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Evancho A, Tyler WJ, McGregor K. A review of combined neuromodulation and physical therapy interventions for enhanced neurorehabilitation. Front Hum Neurosci 2023; 17:1151218. [PMID: 37545593 PMCID: PMC10400781 DOI: 10.3389/fnhum.2023.1151218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Rehabilitation approaches for individuals with neurologic conditions have increasingly shifted toward promoting neuroplasticity for enhanced recovery and restoration of function. This review focuses on exercise strategies and non-invasive neuromodulation techniques that target neuroplasticity, including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and peripheral nerve stimulation (PNS). We have chosen to focus on non-invasive neuromodulation techniques due to their greater potential for integration into routine clinical practice. We explore and discuss the application of these interventional strategies in four neurological conditions that are frequently encountered in rehabilitation settings: Parkinson's Disease (PD), Traumatic Brain Injury (TBI), stroke, and Spinal Cord Injury (SCI). Additionally, we discuss the potential benefits of combining non-invasive neuromodulation with rehabilitation, which has shown promise in accelerating recovery. Our review identifies studies that demonstrate enhanced recovery through combined exercise and non-invasive neuromodulation in the selected patient populations. We primarily focus on the motor aspects of rehabilitation, but also briefly address non-motor impacts of these conditions. Additionally, we identify the gaps in current literature and barriers to implementation of combined approaches into clinical practice. We highlight areas needing further research and suggest avenues for future investigation, aiming to enhance the personalization of the unique neuroplastic responses associated with each condition. This review serves as a resource for rehabilitation professionals and researchers seeking a comprehensive understanding of neuroplastic exercise interventions and non-invasive neuromodulation techniques tailored for specific diseases and diagnoses.
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Affiliation(s)
- Alexandra Evancho
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William J. Tyler
- Department of Biomedical Engineering, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Keith McGregor
- Department of Clinical and Diagnostic Studies, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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2
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Forghani R, Goodnight B, Latchoumane CFV, Karumbaiah L. AutoRG: An automatized reach-to-grasp platform technology for assessing forelimb motor function, neural circuit activation, and cognition in rodents. J Neurosci Methods 2023; 387:109798. [PMID: 36682731 PMCID: PMC10071513 DOI: 10.1016/j.jneumeth.2023.109798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Rodent reach-to-grasp function assessment is a translationally powerful model for evaluating neurological function impairments and recovery responses. Existing assessment platforms are experimenter-dependent, costly, or low-throughput with limited output measures. Further, a direct histologic comparison of neural activation has never been conducted between any novel, automated platform and the well-established single pellet skilled reach task (SRT). NEW METHOD To address these technological and knowledge gaps, we designed an open-source, low-cost Automatized Reach-to-Grasp (AutoRG) pull platform that reduces experimenter interventions and variability. We assessed reach-to-grasp function in rats across seven progressively difficult stages using AutoRG. We mapped AutoRG and SRT-activated motor circuitries in the rat brain using volumetric imaging of the immediate early gene-encoded Arc (activity-regulated cytoskeleton-associated) protein. RESULTS Rats demonstrated robust forelimb reaching and pulling behavior after training in AutoRG. Reliable force versus time responses were recorded for individual reach events in real time, which were used to derive several secondary functional measures of performance. Moreover, we provide the first demonstration that for a training period of 30 min, AutoRG and SRT both engage similar neural responses in the caudal forelimb area (CFA), rostral forelimb area (RFA), and sensorimotor area (S1). CONCLUSION AutoRG is the first low-cost, open-source pull system designed for the scale-up of volitional forelimb motor function testing and characterization of rodent reaching behavior. The similarities in neuronal activation patterns observed in the rat motor cortex after SRT and AutoRG assessments validate the AutoRG as a rigorously characterized, scalable alternative to the conventional SRT and expensive commercial systems.
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Affiliation(s)
- Rameen Forghani
- Regenerative Bioscience Center, University of Georgia, 425 River Road, Athens, GA 30602, USA
| | - Braxton Goodnight
- Regenerative Bioscience Center, University of Georgia, 425 River Road, Athens, GA 30602, USA
| | - Charles-Francois Vincent Latchoumane
- Regenerative Bioscience Center, University of Georgia, 425 River Road, Athens, GA 30602, USA; Department of Animal and Dairy Science, College of Agricultural and Environmental Science, University of Georgia, 425, River Road, Athens, GA 30602, USA.
| | - Lohitash Karumbaiah
- Regenerative Bioscience Center, University of Georgia, 425 River Road, Athens, GA 30602, USA; Department of Animal and Dairy Science, College of Agricultural and Environmental Science, University of Georgia, 425, River Road, Athens, GA 30602, USA; Division of Neuroscience, Biomedical and Translational Sciences Institute, University of Georgia, 203 Pound Hall, 105 Foster Rd, Athens, GA 30602, USA.
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3
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Pasquini M, James ND, Dewany I, Coen FV, Cho N, Lai S, Anil S, Carpaneto J, Barraud Q, Lacour SP, Micera S, Courtine G. Preclinical upper limb neurorobotic platform to assess, rehabilitate, and develop therapies. Sci Robot 2022; 7:eabk2378. [PMID: 35353601 DOI: 10.1126/scirobotics.abk2378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Numerous neurorehabilitative, neuroprosthetic, and repair interventions aim to address the consequences of upper limb impairments after neurological disorders. Although these therapies target widely different mechanisms, they share the common need for a preclinical platform that supports the development, assessment, and understanding of the therapy. Here, we introduce a neurorobotic platform for rats that meets these requirements. A four-degree-of-freedom end effector is interfaced with the rat's wrist, enabling unassisted to fully assisted execution of natural reaching and retrieval movements covering the entire body workspace. Multimodal recording capabilities permit precise quantification of upper limb movement recovery after spinal cord injury (SCI), which allowed us to uncover adaptations in corticospinal tract neuron dynamics underlying this recovery. Personalized movement assistance supported early neurorehabilitation that improved recovery after SCI. Last, the platform provided a well-controlled and practical environment to develop an implantable spinal cord neuroprosthesis that improved upper limb function after SCI.
