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Rejc E, Zaccaron S, Bowersock C, Pisolkar T, Ugiliweneza B, Forrest GF, Agrawal S, Harkema SJ, Angeli CA. Effects of Robotic Postural Stand Training with Epidural Stimulation on Sitting Postural Control in Individuals with Spinal Cord Injury: A Pilot Study. J Clin Med 2024; 13:4309. [PMID: 39124576 PMCID: PMC11313204 DOI: 10.3390/jcm13154309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
(1) Background. High-level spinal cord injury (SCI) disrupts trunk control, leading to an impaired performance of upright postural tasks in sitting and standing. We previously showed that a novel robotic postural stand training with spinal cord epidural stimulation targeted at facilitating standing (Stand-scES) largely improved standing trunk control in individuals with high-level motor complete SCI. Here, we aimed at assessing the effects of robotic postural stand training with Stand-scES on sitting postural control in the same population. (2) Methods. Individuals with cervical (n = 5) or high-thoracic (n = 1) motor complete SCI underwent approximately 80 sessions (1 h/day; 5 days/week) of robotic postural stand training with Stand-scES, which was performed with free hands (i.e., without using handlebars) and included periods of standing with steady trunk control, self-initiated trunk and arm movements, and trunk perturbations. Sitting postural control was assessed on a standard therapy mat, with and without scES targeted at facilitating sitting (Sit-scES), before and after robotic postural stand training. Independent sit time and trunk center of mass (CM) displacement were assessed during a 5 min time window to evaluate steady sitting control. Self-initiated antero-posterior and medial-lateral trunk movements were also attempted from a sitting position, with the goal of covering the largest distance in the respective cardinal directions. Finally, the four Neuromuscular Recovery Scale items focused on sitting trunk control (Sit, Sit-up, Trunk extension in sitting, Reverse sit-up) were assessed. (3) Results. In summary, neither statistically significant differences nor large Effect Size were promoted by robotic postural stand training for the sitting outcomes considered for analysis. (4) Conclusions. The findings of the present study, together with previous observations, may suggest that robotic postural stand training with Stand-scES promoted trunk motor learning that was posture- and/or task-specific and, by itself, was not sufficient to significantly impact sitting postural control.
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Affiliation(s)
- Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100 Udine (UD), Italy;
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
| | - Simone Zaccaron
- Department of Medicine, University of Udine, P.le Kolbe 4, 33100 Udine (UD), Italy;
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy
| | - Collin Bowersock
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Biomechatronics Lab, Department of Mechanical Engineering, Northern Arizona University, S San Francisco St, Flagstaff, AZ 86011, USA
| | - Tanvi Pisolkar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Gail F. Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, 220 S. W. Mudd Building, 500 West 120th Street, New York, NY 10027, USA;
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY 10032, USA
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA; (C.B.); (T.P.); (B.U.); (S.J.H.)
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Claudia A. Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; (G.F.F.); (C.A.A.)
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Quel de Oliveira C, Bundy A, Middleton JW, Refshauge K, Rogers K, Davis GM. Activity-Based Therapy for Mobility, Function and Quality of Life after Spinal Cord Injuries-A Mixed-Methods Case Series. J Clin Med 2023; 12:7588. [PMID: 38137657 PMCID: PMC10743935 DOI: 10.3390/jcm12247588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Despite inconclusive evidence on the benefits of activity-based therapies (ABTs) in people with spinal cord injuries, implementation has occurred in clinics worldwide in response to consumers' requests. We explored the clinical changes and participants' perceptions from engaging in an ABT program in the community. (2) Methods: This mixed-methods study involved a pragmatic observational multiple-baseline design and an evaluation of participants' perceptions. Fifteen participants were included. Outcome measures were balance in sitting using the Seated Reach Distance test, mobility using the Modified Rivermead Mobility Index and quality of life using the Quality of Life Index SCI version pre- and post-participation in an ABT community-based program. Linear mixed models and logistic regressions were used to analyse the effects of intervention. Semi-structured interviews explored participants' perceptions using inductive thematic analysis. (3) Results: There was an increase of 9% in the standardised reach distance (95% CI 2-16) for sitting balance, 1.33 points (95% CI: 0.81-1.85) in mobility and 1.9 points (0.17-2.1) in quality of life. Two themes emerged from the interviews: (1) reduced impact of disability and an increased sense of life as before, and (2) the program was superior to usual rehabilitation. No adverse events related to the intervention were observed. (4) Conclusion: ABT delivered in the community improved clinical outcomes in people with a chronic SCI. High levels of satisfaction with the program were reported.
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Affiliation(s)
- Camila Quel de Oliveira
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Anita Bundy
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80524, USA
| | - James W. Middleton
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Sydney Medical School Northern, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Kathryn Refshauge
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
| | - Kris Rogers
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Glen M. Davis
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
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3
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Schmidt A, Madsen JG, Hyttel MK, Hansen EA. Freely Chosen Cadence is Increased during Repeated Bouts of Submaximal Ergometer Pedalling. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2022; 15:1142-1155. [PMID: 35989701 PMCID: PMC9362883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
It was investigated whether the phenomenon of repeated bout rate enhancement occurs during submaximal ergometer cycling. Repeated bout rate enhancement is defined as an increase of the freely, or spontaneously, chosen cadence during repeated bouts of pedalling and has previously been reported for finger tapping. This is relevant to study since cadence can affect biomechanical and physiological responses. Recreationally active individuals (n=27) performed five consecutive 5-min bouts of cycling at 100 W using freely chosen cadence. All bouts were separated by 10-min rest. Cadence, pedal force profile characteristics, heart rate, tympanic temperature, and rate of perceived exertion were determined during cycling. The primary result was that cadence at the end of 5. bout was statistically significantly higher than at the end of all other bouts. Overall, the cadence at the end of 5. bout was 15.6%±20.4% higher than at the end of 1. bout. The altered rhythmic motor behaviour was accompanied by a statistically significant effect of bout on the pedal force profile. Also, there was a statistically significant effect of bout on heart rate, which amounted to 125±17 and 131±26 beats/min at the end of 1. and 5. bout, respectively. Perhaps the observed increase of cadence occurred as a nonconscious rhythmogenesis process in form of a net excitation of relevant parts of the nervous system. In conclusion, repeated bout rate enhancement during submaximal ergometer cycling occurred. The freely chosen cadence showed an increase of on average about 15%, or 10 rpm, as accumulated values across five bouts of cycling.
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Affiliation(s)
- Andreas Schmidt
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | - Jonas G Madsen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | - Magnus K Hyttel
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | - Ernst A Hansen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
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Faw TD, Lakhani B, Schmalbrock P, Knopp MV, Lohse KR, Kramer JLK, Liu H, Nguyen HT, Phillips EG, Bratasz A, Fisher LC, Deibert RJ, Boyd LA, McTigue DM, Basso DM. Eccentric rehabilitation induces white matter plasticity and sensorimotor recovery in chronic spinal cord injury. Exp Neurol 2021; 346:113853. [PMID: 34464653 PMCID: PMC10084731 DOI: 10.1016/j.expneurol.2021.113853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022]
Abstract
Experience-dependent white matter plasticity offers new potential for rehabilitation-induced recovery after neurotrauma. This first-in-human translational experiment combined myelin water imaging in humans and genetic fate-mapping of oligodendrocyte lineage cells in mice to investigate whether downhill locomotor rehabilitation that emphasizes eccentric muscle actions promotes white matter plasticity and recovery in chronic, incomplete spinal cord injury (SCI). In humans, of 20 individuals with SCI that enrolled, four passed the imaging screen and had myelin water imaging before and after a 12-week (3 times/week) downhill locomotor treadmill training program (SCI + DH). One individual was excluded for imaging artifacts. Uninjured control participants (n = 7) had two myelin water imaging sessions within the same day. Changes in myelin water fraction (MWF), a histopathologically-validated myelin biomarker, were analyzed in a priori motor learning and non-motor learning brain regions and the cervical spinal cord using statistical approaches appropriate for small sample sizes. PDGFRα-CreERT2:mT/mG mice, that express green fluorescent protein on oligodendrocyte precursor cells and subsequent newly-differentiated oligodendrocytes upon tamoxifen-induced recombination, were either naive (n = 6) or received a moderate (75 kilodyne), contusive SCI at T9 and were randomized to downhill training (n = 6) or unexercised groups (n = 6). We initiated recombination 29 days post-injury, seven days prior to downhill training. Mice underwent two weeks of daily downhill training on the same 10% decline grade used in humans. Between-group comparison of functional (motor and sensory) and histological (oligodendrogenesis, oligodendroglial/axon interaction, paranodal structure) outcomes occurred post-training. In humans with SCI, downhill training increased MWF in brain motor learning regions (postcentral, precuneus) and mixed motor and sensory tracts of the ventral cervical spinal cord compared to control participants (P < 0.05). In mice with thoracic SCI, downhill training induced oligodendrogenesis in cervical dorsal and lateral white matter, increased axon-oligodendroglial interactions, and normalized paranodal structure in dorsal column sensory tracts (P < 0.05). Downhill training improved sensorimotor recovery in mice by normalizing hip and knee motor control and reducing hyperalgesia, both of which were associated with new oligodendrocytes in the cervical dorsal columns (P < 0.05). Our findings indicate that eccentric-focused, downhill rehabilitation promotes white matter plasticity and improved function in chronic SCI, likely via oligodendrogenesis in nervous system regions activated by the training paradigm. Together, these data reveal an exciting role for eccentric training in white matter plasticity and sensorimotor recovery after SCI.
