1
|
Ivanenko Y, Shapkova EY, Petrova DA, Kleeva DF, Lebedev MA. Exoskeleton gait training with spinal cord neuromodulation. Front Hum Neurosci 2023; 17:1194702. [PMID: 37250689 PMCID: PMC10213721 DOI: 10.3389/fnhum.2023.1194702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Neuromodulating the locomotor network through spinal cord electrical stimulation (SCES) is effective for restoring function in individuals with gait deficits. However, SCES alone has limited effectiveness without concurrent locomotor function training that enhances activity-dependent plasticity of spinal neuronal networks by sensory feedback. This mini review discusses recent developments in using combined interventions, such as SCES added to exoskeleton gait training (EGT). To develop personalized therapies, it is crucial to assess the state of spinal circuitry through a physiologically relevant approach that identifies individual characteristics of spinal cord function to develop person-specific SCES and EGT. The existing literature suggests that combining SCES and EGT to activate the locomotor network can have a synergistic rehabilitative effect on restoring walking abilities, somatic sensation, and cardiovascular and bladder function in paralyzed individuals.
Collapse
Affiliation(s)
| | - Elena Y. Shapkova
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Saint Petersburg, Russia
- Institute of Translational Biomedicine, St. Petersburg State University, Saint Petersburg, Russia
| | - Daria A. Petrova
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Daria F. Kleeva
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Mikhail A. Lebedev
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow, Russia
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg, Russia
| |
Collapse
|
2
|
Bandres MF, Gomes JL, Moreno Romero GN, Twyman AR, McPherson JG. Precision neuromodulation: Promises and challenges of spinal stimulation for multi-modal rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1135593. [PMID: 37152244 PMCID: PMC10154513 DOI: 10.3389/fresc.2023.1135593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/24/2023] [Indexed: 05/09/2023]
Abstract
Spinal cord injury results in multiple, simultaneous sensorimotor deficits. These include, but are not limited to, full or partial paralysis of muscles below the lesion, muscle spasms, spasticity, and neuropathic pain. Bowel, bladder, and sexual dysfunction are also prevalent. Yet, the majority of emerging spinal stimulation-based therapies focus on a single issue: locomotor rehabilitation. Despite the enormous potential of these translational advances to transform the lives of people living with spinal cord injury, meaningful recovery in other domains deemed critical priorities remains lacking. Here, we highlight the importance of considering the diverse patterns of neural transmission that underlie clinically similar presentations when developing spinal stimulation-based therapies. We also motivate advancement of multi-modal rehabilitation paradigms, which leverage the dense interconnectivity of sensorimotor spinal networks and the unique ability of electrical stimulation to modulate these networks to facilitate and guide simultaneous rehabilitation across domains.
Collapse
Affiliation(s)
- Maria F. Bandres
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Jefferson L. Gomes
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Gerson N. Moreno Romero
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Avery R. Twyman
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Jacob Graves McPherson
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Washington University Pain Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Washington University Program in Neurosciences, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
3
|
Edgerton VR, Gad P. Spinal automaticity of movement control and its role in recovering function after spinal injury. Expert Rev Neurother 2022; 22:655-667. [PMID: 36043398 DOI: 10.1080/14737175.2022.2115359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The significance of the spinal circuitry in controlling postural and locomotor functions largely re-emerged in the mid-1970s under the leadership of Sten Grillner, demonstrating key phenomena of "central pattern generation" and "fictive locomotion" with an evolutionary perspective. These concepts raised the question of how much function can be recovered after paralysis, given the intrinsic automaticity of spinal networks in injured and uninjured states in adults. AREAS COVERED This review explores biological mechanisms governing spinal control of movements such as posture and locomotion. We focus on concepts that have evolved from experiments performed over the past decade. Rather than a comprehensive review of the vast literature on the neural control of posture and locomotion, we focus on the various mechanisms underlying functional automaticity, and their clinical relevance. EXPERT OPINION We propose that multiple combinations of sensory mechanoreceptors linked to proprioception generate an infinite number of different sensory ensembles, having species-specific meaning and extensive influence in controlling posture and locomotion. These sensory ensembles are translated as a probabilistic phenomenon into highly specific but indeterminate actions. Therefore, we opine that spinal translation of these ensembles in real-time plays a central role in the automaticity of motor control in individuals with and without severe neuromotor dysfunction.