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Affiliation(s)
- Maria Pasquini
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Nicholas D James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Inssia Dewany
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Florent-Valéry Coen
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Center for Neuroprosthetics, Institute of Electrical and MicroEngineering and Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Newton Cho
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Stefano Lai
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'anna, Pisa, Italy
| | - Selin Anil
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Jacopo Carpaneto
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'anna, Pisa, Italy
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Center for Neuroprosthetics, Institute of Electrical and MicroEngineering and Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Silvestro Micera
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
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Tseng CT, Gaulding SJ, Dancel CLE, Thorn CA. Local activation of α2 adrenergic receptors is required for vagus nerve stimulation induced motor cortical plasticity. Sci Rep 2021; 11:21645. [PMID: 34737352 PMCID: PMC8568982 DOI: 10.1038/s41598-021-00976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022] Open
Abstract
Vagus nerve stimulation (VNS) paired with rehabilitation training is emerging as a potential treatment for improving recovery of motor function following stroke. In rats, VNS paired with skilled forelimb training results in significant reorganization of the somatotopic cortical motor map; however, the mechanisms underlying this form of VNS-dependent plasticity remain unclear. Recent studies have shown that VNS-driven cortical plasticity is dependent on noradrenergic innervation of the neocortex. In the central nervous system, noradrenergic α2 receptors (α2-ARs) are widely expressed in the motor cortex and have been critically implicated in synaptic communication and plasticity. In current study, we examined whether activation of cortical α2-ARs is necessary for VNS-driven motor cortical reorganization to occur. Consistent with previous studies, we found that VNS paired with motor training enlarges the map representation of task-relevant musculature in the motor cortex. Infusion of α2-AR antagonists into M1 blocked VNS-driven motor map reorganization from occurring. Our results suggest that local α2-AR activation is required for VNS-induced cortical reorganization to occur, providing insight into the mechanisms that may underlie the neuroplastic effects of VNS therapy.
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Affiliation(s)
- Ching-Tzu Tseng
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Solomon J Gaulding
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Canice Lei E Dancel
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Catherine A Thorn
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W. Campbell Rd, Richardson, TX, 75080, USA.
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5
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Tseng CT, Brougher J, Gaulding SJ, Hassan BS, Thorn CA. Vagus nerve stimulation promotes cortical reorganization and reduces task-dependent calorie intake in male and female rats. Brain Res 2020; 1748:147099. [DOI: 10.1016/j.brainres.2020.147099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/29/2022]
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Adcock KS, Blount AE, Morrison RA, Alvarez-Dieppa A, Kilgard MP, Engineer CT, Hays SA. Deficits in skilled motor and auditory learning in a rat model of Rett syndrome. J Neurodev Disord 2020; 12:27. [PMID: 32988374 PMCID: PMC7523346 DOI: 10.1186/s11689-020-09330-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/18/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Rett syndrome is an X-linked neurodevelopmental disorder caused by a mutation in the gene MECP2. Individuals with Rett syndrome display developmental regression at an early age, and develop a range of motor, auditory, cognitive, and social impairments. Several studies have successfully modeled some aspects of dysfunction and Rett syndrome-like phenotypes in transgenic mouse and rat models bearing mutations in the MECP2 gene. Here, we sought to extend these findings and characterize skilled learning, a more complex behavior known to be altered in Rett syndrome. METHODS We evaluated the acquisition and performance of auditory and motor function on two complex tasks in heterozygous female Mecp2 rats. Animals were trained to perform a speech discrimination task or a skilled forelimb reaching task. RESULTS Our results reveal that Mecp2 rats display slower acquisition and reduced performance on an auditory discrimination task than wild-type (WT) littermates. Similarly, Mecp2 rats exhibit impaired learning rates and worse performance on a skilled forelimb motor task compared to WT. CONCLUSIONS Together, these findings illustrate novel deficits in skilled learning consistent with clinical manifestation of Rett syndrome and provide a framework for development of therapeutic strategies to improve these complex behaviors.
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Affiliation(s)
- Katherine S Adcock
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA.
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA.
| | - Abigail E Blount
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Robert A Morrison
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Amanda Alvarez-Dieppa
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Michael P Kilgard
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Crystal T Engineer
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
| | - Seth A Hays
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080-3021, USA
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7
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Beta Frequency Oscillations in the Subthalamic Nucleus Are Not Sufficient for the Development of Symptoms of Parkinsonian Bradykinesia/Akinesia in Rats. eNeuro 2019; 6:ENEURO.0089-19.2019. [PMID: 31540998 PMCID: PMC6817717 DOI: 10.1523/eneuro.0089-19.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/30/2019] [Accepted: 09/11/2019] [Indexed: 11/21/2022] Open
Abstract
Substantial correlative evidence links the synchronized, oscillatory patterns of neural activity that emerge in Parkinson's disease (PD) in the beta (β) frequency range (13-30 Hz) with bradykinesia in PD. However, conflicting evidence exists, and whether these changes in neural activity are causal of motor symptoms in PD remains unclear. We tested the hypothesis that the synchronized β oscillations that emerge in PD are causal of symptoms of bradykinesia/akinesia. We designed patterns of stimulation that mimicked the temporal characteristics of single unit β bursting activity seen in PD animals and humans. We applied these β-patterned stimulation patterns along with continuous low-frequency and high-frequency controls to the subthalamic nucleus (STN) of intact and 6-OHDA-lesioned female Long-Evans and Sprague-Dawley rats. β-Patterned paradigms were superior to low-frequency controls at induction of β power in downstream substantia nigra reticulata (SNr) neurons and in ipsilateral motor cortex. However, we did not detect deleterious effects on motor performance across a wide battery of validated behavioral tasks. Our results suggest that β frequency oscillations (BFOs) may not be sufficient for the generation of bradykinesia/akinesia in PD.