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Affiliation(s)
- Timothy D Faw
- Neuroscience Graduate Program, The Ohio State University, Columbus, OH 43210, USA; Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH 43210, USA; Department of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
| | - Bimal Lakhani
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Petra Schmalbrock
- Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Michael V Knopp
- Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Keith R Lohse
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT 84112, USA; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - John L K Kramer
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Hanwen Liu
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Huyen T Nguyen
- Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Eileen G Phillips
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH 43210, USA; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Anna Bratasz
- Small Animal Imaging Shared Resources, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Lesley C Fisher
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH 43210, USA; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Rochelle J Deibert
- Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH 43210, USA; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Dana M McTigue
- Neuroscience Graduate Program, The Ohio State University, Columbus, OH 43210, USA; Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH 43210, USA; Department of Neuroscience, The Ohio State University, Columbus, OH 43210, USA
| | - D Michele Basso
- Neuroscience Graduate Program, The Ohio State University, Columbus, OH 43210, USA; Center for Brain and Spinal Cord Repair, The Ohio State University, Columbus, OH 43210, USA; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210, USA.
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5
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Siddiqui AM, Islam R, Cuellar CA, Silvernail JL, Knudsen B, Curley DE, Strickland T, Manske E, Suwan PT, Latypov T, Akhmetov N, Zhang S, Summer P, Nesbitt JJ, Chen BK, Grahn PJ, Madigan NN, Yaszemski MJ, Windebank AJ, Lavrov IA. Newly regenerated axons via scaffolds promote sub-lesional reorganization and motor recovery with epidural electrical stimulation. NPJ Regen Med 2021; 6:66. [PMID: 34671050 PMCID: PMC8528837 DOI: 10.1038/s41536-021-00176-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023] Open
Abstract
Here, we report the effect of newly regenerated axons via scaffolds on reorganization of spinal circuitry and restoration of motor functions with epidural electrical stimulation (EES). Motor recovery was evaluated for 7 weeks after spinal transection and following implantation with scaffolds seeded with neurotrophin producing Schwann cell and with rapamycin microspheres. Combined treatment with scaffolds and EES-enabled stepping led to functional improvement compared to groups with scaffold or EES, although, the number of axons across scaffolds was not different between groups. Re-transection through the scaffold at week 6 reduced EES-enabled stepping, still demonstrating better performance compared to the other groups. Greater synaptic reorganization in the presence of regenerated axons was found in group with combined therapy. These findings suggest that newly regenerated axons through cell-containing scaffolds with EES-enabled motor training reorganize the sub-lesional circuitry improving motor recovery, demonstrating that neuroregenerative and neuromodulatory therapies cumulatively enhancing motor function after complete SCI.
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Affiliation(s)
| | - Riazul Islam
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Carlos A Cuellar
- School of Sport Sciences, Universidad Anáhuac México, Campus Norte, Huixquilucan, State of Mexico, Mexico
| | | | - Bruce Knudsen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dallece E Curley
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Neuroscience, Brown University, Providence, Rhode Island, USA
| | | | - Emilee Manske
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Neuroscience, Scripps College, Claremont, CA, USA
| | - Parita T Suwan
- Paracelsus Medical Private University, Salzburg, Austria
| | - Timur Latypov
- Division of Brain, Imaging, and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nafis Akhmetov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Shuya Zhang
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Priska Summer
- Paracelsus Medical Private University, Salzburg, Austria
| | | | - Bingkun K Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Peter J Grahn
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Igor A Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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Unprompted Alteration of Freely Chosen Movement Rate During Stereotyped Rhythmic Movement: Examples and Review. Motor Control 2021; 25:385-402. [PMID: 33883299 DOI: 10.1123/mc.2020-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/18/2022]
Abstract
Investigations of behavior and control of voluntary stereotyped rhythmic movement contribute to the enhancement of motor function and performance of disabled, sick, injured, healthy, and exercising humans. The present article presents examples of unprompted alteration of freely chosen movement rate during voluntary stereotyped rhythmic movements. The examples, in the form of both increases and decreases of movement rate, are taken from activities of cycling, finger tapping, and locomotion. It is described that, for example, strength training, changed power output, repeated bouts, and changed locomotion speed can elicit an unprompted alteration of freely chosen movement rate. The discussion of the examples is based on a tripartite interplay between descending drive, rhythm-generating spinal neural networks, and sensory feedback, as well as terminology from dynamic systems theory.
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Momeni K, Ramanujam A, Ravi M, Garbarini E, Forrest GF. Effects of Multi-Muscle Electrical Stimulation and Stand Training on Stepping for an Individual With SCI. Front Hum Neurosci 2020; 14:549965. [PMID: 33100994 PMCID: PMC7546792 DOI: 10.3389/fnhum.2020.549965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to evaluate the biomechanical, neural, and functional outcomes during a 10-min treadmill stepping trial before and after two independent interventions with neuromuscular electrical stimulation (ES) in an individual with spinal cord injury (SCI). In this longitudinal study, a 34-year-old male with sensory- and motor-complete SCI (C5/C6) underwent two consecutive interventions: 61 h of supine lower limb ES (ES-alone) followed by 51 h of ES combined with stand training (ST) using an overhead body-weight support (BWS) system (ST + ES). In post ES-alone (unloaded), compared to baseline, the majority (∼60%) of lower extremity muscles decreased their peak surface electromyography (sEMG) amplitude, while in post ST + ES (loaded), compared to post ES-alone, there was a restoration in muscle activation that endured the continuous 10-min stepping. Temporal α-motor neuron activity patterns were observed for the SCI participant. In post ST + ES, there were increases in spinal activity patterns during mid-stance at spinal levels L5–S2 for the right and left limbs. Moreover, in post ES-alone, trunk stability increased with excursions from the midline of the base-of-support (50%) to the left (44.2%; Baseline: 54.2%) and right (66.4%; baseline: 77.5%). The least amount of trunk excursion observed post ST + ES, from midline to left (43%; AB: 22%) and right (64%; AB: 64%). Overall, in post ES-alone, there were gains in trunk independence with a decrease in lower limb muscle activation, whereas in post ST + ES, there were gains in trunk independence and increased muscle activation in both bilateral trunk muscles as well as lower limb muscles during the treadmill stepping paradigm. The results of the study illustrate the importance of loading during the stimulation for neural and mechanical gains.