Collapse
Affiliation(s)
- V Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, CA 90095 USA.,Department of Neurosurgery, University of California, Los Angeles, CA 90095 USA.,Brain Research Institute, University of California, Los Angeles, CA 90095 USA.,Institut Guttmann. Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, 08916 Badalona, Spain
| | - Parag Gad
- Department of Neurobiology, University of California, Los Angeles, CA 90095 USA
| |
Collapse
|
4
|
Stochastic spinal neuromodulation tunes the intrinsic logic of spinal neural networks. Exp Neurol 2022; 355:114138. [DOI: 10.1016/j.expneurol.2022.114138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022]
|
5
|
Solopova IA, Selionov VA, Blinov EO, Dolinskaya IY, Zhvansky DS, Lacquaniti F, Ivanenko Y. Higher Responsiveness of Pattern Generation Circuitry to Sensory Stimulation in Healthy Humans Is Associated with a Larger Hoffmann Reflex. BIOLOGY 2022; 11:biology11050707. [PMID: 35625435 PMCID: PMC9138260 DOI: 10.3390/biology11050707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Abstract
Simple Summary Individual differences in the sensorimotor circuitry play an important role for understanding the nature of behavioral variability and developing personalized therapies. While the spinal network likely requires relatively rigid organization, it becomes increasingly evident that adaptability and inter-individual variability in the functioning of the neuronal circuitry is present not only in the brain but also in the spinal cord. In this study we investigated the relationship between the excitability of pattern generation circuitry and segmental reflexes in healthy humans. We found that the high individual responsiveness of pattern generation circuitries to tonic sensory input in both the upper and lower limbs was related to larger H-reflexes. The results provide further evidence for the importance of physiologically relevant assessments of spinal cord neuromodulation and the individual physiological state of reflex pathways. Abstract The state and excitability of pattern generators are attracting the increasing interest of neurophysiologists and clinicians for understanding the mechanisms of the rhythmogenesis and neuromodulation of the human spinal cord. It has been previously shown that tonic sensory stimulation can elicit non-voluntary stepping-like movements in non-injured subjects when their limbs were placed in a gravity-neutral unloading apparatus. However, large individual differences in responsiveness to such stimuli were observed, so that the effects of sensory neuromodulation manifest only in some of the subjects. Given that spinal reflexes are an integral part of the neuronal circuitry, here we investigated the extent to which spinal pattern generation excitability in response to the vibrostimulation of muscle proprioceptors can be related to the H-reflex magnitude, in both the lower and upper limbs. For the H-reflex measurements, three conditions were used: stationary limbs, voluntary limb movement and passive limb movement. The results showed that the H-reflex was considerably higher in the group of participants who demonstrated non-voluntary rhythmic responses than it was in the participants who did not demonstrate them. Our findings are consistent with the idea that spinal reflex measurements play important roles in assessing the rhythmogenesis of the spinal cord.
Collapse
Affiliation(s)
- Irina A. Solopova
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Russian Academy of Sciences, 127951 Moscow, Russia; (I.A.S.); (V.A.S.); (I.Y.D.); (D.S.Z.)
| | - Victor A. Selionov
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Russian Academy of Sciences, 127951 Moscow, Russia; (I.A.S.); (V.A.S.); (I.Y.D.); (D.S.Z.)
| | - Egor O. Blinov
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, 141701 Dolgoprudny, Russia;
| | - Irina Y. Dolinskaya
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Russian Academy of Sciences, 127951 Moscow, Russia; (I.A.S.); (V.A.S.); (I.Y.D.); (D.S.Z.)
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, 141701 Dolgoprudny, Russia;
| | - Dmitry S. Zhvansky
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Russian Academy of Sciences, 127951 Moscow, Russia; (I.A.S.); (V.A.S.); (I.Y.D.); (D.S.Z.)