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8
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Sindhurakar A, Butensky SD, Carmel JB. Automated Forelimb Tasks for Rodents: Current Advantages and Limitations, and Future Promise. Neurorehabil Neural Repair 2019; 33:503-512. [PMID: 31189409 DOI: 10.1177/1545968319855034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rodent tests of function have advanced our understanding of movement, largely through the human training and testing and manual assessment. Tools such as reaching and grasping of a food pellet have been widely adopted because they are effective and simple to use. However, these tools are time-consuming, subjective, and often qualitative. Automation of training, testing, and assessment has the potential to increase efficiency while ensuring tasks are objective and quantitative. We detail new methods for automating rodent forelimb tests, including the use of pellet dispensers, sensors, computer vision, and home cage systems. We argue that limitations in existing forelimb tasks are driving the innovations in automated systems. We further argue that automated tasks partially address these limitations, and we outline necessary precautions and remaining challenges when adopting these types of tasks. Finally, we suggest attributes of future automated rodent assessment tools that can enable widespread adoption and help us better understand forelimb function in health and disease.
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Affiliation(s)
| | - Samuel D Butensky
- 2 Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Hulsey DR, Shedd CM, Sarker SF, Kilgard MP, Hays SA. Norepinephrine and serotonin are required for vagus nerve stimulation directed cortical plasticity. Exp Neurol 2019; 320:112975. [PMID: 31181199 DOI: 10.1016/j.expneurol.2019.112975] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 11/18/2022]
Abstract
Vagus nerve stimulation (VNS) paired with forelimb training drives robust, specific reorganization of movement representations in the motor cortex. This effect is hypothesized to be mediated by VNS-dependent engagement of neuromodulatory networks. VNS influences activity in the locus coeruleus (LC) and dorsal raphe nucleus (DRN), but the involvement of these neuromodulatory networks in VNS-directed plasticity is unknown. We tested the hypothesis that cortical norepinephrine and serotonin are required for VNS-dependent enhancement of motor cortex plasticity. Rats were trained on a lever pressing task emphasizing proximal forelimb use. Once proficient, all rats received a surgically implanted vagus nerve cuff and cortical injections of either immunotoxins to deplete serotonin or norepinephrine, or vehicle control. Following surgical recovery, rats received half second bursts of 0.8 mA or sham VNS after successful trials. After five days of pairing intracortical microstimulation (ICMS) was performed in the motor cortex contralateral to the trained limb. VNS paired with training more than doubled cortical representations of proximal forelimb movements. Depletion of either cortical norepinephrine or serotonin prevented this effect. The requirement of multiple neuromodulators is consistent with earlier studies showing that these neuromodulators regulate synaptic plasticity in a complimentary fashion.
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Affiliation(s)
- Daniel R Hulsey
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America.
| | - Christine M Shedd
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, United States of America
| | - Sadmaan F Sarker
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, United States of America
| | - Seth A Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX 75080-3021, United States of America
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Engineer ND, Kimberley TJ, Prudente CN, Dawson J, Tarver WB, Hays SA. Targeted Vagus Nerve Stimulation for Rehabilitation After Stroke. Front Neurosci 2019; 13:280. [PMID: 30983963 PMCID: PMC6449801 DOI: 10.3389/fnins.2019.00280] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/08/2019] [Indexed: 01/14/2023] Open
Abstract
Stroke is a leading cause of disability worldwide, and in approximately 60% of individuals, upper limb deficits persist 6 months after stroke. These deficits adversely affect the functional use of the upper limb and restrict participation in day to day activities. An important goal of stroke rehabilitation is to improve the quality of life by enhancing functional independence and participation in activities. Since upper limb deficits are one of the best predictors of quality of life after stroke, effective interventions targeting these deficits may represent a means to improve quality of life. An increased understanding of the neurobiological processes underlying stroke recovery has led to the development of targeted approaches to improve motor deficits. One such targeted strategy uses brief bursts of Vagus Nerve Stimulation (VNS) paired with rehabilitation to enhance plasticity and support recovery of upper limb function after chronic stroke. Stimulation of the vagus nerve triggers release of plasticity promoting neuromodulators, such as acetylcholine and norepinephrine, throughout the cortex. Timed engagement of neuromodulators concurrent with motor training drives task-specific plasticity in the motor cortex to improve function and provides the basis for paired VNS therapy. A number of studies in preclinical models of ischemic stroke demonstrated that VNS paired with rehabilitative training significantly improved the recovery of forelimb motor function compared to rehabilitative training without VNS. The improvements were associated with synaptic reorganization of cortical motor networks and recruitment of residual motor neurons controlling the impaired forelimb, demonstrating the putative neurobiological mechanisms underlying recovery of motor function. These preclinical studies provided the basis for conducting two multi-site, randomized controlled pilot trials in individuals with moderate to severe upper limb weakness after chronic ischemic stroke. In both studies, VNS paired with rehabilitation improved motor deficits compared to rehabilitation alone. The trials provided support for a 120-patient pivotal study designed to evaluate the efficacy of paired VNS therapy in individuals with chronic ischemic stroke. This manuscript will discuss the neurobiological rationale for VNS therapy, provide an in-depth discussion of both animal and human studies of VNS therapy for stroke, and outline the challenges and opportunities for the future use of VNS therapy.
