Spinal cord injuries (SCI) are disruptive neurological events that severly affect the body leading to the interruption of sensorimotor and autonomic pathways. Recent research highlighted SCI-related alterations extend beyond than the expected network, involving most of the central nervous system and goes far beyond primary sensorimotor cortices. The present perspective offers an alternative, useful way to interpret conflicting findings by focusing on the deafferented and deefferented body as the central object of interest. After an introduction to the main processes involved in reorganization according to SCI, we will focus separately on the body regions of the head, upper limbs, and lower limbs in complete, incomplete, and deafferent SCI participants. On one hand, the imprinting of the body’s spatial organization is entrenched in the brain such that its representation likely lasts for the entire lifetime of patients, independent of the severity of the SCI. However, neural activity is extremely adaptable, even over short time scales, and is modulated by changing conditions or different compensative strategies. Therefore, a better understanding of both aspects is an invaluable clinical resource for rehabilitation and the successful use of modern robotic technologies.

Neuropathic pain (NP) is a chronic, debilitating, and resistant form of pain. The onset rate of NP following spinal cord injuries (SCI) is high and may reduce the quality of life more than the sensorimotor loss itself. The long-term ineffectiveness of current treatments in managing symptoms and counteracting maladaptive plasticity highlights the need to find alternative therapeutic approaches. Virtual reality (VR) is possibly the best way to administer the specific illusory or reality-like experience and promote behavioral responses that may be effective in mitigating the effects of long-established NP. This approach aims to promote a more systematic adoption of VR-related techniques in pain research and management procedures, highlighting the encouraging preliminary results in SCI. We suggest that the multisensory modulation of the sense of agency and ownership by residual body signals may produce positive responses in cases of brain-body disconnection. First, we focus on the transversal role embodiment and how multisensory and environmental or artificial stimuli modulate illusory sensations of bodily presence and ownership. Then, we present a brief overview of the use of VR in healthcare and pain management. Finally, we discus research experiences which used VR in patients with SCI to treating NP, including the most recent combinations of VR with further stimulation techniques.

Objective We investigated how the ability to control whether or not to inhibit an action is affected by the response preparation. Background The ability to control actions is a central skill to properly behave in complex environments. Increased levels of response preparation are associated with reduced response times, but how they directly affect the ability to control actions is not well explored. We investigated how the response preparation affects the ability to control the generation of actions in the context of a stop selective task. Method Participants performed a visuo-motor stop selective task. Results We found that an increased level of response preparation reduced the ability to control actions. In the condition with high preparation, we observed shorter response times and increased probability of wrong responses to a request to stop, compared to a condition with a lower level of preparation. Conclusion We demonstrated that high response preparation hinders action control. Application Understanding the cognitive factors that affect the ability to properly control actions is crucial to develop devices that can be exploited in different contexts such as the aviation, industrial, and military. We demonstrated that subjects’ response preparation is a key factor influencing their ability to flexibly control their reaction to different stimuli. This study offers a suitable paradigm that can be used to investigate which system features in a controlled task promote an optimal balance between response speed and error rate.

Neuropathic pain (NP) is a common chronic condition that severely affects patients with spinal cord injuries (SCI). It impairs the overall quality of life and is considered difficult to treat. Currently, clinical management of NP is often limited to drug therapy, primarily with opioid analgesics that have limited therapeutic efficacy. The persistence and intractability of NP following SCI and the potential health risks associated with opioids necessitate improved treatment approaches. Nanomedicine has gained increasing attention in recent years for its potential to improve therapeutic efficacy while minimizing toxicity by providing sensitive and targeted treatments that overcome the limitations of conventional pain medications. The current perspective begins with a brief discussion of the pathophysiological mechanisms underlying NP and the current pain treatment for SCI. We discuss the most frequently used nanomaterials in pain diagnosis and treatment as well as recent and ongoing efforts to effectively treat pain by proactively mediating pain signals following SCI. Although nanomedicine is a rapidly growing field, its application to NP in SCI is still limited. Therefore, additional work is required to improve the current treatment of NP following SCI.

Goal-oriented actions often require the coordinated movement of two or more effectors. Sometimes multi-effector movements need to be adjusted according to a continuously changing environment, requiring stopping an effector without interrupting the movement of the others. This form of control has been investigated by the selective Stop Signal Task (SST), requiring the inhibition of an effector of a multicomponent action. This form of selective inhibition has been hypothesized to act through a two-step process, where a temporary global inhibition deactivating all the ongoing motor responses is followed by a restarting process that reactivates only the moving effector. When this form of inhibition takes place, the reaction time (RT) of the moving effector pays the cost of the previous global inhibition. However, it is poorly investigated if and how this cost delays the RT of the effector that was required to be stopped but was erroneously moved (Stop Error trials). Here we measure the Stop Error RT in a group of participants instructed to simultaneously rotate the wrist and lift the foot when a Go Signal occurred, and interrupt both movements (non-selective Stop version) or only one of them (selective Stop version) when a Stop Signal was presented. We presented this task in two experimental conditions to evaluate how different contexts can influence a possible proactive inhibition on the RT of the moving effector in the selective Stop versions. In one context, we provided the foreknowledge of the effector to be inhibited by presenting the same selective or non-selective Stop versions in the same block of trials. In a different context, while providing no foreknowledge of the effector(s) to be stopped, the selective and non-selective Stop versions were intermingled, and the information on the effector to be stopped was delivered at the time of the Stop Signal presentation. We detected a cost in both Correct and Error selective Stop RTs that was influenced by the different task conditions. Results are discussed within the framework of the race model related to the SST, and its relationship with a restart model developed for selective versions of this paradigm.

Interaction with the environment requires us to predict the potential reward that will follow our choices. Rewards could change depending on the context and our behavior adapts accordingly. Previous studies have shown that, depending on reward regimes, actions can be facilitated (i.e., increasing the reward for response) or interfered (i.e., increasing the reward for suppression). Here we studied how the change in reward perspective can influence subjects’ adaptation strategy. Students were asked to perform a modified version of the Stop-Signal task. Specifically, at the beginning of each trial, a Cue Signal informed subjects of the value of the reward they would receive; in one condition, Go Trials were rewarded more than Stop Trials, in another, Stop Trials were rewarded more than Go Trials, and in the last, both trials were rewarded equally. Subjects participated in a virtual competition, and the reward consisted of points to be earned to climb the leaderboard and win (as in a video game contest). The sum of points earned was updated with each trial. After a learning phase in which the three conditions were presented separately, each subject performed 600 trials testing phase in which the three conditions were randomly mixed. Based on the previous studies, we hypothesized that subjects could employ different strategies to perform the task, including modulating inhibition efficiency, adjusting response speed, or employing a constant behavior across contexts. We found that to perform the task, subjects preferentially employed a strategy-related speed of response adjustment, while the duration of the inhibition process did not change significantly across the conditions. The investigation of strategic motor adjustments to reward’s prospect is relevant not only to understanding how action control is typically regulated, but also to work on various groups of patients who exhibit cognitive control deficits, suggesting that the ability to inhibit can be modulated by employing reward prospects as motivational factors.