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Bjørndal JR, Beck MM, Jespersen L, Christiansen L, Lundbye-Jensen J. Hebbian priming of human motor learning. Nat Commun 2024; 15:5126. [PMID: 38879614 PMCID: PMC11180091 DOI: 10.1038/s41467-024-49478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/03/2024] [Indexed: 06/19/2024] Open
Abstract
Motor learning relies on experience-dependent plasticity in relevant neural circuits. In four experiments, we provide initial evidence and a double-blinded, sham-controlled replication (Experiment I-II) demonstrating that motor learning involving ballistic index finger movements is improved by preceding paired corticospinal-motoneuronal stimulation (PCMS), a human model for exogenous induction of spike-timing-dependent plasticity. Behavioral effects of PCMS targeting corticomotoneuronal (CM) synapses are order- and timing-specific and partially bidirectional (Experiment III). PCMS with a 2 ms inter-arrival interval at CM-synapses enhances learning and increases corticospinal excitability compared to control protocols. Unpaired stimulations did not increase corticospinal excitability (Experiment IV). Our findings demonstrate that non-invasively induced plasticity interacts positively with experience-dependent plasticity to promote motor learning. The effects of PCMS on motor learning approximate Hebbian learning rules, while the effects on corticospinal excitability demonstrate timing-specificity but not bidirectionality. These findings offer a mechanistic rationale to enhance motor practice effects by priming sensorimotor training with individualized PCMS.
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Affiliation(s)
- Jonas Rud Bjørndal
- Movement & Neuroscience, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Nørre Allé 51, Copenhagen N, Denmark.
| | - Mikkel Malling Beck
- Movement & Neuroscience, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Nørre Allé 51, Copenhagen N, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Allé 30, Hvidovre, Denmark
| | - Lasse Jespersen
- Movement & Neuroscience, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Nørre Allé 51, Copenhagen N, Denmark
| | - Lasse Christiansen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Allé 30, Hvidovre, Denmark
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, Denmark
| | - Jesper Lundbye-Jensen
- Movement & Neuroscience, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Nørre Allé 51, Copenhagen N, Denmark.
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Martino Cinnera A, Bonanno M, Calabrò RS, Bisirri A, D'Arienzo M, D'Acunto A, Ciancarelli I, Morone G, Koch G. Paired associative stimulation to enhance motor outcome in spinal cord injury: a systematic review of first evidence. Expert Rev Med Devices 2024:1-12. [PMID: 38768088 DOI: 10.1080/17434440.2024.2358048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Spinal cord injuries (SCI) often result in motor impairment and lifelong disability. METHODS This systematic review, conducted in agreement with PRISMA guidelines, aimed to evaluate the effects of cortico-spinal paired associative stimulation (PAS) on motor outcomes in individuals with SCI. PubMed, Scopus/EMBASE, Pedro, and Cochrane databases were consulted from inception to 2023/01/12. RESULTS In 1021 articles, 10 studies involving 84 patients meet the inclusion criteria, 7 case series/study, and 3 clinical trials. Despite light differences, the included studies performed a cortico-peripheral PAS using a single transcranial magnetic stimulation and high frequency electrical peripheral nerve stimulation for a consistent number of sessions (>20). All included studies reported improvement in motor outcomes recorded via clinical and/or neurophysiological assessment. CONCLUSION Available evidence showed an increase in motor outcomes after PAS stimulation. Indeed, both clinical and neurophysiological outcomes suggest the effectiveness of a high number of PAS sessions in chronic individuals with SCI. Due to a limited number of studies and an unsatisfactory study design, well-designed RCTs are needed to confirm the potentiality of these approaches and clarify the adequate dose-response of PAS in the SCI population. REGISTRATION ID The protocol was registered on the PROSPERO database (CRD42023485703).
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Affiliation(s)
- Alex Martino Cinnera
- Scientific Institute for Research, Hospitalisation and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | | | | | | | - Martina D'Arienzo
- Scientific Institute for Research, Hospitalisation and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Alessia D'Acunto
- Department of Neurosciences, Paediatric neurology, University of Rome Tor Vergata, Rome, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Urbin MA, Lafe CW, Bautista ME, Wittenberg GF, Simpson TW. Effects of noninvasive neuromodulation targeting the spinal cord on early learning of force control by the digits. CNS Neurosci Ther 2024; 30:e14561. [PMID: 38421127 PMCID: PMC10851178 DOI: 10.1111/cns.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS Control of finger forces underlies our capacity for skilled hand movements acquired during development and reacquired after neurological injury. Learning force control by the digits, therefore, predicates our functional independence. Noninvasive neuromodulation targeting synapses that link corticospinal neurons onto the final common pathway via spike-timing-dependent mechanisms can alter distal limb motor output on a transient basis, yet these effects appear subject to individual differences. Here, we investigated how this form of noninvasive neuromodulation interacts with task repetition to influence early learning of force control during precision grip. METHODS The unique effects of neuromodulation, task repetition, and neuromodulation coinciding with task repetition were tested in three separate conditions using a within-subject, cross-over design (n = 23). RESULTS We found that synchronizing depolarization events within milliseconds of stabilizing precision grip accelerated learning but only after accounting for individual differences through inclusion of subjects who showed upregulated corticospinal excitability at 2 of 3 time points following conditioning stimulation (n = 19). CONCLUSIONS Our findings provide insights into how the state of the corticospinal system can be leveraged to drive early motor skill learning, further emphasizing individual differences in the response to noninvasive neuromodulation. We interpret these findings in the context of biological mechanisms underlying the observed effects and implications for emerging therapeutic applications.