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Affiliation(s)
| | - Teresa J. Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, United States
| | | | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, United Kingdom
| | | | - Seth A. Hays
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, United States
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, United States
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Morrison RA, Hulsey DR, Adcock KS, Rennaker RL, Kilgard MP, Hays SA. Vagus nerve stimulation intensity influences motor cortex plasticity. Brain Stimul 2018; 12:256-262. [PMID: 30409712 DOI: 10.1016/j.brs.2018.10.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) paired with forelimb motor training enhances reorganization of movement representations in the motor cortex. Previous studies have shown an inverted-U relationship between VNS intensity and plasticity in other brain areas, such that moderate intensity VNS yields greater cortical plasticity than low or high intensity VNS. However, the relationship between VNS intensity and plasticity in the motor cortex is unknown. OBJECTIVE In this study we sought to test the hypothesis that VNS intensity exhibits an inverted-U relationship with the degree of motor cortex plasticity in rats. METHODS Rats were taught to perform a lever pressing task emphasizing use of the proximal forelimb musculature. Once proficient, rats underwent five additional days of behavioral training in which low intensity VNS (0.4 mA), moderate intensity VNS (0.8 mA), high intensity VNS (1.6 mA), or sham stimulation was paired with forelimb movement. 24 h after the completion of behavioral training, intracortical microstimulation (ICMS) was used to document movement representations in the motor cortex. RESULTS VNS delivered at 0.8 mA caused a significant increase in motor cortex proximal forelimb representation compared to training alone. VNS delivered at 0.4 mA and 1.6 mA failed to cause a significant expansion of proximal forelimb representation. CONCLUSION Moderate intensity 0.8 mA VNS optimally enhances motor cortex plasticity while low intensity 0.4 mA and high intensity 1.6 mA VNS fail to enhance plasticity. Plasticity in the motor cortex exhibits an inverted-U function of VNS intensity similar to previous findings in auditory cortex.
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Affiliation(s)
- Robert A Morrison
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, USA.
| | - Daniel R Hulsey
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, USA
| | - Katherine S Adcock
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, USA
| | - Robert L Rennaker
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, USA; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, TX, USA
| | - Michael P Kilgard
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, USA; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, TX, USA
| | - Seth A Hays
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, USA; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, TX, USA
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Vagus nerve stimulation promotes generalization of conditioned fear extinction and reduces anxiety in rats. Brain Stimul 2018; 12:9-18. [PMID: 30287193 DOI: 10.1016/j.brs.2018.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Exposure-based therapies are used to treat a variety of trauma- and anxiety-related disorders by generating successful extinction following cue exposure during treatment. The development of adjuvant strategies that accelerate extinction learning, improve tolerability, and increase efficiency of treatment could increase the efficacy of exposure-based therapies. Vagus nerve stimulation (VNS) paired with exposure can enhance fear extinction, in rat models of psychiatric disorders, and chronic administration of VNS reduces anxiety in rats and humans. OBJECTIVE We tested whether VNS, like other cognitive enhancers, could produce generalization of extinction for stimuli that are not presented during the extinction sessions, but are associated with the fear event. METHODS Male Sprague Dawley rats underwent auditory fear conditioning with two easily discriminable auditory stimuli. Following fear conditioning, extinction training consisted of exposure to only one of the conditioned sounds. Half of the rats received VNS and half received sham stimulation during with sound presentations. VNS effects on anxiety were examined in a separate study where VNS was administered prior to testing on the elevated plus maze. RESULTS Sham stimulated rats given 20 presentations of a conditioned stimulus (CS) during the extinction session showed performance that was matched to VNS-treated rats given only 4 presentations of the CS. Despite comparable levels of freezing to the presented CS, only the VNS-treated rats showed a significant decrease in freezing to the CS that was not presented. VNS-induced generalization of extinction was observed only when the two sounds were paired with footshock within the same fear conditioning session; VNS did not promote generalization of extinction when the two sounds were conditioned on different days or in different contexts. On the anxiety test, VNS administration significantly increased time spent in the open arms of the elevated plus maze. CONCLUSION These results provide evidence that VNS can promote generalization of extinction to other stimuli associated with a specific fear experience. Furthermore, non-contingent VNS appears to reduce anxiety. The ability to generalize extinction and reduce anxiety makes VNS a potential candidate for use as an adjunctive strategy to improve the efficacy and tolerability of exposure-based therapies.
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Noble LJ, Gonzalez IJ, Meruva VB, Callahan KA, Belfort BD, Ramanathan KR, Meyers E, Kilgard MP, Rennaker RL, McIntyre CK. Effects of vagus nerve stimulation on extinction of conditioned fear and post-traumatic stress disorder symptoms in rats. Transl Psychiatry 2017; 7:e1217. [PMID: 28892066 PMCID: PMC5611754 DOI: 10.1038/tp.2017.191] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/05/2017] [Accepted: 07/04/2017] [Indexed: 12/31/2022] Open
Abstract
Exposure-based therapies help patients with post-traumatic stress disorder (PTSD) to extinguish conditioned fear of trauma reminders. However, controlled laboratory studies indicate that PTSD patients do not extinguish conditioned fear as well as healthy controls, and exposure therapy has high failure and dropout rates. The present study examined whether vagus nerve stimulation (VNS) augments extinction of conditioned fear and attenuates PTSD-like symptoms in an animal model of PTSD. To model PTSD, rats were subjected to a single prolonged stress (SPS) protocol, which consisted of restraint, forced swim, loss of consciousness, and 1 week of social isolation. Like PTSD patients, rats subjected to SPS show impaired extinction of conditioned fear. The SPS procedure was followed, 1 week later, by auditory fear conditioning (AFC) and extinction. VNS or sham stimulation was administered during half of the extinction days, and was paired with presentations of the conditioned stimulus. One week after completion of extinction training, rats were given a battery of behavioral tests to assess anxiety, arousal and avoidance. Results indicated that rats given SPS 1 week prior to AFC (PTSD model) failed to extinguish the freezing response after eleven consecutive days of extinction. Administration of VNS reversed the extinction impairment and attenuated reinstatement of the conditioned fear response. Delivery of VNS during extinction also eliminated the PTSD-like symptoms, such as anxiety, hyperarousal and social avoidance for more than 1 week after VNS treatment. These results provide evidence that extinction paired with VNS treatment can lead to remission of fear and improvements in PTSD-like symptoms. Taken together, these findings suggest that VNS may be an effective adjunct to exposure therapy for the treatment of PTSD.