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Affiliation(s)
- Kamyar Momeni
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Arvind Ramanujam
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Manikandan Ravi
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Erica Garbarini
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
| | - Gail F Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
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8
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Lin JT, Hsu CJ, Dee W, Chen D, Rymer WZ, Wu M. Varied movement errors drive learning of dynamic balance control during walking in people with incomplete spinal cord injury: a pilot study. Exp Brain Res 2020; 238:981-993. [PMID: 32189042 DOI: 10.1007/s00221-020-05776-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to determine whether the application of a varied pelvis perturbation force would improve dynamic balance control and gait stability of people with incomplete spinal cord injury (iSCI). Fourteen participants with iSCI completed the test in two conditions, i.e., walking paired with pelvis perturbation force and treadmill walking only, with 1-week interval in between. The order of the testing condition was randomized across participants. For the pelvis pertubation condition, subjects walked on a treadmill with no force for 1 min, with a varied pelvis perturbation force that was bilaterally applied in the medial-lateral direction for 10 min, without force for 1 min, and then with the perturbation for another 10 min after a sitting break. For the treadmill only condition, a protocol that was similar to the perturbation condition was used but no force was applied. Margin of stability (MoS), weight shifting, and other spatiotemporal gait parameters were calculated. Compared to treadmill training only, participants showed significant smaller MoS and double-leg support time after treadmill walking with pelvis perturbation. In addition, participants showed significantly greater improvements in overground walking speed after treadmill walking with pelvis perturbation than treadmill only (p = 0.021). Results from this study suggest that applying a varied pelvis perturbation force during treadmill walking could improve dynamic balance control in people with iSCI, which could be transferred to overground walking. These findings may be used to develop a new intervention to improve balance and walking function in people with iSCI.
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Affiliation(s)
- Jui-Te Lin
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA
| | - David Chen
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA
| | - W Zev Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 East Erie Street, 23rd Floor, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA. .,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.
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9
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Chia R, Zhong H, Vissel B, Edgerton VR, Gad P. Novel Activity Detection Algorithm to Characterize Spontaneous Stepping During Multimodal Spinal Neuromodulation After Mid-Thoracic Spinal Cord Injury in Rats. Front Syst Neurosci 2020; 13:82. [PMID: 32009910 PMCID: PMC6974470 DOI: 10.3389/fnsys.2019.00082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/16/2019] [Indexed: 12/18/2022] Open
Abstract
A mid-thoracic spinal cord injury (SCI) severely impairs activation of the lower limb sensorimotor spinal networks, leading to paralysis. Various neuromodulatory techniques including electrical and pharmacological activation of the spinal networks have been successful in restoring locomotor function after SCI. We hypothesized that the combination of self-training in a natural environment with epidural stimulation (ES), quipazine (Quip), and strychnine (Strych) would result in greater activity in a cage environment after paralysis compared to either intervention alone. To assess this, we developed a method measuring and characterizing the chronic EMG recordings from tibialis anterior (TA) and soleus (Sol) muscles while rats were freely moving in their home cages. We then assessed the relationship between the change in recorded activity over time and motor-evoked potentials (MEPs) in animals receiving treatments. We found that the combination of ES, Quip, and Strych (sqES) generated the greatest level of recovery followed by ES + Quip (qES) while ES + Strych (sES) and ES alone showed least improvement in recorded activity. Further, we observed an exponential relationship between late response (LR) component of the MEPs and spontaneously generated step-like activity. Our data demonstrate the feasibility and potential importance of quantitatively monitoring mechanistic factors linked to activity-dependence in response to combinatorial interventions compared to individual therapies after SCI.
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Affiliation(s)
- Raymond Chia
- Faculty of Science, Centre for Neuroscience and Regenerative Medicine, University of Technology Sydney, Sydney, NSW, Australia.,St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Hui Zhong
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bryce Vissel
- Faculty of Science, Centre for Neuroscience and Regenerative Medicine, University of Technology Sydney, Sydney, NSW, Australia.,St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - V Reggie Edgerton
- Faculty of Science, Centre for Neuroscience and Regenerative Medicine, University of Technology Sydney, Sydney, NSW, Australia.,Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States.,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States.,Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari Adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Parag Gad
- Faculty of Science, Centre for Neuroscience and Regenerative Medicine, University of Technology Sydney, Sydney, NSW, Australia.,Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States
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10
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Harnie J, Doelman A, de Vette E, Audet J, Desrochers E, Gaudreault N, Frigon A. The recovery of standing and locomotion after spinal cord injury does not require task-specific training. eLife 2019; 8:50134. [PMID: 31825306 PMCID: PMC6924957 DOI: 10.7554/elife.50134] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/08/2019] [Indexed: 12/20/2022] Open
Abstract
After complete spinal cord injury, mammals, including mice, rats and cats, recover hindlimb locomotion with treadmill training. The premise is that sensory cues consistent with locomotion reorganize spinal sensorimotor circuits. Here, we show that hindlimb standing and locomotion recover after spinal transection in cats without task-specific training. Spinal-transected cats recovered full weight bearing standing and locomotion after five weeks of rhythmic manual stimulation of triceps surae muscles (non-specific training) and without any intervention. Moreover, cats modulated locomotor speed and performed split-belt locomotion six weeks after spinal transection, functions that were not trained or tested in the weeks prior. This indicates that spinal networks controlling standing and locomotion and their interactions with sensory feedback from the limbs remain largely intact after complete spinal cord injury. We conclude that standing and locomotor recovery is due to the return of neuronal excitability within spinal sensorimotor circuits that do not require task-specific activity-dependent plasticity.
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Affiliation(s)
- Jonathan Harnie
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Adam Doelman
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Emmanuelle de Vette
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Johannie Audet
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Etienne Desrochers
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Nathaly Gaudreault
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Alain Frigon
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
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11
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Spinal Cord Epidural Stimulation for Lower Limb Motor Function Recovery in Individuals with Motor Complete Spinal Cord Injury. Phys Med Rehabil Clin N Am 2019; 30:337-354. [DOI: 10.1016/j.pmr.2018.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Gerasimenko Y, Sayenko D, Gad P, Kozesnik J, Moshonkina T, Grishin A, Pukhov A, Moiseev S, Gorodnichev R, Selionov V, Kozlovskaya I, Edgerton VR. Electrical Spinal Stimulation, and Imagining of Lower Limb Movements to Modulate Brain-Spinal Connectomes That Control Locomotor-Like Behavior. Front Physiol 2018; 9:1196. [PMID: 30283341 PMCID: PMC6157483 DOI: 10.3389/fphys.2018.01196] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/08/2018] [Indexed: 12/26/2022] Open
Abstract
Neuronal control of stepping movement in healthy human is based on integration between brain, spinal neuronal networks, and sensory signals. It is generally recognized that there are continuously occurring adjustments in the physiological states of supraspinal centers during all routines movements. For example, visual as well as all other sources of information regarding the subject's environment. These multimodal inputs to the brain normally play an important role in providing a feedforward source of control. We propose that the brain routinely uses these continuously updated assessments of the environment to provide additional feedforward messages to the spinal networks, which provides a synergistic feedforwardness for the brain and spinal cord. We tested this hypothesis in 8 non-injured individuals placed in gravity neutral position with the lower limbs extended beyond the edge of the table, but supported vertically, to facilitate rhythmic stepping. The experiment was performed while visualizing on the monitor a stick figure mimicking bilateral stepping or being motionless. Non-invasive electrical stimulation was used to neuromodulate a wide range of excitabilities of the lumbosacral spinal segments that would trigger rhythmic stepping movements. We observed that at the same intensity level of transcutaneous electrical spinal cord stimulation (tSCS), the presence or absence of visualizing a stepping-like movement of a stick figure immediately initiated or terminated the tSCS-induced rhythmic stepping motion, respectively. We also demonstrated that during both voluntary and imagined stepping, the motor potentials in leg muscles were facilitated when evoked cortically, using transcranial magnetic stimulation (TMS), and inhibited when evoked spinally, using tSCS. These data suggest that the ongoing assessment of the environment within the supraspinal centers that play a role in planning a movement can routinely modulate the physiological state of spinal networks that further facilitates a synergistic neuromodulation of the brain and spinal cord in preparing for movements.
