Restoration Of Motor Function Research Articles

Assessing the Effect of Cervical Transcutaneous Spinal Stimulation with an Upper Limb Robotic Exoskeleton and Surface Electromyography.

Transcutaneous Spinal Stimulation (TSS) is a promising rehabilitative intervention to restore motor function and coordination for individuals with spinal cord injury (SCI). The effects of TSS are most commonly assessed by evaluating muscle response to stimulation using surface electromyography (sEMG). Given the increasing use of robotic devices to deliver therapy and the emerging potential of hybrid rehabilitation interventions that combine neuromodulation with robotic devices, there is an opportunity to leverage the on-board sensors of the robots to measure kinematic and torque changes of joints in the presence of stimulation. This paper explores the potential for robotic assessment of the effects of TSS delivered to the cervical spinal cord. We used a four degree-of-freedom exoskeleton to measure the torque response of upper limb joints during stimulation, while simultaneously recording sEMG. We analyzed joint torque and electromyography data generated during TSS delivered over individual sites of the cervical spinal cord in neurologically intact participants. We show that site-specific effects of TSS are manifested not only by modulation of the amplitude of spinally evoked motor potentials in upper limb (UL) muscles, but also by changes in torque generated by individual UL joints. We observed preferential resultant action of proximal muscles and joints with stimulation at the rostral site, and of proximal joints with rostral-lateral stimulation. Robotic assessment can be used to measure the effects of TSS, and could be integrated into complex control algorithms that govern the behavior of hybrid neuromodulation-robotic systems.

Theoretical proposal for restoration of hand motor function based on plasticity of motor-cortical interhemispheric interaction and its developmental rule.

After stroke, the poorer recovery of motor function of upper extremities compared to other body parts is a longstanding problem. Based on our recent functional MRI evidence on healthy volunteers, this perspective paper proposes systematic hand motor rehabilitation utilizing the plasticity of interhemispheric interaction between motor cortices and following its developmental rule. We first discuss the effectiveness of proprioceptive intervention on the paralyzed (immobile) hand synchronized with voluntary movement of the intact hand to induce muscle activity in the paretic hand. In healthy participants, we show that this bilateral proprioceptive-motor coupling intervention activates the bilateral motor cortices (= bilaterally active mode), facilitates interhemispheric motor-cortical functional connectivity, and augments muscle activity of the passively-moved hand. Next, we propose training both hands to perform different movements, which would be effective for stroke patients who becomes able to manage to move the paretic hand. This bilaterally different movement training may guide the motor cortices into left-right independent mode to improve interhemispheric inhibition and hand dexterity, because we have shown in healthy older adults that this training reactivates motor-cortical interhemispheric inhibition (= left-right independent mode) declined with age, and can improve hand dexterity. Transition of both motor cortices from the bilaterally active mode to the left-right independent mode is a developmental rule of hand motor function and a common feature of motor function recovery after stroke. Hence, incorporating the brain's inherent capacity for spontaneous recovery and adhering to developmental principles may be crucial considerations in designing effective rehabilitation strategies.

Results of Tendon Transfers in Radial Nerve Palsies: A New Evaluation Protocol.

Radial nerve palsies present a challenging clinical scenario, often leading to substantial functional impairment. This study focuses on evaluating the outcomes of tendon transfer surgeries in patients with post-traumatic radial nerve injuries. The radial nerve, vital for upper limb movements, faces various etiologies, such as trauma, compression, or idiopathy. Patients with radial nerve palsy encounter difficulties in daily activities, emphasizing the need for effective management strategies. The research introduces a novel evaluation protocol, aiming to comprehensively assess tendon transfer outcomes. This protocol incorporates functional movements of wrist and finger joints, encompassing both objective and subjective parameters. The retrospective study includes eleven patients treated between 2010 and 2022, with a minimum follow-up of one year post-surgery. Tendon transfers demonstrated positive results. The evaluation protocol covers a wide range of parameters, including wrist and finger mobility, thumb function, grip strength, and patient satisfaction. The results indicate successful restoration of motor function, with an average grip strength of 70% compared to the healthy arm. The proposed evaluation protocol facilitates standardized and reproducible assessment, minimizing subjective errors in clinical evaluations. Despite the study's limitations, such as a relatively small sample size, the findings underscore the effectiveness of tendon transfers in treating radial nerve palsies. The introduced evaluation scheme provides a comprehensive and reproducible approach to assess outcomes, contributing to the global standardization of tendon transfer assessments in radial nerve injuries.

The expression profile of brain-derived exosomal miRNAs reveals the key molecules responsible for spontaneous motor function recovery in a rat model with permanent middle cerebral artery occlusion.

