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Duguay M, Bonizzato M, Delivet-Mongrain H, Fortier-Lebel N, Martinez M. Uncovering and leveraging the return of voluntary motor programs after paralysis using a bi-cortical neuroprosthesis. Prog Neurobiol 2023; 228:102492. [PMID: 37414352 DOI: 10.1016/j.pneurobio.2023.102492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
Rehabilitative and neuroprosthetic approaches after spinal cord injury (SCI) aim to reestablish voluntary control of movement. Promoting recovery requires a mechanistic understanding of the return of volition over action, but the relationship between re-emerging cortical commands and the return of locomotion is not well established. We introduced a neuroprosthesis delivering targeted bi-cortical stimulation in a clinically relevant contusive SCI model. In healthy and SCI cats, we controlled hindlimb locomotor output by tuning stimulation timing, duration, amplitude, and site. In intact cats, we unveiled a large repertoire of motor programs. After SCI, the evoked hindlimb lifts were highly stereotyped, yet effective in modulating gait and alleviating bilateral foot drag. Results suggest that the neural substrate underpinning motor recovery had traded-off selectivity for efficacy. Longitudinal tests revealed that the return of locomotion after SCI was correlated with recovery of the descending drive, which advocates for rehabilitation interventions directed at the cortical target.
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Affiliation(s)
- Maude Duguay
- Département de Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Québec, Canada; CIUSSS du Nord-de-l'Île-de-Montréal, Québec, Canada
| | - Marco Bonizzato
- Département de Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Québec, Canada; CIUSSS du Nord-de-l'Île-de-Montréal, Québec, Canada; Department of Electrical Engineering, Polytechnique Montréal, Québec, Canada
| | - Hugo Delivet-Mongrain
- Département de Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Québec, Canada
| | - Nicolas Fortier-Lebel
- Département de Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Québec, Canada
| | - Marina Martinez
- Département de Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Québec, Canada; CIUSSS du Nord-de-l'Île-de-Montréal, Québec, Canada.
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Hasse BA, Sheets DEG, Holly NL, Gothard KM, Fuglevand AJ. Restoration of complex movement in the paralyzed upper limb. J Neural Eng 2022; 19. [PMID: 35728568 DOI: 10.1088/1741-2552/ac7ad7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Functional electrical stimulation (FES) involves artificial activation of skeletal muscles to reinstate motor function in paralyzed individuals. While FES applied to the upper limb has improved the ability of tetraplegics to perform activities of daily living, there are key shortcomings impeding its widespread use. One major limitation is that the range of motor behaviors that can be generated is restricted to a small set of simple, preprogrammed movements. This limitation stems from the substantial difficulty in determining the patterns of stimulation across many muscles required to produce more complex movements. Therefore, the objective of this study was to use machine learning to flexibly identify patterns of muscle stimulation needed to evoke a wide array of multi-joint arm movements. APPROACH Arm kinematics and electromyographic activity from 29 muscles were recorded while a 'trainer' monkey made an extensive range of arm movements. Those data were used to train an artificial neural network that predicted patterns of muscle activity associated with a new set of movements. Those patterns were converted into trains of stimulus pulses that were delivered to upper limb muscles in two other temporarily paralyzed monkeys. RESULTS Machine-learning based prediction of EMG was good for within-subject predictions but appreciably poorer for across-subject predictions. Evoked responses matched the desired movements with good fidelity only in some cases. Means to mitigate errors associated with FES-evoked movements are discussed. SIGNIFICANCE Because the range of movements that can be produced with our approach is virtually unlimited, this system could greatly expand the repertoire of movements available to individuals with high level paralysis.