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Affiliation(s)
- Yury Gerasimenko
- Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia.,Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Dimitry Sayenko
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Parag Gad
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Justin Kozesnik
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tatiana Moshonkina
- Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia
| | - Aleksandr Grishin
- Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia
| | - Aleksandr Pukhov
- Velikie Luki State Academy of Physical Education and Sport, Velikiye Luki, Russia
| | - Sergey Moiseev
- Velikie Luki State Academy of Physical Education and Sport, Velikiye Luki, Russia
| | - Ruslan Gorodnichev
- Velikie Luki State Academy of Physical Education and Sport, Velikiye Luki, Russia
| | - Victor Selionov
- Institute for Information Transmission Problems, Russian Academy of Science, Moscow, Russia
| | - Inessa Kozlovskaya
- Russian Federation State Scientific Center, Institute for Bio-Medical Problems, Russian Academy of Sciences, Moscow, Russia
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States.,Institute Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Badalona, Spain.,The Center for Neuroscience and Regenerative Medicine, University of Technology Sydney, Ultimo, NSW, Australia
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13
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Wolpaw JR. The negotiated equilibrium model of spinal cord function. J Physiol 2018; 596:3469-3491. [PMID: 29663410 PMCID: PMC6092289 DOI: 10.1113/jp275532] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/05/2018] [Indexed: 12/25/2022] Open
Abstract
The belief that the spinal cord is hardwired is no longer tenable. Like the rest of the CNS, the spinal cord changes during growth and ageing, when new motor behaviours are acquired, and in response to trauma and disease. This paper describes a new model of spinal cord function that reconciles its recently appreciated plasticity with its long-recognized reliability as the final common pathway for behaviour. According to this model, the substrate of each motor behaviour comprises brain and spinal plasticity: the plasticity in the brain induces and maintains the plasticity in the spinal cord. Each time a behaviour occurs, the spinal cord provides the brain with performance information that guides changes in the substrate of the behaviour. All the behaviours in the repertoire undergo this process concurrently; each repeatedly induces plasticity to preserve its key features despite the plasticity induced by other behaviours. The aggregate process is a negotiation among the behaviours: they negotiate the properties of the spinal neurons and synapses that they all use. The ongoing negotiation maintains the spinal cord in an equilibrium - a negotiated equilibrium - that serves all the behaviours. This new model of spinal cord function is supported by laboratory and clinical data, makes predictions borne out by experiment, and underlies a new approach to restoring function to people with neuromuscular disorders. Further studies are needed to test its generality, to determine whether it may apply to other CNS areas such as the cerebral cortex, and to develop its therapeutic implications.
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Affiliation(s)
- Jonathan R. Wolpaw
- National Center for Adaptive Neurotechnologies, Wadsworth CenterNYS Department of HealthAlbanyNYUSA
- Department of NeurologyStratton VA Medical CenterAlbanyNYUSA
- Department of Biomedical SciencesSchool of Public HealthSUNY AlbanyNYUSA
- Department of Neurology, Neurological InstituteColumbia UniversityNew YorkNYUSA
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14
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Tian T, Yu Z, Zhang N, Chang Y, Zhang Y, Zhang L, Zhou S, Zhang C, Feng G, Huang F. Modified acellular nerve-delivering PMSCs improve functional recovery in rats after complete spinal cord transection. Biomater Sci 2018; 5:2480-2492. [PMID: 29106428 DOI: 10.1039/c7bm00485k] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Due to the poor regeneration capacity of neurons and the inhibitory microenvironment, spontaneous regeneration in spinal cord injury (SCI) remains challenging. Tissue engineering is considered a promising approach for enhancing the regeneration of SCI by reconstructing the inherent structure and improving the microenvironment. In this study, the possibility of engineering a nerve complex, which is constructed by acellular nerve delivering placenta mesenchymal stem cells (PMSCs), was assessed for the recovery of a transected spinal cord. Modified acellular nerve grafts were developed, and PMSCs labeled with green fluorescent protein (GFP) were seeded on the graft to construct the engineered nerve complex. Then, the engineered nerve complex was implanted into a 2 mm-length transected gap of the spinal cord. Four weeks after the transplantation, numerous surviving PMSCs were observed in the lesion cavity by immunofluorescence staining. Moreover, co-localization between GFP and neurofilament-200 (NF200) and Neuronal Class III β-Tubulin (Tuj1) was observed at the bridge interface. The PMSCs-graft group exhibited significant function improvement as evaluated by the Basso, Beattie and Bresnahan (BBB) locomotion score and footprint analysis. Eight weeks after surgery, the evoked response was restored in the PMSCs-graft group and numerous thick myelin sheathes were observed compared to that in the control groups. Collectively, our findings suggest that the nerve complex prepared by acellular nerve delivering PMSCs enhanced the structure and function regeneration of the spinal cord after SCI.
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Affiliation(s)
- Ting Tian
- Institute of Human Anatomy and Histology and Embryology, Otology & Neuroscience Center, Binzhou Medical University, 346 Guanhai Road, Laishan District, Shandong Province 264003, China.
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15
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Liefeith A, Kiely J, Collins D, Richards J. Back to the Future– in support of a renewed emphasis on generic agility training within sports-specific developmental pathways. J Sports Sci 2018. [DOI: 10.1080/02640414.2018.1449088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - John Kiely
- Institute of Coaching and Performance, University of Central Lancashire, Preston, UK
| | - Dave Collins
- Institute of Coaching and Performance, University of Central Lancashire, Preston, UK
| | - Jim Richards
- Allied Health Research Unit, School of Health Sciences, University of Central Lancashire, Preston, UK
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16
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Bochkezanian V, Newton RU, Trajano GS, Vieira A, Pulverenti TS, Blazevich AJ. Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on muscle force production in people with spinal cord injury (SCI). BMC Neurol 2018; 18:17. [PMID: 29433467 PMCID: PMC5809925 DOI: 10.1186/s12883-018-1020-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/02/2018] [Indexed: 12/13/2022] Open
Abstract
Background Neuromuscular electrical stimulation (NMES) is commonly used in skeletal muscles in people with spinal cord injury (SCI) with the aim of increasing muscle recruitment and thus muscle force production. NMES has been conventionally used in clinical practice as functional electrical stimulation (FES), using low levels of evoked force that cannot optimally stimulate muscular strength and mass improvements, and thus trigger musculoskeletal changes in paralysed muscles. The use of high intensity intermittent NMES training using wide-pulse width and moderate-intensity as a strength training tool could be a promising method to increase muscle force production in people with SCI. However, this type of protocol has not been clinically adopted because it may generate rapid muscle fatigue and thus prevent the performance of repeated high-intensity muscular contractions in paralysed muscles. Moreover, superimposing patellar tendon vibration onto the wide-pulse width NMES has been shown to elicit further increases in impulse or, at least, reduce the rate of fatigue in repeated contractions in able-bodied populations, but there is a lack of evidence to support this argument in people with SCI. Methods Nine people with SCI received two NMES protocols with and without superimposing patellar tendon vibration on different days (i.e. STIM and STIM+vib), which consisted of repeated 30 Hz trains of 58 wide-pulse width (1000 μs) symmetric biphasic pulses (0.033-s inter-pulse interval; 2 s stimulation train; 2-s inter-train interval) being delivered to the dominant quadriceps femoris. Starting torque was 20% of maximal doublet-twitch torque and stimulations continued until torque declined to 50% of the starting torque. Total knee extensor impulse was calculated as the primary outcome variable. Results Total knee extensor impulse increased in four subjects when patellar tendon vibration was imposed (59.2 ± 15.8%) but decreased in five subjects (− 31.3 ± 25.7%). However, there were no statistically significant differences between these sub-groups or between conditions when the data were pooled. Conclusions Based on the present results there is insufficient evidence to conclude that patellar tendon vibration provides a clear benefit to muscle force production or delays muscle fatigue during wide-pulse width, moderate-intensity NMES in people with SCI. Trial registration ACTRN12618000022268. Date: 11/01/2018. Retrospectively registered.
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Affiliation(s)
- Vanesa Bochkezanian
- Department of Exercise and Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Building 34.1.02, Bruce Highway, North Rockhampton, Qld, 4702, Australia. .,Exercise Medicine Research Clinic, Edith Cowan University, Perth, Australia. .,Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.
| | - Robert U Newton
- Exercise Medicine Research Clinic, Edith Cowan University, Perth, Australia.,Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
| | | | - Timothy S Pulverenti
- Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Anthony J Blazevich
- Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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17
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Rejc E, Angeli CA, Atkinson D, Harkema SJ. Motor recovery after activity-based training with spinal cord epidural stimulation in a chronic motor complete paraplegic. Sci Rep 2017; 7:13476. [PMID: 29074997 PMCID: PMC5658385 DOI: 10.1038/s41598-017-14003-w] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022] Open
Abstract
The prognosis for recovery of motor function in motor complete spinal cord injured (SCI) individuals is poor. Our research team has demonstrated that lumbosacral spinal cord epidural stimulation (scES) and activity-based training can progressively promote the recovery of volitional leg movements and standing in individuals with chronic clinically complete SCI. However, scES was required to perform these motor tasks. Herein, we show the progressive recovery of voluntary leg movement and standing without scES in an individual with chronic, motor complete SCI throughout 3.7 years of activity-based interventions utilizing scES configurations customized for the different motor tasks that were specifically trained (standing, stepping, volitional leg movement). In particular, this report details the ongoing neural adaptations that allowed a functional progression from no volitional muscle activation to a refined, task-specific activation pattern and movement generation during volitional attempts without scES. Similarly, we observed the re-emergence of muscle activation patterns sufficient for standing with independent knee and hip extension. These findings highlight the recovery potential of the human nervous system after chronic clinically motor complete SCI.
