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

Frontiers in Neuroscience, 2016 · DOI: 10.3389/fnins.2016.00584 · Published: December 27, 2016

Neurology Neuroplasticity Neurorehabilitation

Simple Explanation

Researchers are exploring ways to restore the nervous system and lessen the impact of stroke, spinal cord injury, or traumatic brain injury. Neurobiologists are focused on changing the environment around cells to help them regenerate. Neuro-engineers are working on brain-machine interfaces to bypass injuries and restore function. Neurorehabilitation specialists are developing new ways to revitalize the nervous system, even in long-term conditions. These methods can now work together to improve motor function beyond what was previously thought possible. Functional axonal regrowth and rewiring have even been observed in animal models. To achieve this, rehabilitation methods that combine cortical intent with activation of affected circuits and positive neurofeedback seem necessary. This review argues that combined, multi-modal therapy is essential for significant recovery. The success of microscopic techniques may hinge on integrating them into macroscopic frameworks that include task-based neurorehabilitation.

Study Duration

Not specified

Participants

Animal models and human patients

Evidence Level

Review

Key Findings

1
Multi-disciplinary approaches are critical for therapeutic techniques to realize their full potential, suggesting that well-timed, goal-directed therapy and positive feedback mechanisms are necessary for axonal sprouting and lasting functional improvement.
2
For patients with disorders of consciousness, proximally-based interventions like cortical stimulation, combined with feedback mechanisms such as peripheral nerve stimulation or passive movement, along with pharmacologic therapy aimed at promoting alertness, might substitute for active participation in rehabilitation.
3
New biological approaches may need to be applied with goal-directed rehabilitation paradigms to realize their therapeutic potential and may fail in isolation. This principle could also apply to stem cells, gene therapies, optogenetics, neuronal transplantation, and novel biological or immunotherapies.

Research Summary

Researchers have long been developing ways to improve the quality of life for patients who suffer from SCI, stroke, and other neurological disorders classically categorized as permanent. Patients are now starting to show recovery beyond that which was previously thought possible, which is due to advances in modern neurobiological, neuro-engineering, and neurorehabilitation strategies. The development of immunotherapies, electrical stimulation, neural interfaces, stem cells, optogenetics, and gene therapies, their reparative potential may only be realized by integrating them into a rehabilitation framework that includes conscious intention and positive neural feedback.

Practical Implications

Improved Rehabilitation Strategies

Integrate multidisciplinary approaches in neurorehabilitation, combining neurobiology, neuro-engineering, and neurorehabilitation techniques for synergistic effects.

Targeted Therapies for Consciousness Disorders

Develop proximally-based interventions like cortical stimulation and pharmacologic therapies to promote alertness in patients with disorders of consciousness.

Timing and Sequencing of Interventions

Carefully time and sequence therapeutic interventions, such as drug administration followed by task-specific training, to maximize recovery outcomes.

Study Limitations

1
Translation of lab findings (e.g., NgR deletions, anti-NogoA antibodies) to bedside applications remains a challenge.
2
Generating axonal regrowth on its own does not ensure restoration of function.
3
Relative paucity of biomarkers that might help drive prognosis and diagnose phases of injury/recovery.

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