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Affiliation(s)
- Brady A Hasse
- Department of Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Avenue, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Drew E G Sheets
- Department of Organismal Biology & Anatomy, University of Chicago Biological Sciences Division, Anatomy, 1027 E 57th Street Chicago, IL 60637, Chicago, Illinois, 60637-5416, UNITED STATES
| | - Nicole L Holly
- Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Avenue, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Katalin M Gothard
- Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Ave, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Andrew J Fuglevand
- Department of Physiology, University of Arizona, Arizona Health Sciences Center, 1501 N. Campbell Ave, Tucson, Arizona, 85724-5051, UNITED STATES
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Spinal Locomotion in Cats Following Spinal Cord Injury: A Prospective Study. Animals (Basel) 2021; 11:ani11071994. [PMID: 34359122 PMCID: PMC8300158 DOI: 10.3390/ani11071994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 01/09/2023] Open
Abstract
Simple Summary Functional neurorehabilitation promotes neural reorganization by stimulating subjects without deep pain perception, leading to a faster recovery when compared to spontaneous recovery, and achieving fewer compensatory errors, or even deviations to neuropathic or adaptive pain pathways, such as spasticity. The present study demonstrates the importance of intensive and repetition-based functional neurorehabilitation, which is essential for subjects classified as grade 0 according to the modified Frankel scale. Abstract This article aimed to evaluate the safety and efficacy of intensive neurorehabilitation in paraplegic cats, with no deep pain perception (grade 0 on the modified Frankel scale), with more than three months of injury. Nine cats, admitted to the Arrábida Veterinary Hospital/Arrábida Animal Rehabilitation Center (CRAA), were subjected to a 12-week intensive functional neurorehabilitation protocol, based on ground and underwater treadmill locomotor training, electrostimulation, and kinesiotherapy exercises, aiming to obtain a faster recovery to ambulation and a modulated locomotor pattern of flexion/extension. Of the nine cats that were admitted in this study, 56% (n = 5) recovered from ambulation, 44% of which (4/9) did so through functional spinal locomotion by reflexes, while one achieved this through the recovery of deep pain perception. These results suggest that intensive neurorehabilitation can play an important role in ambulation recovery, allowing for a better quality of life and well-being, which may lead to a reduction in the number of euthanasia procedures performed on paraplegic animals.
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Bonizzato M. Neuroprosthetics: an outlook on active challenges toward clinical adoption. J Neurophysiol 2020; 125:105-109. [PMID: 33206578 DOI: 10.1152/jn.00496.2020] [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] [Indexed: 11/22/2022] Open
Abstract
Neural prostheses are designed to counter the effects of neurotrauma and restore the fundamental building blocks of human experience including motor action, sensation, and meaningful communication with other individuals. Here, we present an overview of active avenues, open questions, and debated topics in neuroprosthetics, such as targeting the mechanisms of sensorimotor recovery and designing brain interfaces for scalability. We review leading opinions in this thriving field, aiming to inform translational practice toward clinical adoption.
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Affiliation(s)
- Marco Bonizzato
- Department of Neurosciences and Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, Montreal, Quebec, Canada.,CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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Boakye M, Morehouse J, Ethridge J, Burke DA, Khattar NK, Kumar C, Manouchehri N, Streijger F, Reed R, Magnuson DS, Sherwood L, Kwon BK, Howland DR. Treadmill-Based Gait Kinematics in the Yucatan Mini Pig. J Neurotrauma 2020; 37:2277-2291. [PMID: 32605423 PMCID: PMC9836690 DOI: 10.1089/neu.2020.7050] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Yucatan miniature pigs (YMPs) are similar to humans in spinal cord size as well as physiological and neuroanatomical features, making them a useful model for human spinal cord injury. However, little is known regarding pig gait kinematics, especially on a treadmill. In this study, 12 healthy YMPs were assessed during bipedal and/or quadrupedal stepping on a treadmill at six speeds (1.0, 1.5, 2.0, 2.5, 3.0, and 3.5 km/h). Kinematic parameters, including limb coordination and proximal and distal limb angles, were measured. Findings indicate that YMPs use a lateral sequence footfall pattern across all speeds. Stride and stance durations decreased with increasing speed whereas swing duration showed no significant change. Across all speeds assessed, no significant differences were noted between hindlimb stepping parameters for bipedal or quadrupedal gait with the exception of distal limb angular kinematics. Specifically, significant differences were observed between locomotor tasks during maximum flexion (quadrupedal > bipedal), total excursion (bipedal > quadrupedal), and the phase relationship between the timing of maximum extension between the right and left hindlimbs (bipedal > quadrupedal). Speed also impacted maximum flexion and right-left phase relationships given that significant differences were found between the fastest speed (3.5 km/h) relative to each of the other speeds. This study establishes a methodology for bipedal and quadrupedal treadmill-based kinematic testing in healthy YMPs. The treadmill approach used was effective in recruiting primarily the spinal circuitry responsible for the basic stepping patterns as has been shown in cats. We recommend 2.5 km/h (0.7 m/sec) as a target walking gait for pre-clinical studies using YMPs, which is similar to that used in cats.
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Affiliation(s)
- Maxwell Boakye
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Johnny Morehouse
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Jay Ethridge
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Darlene A. Burke
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Nicolas K. Khattar
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Chitra Kumar
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Neda Manouchehri
- International Collaboration on Repair Discoveries, Department of Orthopedics, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries, Department of Orthopedics, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Robert Reed
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - David S.K. Magnuson
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Leslie Sherwood
- Research Resources Facilities, University of Louisville, Louisville, Kentucky, USA
| | - Brian K. Kwon
- International Collaboration on Repair Discoveries, Department of Orthopedics, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Vancouver Spine Surgery Institute, Department of Orthopedics, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Dena R. Howland
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
- Research Service, Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
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