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Affiliation(s)
- L J Noble
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA,Behavior and Brain Sciences, The University of Texas at Dallas, 800 W Campbell Rd, BSB 14.102E, Richardson, TX 75080, USA. E-mail:
| | - I J Gonzalez
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - V B Meruva
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - K A Callahan
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - B D Belfort
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - K R Ramanathan
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - E Meyers
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - M P Kilgard
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - R L Rennaker
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - C K McIntyre
- Behavior and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
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Butensky SD, Sloan AP, Meyers E, Carmel JB. Dexterity: A MATLAB-based analysis software suite for processing and visualizing data from tasks that measure arm or forelimb function. J Neurosci Methods 2017; 286:114-124. [PMID: 28583476 DOI: 10.1016/j.jneumeth.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hand function is critical for independence, and neurological injury often impairs dexterity. To measure hand function in people or forelimb function in animals, sensors are employed to quantify manipulation. These sensors make assessment easier and more quantitative and allow automation of these tasks. While automated tasks improve objectivity and throughput, they also produce large amounts of data that can be burdensome to analyze. We created software called Dexterity that simplifies data analysis of automated reaching tasks. NEW METHOD Dexterity is MATLAB software that enables quick analysis of data from forelimb tasks. Through a graphical user interface, files are loaded and data are identified and analyzed. These data can be annotated or graphed directly. Analysis is saved, and the graph and corresponding data can be exported. For additional analysis, Dexterity provides access to custom scripts created by other users. RESULTS To determine the utility of Dexterity, we performed a study to evaluate the effects of task difficulty on the degree of impairment after injury. Dexterity analyzed two months of data and allowed new users to annotate the experiment, visualize results, and save and export data easily. COMPARISON WITH EXISTING METHOD(S) Previous analysis of tasks was performed with custom data analysis, requiring expertise with analysis software. Dexterity made the tools required to analyze, visualize and annotate data easy to use by investigators without data science experience. CONCLUSIONS Dexterity increases accessibility to automated tasks that measure dexterity by making analysis of large data intuitive, robust, and efficient.
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Affiliation(s)
| | - Andrew P Sloan
- Texas Biomedical Center, The University of Texas at Dallas, Richardson, TX, 75080, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA.
| | - Eric Meyers
- Texas Biomedical Center, The University of Texas at Dallas, Richardson, TX, 75080, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA.
| | - Jason B Carmel
- Burke Medical Research Institute, White Plains, NY, 10605, USA; Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, 10065, USA; Departments of Neurology and Pediatrics, Weill Cornell Medical College, New York, NY, USA.
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15
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Leemburg S, Iijima M, Lambercy O, Nallet-Khosrofian L, Gassert R, Luft A. Investigating Motor Skill Learning Processes with a Robotic Manipulandum. J Vis Exp 2017. [PMID: 28287570 DOI: 10.3791/54970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Skilled reaching tasks are commonly used in studies of motor skill learning and motor function under healthy and pathological conditions, but can be time-intensive and ambiguous to quantify beyond simple success rates. Here, we describe the training procedure for reach-and-pull tasks with ETH Pattus, a robotic platform for automated forelimb reaching training that records pulling and hand rotation movements in rats. Kinematic quantification of the performed pulling attempts reveals the presence of distinct temporal profiles of movement parameters such as pulling velocity, spatial variability of the pulling trajectory, deviation from midline, as well as pulling success. We show how minor adjustments in the training paradigm result in alterations in these parameters, revealing their relation to task difficulty, general motor function or skilled task execution. Combined with electrophysiological, pharmacological and optogenetic techniques, this paradigm can be used to explore the mechanisms underlying motor learning and memory formation, as well as loss and recovery of function (e.g. after stroke).
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Affiliation(s)
- Susan Leemburg
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich;
| | - Maiko Iijima
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich
| | | | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich
| | - Andreas Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich;
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Abstract
Pathological neural activity could be treated by directing specific plasticity to renormalize circuits and restore function. Rehabilitative therapies aim to promote adaptive circuit changes after neurological disease or injury, but insufficient or maladaptive plasticity often prevents a full recovery. The development of adjunctive strategies that broadly support plasticity to facilitate the benefits of rehabilitative interventions has the potential to improve treatment of a wide range of neurological disorders. Recently, stimulation of the vagus nerve in conjunction with rehabilitation has emerged as one such potential targeted plasticity therapy. Vagus nerve stimulation (VNS) drives activation of neuromodulatory nuclei that are associated with plasticity, including the cholinergic basal forebrain and the noradrenergic locus coeruleus. Repeatedly pairing brief bursts of VNS sensory or motor events drives robust, event-specific plasticity in neural circuits. Animal models of chronic tinnitus, ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and post-traumatic stress disorder benefit from delivery of VNS paired with successful trials during rehabilitative training. Moreover, mounting evidence from pilot clinical trials provides an initial indication that VNS-based targeted plasticity therapies may be effective in patients with neurological diseases and injuries. Here, I provide a discussion of the current uses and potential future applications of VNS-based targeted plasticity therapies in animal models and patients, and outline challenges for clinical implementation.