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy;
- Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy;
- Correspondence:
| |
Collapse
|
6
|
Falgairolle M, O'Donovan MJ. Motoneuronal Regulation of Central Pattern Generator and Network Function. ADVANCES IN NEUROBIOLOGY 2022; 28:259-280. [PMID: 36066829 DOI: 10.1007/978-3-031-07167-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter reviews recent work showing that vertebrate motoneurons can trigger spontaneous rhythmic activity in the developing spinal cord and can modulate the function of several different central pattern generators later in development. In both the embryonic chick and the fetal mouse spinal cords, antidromic activation of motoneurons can trigger bouts of rhythmic activity. In the neonatal mouse, optogenetic manipulation of motoneuron firing can modulate the frequency of fictive locomotion activated by a drug cocktail. In adult animals, motoneurons have been shown to regulate swimming in the zebrafish, and vocalization in fish and frogs. We discuss the significance of these findings and the degree to which motoneurons may be considered a part of these central pattern generators.
Collapse
|
7
|
Optogenetic Activation of V1 Interneurons Reveals the Multimodality of Spinal Locomotor Networks in the Neonatal Mouse. J Neurosci 2021; 41:8545-8561. [PMID: 34446573 DOI: 10.1523/jneurosci.0875-21.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/16/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
In the spinal cord, classes of interneurons have been studied in vitro to determine their role in producing or regulating locomotion. It is unclear whether all locomotor behaviors are produced by the same circuitry or engage different subsets of neurons. Here, in neonatal mice of either sex, we test this idea by comparing the actions of a class of spinal, inhibitory interneuron (V1) expressing channelrhodopsin driven by the engrailed-1 transcription factor on the rhythms elicited by different methods. We find that, although the overall locomotor activities in vitro are similar, V1 interneuron depolarization produces opposite effects depending of the mode of activation of the locomotor circuitry. The differential behavior of V1 neurons suggests that their function depends on how the locomotor rhythm is activated and is consistent with the idea that the functional organization of the corresponding locomotor networks also differs.SIGNIFICANCE STATEMENT The neural networks dictating the execution of fictive locomotion are located in the spinal cord. It is generally assumed that the mode of activation of these spinal networks should not change the recruitment or function of neurons. Here, we manipulated the activity of a class of interneuron (V1), which targets these networks and found that their activation induces opposite effects depending on the mode of activation. This suggests that the mode of activation of the spinal networks differentially recruits either V1 interneurons or other interneurons, or both.
Collapse
|
8
|
Feldman AG, Levin MF, Garofolini A, Piscitelli D, Zhang L. Central pattern generator and human locomotion in the context of referent control of motor actions. Clin Neurophysiol 2021; 132:2870-2889. [PMID: 34628342 DOI: 10.1016/j.clinph.2021.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/13/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
Unperturbed human locomotion presumably results from feedforward shifts in stable body equilibrium in the environment, thus avoiding falling and subsequent catching considered in alternative theories of locomotion. Such shifts are achieved by relocation of the referent body configuration at which multiple muscle recruitment begins. Rather than being directly specified by a central pattern generator, multiple muscles are activated depending on the extent to which the body is deflected from the referent, threshold body configuration, as confirmed in previous studies. Based on the referent control theory of action and perception, solutions to classical problems in motor control are offered, including the previously unresolved problem of the integration of central and reflex influences on motoneurons and the problem of how posture and movement are related. The speed of locomotion depends on the rate of shifts in the referent body configuration. The transition from walking to running results from increasing the rate of referent shifts. It is emphasised that there is a certain hierarchy between reciprocal and co-activation of agonist and antagonist muscles during locomotion and other motor actions, which is also essential for the understanding of how locomotor speed is regulated. The analysis opens a new avenue in neurophysiological approaches to human locomotion with clinical implications.
Collapse
Affiliation(s)
- Anatol G Feldman
- Department of Neuroscience, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada.