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Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Frazier Rehab Institute, Louisville, Kentucky, USA
| | - Darryn Atkinson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA. .,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA. .,Frazier Rehab Institute, Louisville, Kentucky, USA.
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18
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Chen BK, Madigan NN, Hakim JS, Dadsetan M, McMahon SS, Yaszemski MJ, Windebank AJ. GDNF Schwann cells in hydrogel scaffolds promote regional axon regeneration, remyelination and functional improvement after spinal cord transection in rats. J Tissue Eng Regen Med 2017; 12:e398-e407. [DOI: 10.1002/term.2431] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 02/08/2017] [Accepted: 02/24/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Bingkun K. Chen
- Department of Neurology, Mayo Clinic College of Medicine; Mayo Clinic; Rochester Minnesota
| | - Nicolas N. Madigan
- Department of Neurology, Mayo Clinic College of Medicine; Mayo Clinic; Rochester Minnesota
| | - Jeffrey S. Hakim
- Department of Neurology, Mayo Clinic College of Medicine; Mayo Clinic; Rochester Minnesota
| | - Mahrokh Dadsetan
- Department of Orthopedic Surgery; Mayo Clinic College of Medicine; Rochester Minnesota
| | - Siobhan S. McMahon
- Department of Medicine; Regenerative Medicine Institute (REMEDI), National University of Ireland; Galway
| | - Michael J. Yaszemski
- Department of Orthopedic Surgery; Mayo Clinic College of Medicine; Rochester Minnesota
| | - Anthony J. Windebank
- Department of Neurology, Mayo Clinic College of Medicine; Mayo Clinic; Rochester Minnesota
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19
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Bochkezanian V, Newton RU, Trajano GS, Vieira A, Pulverenti TS, Blazevich AJ. Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on the decline and recovery of muscle force. BMC Neurol 2017; 17:82. [PMID: 28464800 PMCID: PMC5414318 DOI: 10.1186/s12883-017-0862-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) is commonly used to activate skeletal muscles and reverse muscle atrophy in clinical populations. Clinical recommendations for NMES suggest the use of short pulse widths (100-200 μs) and low-to-moderate pulse frequencies (30-50 Hz). However, this type of NMES causes rapid muscle fatigue due to the (non-physiological) high stimulation intensities and non-orderly recruitment of motor units. The use of both wide pulse widths (1000 μs) and tendon vibration might optimize motor unit activation through spinal reflex pathways and thus delay the onset of muscle fatigue, increasing muscle force and mass. Thus, the objective of this study was to examine the acute effects of patellar tendon vibration superimposed onto wide-pulse width (1000 μs) knee extensor electrical stimulation (NMES, 30 Hz) on peak muscle force, total impulse before "muscle fatigue", and the post-exercise recovery of muscle function. METHODS Tendon vibration (Vib), NMES (STIM) or NMES superimposed onto vibration (STIM + Vib) were applied in separate sessions to 16 healthy adults. Total torque-time integral (TTI), maximal voluntary contraction torque (MVIC) and indirect measures of muscle damage were tested before, immediately after, 1 h and 48 h after each stimulus. RESULTS TTI increased (145.0 ± 127.7%) in STIM only for "positive responders" to the tendon vibration (8/16 subjects), but decreased in "negative responders" (-43.5 ± 25.7%). MVIC (-8.7%) and rectus femoris electromyography (RF EMG) (-16.7%) decreased after STIM (group effect) for at least 1 h, but not after STIM + Vib. No changes were detected in indirect markers of muscle damage in any condition. CONCLUSIONS Tendon vibration superimposed onto wide-pulse width NMES increased TTI only in 8 of 16 subjects, but reduced voluntary force loss (fatigue) ubiquitously. Negative responders to tendon vibration may derive greater benefit from wide-pulse width NMES alone.
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Affiliation(s)
- Vanesa Bochkezanian
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia. .,Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia.,Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | | | - Timothy S Pulverenti
- Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Anthony J Blazevich
- Centre for Sports and Exercise Science, School of Medical and Health Sciences, Edith Cowan University, Joondalup 270 Joondalup Drive, Joondalup, WA, 6027, Australia
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20
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Bui TV, Stifani N, Akay T, Brownstone RM. Spinal microcircuits comprising dI3 interneurons are necessary for motor functional recovery following spinal cord transection. eLife 2016; 5. [PMID: 27977000 PMCID: PMC5218533 DOI: 10.7554/elife.21715] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023] Open
Abstract
The spinal cord has the capacity to coordinate motor activities such as locomotion. Following spinal transection, functional activity can be regained, to a degree, following motor training. To identify microcircuits involved in this recovery, we studied a population of mouse spinal interneurons known to receive direct afferent inputs and project to intermediate and ventral regions of the spinal cord. We demonstrate that while dI3 interneurons are not necessary for normal locomotor activity, locomotor circuits rhythmically inhibit them and dI3 interneurons can activate these circuits. Removing dI3 interneurons from spinal microcircuits by eliminating their synaptic transmission left locomotion more or less unchanged, but abolished functional recovery, indicating that dI3 interneurons are a necessary cellular substrate for motor system plasticity following transection. We suggest that dI3 interneurons compare inputs from locomotor circuits with sensory afferent inputs to compute sensory prediction errors that then modify locomotor circuits to effect motor recovery.
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Affiliation(s)
- Tuan V Bui
- Department of Biology, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - Nicolas Stifani
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Turgay Akay
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Robert M Brownstone
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada.,Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Canada.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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21
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Rejc E, Angeli CA, Bryant N, Harkema SJ. Effects of Stand and Step Training with Epidural Stimulation on Motor Function for Standing in Chronic Complete Paraplegics. J Neurotrauma 2016; 34:1787-1802. [PMID: 27566051 DOI: 10.1089/neu.2016.4516] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Individuals affected by motor complete spinal cord injury are unable to stand, walk, or move their lower limbs voluntarily; this diagnosis normally implies severe limitations for functional recovery. We have recently shown that the appropriate selection of epidural stimulation parameters was critical to promoting full-body, weight-bearing standing with independent knee extension in four individuals with chronic clinically complete paralysis. In the current study, we examined the effects of stand training and subsequent step training with epidural stimulation on motor function for standing in the same four individuals. After stand training, the ability to stand improved to different extents in the four participants. Step training performed afterwards substantially impaired standing ability in three of the four individuals. Improved standing ability generally coincided with continuous electromyography (EMG) patterns with constant levels of ground reaction forces. Conversely, poorer standing ability was associated with more variable EMG patterns that alternated EMG bursts and longer periods of negligible activity in most of the muscles. Stand and step training also differentially affected the evoked potentials amplitude modulation induced by sitting-to-standing transition. Finally, stand and step training with epidural stimulation were not sufficient to improve motor function for standing without stimulation. These findings show that the spinal circuitry of motor complete paraplegics can generate motor patterns effective for standing in response to task-specific training with optimized stimulation parameters. Conversely, step training can lead to neural adaptations resulting in impaired motor function for standing.