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Affiliation(s)
- Seth A Hays
- Texas Biomedical Device Center, Richardson, TX, USA.
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, USA.
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA.
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17
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Meyers E, Sindhurakar A, Choi R, Solorzano R, Martinez T, Sloan A, Carmel J, Kilgard MP, Rennaker RL, Hays S. The supination assessment task: An automated method for quantifying forelimb rotational function in rats. J Neurosci Methods 2016; 266:11-20. [PMID: 26976724 DOI: 10.1016/j.jneumeth.2016.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/05/2016] [Accepted: 03/08/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neurological injuries or disease can impair the function of motor circuitry controlling forearm supination, and recovery is often limited. Preclinical animal models are essential tools for developing therapeutic interventions to improve motor function after neurological damage. Here we describe the supination assessment task, an automated measure of quantifying forelimb supination in the rat. NEW METHOD Animals were trained to reach out of a slot in a cage, grasp a spherical manipulandum, and supinate the forelimb. The angle of the manipulandum was measured using a rotary encoder. If the animal exceeded the predetermined turn angle, a reward pellet was delivered. This automated task provides a large, high-resolution dataset of turn angle over time. Multiple parameters can be measured including success rate, peak turn angle, turn velocity, area under the curve, and number of rotations per trial. The task provides a high degree of flexibility to the user, with both software and hardware parameters capable of being adjusted. RESULTS We demonstrate the supination assessment task can effectively measure significant deficits in multiple parameters of rotational motor function for multiple weeks in two models of ischemic stroke. COMPARISON WITH EXISTING METHODS Preexisting motor assays designed to measure forelimb supination in the rat require high-speed video analysis techniques. This operant task provides a high-resolution, quantitative end-point dataset of turn angle, which obviates the necessity of video analysis. CONCLUSIONS The supination assessment task represents a novel, efficient method of evaluating forelimb rotation and may help decrease the cost and time of running experiments.
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Affiliation(s)
- Eric Meyers
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX 75080-3021, United States.
| | - Anil Sindhurakar
- Burke Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, United States
| | - Rachel Choi
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, United States
| | - Ruby Solorzano
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Taylor Martinez
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, United States
| | - Andrew Sloan
- Vulintus Inc., 17217 Waterview Pkwy, Ste 1.202BB, Dallas, TX 75252, United States
| | - Jason Carmel
- Burke Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, United States; Weill Cornell Medical College, Brain Mind Research Institute and Departments of Neurology and Pediatrics, United States
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Robert L Rennaker
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; Vulintus Inc., 17217 Waterview Pkwy, Ste 1.202BB, Dallas, TX 75252, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Seth Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, Richardson, TX 75080-3021, United States
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18
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Ribeiro RP, Santos DB, Colle D, Naime AA, Gonçalves CL, Ghizoni H, Hort MA, Godoi M, Dias PF, Braga AL, Farina M. Decreased forelimb ability in mice intracerebroventricularly injected with low dose 6-hydroxidopamine: A model on the dissociation of bradykinesia from hypokinesia. Behav Brain Res 2016; 305:30-6. [PMID: 26921691 DOI: 10.1016/j.bbr.2016.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 12/20/2022]
Abstract
Bradykinesia and hypokinesia represent well-known motor symptoms of Parkinson's disease (PD). While bradykinesia (slow execution of movements) is present in less affected PD patients and aggravates as the disease severity increases, hypokinesia (reduction of movement) seems to emerge prominently only in the more affected patients. Here we developed a model based on the central infusion of low dose (40μg) 6-hydroxydopamine (6-OHDA) in mice in an attempt to discriminate bradykinesia (accessed through forelimb inability) from hypokinesia (accessed through locomotor and exploratory activities). The potential beneficial effects of succinobucol against 6-OHDA-induced forelimb inability were also evaluated. One week after the beginning of treatment with succinobucol (i.p. injections, 10mg/kg/day), mice received a single i.c.v. infusion of 6-OHDA (40μg/site). One week after 6-OHDA infusion, general locomotor/exploratory activities (open field test), muscle strength (grid test), forelimb skill (single pellet task), as well as striatal biochemical parameters related to oxidative stress and cellular homeostasis (glutathione peroxidase, glutathione reductase and NADH dehydrogenases activities, lipid peroxidation and TH levels), were evaluated. 6-OHDA infusions did not change locomotor/exploratory activities and muscle strength, as well as the evaluated striatal biochemical parameters. However, 6-OHDA infusions caused significant reductions (50%) in the single pellet reaching task performance, which detects forelimb skill inability and can be used to experimentally identify bradykinesia. Succinobucol partially protected against 6-OHDA-induced forelimb inability. The decreased forelimb ability with no changes in locomotor/exploratory behavior indicates that our 6-OHDA-based protocol represents a useful tool to mechanistically study the dissociation of bradykinesia and hypokinesia in PD.
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Affiliation(s)
- Renata Pietsch Ribeiro
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil; Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil; Departamento Acadêmico de Saúde e Serviço, Instituto Federal de Santa Catarina, 88020030 Florianópolis, Santa Catarina, Brazil
| | - Danúbia Bonfanti Santos
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil
| | - Dirleise Colle
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil
| | - Aline Aita Naime
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil
| | - Cinara Ludvig Gonçalves
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil
| | - Heloisa Ghizoni
- Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil
| | - Mariana Appel Hort
- Instituto de Ciências Biológicas, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Marcelo Godoi
- Escola de Química e Alimentos, Universidade Federal de Rio Grande, Campus Santo Antônio da Patrulha, Rio Grande do Sul, Brazil
| | - Paulo Fernando Dias
- Departamento de Biologia Celular, Embriologia e Genética, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Antonio Luiz Braga
- Departamento de Química, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Marcelo Farina
- Programa de Pós-Graduação em Neurociências, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil; Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040900 Florianópolis, Santa Catarina, Brazil.
