Enhancing neurorehabilitation by targeting beneﬁcial plasticity

Front. Rehabil. Sci., 2023 · DOI: 10.3389/fresc.2023.1198679 · Published: June 29, 2023

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

Neurorehabilitation aims to restore skills impaired by CNS injury or disease, leveraging the brain's lifelong plasticity. The substrate of a skill is a distributed network of neurons and synapses called a “heksor.” The primary goal is to enable damaged heksors to repair themselves so that their skills are once again performed well. Standard rehabilitation therapy, which involves skill-specific practice, often fails to optimally engage the many sites and kinds of plasticity available in the damaged CNS. New technology-based interventions can target beneﬁcial plasticity to critical sites in damaged heksors, enhancing skill recovery. Targeted-plasticity interventions include operant conditioning of a spinal reflex or corticospinal motor evoked potential (MEP), paired-pulse facilitation of corticospinal connections, and brain-computer interface (BCI)-based training of electroencephalographic (EEG) sensorimotor rhythms.

Study Duration

Not specified

Participants

Varied across studies, including people with spinal cord injury, stroke, or multiple sclerosis

Evidence Level

Mini Review

Key Findings

1
Operant down-conditioning of the soleus H-reﬂex in people with spinal cord injury resulted in faster and more symmetrical walking, with improvements in EMG activity and reports of enhanced daily walking abilities.
2
Paired corticospinal-motoneuronal stimulation (PCMS) improved both hand-arm function and locomotion in people with chronic spinal cord injuries, with improvements persisting six months later.
3
Brain-computer interface (BCI)-based feedback targeting corticothalamic circuits enhanced sensorimotor rhythm desynchronization, leading to superior functional recovery in upper extremity function compared to skill-speciﬁc practice alone in stroke patients.

Research Summary

Neurorehabilitation is enhanced by targeting beneﬁcial plasticity in the central nervous system (CNS). Skilled behaviors are maintained by distributed networks called heksors, and rehabilitation aims to repair damaged heksors to restore skill performance. Skill-speciﬁc practice, the standard rehabilitation approach, often fails to fully engage CNS plasticity. Noninvasive interventions targeting beneﬁcial plasticity at critical sites in damaged heksors can improve outcomes. Targeted-plasticity interventions, such as H-reﬂex conditioning, PCMS, and BCI-based training, have shown promise in enhancing functional recovery in people with SCI, stroke, and MS, with beneﬁts persisting after treatment ends.

Practical Implications

Enhanced Rehabilitation Strategies

Integrating targeted-plasticity interventions with skill-specific practice can lead to more effective neurorehabilitation outcomes.

Personalized Treatment Approaches

Tailoring targeted-plasticity interventions to address specific deficits in individual patients may optimize recovery.

Long-Term Functional Improvements

The persistence of beneﬁcial effects after targeted-plasticity interventions suggests the potential for sustained improvements in motor function.

Study Limitations

1
Varied study designs and participant characteristics make broad generalizations difficult.
2
The neural mechanisms underlying the observed plasticity require further investigation.
3
Determining appropriate targets for plasticity in some patients may be challenging.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury