Precision neuromodulation: Promises and challenges of spinal stimulation for multi-modal rehabilitation

Frontiers in Rehabilitation Sciences, 2023 · DOI: 10.3389/fresc.2023.1135593 · Published: April 19, 2023

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Spinal cord injuries (SCI) result in a variety of sensorimotor deficits, including paralysis, muscle spasms, and neuropathic pain. Current spinal stimulation therapies primarily target locomotor rehabilitation, neglecting other critical areas like bowel, bladder, and sexual function. This paper emphasizes the importance of addressing the diverse neural transmission patterns underlying similar clinical presentations and promotes the advancement of multi-modal rehabilitation paradigms. These paradigms would use electrical stimulation to modulate spinal networks and facilitate simultaneous rehabilitation across multiple domains. The authors highlight the need for precision neuromodulation, which involves tailoring therapies to individual patients based on their unique injury profiles and neural dynamics. This approach aims to enhance the central nervous system's ability to reorganize and repair itself.

Study Duration

Not specified

Participants

15 rats with chronic SCI

Evidence Level

Not specified

Key Findings

1
Underlying differences in neural network behavior exist among individuals with similar motor impairments after SCI. These differences are often masked by population-level analyses, highlighting the need for personalized approaches.
2
Motor-targeted intraspinal microstimulation (ISMS) differentially modulates neural transmission across animals with and without SCI-related neuropathic pain, suggesting that stimulation acts via different pathways and may have varying therapeutic efficacy.
3
Closed-loop neuromodulation, where spinal stimulation is synchronized with functionally relevant neural events, shows greater efficacy in promoting long-lasting motor recovery compared to open-loop stimulation.

Research Summary

This perspective paper highlights the limitations of current spinal stimulation therapies that primarily focus on locomotor rehabilitation after spinal cord injury (SCI), while neglecting other critical sensorimotor consequences such as pain, bowel, bladder, and sexual dysfunction. The authors advocate for precision neuromodulation, emphasizing the importance of considering the diverse patterns of neural transmission underlying clinically similar presentations and advancing multi-modal rehabilitation paradigms that leverage the interconnectivity of spinal networks. Key recommendations include focusing on closed-loop neuromodulation, incorporating assessments of off-target effects in epidural spinal stimulation studies, and elucidating how patterns of intraspinal neural transmission relate to action and perception through spinal network analyses.

Practical Implications

Personalized Therapy Design

Tailoring spinal stimulation therapies to individual patients based on their unique neural dynamics and injury profiles may improve therapeutic efficacy.

Multi-Modal Rehabilitation Strategies

Developing spinal stimulation paradigms that address multiple sensorimotor consequences of SCI, such as pain and bladder function, could significantly improve the quality of life for individuals with SCI.

Closed-Loop Neuromodulation Optimization

Further research is needed to optimize closed-loop spinal stimulation paradigms, including identifying appropriate stimulus triggers and understanding the spatiotemporal specificity of stimulation effects.

Study Limitations

1
The study primarily uses pre-clinical models (rats), which may not fully translate to human clinical outcomes.
2
The analysis of neural dynamics relies on microelectrode arrays, which provide detailed information but may not be feasible for widespread clinical application.
3
The paper is a perspective piece and does not present new clinical data, limiting the direct evidence supporting the proposed strategies.

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