Reply: No dawn yet of a new age in spinal cord rehabilitation

Angeli, Cláudia A.; Edgerton, V. Reggie; Gerasimenko, Yury; Harkema, Susan J.

doi:10.1093/brain/awu376

Cited by 9 publications

(9 citation statements)

References 2 publications

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“…Simulations (Capogrosso et al, 2013;Rattay et al, 2000) and experimental studies (Gerasimenko et al, 2006;Hofstoetter et al, 2015) have provided evidence that EES primarily engages large-diameter afferent fibers. The prevailing view is that the recruitment of these afferents activates central-pattern generating networks (Angeli et al, 2014;Danner et al, 2015) and raises the excitability of spinal circuits to a level that enables sensory information to become a source of motor control (Edgerton et al, 2008). Despite the wide acceptance of this interpretation, the principles from which the recruitment of afferents fibers Rats with complete SCI were tested in two challenging tasks under non-controlled versus controlled conditions.…”

Section: Mechanisms Underlying Motor Pattern Formation During Eesmentioning

confidence: 99%

“…Albeit intact, denervated lumbar circuits remain in a state that is not permissive for standing and walking. Electrical epidural stimulation (EES) of lumbar segments provides a strategy to reactivate these circuits (Angeli et al, 2014;Carhart et al, 2004;Hofstoetter et al, 2015). For example, individuals with a chronic, functionally complete SCI immediately regained the ability to stand and produce voluntary movements during continuous EES of lumbar segments (Angeli et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Computer simulations (Capogrosso et al, 2013;Rattay et al, 2000) and experimental studies (Gerasimenko et al, 2006;Hofstoetter et al, 2015) provided evidence that EES primarily engages large myelinated fibers associated with proprioceptive and cutaneous feedback circuits. The prevailing view is that the recruitment of these fibers raises the excitability of spinal circuits and modulates central pattern generator networks (Angeli et al, 2014;Danner et al, 2015). This conceptual framework has restricted the clinical application of EES to continuous, non-modulated stimulation patterns (Angeli et al, 2014;Carhart et al, 2004;Hofstoetter et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…The prevailing view is that the recruitment of these fibers raises the excitability of spinal circuits and modulates central pattern generator networks (Angeli et al, 2014;Danner et al, 2015). This conceptual framework has restricted the clinical application of EES to continuous, non-modulated stimulation patterns (Angeli et al, 2014;Carhart et al, 2004;Hofstoetter et al, 2015). However, this strategy fails to address subject-specific deficits of gait and balance throughout movement execution, which is essential to maximize the outcome of rehabilitation protocols (Barbeau et al, 1999;Edgerton et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms Underlying the Neuromodulation of Spinal Circuits for Correcting Gait and Balance Deficits after Spinal Cord Injury

Moraud

Capogrosso

Formento

et al. 2016

Neuron

165

183

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Epidural electrical stimulation of lumbar segments facilitates standing and walking in animal models and humans with spinal cord injury. However, the mechanisms through which this neuromodulation therapy engages spinal circuits remain enigmatic. Using computer simulations and behavioral experiments, we provide evidence that epidural electrical stimulation interacts with muscle spindle feedback circuits to modulate muscle activity during locomotion. Hypothesis-driven strategies emerging from simulations steered the design of stimulation protocols that adjust bilateral hindlimb kinematics throughout gait execution. These stimulation strategies corrected subject-specific gait and balance deficits in rats with incomplete and complete spinal cord injury. The conservation of muscle spindle feedback circuits across mammals suggests that the same mechanisms may facilitate motor control in humans. These results provide a conceptual framework to improve stimulation protocols for clinical applications.

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Section: Mechanisms Underlying Motor Pattern Formation During Eesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mechanisms Underlying the Neuromodulation of Spinal Circuits for Correcting Gait and Balance Deficits after Spinal Cord Injury

Moraud

Capogrosso

Formento

et al. 2016

Neuron

165

183

View full text Add to dashboard Cite

show abstract

“…The most effective pharmacological interventions targeted 5HT 1A , 5HT 2A/C and 5HT 7 receptors subtypes-for example with Quipazine and 8-OHDPAT (Courtine et al 2009). Direct spinal cord stimulation has been achieved with invasive and noninvasive neurotechnologies that include intraspinal stimulation/epidural electrical stimulation and transcutaneous electrical stimulation/magnetic stimulation, respectively (Gerasimenko et al 2015;Wenger et al 2016;Grahn et al 2017;Angeli et al 2015;Herman et al 2002;van den Brand et al 2012;Danner et al 2015;Minev et al 2015;Holinski et al 2016;Zimmermann et al 2011;Kasten et al 2013;Angeli et al 2014;Lu et al 2016). Thus far, epidural electrical stimulation (EES) applied over the dorsal aspect of the spinal cord has been the most promising paradigm to engage lumbosacral circuits.…”

Section: Targeting Circuits Below the Sci: Infralesional Neuromodulatmentioning

confidence: 99%

Neurorestorative interventions involving bioelectronic implants after spinal cord injury

et al. 2019

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In the absence of approved treatments to repair damage to the central nervous system, the role of neurosurgeons after spinal cord injury (SCI) often remains confined to spinal cord decompression and vertebral fracture stabilization. However, recent advances in bioelectronic medicine are changing this landscape. Multiple neuromodulation therapies that target circuits located in the brain, midbrain, or spinal cord have been able to improve motor and autonomic functions. The spectrum of implantable brain-computer interface technologies is also expanding at a fast pace, and all these neurotechnologies are being progressively embedded within rehabilitation programs in order to augment plasticity of spared circuits and residual projections with training. Here, we summarize the impending arrival of bioelectronic medicine in the field of SCI. We also discuss the new role of functional neurosurgeons in neurorestorative interventional medicine, a new discipline at the intersection of neurosurgery, neuro-engineering, and neurorehabilitation.

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Motor Control of Human Spinal Cord Disconnected from the Brain and Under External Movement

Mayr

Krenn

Dimitrijevič

2016

Advances in Experimental Medicine and Biology

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Motor control after spinal cord injury is strongly depending on residual ascending and descending pathways across the lesion. The individually altered neurophysiology is in general based on still intact sublesional control loops with afferent sensory inputs linked via interneuron networks to efferent motor outputs. Partial or total loss of translesional control inputs reduces and alters the ability to perform voluntary movements and results in motor incomplete (residual voluntary control of movement functions) or motor complete (no residual voluntary control) spinal cord injury classification. Of particular importance are intact functionally silent neural structures with residual brain influence but reduced state of excitability that inhibits execution of voluntary movements. The condition is described by the term discomplete spinal cord injury. There are strong evidences that artificial afferent input, e.g., by epidural or noninvasive electrical stimulation of the lumbar posterior roots, can elevate the state of excitability and thus re-enable or augment voluntary movement functions. This modality can serve as a powerful assessment technique for monitoring details of the residual function profile after spinal cord injury, as a therapeutic tool for support of restoration of movement programs and as a neuroprosthesis component augmenting and restoring movement functions, per se or in synergy with classical neuromuscular or muscular electrical stimulation.

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Reply: No dawn yet of a new age in spinal cord rehabilitation

Cited by 9 publications

References 2 publications

Mechanisms Underlying the Neuromodulation of Spinal Circuits for Correcting Gait and Balance Deficits after Spinal Cord Injury

Mechanisms Underlying the Neuromodulation of Spinal Circuits for Correcting Gait and Balance Deficits after Spinal Cord Injury

Neurorestorative interventions involving bioelectronic implants after spinal cord injury

Motor Control of Human Spinal Cord Disconnected from the Brain and Under External Movement

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