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Affiliation(s)
- Enrico Rejc
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville , Louisville, Kentucky
| | - Claudia A Angeli
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,3 Frazier Rehab Institute , Kentucky One Health, Louisville, Kentucky
| | - Nicole Bryant
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky
| | - Susan J Harkema
- 1 Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.,2 Department of Neurological Surgery, University of Louisville , Louisville, Kentucky.,3 Frazier Rehab Institute , Kentucky One Health, Louisville, Kentucky
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22
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Alam M, Rodrigues W, Pham BN, Thakor NV. Brain-machine interface facilitated neurorehabilitation via spinal stimulation after spinal cord injury: Recent progress and future perspectives. Brain Res 2016; 1646:25-33. [DOI: 10.1016/j.brainres.2016.05.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/24/2016] [Accepted: 05/19/2016] [Indexed: 01/05/2023]
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23
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Measures and Outcome Instruments for Pediatric Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0126-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Neuromodulation of the neural circuits controlling the lower urinary tract. Exp Neurol 2016; 285:182-189. [PMID: 27381425 DOI: 10.1016/j.expneurol.2016.06.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 01/01/2023]
Abstract
The inability to control timely bladder emptying is one of the most serious challenges among the many functional deficits that occur after a spinal cord injury. We previously demonstrated that electrodes placed epidurally on the dorsum of the spinal cord can be used in animals and humans to recover postural and locomotor function after complete paralysis and can be used to enable voiding in spinal rats. In the present study, we examined the neuromodulation of lower urinary tract function associated with acute epidural spinal cord stimulation, locomotion, and peripheral nerve stimulation in adult rats. Herein we demonstrate that electrically evoked potentials in the hindlimb muscles and external urethral sphincter are modulated uniquely when the rat is stepping bipedally and not voiding, immediately pre-voiding, or when voiding. We also show that spinal cord stimulation can effectively neuromodulate the lower urinary tract via frequency-dependent stimulation patterns and that neural peripheral nerve stimulation can activate the external urethral sphincter both directly and via relays in the spinal cord. The data demonstrate that the sensorimotor networks controlling bladder and locomotion are highly integrated neurophysiologically and behaviorally and demonstrate how these two functions are modulated by sensory input from the tibial and pudental nerves. A more detailed understanding of the high level of interaction between these networks could lead to the integration of multiple neurophysiological strategies to improve bladder function. These data suggest that the development of strategies to improve bladder function should simultaneously engage these highly integrated networks in an activity-dependent manner.
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Chen X, Zeng Y, Yin Y. Improving the Transparency of an Exoskeleton Knee Joint Based on the Understanding of Motor Intent Using Energy Kernel Method of EMG. IEEE Trans Neural Syst Rehabil Eng 2016; 25:577-588. [PMID: 27333607 DOI: 10.1109/tnsre.2016.2582321] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Transparent control is still highly challenging for robotic exoskeletons, especially when a simple strategy is expected for a large-impedance device. To improve the transparency for late-phase rehabilitation when "patient-in-charge" mode is necessary, this paper aims at adaptive identification of human motor intent, and proposed an iterative prediction-compensation motion control scheme for an exoskeleton knee joint. Based on the analysis of human-machine interactive mechanism (HMIM) and the semiphenomenological biomechanical model of muscle, an online adaptive predicting controller is designed using a focused time-delay neural network (FTDNN) with the inputs of electromyography (EMG), position and interactive force, where the activation level of muscle is estimated from EMG using a novel energy kernel method. The compensating controller is designed using the normative force-position control paradigm. Initial experiments on the human-machine integrated knee system validated the effectiveness and ease of use of the proposed control scheme.
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Shah PK, Sureddi S, Alam M, Zhong H, Roy RR, Edgerton VR, Gerasimenko Y. Unique Spatiotemporal Neuromodulation of the Lumbosacral Circuitry Shapes Locomotor Success after Spinal Cord Injury. J Neurotrauma 2016; 33:1709-23. [PMID: 26792233 DOI: 10.1089/neu.2015.4256] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spinal cord epidural stimulation has resulted in the initiation of voluntary leg movements and improvement in postural, bladder, and sexual function. However, one of the limitations in reaching the full potential of epidural stimulation for therapeutic purposes in humans has been the identification of optimal stimulation configurations that can neuromodulate the spinal cord for stepping. In the present work, we investigated the mechanisms underlying the specificity of interaction between the rostral and caudal spinal cord circuitries in enabling locomotion in spinal rats (n = 10) by epidural spinal cord stimulation. By using unique spatiotemporal epidural stimulation parameters of the lumbar and sacral spinal cords, a robust stepping pattern in spinal rats was observed with only six training sessions and as early as 3 weeks post-injury. Electrophysiological evidence reveals that in addition to frequency of stimulation pulses at the stimulation sites, the relative timing between stimulation pulses applied at the lumbar (L2) and sacral (S1) segments of the spinal cord heavily impacted stepping performance. Best stepping was established at a higher stimulation frequency (40 Hz vs. 5, 10, 15, and 20Hz) and at specific relative time-intervals between the stimulation pulses (L2 pulse applied at 18-25 msec after the onset of the S1 pulse; S1 pulse applied 0-7 msec after the L2 pulse). Our data suggest that controlling pulse-to-pulse timing at multiple stimulation sources provides a novel strategy to optimize spinal stepping by fine-tuning the physiological state of the locomotor networks. These findings hold direct relevance to the clinician who will incorporate electrical stimulation strategies for optimizing control of locomotion after complete paralysis.
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Affiliation(s)
- Prithvi K Shah
- 1 Division of Rehabilitation Sciences, School of Health Technology and Management, Stony Brook University , Stony Brook, New York.,2 Department of Neurobiology, Stony Brook University , Stony Brook, New York
| | - Shakthi Sureddi
- 3 Department of Neuroscience, University of California , Los Angeles, California
| | - Monzurul Alam
- 4 Department of Neurosurgery, University of California , Los Angeles, California
| | - Hui Zhong
- 5 Department of Integrative Biology and Physiology, University of California , Los Angeles, California
| | - Roland R Roy
- 5 Department of Integrative Biology and Physiology, University of California , Los Angeles, California.,6 Brain Research Institute, University of California , Los Angeles, California
| | - V Reggie Edgerton
- 4 Department of Neurosurgery, University of California , Los Angeles, California.,5 Department of Integrative Biology and Physiology, University of California , Los Angeles, California.,6 Brain Research Institute, University of California , Los Angeles, California.,7 Department of Neurobiology, University of California , Los Angeles, California
| | - Yury Gerasimenko
- 5 Department of Integrative Biology and Physiology, University of California , Los Angeles, California.,8 Pavlov Institute of Physiology, St. Petersburg, Russia .,9 Institute of Fundamental Medicine and Biology, Kazan Federal University , Kazan, Russia
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Active paraplegics are protected against exercise-induced oxidative damage through the induction of antioxidant enzymes. Spinal Cord 2016; 54:830-837. [PMID: 26882488 DOI: 10.1038/sc.2016.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/12/2015] [Accepted: 12/13/2015] [Indexed: 12/24/2022]
Abstract
STUDY DESIGN Experimental study. OBJECTIVES Exercise improves functional capacity in spinal cord injury (SCI). However, exhaustive exercise, especially when sporadic, is linked to the production of reactive oxygen species that may have a detrimental effect on SCI. We aimed to study the effect of a single bout of exhaustive exercise on systemic oxidative stress parameters and on the expression of antioxidant enzymes in individuals with paraplegia. SETTING The study was conducted in the Physical Therapy department and the Physical Education and Sports department of the University of Valencia. METHODS Sixteen paraplegic subjects were submitted to a graded exercise test (GET) until volitional exhaustion. They were divided into active or non-active groups. Blood samples were drawn immediately, 1 and 2 h after the GET. We determined plasma malondialdehyde (MDA) and protein carbonylation as markers of oxidative damage. Antioxidant gene expression (catalase and glutathione peroxidase-GPx) was determined in peripheral blood mononuclear cells. RESULTS We found a significant increase in plasma MDA and protein carbonyls immediately after the GET (P<0.05). This increment correlated significantly with the lactate levels. Active paraplegics showed lower levels of exercise-induced oxidative damage (P<0.05) and higher exercise-induced catalase (P<0.01) and GPx (P<0.05) gene expression after the GET. CONCLUSIONS These results suggest that exercise training may be useful in SCI patients to develop systemic antioxidant defenses that may protect them against exercise-induced oxidative damage.
