refers to alterations in neuronal activity for therapeutic purposes. Beneficial effects are established in disease states such as Parkinson's Disease (PD), chronic pain, epilepsy, and SCI. The repertoire of neuromodulation and bioelectric medicine is rapidly expanding. After SCI, cohort studies have reported the benefits of epidural stimulation (ES) combined with training. Recently, we have explored combining ES with deep brain stimulation (DBS) to increase activation of descending motor systems to address limitations of ES in severe SCI. In this review, we describe the types of applied neuromodulation that could be combined in SCI to amplify efficacy to enable movement. These include ES, mesencephalic locomotor region (MLR) - DBS, noninvasive transcutaneous stimulation, transcranial magnetic stimulation, paired-pulse paradigms, and neuromodulatory drugs. We examine immediate and longer-term effects and what is known about: (1) induced neuroplastic changes, (2) potential safety concerns; (3) relevant outcome measures; (4) optimization of stimulation; (5) therapeutic limitations and prospects to overcome these. RECENT FINDINGS DBS of the mesencephalic locomotor region is emerging as a potential clinical target to amplify supraspinal command circuits for locomotion. SUMMARY Combinations of neuromodulatory methods may have additive value for restoration of function after spinal cord injury.
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Affiliation(s)
- Brian R Noga
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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18
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Zhang H, Liu Y, Zhou K, Wei W, Liu Y. Restoring Sensorimotor Function Through Neuromodulation After Spinal Cord Injury: Progress and Remaining Challenges. Front Neurosci 2021; 15:749465. [PMID: 34720867 PMCID: PMC8551759 DOI: 10.3389/fnins.2021.749465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/13/2021] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) is a major disability that results in motor and sensory impairment and extensive complications for the affected individuals which not only affect the quality of life of the patients but also result in a heavy burden for their families and the health care system. Although there are few clinically effective treatments for SCI, research over the past few decades has resulted in several novel treatment strategies which are related to neuromodulation. Neuromodulation-the use of neuromodulators, electrical stimulation or optogenetics to modulate neuronal activity-can substantially promote the recovery of sensorimotor function after SCI. Recent studies have shown that neuromodulation, in combination with other technologies, can allow paralyzed patients to carry out intentional, controlled movement, and promote sensory recovery. Although such treatments hold promise for completely overcoming SCI, the mechanisms by which neuromodulation has this effect have been difficult to determine. Here we review recent progress relative to electrical neuromodulation and optogenetics neuromodulation. We also examine potential mechanisms by which these methods may restore sensorimotor function. We then highlight the strengths of these approaches and remaining challenges with respect to its application.
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Affiliation(s)
- Hui Zhang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Yaping Liu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Kai Zhou
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Wei Wei
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Yaobo Liu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
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19
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Syed MUS, Khan Z, Zulfiqar A, Basham MA, Abdul Haseeb H, Azizullah S, Ismail H, Elbahnasawy M, Nadeem Z, Karimi S. Electrocardiographic Abnormalities in Patients With Spinal Cord Injury With Deranged Lipid Profile. Cureus 2021; 13:e18246. [PMID: 34722039 PMCID: PMC8544921 DOI: 10.7759/cureus.18246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Spinal cord injury (SCI) can lead to severe disability and neurogenic shock, arrhythmias, autonomic dysfunction, pressure ulcers, etc., of the autonomic nervous system. Therefore, in these patients, cardiovascular problems should be investigated frequently. This study was conducted to evaluate the electrocardiographic (ECG) abnormalities in patients with spinal cord injury having inappropriate lipid profiles and their relationship with each other. Materials and methods This cross-sectional study was held in the Internal Medicine Department of Mayo Hospital, Lahore, for a one-year duration from May 2020 to May 2021. It included 58 patients with spinal cord injury, 35 of whom had paraplegia, and 23 had tetraplegia. Fasting blood samples were taken for lipid profile analysis. Twelve-lead ECGs three times a day for one month were taken and analyzed in the context of previously available ECGs. Results Out of 58, the lipid profiles were found abnormal in 47 patients, 18 of whom had a normal ECG. The lipid profile was normal in 12, of which only one patient had ECG abnormalities. Cholesterol levels were found normal in 39 patients and deranged in 19 patients; low-density lipoproteins in nine patients, triglycerides in 18 patients, and high-density lipoprotein values in one patient were abnormal. Conclusions Sinus bradycardia was the most common ECG abnormality found in SCI patients with deranged lipid profiles. Further studies are needed in the future to validate the findings of this study.
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Affiliation(s)
| | - Zunaira Khan
- Accident and Emergency, Kingston Hospital, London, GBR
| | - Arif Zulfiqar
- Internal Medicine, Dow Medical College, Karachi, PAK
| | | | | | - Saad Azizullah
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hebatalla Ismail
- Medicine and Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Mohammad Elbahnasawy
- Internal Medicine, Alexandria Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Zubia Nadeem
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sundas Karimi
- Orthopedic Surgery, Dow University of Health Sciences, Karachi, PAK
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20
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Teng YD, Zafonte RD. Prelude to the special issue on novel neurocircuit, cellular and molecular targets for developing functional rehabilitation therapies of neurotrauma. Exp Neurol 2021; 341:113689. [PMID: 33745921 DOI: 10.1016/j.expneurol.2021.113689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 11/15/2022]
Abstract
The poor endogenous recovery capacity and other impediments to reinstating sensorimotor or autonomic function after adult neurotrauma have perplexed modern neuroscientists, bioengineers, and physicians for over a century. However, despite limited improvement in options to mitigate acute pathophysiological sequalae, the past 20 years have witnessed marked progresses in developing efficacious rehabilitation strategies for chronic spinal cord and brain injuries. The achievement is mainly attributable to research advancements in elucidating neuroplastic mechanisms for the potential to enhance clinical prognosis. Innovative cross-disciplinary studies have established novel therapeutic targets, theoretical frameworks, and regiments to attain treatment efficacy. This Special Issue contained eight papers that described experimental and human data along with literature reviews regarding the essential roles of the conventionally undervalued factors in neural repair: systemic inflammation, neural-respiratory inflammasome axis, modulation of glutamatergic and monoaminergic neurotransmission, neurogenesis, nerve transfer, recovery neurobiology components, and the spinal cord learning, respiration and central pattern generator neurocircuits. The focus of this work was on how to induce functional recovery from manipulating these underpinnings through their interactions with secondary injury events, peripheral and supraspinal inputs, neuromusculoskeletal network, and interventions (i.e., activity training, pharmacological adjuncts, electrical stimulation, and multimodal neuromechanical, brain-computer interface [BCI] and robotic assistance [RA] devices). The evidence suggested that if key neurocircuits are therapeutically reactivated, rebuilt, and/or modulated under proper sensory feedback, neurological function (e.g., cognition, respiration, limb movement, locomotion, etc.) will likely be reanimated after neurotrauma. The efficacy can be optimized by individualizing multimodal rehabilitation treatments via BCI/RA-integrated drug administration and neuromechanical protheses.
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Affiliation(s)
- Yang D Teng
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Neurotrauma Recovery Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Network, Mass General Brigham, and Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Spaulding Rehabilitation Hospital Network, Boston, MA, USA.
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Neurotrauma Recovery Research, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Network, Mass General Brigham, and Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Spaulding Rehabilitation Hospital Network, Boston, MA, USA.
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