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
| | - Alessandro Garofolini
- Institute for Health and Sport (IHES), Victoria University, PO Box 14428, Melbourne, VIC 8001, Australia
| | - Daniele Piscitelli
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada
| | - Lei Zhang
- Institut für Neuroinformatik, Ruhr-Universität Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| |
Collapse
|
9
|
Lindén H, Berg RW. Why Firing Rate Distributions Are Important for Understanding Spinal Central Pattern Generators. Front Hum Neurosci 2021; 15:719388. [PMID: 34539363 PMCID: PMC8446347 DOI: 10.3389/fnhum.2021.719388] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 06/02/2021] [Indexed: 01/16/2023] Open
Abstract
Networks in the spinal cord, which are responsible for the generation of rhythmic movements, commonly known as central pattern generators (CPGs), have remained elusive for decades. Although it is well-known that many spinal neurons are rhythmically active, little attention has been given to the distribution of firing rates across the population. Here, we argue that firing rate distributions can provide an important clue to the organization of the CPGs. The data that can be gleaned from the sparse literature indicate a firing rate distribution, which is skewed toward zero with a long tail, akin to a normal distribution on a log-scale, i.e., a “log-normal” distribution. Importantly, such a shape is difficult to unite with the widespread assumption of modules composed of recurrently connected excitatory neurons. Spinal modules with recurrent excitation has the propensity to quickly escalate their firing rate and reach the maximum, hence equalizing the spiking activity across the population. The population distribution of firing rates hence would consist of a narrow peak near the maximum. This is incompatible with experiments, that show wide distributions and a peak close to zero. A way to resolve this puzzle is to include recurrent inhibition internally in each CPG modules. Hence, we investigate the impact of recurrent inhibition in a model and find that the firing rate distributions are closer to the experimentally observed. We therefore propose that recurrent inhibition is a crucial element in motor circuits, and suggest that future models of motor circuits should include recurrent inhibition as a mandatory element.
Collapse
Affiliation(s)
- Henrik Lindén
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rune W Berg
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
10
|
Latash ML. One more time about motor (and non-motor) synergies. Exp Brain Res 2021; 239:2951-2967. [PMID: 34383080 DOI: 10.1007/s00221-021-06188-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
We revisit the concept of synergy based on the recently translated classical book by Nikolai Bernstein (On the construction of movements, Medgiz, Moscow 1947; Latash, Bernstein's Construction of Movements, Routledge, Abingdon 2020b) and progress in understanding the physics and neurophysiology of biological action. Two aspects of synergies are described: organizing elements into stable groups (modes) and ensuring dynamical stability of salient performance variables. The ability of the central nervous system to attenuate synergies in preparation for a quick action-anticipatory synergy adjustments-is emphasized. Recent studies have demonstrated synergies at the level of hypothetical control variables associated with spatial referent coordinates for effectors. Overall, the concept of synergies fits naturally the hierarchical scheme of control with referent coordinates with an important role played by back-coupling loops within the central nervous system and from peripheral sensory endings. Further, we review studies showing non-trivial changes in synergies with development, aging, fatigue, practice, and a variety of neurological disorders. Two aspects of impaired synergic control-impaired stability and impaired agility-are introduced. The recent generalization of the concept of synergies for non-motor domains, including perception, is discussed. We end the review with a list of unresolved and troubling issues.
Collapse
Affiliation(s)
- Mark L Latash
- Department of Kinesiology, Rec.Hall-268N, The Pennsylvania State University, University Park, PA, 16802, USA.
| |
Collapse
|
11
|
Abstract
Even for a stereotyped task, sensorimotor behavior is generally variable due to noise, redundancy, adaptability, learning or plasticity. The sources and significance of different kinds of behavioral variability have attracted considerable attention in recent years. However, the idea that part of this variability depends on unique individual strategies has been explored to a lesser extent. In particular, the notion of style recurs infrequently in the literature on sensorimotor behavior. In general use, style refers to a distinctive manner or custom of behaving oneself or of doing something, especially one that is typical of a person, group of people, place, context, or period. The application of the term to the domain of perceptual and motor phenomenology opens new perspectives on the nature of behavioral variability, perspectives that are complementary to those typically considered in the studies of sensorimotor variability. In particular, the concept of style may help toward the development of personalised physiology and medicine by providing markers of individual behaviour and response to different stimuli or treatments. Here, we cover some potential applications of the concept of perceptual-motor style to different areas of neuroscience, both in the healthy and the diseased. We prefer to be as general as possible in the types of applications we consider, even at the expense of running the risk of encompassing loosely related studies, given the relative novelty of the introduction of the term perceptual-motor style in neurosciences.
Collapse
Affiliation(s)
- Pierre-Paul Vidal
- CNRS, SSA, ENS Paris Saclay, Université de Paris, Centre Borelli, 75005 Paris, France
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China
| | - Francesco Lacquaniti
- Department of Systems Medicine, Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory of Neuromotor Physiology, Santa Lucia Foundation IRCCS, 00179 Rome, Italy
| |
Collapse
|