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Knaepen K, Beyl P, Duerinck S, Hagman F, Lefeber D, Meeusen R. Human–Robot Interaction: Kinematics and Muscle Activity Inside a Powered Compliant Knee Exoskeleton. IEEE Trans Neural Syst Rehabil Eng 2014; 22:1128-37. [DOI: 10.1109/tnsre.2014.2324153] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Molecular mechanisms of treadmill therapy on neuromuscular atrophy induced via botulinum toxin A. Neural Plast 2013; 2013:593271. [PMID: 24327926 PMCID: PMC3845528 DOI: 10.1155/2013/593271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/13/2013] [Accepted: 10/01/2013] [Indexed: 01/09/2023] Open
Abstract
Botulinum toxin A (BoNT-A) is a bacterial zinc-dependent endopeptidase that acts specifically on neuromuscular junctions. BoNT-A blocks the release of acetylcholine, thereby decreasing the ability of a spastic muscle to generate forceful contraction, which results in a temporal local weakness and the atrophy of targeted muscles. BoNT-A-induced temporal muscle weakness has been used to manage skeletal muscle spasticity, such as poststroke spasticity, cerebral palsy, and cervical dystonia. However, the combined effect of treadmill exercise and BoNT-A treatment is not well understood. We previously demonstrated that for rats, following BoNT-A injection in the gastrocnemius muscle, treadmill running improved the recovery of the sciatic functional index (SFI), muscle contraction strength, and compound muscle action potential (CMAP) amplitude and area. Treadmill training had no influence on gastrocnemius mass that received BoNT-A injection, but it improved the maximal contraction force of the gastrocnemius, and upregulation of GAP-43, IGF-1, Myo-D, Myf-5, myogenin, and acetylcholine receptor (AChR) subunits α and β was found following treadmill training. Taken together, these results suggest that the upregulation of genes associated with neurite and AChR regeneration following treadmill training may contribute to enhanced gastrocnemius strength recovery following BoNT-A injection.
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Abstract
Skeletal muscle fatigue is defined as the fall of force or power in response to contractile activity. Both the mechanisms of fatigue and the modes used to elicit it vary tremendously. Conceptual and technological advances allow the examination of fatigue from the level of the single molecule to the intact organism. Evaluation of muscle fatigue in a wide range of disease states builds on our understanding of basic function by revealing the sources of dysfunction in response to disease.
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Affiliation(s)
- Jane A Kent-Braun
- Department of Kinesiology, University of Massachusetts-Amherst, Amherst, Massachusetts, USA.
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Kamgar P, Agarwal A, Chao T, Askari S, Tan M, Honor R, Won DS. Step trajectory analysis of spinal cord injured rats trained with neuromuscular electrical stimulation coordinated with robotic treadmill training. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:1864-7. [PMID: 23366276 DOI: 10.1109/embc.2012.6346315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Applying neuromuscular electrical stimulation (NMES) during treadmill training (TT) has been shown to improve functional outcomes, such as gait speed and walking distance, in spinal cord injury (SCI) patients. However, ways to improve this combined NMES+TT therapy have not been investigated. We have developed NMES system for a rodent model of SCI to investigate whether and how more precisely timing the stimulation to robotically assisted hindlimb position might achieve rehabilitation of independent stepping after SCI. In our therapy (NMES+RTT), rodent ankle flexor muscles are stimulated while the hindlimbs are robotically driven through pre-programmed trajectories during treadmill training. The objectives of the work presented here were to quantify changes in step trajectory resulting from our combined NMES+RTT therapy and compare those effects with those induced by robotic treadmill training (RTT) alone. Animals were spinally contused to model severe SCI, and either received 2 weeks of NMES+RTT followed by 2 weeks of RTT (n=6) or 2 weeks of RTT followed by 2 weeks of NMES+RTT (n=7). Changes in step trajectories after training were analyzed. According to a deviation measure we developed, the step trajectories improved after either NMES+RTT or RTT training but more closely matched the desired pre-programmed trajectories after NMES+RTT than after RTT only. The step trajectories are also more consistent, as indicated by a coefficient of variation measure, after training and more so after NMES+RTT than after RTT only. These preliminary results from our NMES+RTT vs. RTT study are consistent with the hypothesis that appropriately timing NMES with hindlimb movements during stepping is an effective therapy for restoring the ability to step after spinal cord injury.
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Affiliation(s)
- P Kamgar
- Electrical and Computer Engineering Department, California State University - Los Angeles, Los Angeles, CA 90032, USA.
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Lam T, Chen Z, Sayed-Ahmed MM, Krassioukov A, Al-Yahya AA. Potential role of oxidative stress on the prescription of rehabilitation interventions in spinal cord injury. Spinal Cord 2013; 51:656-62. [PMID: 23857328 DOI: 10.1038/sc.2013.71] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/28/2013] [Accepted: 06/05/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review article. OBJECTIVES To provide an overview of free radical biology, particularly with respect to muscle physiology, as well as the potential effects of muscle morphological changes, physical capacity and nutritional status on oxidative stress in people with chronic spinal cord injury (SCI). The potential implications of these factors for determining the optimal dosage of rehabilitation training interventions in people with chronic SCI will also be presented. SETTING Vancouver, BC, Canada. METHODS Literature review. RESULTS Not applicable. CONCLUSION There has been a great deal of focus on rehabilitation exercise interventions providing intensive practice of movements to enhance functional recovery and physical capacity following SCI. However, there is still much to be understood about the appropriate dosage of training parameters (e.g. frequency, duration). It has been known for several decades that exercise increases free radical production, leading to oxidative stress. To date, there has been little consideration of the potential interaction of oxidative stress with training parameters on functional outcomes in chronic SCI. Furthermore, individuals with chronic SCI face many secondary consequences of their injury, such as muscle atrophy, change in muscle fiber type, general deconditioning and nutritional status, that are known to influence free radical production and antioxidant capacity. Better understanding of the potential confounding effects of oxidative stress associated with exercise will improve our ability to determine the optimal 'dose' of rehabilitation training to maximize functional recovery following SCI.
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Affiliation(s)
- T Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Infants with spina bifida: immediate responses to contextual and manual sensory augmentation during treadmill stepping. Pediatr Phys Ther 2013; 25:36-45. [PMID: 23288007 DOI: 10.1097/pep.0b013e31827a7533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE This study examined the effect of combined sensory enhancements and manual assistance on the immediate motor responsiveness of infants with spina bifida during treadmill trials. METHODS Six infants with spina bifida, aged 4 to 9.5 months, with lesion levels ranging from L4 to S3 were tested in each of 3 randomly ordered sets of enhanced sensory conditions across 3 weekly visits to the laboratory. Sensory enhancements included visual flow, unloading, load, and friction, presented in single and combined applications, as well as a set of trials with manual assistance for stepping at 2 treadmill belt speeds. Dependent variables included step frequencies and overall infant activity. RESULTS Friction+load was the most salient of the contextual sensory enhancements. Manual assistance at the slower speed was also effective at increasing infant stepping. CONCLUSIONS Sensory enhancements that increase stance excursion and vertical clearance during swing need further study.
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Askari S, Chao T, de Leon RD, Won DS. The effect of timing electrical stimulation to robotic-assisted stepping on neuromuscular activity and associated kinematics. ACTA ACUST UNITED AC 2013; 50:875-92. [DOI: 10.1682/jrrd.2012.06.0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Ray D. de Leon
- School of Kinesiology and Nutritional Science, California State University, Los Angeles, CA
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Qiao M, Jindrich DL. Task-level strategies for human sagittal-plane running maneuvers are consistent with robotic control policies. PLoS One 2012; 7:e51888. [PMID: 23284804 PMCID: PMC3527458 DOI: 10.1371/journal.pone.0051888] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 11/12/2012] [Indexed: 11/26/2022] Open
Abstract
The strategies that humans use to control unsteady locomotion are not well understood. A “spring-mass” template comprised of a point mass bouncing on a sprung leg can approximate both center of mass movements and ground reaction forces during running in humans and other animals. Legged robots that operate as bouncing, “spring-mass” systems can maintain stable motion using relatively simple, distributed feedback rules. We tested whether the changes to sagittal-plane movements during five running tasks involving active changes to running height, speed, and orientation were consistent with the rules used by bouncing robots to maintain stability. Changes to running height were associated with changes to leg force but not stance duration. To change speed, humans primarily used a “pogo stick” strategy, where speed changes were associated with adjustments to fore-aft foot placement, and not a “unicycle” strategy involving systematic changes to stance leg hip moment. However, hip moments were related to changes to body orientation and angular speed. Hip moments could be described with first order proportional-derivative relationship to trunk pitch. Overall, the task-level strategies used for body control in humans were consistent with the strategies employed by bouncing robots. Identification of these behavioral strategies could lead to a better understanding of the sensorimotor mechanisms that allow for effective unsteady locomotion.