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Affiliation(s)
- Michael A. Urbin
- Human Engineering Research Laboratories, VA RR&D Center of ExcellenceVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Charley W. Lafe
- Human Engineering Research Laboratories, VA RR&D Center of ExcellenceVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Manuel E. Bautista
- Human Engineering Research Laboratories, VA RR&D Center of ExcellenceVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - George F. Wittenberg
- Human Engineering Research Laboratories, VA RR&D Center of ExcellenceVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Rehabilitation Neural Engineering Laboratories, Department of Physical Medicine & RehabilitationUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Tyler W. Simpson
- Rehabilitation Neural Engineering Laboratories, Department of Physical Medicine & RehabilitationUniversity of PittsburghPittsburghPennsylvaniaUSA
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Martinez M. A bi-cortical neuroprosthesis to modulate locomotion after incomplete spinal cord injury. Sci Prog 2023; 106:368504231212788. [PMID: 38189274 PMCID: PMC10775731 DOI: 10.1177/00368504231212788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Neuroprosthetic strategies seek to immediately alleviate deficits and reinstate voluntary control of movement. To facilitate recovery, it is crucial to gain a comprehensive understanding of the mechanisms involved in the return of intentional movement. Nevertheless, the precise relationship between the resurgence of cortical commands and the recovery of locomotion remains somewhat elusive. In the study conducted by Duguay, Bonizzato, Delivet-Mongrain, Fortier-Lebel and Martinez, we introduced a neuroprosthesis designed to deliver precise bi-cortical stimulation in a clinically relevant contusive spinal cord injury model. We conducted experiments in both healthy and spinal cord injured cats, where we fine-tuned the timing, duration, amplitude, and site of stimulation to modulate hindlimb locomotor output. In healthy cats, we observed a wide range of motor programs. However, after spinal cord injury, the induced hindlimb movements became highly stereotyped but were effective in modulating gait and reducing bilateral foot dragging. These results suggest that the neural basis for motor recovery traded off selectivity for effectiveness. Through a series of longitudinal assessments, we found that the restoration of locomotion following spinal cord injury was closely linked to the recovery of the descending neural drive. This underscores the importance of directing rehabilitation interventions toward the cortical target. The study results are discussed in terms of their impact and limitations.
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Affiliation(s)
- Marina Martinez
- Marina Martinez, Département de neurosciences, Faculté de médecine, Université de Montréal, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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Jo HJ, Kizziar E, Sangari S, Chen D, Kessler A, Kim K, Anschel A, Heinemann AW, Mensh BD, Awadalla S, Lieber RL, Oudega M, Perez MA. Multisite Hebbian Plasticity Restores Function in Humans with Spinal Cord Injury. Ann Neurol 2023; 93:1198-1213. [PMID: 36843340 PMCID: PMC10268028 DOI: 10.1002/ana.26622] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/29/2022] [Accepted: 02/06/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Spinal cord injury (SCI) damages synaptic connections between corticospinal axons and motoneurons of many muscles, resulting in devastating paralysis. We hypothesized that strengthening corticospinal-motoneuronal synapses at multiple spinal cord levels through Hebbian plasticity (i.e., "neurons that fire together, wire together") promotes recovery of leg and arm function. METHODS Twenty participants with chronic SCI were randomly assigned to receive 20 sessions of Hebbian or sham stimulation targeting corticospinal-motoneuronal synapses of multiple leg muscles followed by exercise. Based on the results from this study, in a follow-up prospective study, 11 more participants received 40 sessions of Hebbian stimulation targeting corticospinal-motoneuronal synapses of multiple arm and leg muscles followed by exercise. During Hebbian stimulation sessions, 180 paired pulses elicited corticospinal action potentials by magnetic (motor cortex) and/or electrical (thoracic spine) stimulation allowing volleys to arrive at the spinal cord 1-2 milliseconds before motoneurons were activated retrogradely via bilateral electrical stimulation (brachial plexus, ulnar, femoral, and common peroneal nerves) for biceps brachii, first dorsal interosseous, quadriceps femoris, and tibialis anterior muscles as needed. RESULTS We found in our randomized study that participants receiving Hebbian stimulation improved their walking speed and corticospinal function to a greater extent than individuals receiving sham stimulation. In agreement, prospective study participants improved their grasping and walking, corticospinal function, and quality of life metrics, exhibiting greater improvements with more sessions that persisted 9-month post-therapy. INTERPRETATION Our findings suggest that multisite Hebbian stimulation, informed by the physiology of the corticospinal system, represents an effective strategy to promote functional recovery following SCI. ANN NEUROL 2023;93:1198-1213.
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Affiliation(s)
- Hang Jin Jo
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Ethan Kizziar
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA
| | - Sina Sangari
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - David Chen
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Allison Kessler
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Ki Kim
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Alan Anschel
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Allen W. Heinemann
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
| | - Brett D. Mensh
- Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, Virginia, USA
| | - Saria Awadalla
- Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, USA
| | - Richard L. Lieber
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA
- Edward Jr. Hines VA Hospital, Chicago, USA
| | - Martin Oudega
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA
- Edward Jr. Hines VA Hospital, Chicago, USA
| | - Monica A. Perez
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA
- Edward Jr. Hines VA Hospital, Chicago, USA
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