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Hulsey DR, Hays SA, Khodaparast N, Ruiz A, Das P, Rennaker RL, Kilgard MP. Reorganization of Motor Cortex by Vagus Nerve Stimulation Requires Cholinergic Innervation. Brain Stimul 2016; 9:174-81. [PMID: 26822960 DOI: 10.1016/j.brs.2015.12.007] [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] [Received: 07/31/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) paired with forelimb training drives robust, specific reorganization of movement representations in the motor cortex. The mechanisms that underlie VNS-dependent enhancement of map plasticity are largely unknown. The cholinergic nucleus basalis (NB) is a critical substrate in cortical plasticity, and several studies suggest that VNS activates cholinergic circuitry. OBJECTIVE We examined whether the NB is required for VNS-dependent enhancement of map plasticity in the motor cortex. METHODS Rats were trained to perform a lever pressing task and then received injections of the immunotoxin 192-IgG-saporin to selectively lesion cholinergic neurons of the NB. After lesion, rats underwent five days of motor training during which VNS was paired with successful trials. At the conclusion of behavioral training, intracortical microstimulation was used to document movement representations in motor cortex. RESULTS VNS paired with forelimb training resulted in a substantial increase in the representation of proximal forelimb in rats with an intact NB compared to untrained controls. NB lesions prevent this VNS-dependent increase in proximal forelimb area and result in representations similar to untrained controls. Motor performance was similar between groups, suggesting that differences in forelimb function cannot account for the difference in proximal forelimb representation. CONCLUSIONS Together, these findings indicate that the NB is required for VNS-dependent enhancement of plasticity in the motor cortex and may provide insight into the mechanisms that underlie the benefits of VNS therapy.
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Affiliation(s)
- Daniel R Hulsey
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA
| | - Seth A Hays
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA; Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA.
| | - Navid Khodaparast
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA; Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
| | - Andrea Ruiz
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
| | - Priyanka Das
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
| | - Robert L Rennaker
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA; Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
| | - Michael P Kilgard
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA; Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
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A Within-Animal Comparison of Skilled Forelimb Assessments in Rats. PLoS One 2015; 10:e0141254. [PMID: 26506434 PMCID: PMC4624720 DOI: 10.1371/journal.pone.0141254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022] Open
Abstract
A variety of skilled reaching tasks have been developed to evaluate forelimb function in rodent models. The single pellet skilled reaching task and pasta matrix task have provided valuable insight into recovery of forelimb function in models of neurological injury and disease. Recently, several automated measures have been developed to reduce the cost and time burden of forelimb assessment in rodents. Here, we provide a within-subject comparison of three common forelimb assessments to allow direct evaluation of sensitivity and efficiency across tasks. Rats were trained to perform the single pellet skilled reaching task, the pasta matrix task, and the isometric pull task. Once proficient on all three tasks, rats received an ischemic lesion of motor cortex and striatum to impair use of the trained limb. On the second week post-lesion, all three tasks measured a significant deficit in forelimb function. Performance was well-correlated across tasks. By the sixth week post-lesion, only the isometric pull task measured a significant deficit in forelimb function, suggesting that this task is more sensitive to chronic impairments. The number of training days required to reach asymptotic performance was longer for the isometric pull task, but the total experimenter time required to collect and analyze data was substantially lower. These findings suggest that the isometric pull task represents an efficient, sensitive measure of forelimb function to facilitate preclinical evaluation in models of neurological injury and disease.
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21
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The timing and amount of vagus nerve stimulation during rehabilitative training affect poststroke recovery of forelimb strength. Neuroreport 2015; 25:676-82. [PMID: 24818637 DOI: 10.1097/wnr.0000000000000154] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Loss of upper arm strength after stroke is a leading cause of disability. Strategies that can enhance the benefits of rehabilitative training could improve motor function after stroke. Recent studies in a rat model of ischemic stroke have demonstrated that vagus nerve stimulation (VNS) paired with rehabilitative training substantially improves recovery of forelimb strength compared with extensive rehabilitative training without VNS. Here we report that the timing and amount of stimulation affect the degree of forelimb strength recovery. Similar amounts of Delayed VNS delivered 2 h after daily rehabilitative training sessions resulted in significantly less improvement compared with that on delivery of VNS that is paired with identical rehabilitative training. Significantly less recovery also occurred when several-fold more VNS was delivered during rehabilitative training. Both delayed and additional VNS confer moderately improved recovery compared with extensive rehabilitative training without VNS, but fail to enhance recovery to the same degree as VNS that is timed to occur with successful movements. These findings confirm that VNS paired with rehabilitative training holds promise for restoring forelimb strength poststroke and indicate that both the timing and the amount of VNS should be optimized to maximize therapeutic benefits.