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Affiliation(s)
- Mu Qiao
- Kinesiology Program, School of Nutrition and Health Promotion, Arizona State University, Tempe, Arizona, United States of America
| | - Devin L. Jindrich
- Department of Kinesiology, California State University San Marcos, San Marcos, California, United States of America
- * E-mail:
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Ferguson AR, Huie JR, Crown ED, Grau JW. Central nociceptive sensitization vs. spinal cord training: opposing forms of plasticity that dictate function after complete spinal cord injury. Front Physiol 2012; 3:396. [PMID: 23060820 PMCID: PMC3463829 DOI: 10.3389/fphys.2012.00396] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 09/15/2012] [Indexed: 11/13/2022] Open
Abstract
The spinal cord demonstrates several forms of plasticity that resemble brain-dependent learning and memory. Among the most studied form of spinal plasticity is spinal memory for noxious (nociceptive) stimulation. Numerous papers have described central pain as a spinally-stored memory that enhances future responses to cutaneous stimulation. This phenomenon, known as central sensitization, has broad relevance to a range of pathological conditions. Work from the spinal cord injury (SCI) field indicates that the lumbar spinal cord demonstrates several other forms of plasticity, including formal learning and memory. After complete thoracic SCI, the lumbar spinal cord can be trained by delivering stimulation to the hindleg when the leg is extended. In the presence of this response-contingent stimulation the spinal cord rapidly learns to hold the leg in a flexed position, a centrally mediated effect that meets the formal criteria for instrumental (response-outcome) learning. Instrumental flexion training produces a central change in spinal plasticity that enables future spinal learning on both the ipsilateral and contralateral leg. However, if stimulation is given in a response-independent manner, the spinal cord develops central maladaptive plasticity that undermines future spinal learning on both legs. The present paper tests for interactions between spinal cord training and central nociceptive sensitization after complete spinal cord transection. We found that spinal training alters future central sensitization by intradermal formalin (24 h post-training). Conversely intradermal formalin impaired future spinal learning (24 h post-injection). Because formalin-induced central sensitization has been shown to involve NMDA receptor activation, we tested whether pre-treatment with NMDA would also affect spinal learning in manner similar to formalin. We found intrathecal NMDA impaired learning in a dose-dependent fashion, and that this effect endures for at least 24 h. These data provide strong evidence for an opposing relationship between nociceptive plasticity and use-dependent learning in the spinal cord. The present work has clinical implications given recent findings that adaptive spinal training improves recovery in humans with SCI. Nociception below the SCI may undermine this rehabilitation potential.
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Affiliation(s)
- Adam R Ferguson
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California San Francisco San Francisco, CA, USA
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38
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Stigger F, do Nascimento PS, Dutra MF, Couto GK, Ilha J, Achaval M, Marcuzzo S. Treadmill training induces plasticity in spinal motoneurons and sciatic nerve after sensorimotor restriction during early postnatal period: new insights into the clinical approach for children with cerebral palsy. Int J Dev Neurosci 2011; 29:833-8. [PMID: 21925584 DOI: 10.1016/j.ijdevneu.2011.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/19/2011] [Accepted: 09/03/2011] [Indexed: 01/23/2023] Open
Abstract
The aim of the present study was to investigate whether locomotor stimulation training could have beneficial effects on the morphometric alterations of spinal cord and sciatic nerve consequent to sensorimotor restriction (SR). Male Wistar rats were exposed to SR from postnatal day 2 (P2) to P28. Control and experimental rats underwent locomotor stimulation training in a treadmill for three weeks (from P31 to P52). The cross-sectional area (CSA) of spinal motoneurons innervating hind limb muscles was determined. Both fiber and axonal CSA of myelinated fibers were also assessed. The growth-related increase in CSA of motoneurons in the SR group was less than controls. After SR, the mean motoneuron soma size was reduced with an increase in the proportion of motoneurons with a soma size of between 0 and 800 μm(2). The changes in soma size of motoneurons were accompanied by a reduction in the mean fiber and axon CSA of sciatic nerve. The soma size of motoneurons was reestablished at the end of the training period reaching controls level. Our results suggest that SR during early postnatal life retards the growth-related increase in the cell body size of motoneurons in spinal cord and the development of sciatic nerve. Additionally, three weeks of locomotor stimulation using a treadmill seems to have a beneficial effect on motoneurons' soma size.
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Affiliation(s)
- Felipe Stigger
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil.
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Ilha J, Centenaro LA, Broetto Cunha N, de Souza DF, Jaeger M, do Nascimento PS, Kolling J, Ben J, Marcuzzo S, Wyse ATS, Gottfried C, Achaval M. The Beneficial Effects of Treadmill Step Training on Activity-Dependent Synaptic and Cellular Plasticity Markers After Complete Spinal Cord Injury. Neurochem Res 2011; 36:1046-55. [DOI: 10.1007/s11064-011-0446-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2011] [Indexed: 01/15/2023]
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Cycling exercise affects the expression of apoptosis-associated microRNAs after spinal cord injury in rats. Exp Neurol 2010; 226:200-6. [PMID: 20816819 DOI: 10.1016/j.expneurol.2010.08.032] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/18/2010] [Accepted: 08/22/2010] [Indexed: 12/12/2022]
Abstract
There are two major aspects to a spinal cord injury (SCI): an acute, primary mechanical trauma and a progressive phase of secondary tissue damage provoked by inflammation, excitotoxicity, apoptosis, and demyelination. MicroRNAs (miRs) are small, ~22 nucleotide, non-protein-coding RNAs that function at the post-transcriptional level to regulate gene expression. They have important roles in homeostatic processes such as cell proliferation and programmed cell death. In the injured rat spinal cord we performed an expression analysis of miRs and their downstream targets involved in apoptotic pathways and used post-injury cycling exercise to test for activity-dependent plasticity of miR expression. We show that SCI results in increased expression of miR Let-7a and miR16 while exercise leads to elevated levels of miR21 and decreased levels of miR15b. These changes in miR expression are correlated with changes in expression of their target genes: pro-apoptotic (decreased PTEN, PDCD4, and RAS mRNA) and anti-apoptotic (increased Bcl-2 mRNA) target genes. This is accompanied by a down-regulation of mRNA for caspase-7 and caspase-9 and reduced levels of caspase-7 protein. These results indicate possible beneficial effects of exercise through action on multiple miRs and their targets that contribute to the functional regulation of apoptosis after SCI.
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Long and short multifunicular projections of sacral neurons are activated by sensory input to produce locomotor activity in the absence of supraspinal control. J Neurosci 2010; 30:10324-36. [PMID: 20685976 DOI: 10.1523/jneurosci.1208-10.2010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Afferent input from load and joint receptors has been shown to reactivate the central pattern generators for locomotion (CPGs) in spinal cord injury patients and thereby improve their motor function and mobility. Elucidation of the pathways interposed between the afferents and CPGs is critical for the determination of the capacity of sensory input to activate the CPGs when the continuity of the white matter tracts is impaired following spinal cord injury. Using electrophysiological recordings, confocal imaging studies of spinal neurons and surgical manipulations of the white matter, we show that the capacity of sacrocaudal afferent (SCA) input to produce locomotor activity in isolated rat spinal cords depends not only on long ascending pathways, but also on recruitment of sacral proprioneurons interposed between the second order neurons and the hindlimb CPGs. We argue that large heterogeneous populations of second-order and proprioneurons whose crossed and uncrossed axons project rostrally through the ventral, ventrolateral/lateral and dorsolateral white matter funiculi contribute to the generation of the rhythm by the stimulated sacrocaudal input. The complex organization and multiple projection patterns of these populations enable the sacrocaudal afferent input to activate the CPGs even if the white matter pathways are severely damaged. Further studies are required to clarify the mechanisms involved in SCA-induced locomotor activity and assess its potential use for the rescue of lost motor functions after spinal cord injury.
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