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Martino Cinnera A, Bonanno M, Calabrò RS, Bisirri A, D'Arienzo M, D'Acunto A, Ciancarelli I, Morone G, Koch G. Paired associative stimulation to enhance motor outcome in spinal cord injury: a systematic review of first evidence. Expert Rev Med Devices 2024:1-12. [PMID: 38768088 DOI: 10.1080/17434440.2024.2358048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Spinal cord injuries (SCI) often result in motor impairment and lifelong disability. METHODS This systematic review, conducted in agreement with PRISMA guidelines, aimed to evaluate the effects of cortico-spinal paired associative stimulation (PAS) on motor outcomes in individuals with SCI. PubMed, Scopus/EMBASE, Pedro, and Cochrane databases were consulted from inception to 2023/01/12. RESULTS In 1021 articles, 10 studies involving 84 patients meet the inclusion criteria, 7 case series/study, and 3 clinical trials. Despite light differences, the included studies performed a cortico-peripheral PAS using a single transcranial magnetic stimulation and high frequency electrical peripheral nerve stimulation for a consistent number of sessions (>20). All included studies reported improvement in motor outcomes recorded via clinical and/or neurophysiological assessment. CONCLUSION Available evidence showed an increase in motor outcomes after PAS stimulation. Indeed, both clinical and neurophysiological outcomes suggest the effectiveness of a high number of PAS sessions in chronic individuals with SCI. Due to a limited number of studies and an unsatisfactory study design, well-designed RCTs are needed to confirm the potentiality of these approaches and clarify the adequate dose-response of PAS in the SCI population. REGISTRATION ID The protocol was registered on the PROSPERO database (CRD42023485703).
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Affiliation(s)
- Alex Martino Cinnera
- Scientific Institute for Research, Hospitalisation and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | | | | | | | - Martina D'Arienzo
- Scientific Institute for Research, Hospitalisation and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Alessia D'Acunto
- Department of Neurosciences, Paediatric neurology, University of Rome Tor Vergata, Rome, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Tao G, Yang S, Xu J, Wang L, Yang B. Global research trends and hotspots of artificial intelligence research in spinal cord neural injury and restoration-a bibliometrics and visualization analysis. Front Neurol 2024; 15:1361235. [PMID: 38628700 PMCID: PMC11018935 DOI: 10.3389/fneur.2024.1361235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background Artificial intelligence (AI) technology has made breakthroughs in spinal cord neural injury and restoration in recent years. It has a positive impact on clinical treatment. This study explores AI research's progress and hotspots in spinal cord neural injury and restoration. It also analyzes research shortcomings related to this area and proposes potential solutions. Methods We used CiteSpace 6.1.R6 and VOSviewer 1.6.19 to research WOS articles on AI research in spinal cord neural injury and restoration. Results A total of 1,502 articles were screened, in which the United States dominated; Kadone, Hideki (13 articles, University of Tsukuba, JAPAN) was the author with the highest number of publications; ARCH PHYS MED REHAB (IF = 4.3) was the most cited journal, and topics included molecular biology, immunology, neurology, sports, among other related areas. Conclusion We pinpointed three research hotspots for AI research in spinal cord neural injury and restoration: (1) intelligent robots and limb exoskeletons to assist rehabilitation training; (2) brain-computer interfaces; and (3) neuromodulation and noninvasive electrical stimulation. In addition, many new hotspots were discussed: (1) starting with image segmentation models based on convolutional neural networks; (2) the use of AI to fabricate polymeric biomaterials to provide the microenvironment required for neural stem cell-derived neural network tissues; (3) AI survival prediction tools, and transcription factor regulatory networks in the field of genetics were discussed. Although AI research in spinal cord neural injury and restoration has many benefits, the technology has several limitations (data and ethical issues). The data-gathering problem should be addressed in future research, which requires a significant sample of quality clinical data to build valid AI models. At the same time, research on genomics and other mechanisms in this field is fragile. In the future, machine learning techniques, such as AI survival prediction tools and transcription factor regulatory networks, can be utilized for studies related to the up-regulation of regeneration-related genes and the production of structural proteins for axonal growth.
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Affiliation(s)
- Guangyi Tao
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Shun Yang
- Department of Pain, Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Junjie Xu
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Linzi Wang
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Bin Yang
- Department of Pain, Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
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Fasipe G, Goršič M, Rahman MH, Rammer J. Community mobility and participation assessment of manual wheelchair users: a review of current techniques and challenges. Front Hum Neurosci 2024; 17:1331395. [PMID: 38249574 PMCID: PMC10796510 DOI: 10.3389/fnhum.2023.1331395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
According to the World Health Organization, hundreds of individuals commence wheelchair use daily, often due to an injury such as spinal cord injury or through a condition such as a stroke. However, manual wheelchair users typically experience reductions in individual community mobility and participation. In this review, articles from 2017 to 2023 were reviewed to identify means of measuring community mobility and participation of manual wheelchair users, factors that can impact these aspects, and current rehabilitation techniques for improving them. The selected articles document current best practices utilizing self-surveys, in-clinic assessments, and remote tracking through GPS and accelerometer data, which rehabilitation specialists can apply to track their patients' community mobility and participation accurately. Furthermore, rehabilitation methods such as wheelchair training programs, brain-computer interface triggered functional electric stimulation therapy, and community-based rehabilitation programs show potential to improve the community mobility and participation of manual wheelchair users. Recommendations were made to highlight potential avenues for future research.