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22
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Khodaparast N, Hays SA, Sloan AM, Fayyaz T, Hulsey DR, Rennaker RL, Kilgard MP. Vagus nerve stimulation delivered during motor rehabilitation improves recovery in a rat model of stroke. Neurorehabil Neural Repair 2014; 28:698-706. [PMID: 24553102 PMCID: PMC4134702 DOI: 10.1177/1545968314521006] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neural plasticity is widely believed to support functional recovery following brain damage. Vagus nerve stimulation paired with different forelimb movements causes long-lasting map plasticity in rat primary motor cortex that is specific to the paired movement. We tested the hypothesis that repeatedly pairing vagus nerve stimulation with upper forelimb movements would improve recovery of motor function in a rat model of stroke. Rats were separated into 3 groups: vagus nerve stimulation during rehabilitation (rehab), vagus nerve stimulation after rehab, and rehab alone. Animals underwent 4 training stages: shaping (motor skill learning), prelesion training, postlesion training, and therapeutic training. Rats were given a unilateral ischemic lesion within motor cortex and implanted with a left vagus nerve cuff. Animals were allowed 1 week of recovery before postlesion baseline training. During the therapeutic training stage, rats received vagus nerve stimulation paired with each successful trial. All 17 trained rats demonstrated significant contralateral forelimb impairment when performing a bradykinesia assessment task. Forelimb function was recovered completely to prelesion levels when vagus nerve stimulation was delivered during rehab training. Alternatively, intensive rehab training alone (without stimulation) failed to restore function to prelesion levels. Delivering the same amount of stimulation after rehab training did not yield improvements compared with rehab alone. These results demonstrate that vagus nerve stimulation repeatedly paired with successful forelimb movements can improve recovery after motor cortex ischemia and may be a viable option for stroke rehabilitation.
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Affiliation(s)
- Navid Khodaparast
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA
| | - Seth A Hays
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA
| | - Andrew M Sloan
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA
| | - Tabbassum Fayyaz
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA
| | - Daniel R Hulsey
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA
| | - Robert L Rennaker
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA
| | - Michael P Kilgard
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA
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Hays SA, Khodaparast N, Hulsey DR, Ruiz A, Sloan AM, Rennaker RL, Kilgard MP. Vagus nerve stimulation during rehabilitative training improves functional recovery after intracerebral hemorrhage. Stroke 2014; 45:3097-100. [PMID: 25147331 DOI: 10.1161/strokeaha.114.006654] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Vagus nerve stimulation (VNS) delivered during rehabilitative training enhances neuroplasticity and improves recovery in models of cortical ischemic stroke. However, VNS therapy has not been applied in a model of subcortical intracerebral hemorrhage (ICH). We hypothesized that VNS paired with rehabilitative training after ICH would enhance recovery of forelimb motor function beyond rehabilitative training alone. METHODS Rats were trained to perform an automated, quantitative measure of forelimb function. Once proficient, rats received an intrastriatal injection of bacterial collagenase to induce ICH. Rats then underwent VNS paired with rehabilitative training (VNS+Rehab; n=14) or rehabilitative training without VNS (Rehab; n=12). Rehabilitative training began ≥9 days after ICH and continued for 6 weeks. RESULTS VNS paired with rehabilitative training significantly improved recovery of forelimb function when compared with rehabilitative training without VNS. The VNS+Rehab group displayed a 77% recovery of function, whereas the Rehab group only exhibited 29% recovery. Recovery was sustained after cessation of stimulation. Both groups performed similar amounts of trials during rehabilitative, and lesion size was not different between groups. CONCLUSIONS VNS paired with rehabilitative training confers significantly improved forelimb recovery after ICH compared to rehabilitative training without VNS.
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Affiliation(s)
- Seth A Hays
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson.
| | - Navid Khodaparast
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Daniel R Hulsey
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Andrea Ruiz
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Andrew M Sloan
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Robert L Rennaker
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Michael P Kilgard
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
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Khodaparast N, Hays SA, Sloan AM, Hulsey DR, Ruiz A, Pantoja M, Rennaker RL, Kilgard MP. Vagus nerve stimulation during rehabilitative training improves forelimb strength following ischemic stroke. Neurobiol Dis 2013; 60:80-8. [PMID: 23954448 DOI: 10.1016/j.nbd.2013.08.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 07/31/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022] Open
Abstract
Upper limb impairment is a common debilitating consequence of ischemic stroke. Physical rehabilitation after stroke enhances neuroplasticity and improves limb function, but does not typically restore normal movement. We have recently developed a novel method that uses vagus nerve stimulation (VNS) paired with forelimb movements to drive specific, long-lasting map plasticity in rat primary motor cortex. Here we report that VNS paired with rehabilitative training can enhance recovery of forelimb force generation following infarction of primary motor cortex in rats. Quantitative measures of forelimb function returned to pre-lesion levels when VNS was delivered during rehab training. Intensive rehab training without VNS failed to restore function back to pre-lesion levels. Animals that received VNS during rehab improved twice as much as rats that received the same rehabilitation without VNS. VNS delivered during physical rehabilitation represents a novel method that may provide long-lasting benefits towards stroke recovery.
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Affiliation(s)
- N Khodaparast
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA.
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Hays SA, Rennaker RL, Kilgard MP. Targeting plasticity with vagus nerve stimulation to treat neurological disease. PROGRESS IN BRAIN RESEARCH 2013; 207:275-99. [PMID: 24309259 DOI: 10.1016/b978-0-444-63327-9.00010-2] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pathological neural activity in a variety of neurological disorders could be treated by directing plasticity to specifically renormalize aberrant neural circuits, thereby restoring normal function. Brief bursts of acetylcholine and norepinephrine can enhance the neural plasticity associated with coincident events. Vagus nerve stimulation (VNS) represents a safe and effective means to trigger the release of these neuromodulators with a high degree of temporal control. VNS-event pairing can generate highly specific and long-lasting plasticity in sensory and motor cortex. Based on the capacity to drive specific changes in neural circuitry, VNS paired with experience has been successful in effectively ameliorating animal models of chronic tinnitus, stroke, and posttraumatic stress disorder. Targeted plasticity therapy utilizing VNS is currently being translated to humans to treat chronic tinnitus and improve motor recovery after stroke. This chapter will discuss the current progress of VNS paired with experience to drive specific plasticity to treat these neurological disorders and will evaluate additional future applications of targeted plasticity therapy.
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Affiliation(s)
- Seth A Hays
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, USA; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, USA
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