Abstract
Electrical neuromodulation has strongly hit the foundations of spinal cord injury and repair. Clinical and experimental studies have demonstrated the ability to neuromodulate and engage spinal cord circuits to recover volitional motor functions lost after the injury. Although the science and technology behind electrical neuromodulation has attracted much of the attention, it cannot be obviated that electrical stimulation must be applied concomitantly to sensorimotor rehabilitation, and one would be very difficult to understand without the other, as both need to be finely tuned to efficiently execute movements. The present review explores the difficulties faced by experimental and clinical neuroscientists when attempting to neuromodulate and rehabilitate manual dexterity in spinal cord injured subjects. From a translational point of view, we will describe the major rehabilitation interventions employed in animal research to promote recovery of forelimb motor function. On the other hand, we will outline some of the state-of-the-art findings when applying electrical neuromodulation to the spinal cord in animal models and human patients, highlighting how evidences from lumbar stimulation are paving the path to cervical neuromodulation.
Highlights
A shift in scientific paradigm has recently knocked on the spinal cord community’s door
The delivery of electrical stimulation has been evolving over the years, from a very invasive approach using intraspinal electrodes implanted in the spinal parenchyma, to single or arrays of electrodes sutured to the epidural layer surrounding the dorsal surface of the spinal cord, and most recently to transcutaneous stimulation, which delivers the current through adhesive electrodes placed on paravertebral or midline skin (Figure 4)
Unstable fixation of the adhesive electrode on the animal’s skin and the difficulty placing the electrodes identically during longitudinal studies limit its implementation and have led to the development of transvertebral electrical stimulation, in which electrodes are implanted into the vertebral spinous processes, with a mode of action and muscle responses analogous to those evoked by transcutaneous stimulation [153]
Summary
A shift in scientific paradigm has recently knocked on the spinal cord community’s door. The accumulated knowledge of spinal cord physiology, Animals Studies on Activity-Dependent Plasticity locomotor function, and rehabilitation among others, and most recently of spinal stimulation, have established strong bases for quickly and efficiently designing and testing spinal neuromodulation in chronic spinal cord injured patients This scientific success further evidences the necessary synergy between experimental and clinical studies; results obtained from lampreys, rodents, cats and non-human primates have settled a detailed functional map of the brain and the spinal cord and have made it possible to identify, locate and understand the function and connectivity of the spinal networks recipient of the electrical current [5]. We will describe some of the state-ofthe-art results when applying electrical stimulation to the cervical spinal cord in animal models and human patients
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