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Affiliation(s)
- Grace Fasipe
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Maja Goršič
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Mohammad Habibur Rahman
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
- Department of Mechanical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Jacob Rammer
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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Chen M, Chen Z, Xiao X, Zhou L, Fu R, Jiang X, Pang M, Xia J. Corticospinal circuit neuroplasticity may involve silent synapses: Implications for functional recovery facilitated by neuromodulation after spinal cord injury. IBRO Neurosci Rep 2022; 14:185-194. [PMID: 36824667 PMCID: PMC9941655 DOI: 10.1016/j.ibneur.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022] Open
Abstract
Spinal cord injury (SCI) leads to devastating physical consequences, such as severe sensorimotor dysfunction even lifetime disability, by damaging the corticospinal system. The conventional opinion that SCI is intractable due to the poor regeneration of neurons in the adult central nervous system (CNS) needs to be revisited as the CNS is capable of considerable plasticity, which underlie recovery from neural injury. Substantial spontaneous neuroplasticity has been demonstrated in the corticospinal motor circuitry following SCI. Some of these plastic changes appear to be beneficial while others are detrimental toward locomotor function recovery after SCI. The beneficial corticospinal plasticity in the spared corticospinal circuits can be harnessed therapeutically by multiple contemporary neuromodulatory approaches, especially the electrical stimulation-based modalities, in an activity-dependent manner to improve functional outcomes in post-SCI rehabilitation. Silent synapse generation and unsilencing contribute to profound neuroplasticity that is implicated in a variety of neurological disorders, thus they may be involved in the corticospinal motor circuit neuroplasticity following SCI. Exploring the underlying mechanisms of silent synapse-mediated neuroplasticity in the corticospinal motor circuitry that may be exploited by neuromodulation will inform a novel direction for optimizing therapeutic repair strategies and rehabilitative interventions in SCI patients.
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Key Words
- AMPARs, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors
- BDNF, brain-derived neurotrophic factor
- BMIs, brain-machine interfaces
- CPG, central pattern generator
- CST, corticospinal tract
- Corticospinal motor circuitry
- DBS, deep brain stimulation
- ESS, epidural spinal stimulation
- MEPs, motor-evoked potentials
- NHPs, non-human primates
- NMDARs, N-methyl-d-aspartate receptors
- Neuromodulation
- Neuroplasticity
- PSNs, propriospinal neurons
- Rehabilitation
- SCI, spinal cord injury
- STDP, spike timing-dependent plasticity
- Silent synapses
- Spinal cord injury
- TBS, theta burst stimulation
- TMS, transcranial magnetic stimulation
- TrkB, tropomyosin-related kinase B
- cTBS, continuous TBS
- iTBS, intermittent TBS
- mTOR, mammalian target of rapamycin
- rTMS, repetitive TMS
- tDCS, transcranial direct current stimulation
- tcSCS, transcutaneous spinal cord stimulation
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Affiliation(s)
- Mingcong Chen
- Department of Orthopedics and Traumatology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, China
| | - Zuxin Chen
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Neher Neural Plasticity Laboratory, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS); Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong 518055, China
| | - Xiao Xiao
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education; Behavioral and Cognitive Neuroscience Center, Institute of Science and Technology for Brain-Inspired Intelligence; MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200433, China
| | - Libing Zhou
- Guangdong-Hongkong-Macau CNS Regeneration Institute of Jinan University, Key Laboratory of CNS Regeneration (Jinan University)-Ministry of Education, Guangzhou, Guangdong 510632, China
| | - Rao Fu
- Department of Anatomy, School of Medicine, Sun Yat-sen University, Shenzhen, Guangdong 518100, China
| | - Xian Jiang
- Institute of Neurological and Psychiatric Disorder, Shenzhen Bay laboratory, Shenzhen, Guangdong 518000, China
| | - Mao Pang
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong 510630, China
| | - Jianxun Xia
- Department of Basic Medical Sciences, Yunkang School of Medicine and Health, Nanfang College, Guangzhou, Guangdong 510970, China,Corresponding author.
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Nascimento TN, Boffino CC. Case Report: Galvanic Vestibular Stimulation in the Chronic Spinal Cord Injury Patient. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:779846. [PMID: 36189064 PMCID: PMC9397876 DOI: 10.3389/fresc.2022.779846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/07/2022] [Indexed: 06/16/2023]
Abstract
The traumatic spinal cord injury can generate sequels with high clinical severity and dysfunction and limitations of irreversible character. Current studies seek to reverse the sequelae and gain functionality in these individuals. Galvanic vestibular stimulation (GVS) has shown to be beneficial in spinal cord function as an evaluation correlated to functionality and for stimulation with physiological and functional characteristics in disease and healthy people. The present study observed the effects of Noise Galvanic Vestibular Stimulation in a patient with chronic spinal cord injury with tetraplegia on postural and trunk control. The evaluations were the Functional Independence Measure (FIM), the American Spinal Injury Association (ASIA) evaluation, and the Clinical Posturography, using force platform to assess postural balance, in the sitting position, through Sensory Organization and Functional Reach Tests. Ten sessions of Noise Galvanic Vestibular Stimulation associated with customized vestibular and neurofunctional rehabilitation were performed. The effects observed were increments in all assessments and tests that include modifications in functional independence, motor and sensory levels, change in disability grade from A (complete) to C (incomplete), and improvements in postural balance and trunk control. The phenomenon of stochastic resonance has shown benefits in postural control in people without vestibular lesions and we could observe some of these phenomena in our patients. We emphasize the need for evaluation with larger populations to observe the phenomena and effects in this group of patients and potential benefits and limitations.
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