Enhancing Nervous System Recovery through Neurobiologics, Neural Interface Training, and Neurorehabilitation

Abstract

After an initial period of recovery, human neurological injury has long been thought to be static. In order to improve quality of life for those suffering from stroke, spinal cord injury, or traumatic brain injury, researchers have been working to restore the nervous system and reduce neurological deficits through a number of mechanisms. For example, neurobiologists have been identifying and manipulating components of the intra- and extracellular milieu to alter the regenerative potential of neurons, neuro-engineers have been producing brain-machine and neural interfaces that circumvent lesions to restore functionality, and neurorehabilitation experts have been developing new ways to revitalize the nervous system even in chronic disease. While each of these areas holds promise, their individual paths to clinical relevance remain difficult. Nonetheless, these methods are now able to synergistically enhance recovery of native motor function to levels which were previously believed to be impossible. Furthermore, such recovery can even persist after training, and for the first time there is evidence of functional axonal regrowth and rewiring in the central nervous system of animal models. To attain this type of regeneration, rehabilitation paradigms that pair cortically-based intent with activation of affected circuits and positive neurofeedback appear to be required—a phenomenon which raises new and far reaching questions about the underlying relationship between conscious action and neural repair. For this reason, we argue that multi-modal therapy will be necessary to facilitate a truly robust recovery, and that the success of investigational microscopic techniques may depend on their integration into macroscopic frameworks that include task-based neurorehabilitation. We further identify critical components of future neural repair strategies and explore the most updated knowledge, progress, and challenges in the fields of cellular neuronal repair, neural interfacing, and neurorehabilitation, all with the goal of better understanding neurological injury and how to improve recovery.

Exoskeleton and End‐Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review

“…Emerging and advancing robotic technologies can enhance clinical therapeutic techniques by allowing therapists to activate and/or modulate neural networks otherwise lost, to maximize recovery and functional outcomes [46]. Despite most studies claiming that robots would increase rehabilitation intensity, repetition of tasks alone is not sufficient to guide neural plasticity [47].…”

Neuroprotective effect of omega‐3 fatty acids on spinal cord injury induced rats

“…Supplementation with omega‐3 fatty acid significantly inhibited oxidative stress in rat liver regeneration (Ozgur et al, ). Spinal cord injury leads to functional changes in autonomic function, loss of sensation, and muscle wasting (Krucoff et al, ). The induction in apoptosis in neurons and oligodendrocytes has been reported to lead to axonal degeneration, demyelination, and dysfunction (Lee et al, ; Yune et al, ).…”

“…Spinal cord injury leads to functional changes in autonomic function, loss of sensation, and muscle wasting (Krucoff et al, 2016).…”

“…Spinal cord injury leads to functional changes in autonomic function, loss of sensation, and muscle wasting (Krucoff, Rahimpour, Slutzky, Edgerton, & Turner, 2016). The induction in apoptosis in neurons and oligodendrocytes leads to axonal degeneration, demyelination, and dysfunction (Lee et al, 2003;Yune et al, 2008).…”

Intraspinal stimulation with silicon-based 3D microelectrode array for bladder voiding in cats before and after spinal cord injury

“…Twenty animals in that study were implanted with a microwire array with two-dimensional electrode distribution, while only two had the multisite silicon array with 3D electrode distribution. We hypothesized that 3D electrode distribution would provide better access to the spinal gray matter nuclei, particularly in the DGC area and, therefore, would facilitate better targeting with lower current levels and reduced current spread to unrelated nearby neuronal groups (Krucoff et al 2016, Giszter 2015. Other studies have attempted to achieve neuroprosthetic bladder control with individual spinal microwires (Tai et al μ m (or more) and custom-designed tip geometry for more reliable insertion through thick pial membrane that covers the dorsal surface of the spinal cord.…”