The analysis of alterations in the expression and functionality of brain-derived exosomal miRNAs within ischemic stroke lesions provides significant insights into the mechanisms that contribute to disease recovery. We assessed spontaneous motor function in a rat model of permanent middle cerebral artery occlusion (pMCAO) using motor function scores and magnetic resonance imaging (MRI). Brain-derived exosomes from the infarcted brain tissue of the animal model were extracted and high-throughput sequencing of them was performed followed by bioinformatics analysis for differentially expressed miRNAs target genes. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to measure expression levels of differentially expressed miRNAs at various time points. The oxygen-glucose deprivation (OGD) model was established to investigate gene function through the assessment of cell proliferation and apoptosis using EdU proliferation and JC-1 apoptosis assay. The rat model demonstrated a spontaneous recovery of motor function and a reduction in cerebral infarction area from day 1 to day 14 post-operation. Over the course of the recovery period, miR-24-3p, miR-129-1-3p, and miR-212-5p maintained consistent expression levels, reaching their peak on the initial day following surgery. In the cell model, EdU detection indicated that miR-129-1-3p promoted cellular proliferation, while JC-1 detection revealed its suppressive impact on cellular apoptosis. The current research findings indicated the presence of spontaneous motor function restoration in a rat model of ischemic stroke. MiR-24-3p, miR-129-1-3p, and miR-212-5p were identified as pivotal genes in this recovery process, with miR-129-1-3p potentially influencing the restoration of spontaneous motor function in ischemic stroke through the regulation of neuronal proliferation and apoptosis.

The short-term effects of Jin's three needles in conjunction with mirror therapy on brain function in patients with upper limb disability following an ischemic stroke were evaluated using ReHo analysis.

Jin's three needle (JTN) is a commonly utilized treatment for ischemic stroke in China. Mirror therapy (MT) is also gradually transitioning from treating limb discomfort to restoring motor function in the damaged limb. Investigations into the 2 treatments' mechanisms of action are still ongoing. We used functional magnetic resonance imaging (fMRI) technique in this study to examine the effects of JTN combined with mirror therapy MT on brain function in patients with upper limb dysfunction in ischemic stroke, as well as potential central mechanisms. The goal was to provide a solid evidence-based medical basis to support the continued use of JTN combination MT. This study will be a single-blind, randomized, and controlled experiment. Randomization was used to assign 20 patients who met the study's eligibility requirements to the JTN + MT treatment group or the JTN control group. Each intervention will last for 4 weeks, with 6 days of treatment per week. The JTN acupuncture points are 3 temporal acupuncture points on the opposite side of the wounded limb, 3 hand acupuncture points on the injured upper limb, 3 shoulder acupuncture points, Renzhong and Baihui, The (JTN + MT) group simultaneously takes MT for 30 minutes. fMRI of the brain using BOLD and T1-weighted images was done both before and after therapy. Brain areas exhibiting changes in regional homogeneity during the pre and posttreatment periods were analyzed. By the end of the treatment course, Jin three-needle therapy plus MT activated more relevant brain functional regions and increased cerebral blood oxygen perfusion than Jin three-needle therapy alone (P <.05). In patients with upper limb impairment following an ischemic stroke, JTN with MT may improve brain function reconstruction in the relevant areas.

Restoration of Motor and Bladder Functions after Spinal Cord Injury via Sustained Wogonin Release from Carbon Nanotube Incorporated Hydrogels

Restoration of Motor and Bladder Functions after Spinal Cord Injury via Sustained Wogonin Release from Carbon Nanotube Incorporated Hydrogels

A new active rehabilitation training mode for upper limbs based on Tai Chi Pushing Hands

Robot-assisted rehabilitation is a crucial approach to restoring motor function in the limb. However, the current training trajectory lacks sufficient theoretical or practical support, and the monotony of single-mode training is a concern. Tai Chi Pushing Hands, a beneficial and effective daily exercise, has been shown to improve balance function, psychological state, and motor function of the upper extremities in patients recovering from stroke. To address these issues, we propose a new active rehabilitation training that incorporates Tai Chi Pushing Hands movements and yin-yang balance principles. The training trajectory and direction are encoded by the velocity field and consist of two processes: yang (push) and yin (return). During yang, the limb actively pushes the robot to move, while during yin, the limb actively follows the robot’s movement. To provide necessary assistance, an admittance controller with self-adaptive parameters is designed. In addition, we introduce two indexes, the ‘Intention Angle’ (ϖ) and the time ratio (Γ), to evaluate motion perception performance. Our experiment was conducted on a 4-degree-of-freedom upper limb rehabilitation robot platform, and the subjects were separated into a familiar group and an unfamiliar group. The experiment results show that the training could be completed well no matter whether the subject is familiar with Tai Chi Pushing Hands or not. The parameters and the movement of the robot can be adjusted based on the interactive force to adapt to the ability of the subject.

The influence of patient motivation on the motor function restoration during stroke recovery. Preliminary results of a clinical study

BACKGROUND: Acute cerebrovascular accidents lead to disability. The most important task is the rehabilitation and adaptation of these patients to society. Impaired motivation reduces the effectiveness of rehabilitation measures. AIMS: To assess the motivation of patients during stroke recovery; identify relationships between the level of motivation, duration and type of stroke, and cognitive and demographic indicators; and determine the influence of the patient’s initial level of motivation on the effectiveness of the rehabilitation. MATERIALS AND METHODS: This prospective study analyzed 36 patients with hemiparesis in the early and late recovery period of stroke. All patients were assessed according to the international classification of functioning, disability, and health; functional independence scale; Rivermead mobility index; degree of paresis according to the Medical Research Committee scale; level of spasticity according to the Ashford scale; risk of falls assessment according to the Morse scale; assessment of function of the upper and lower extremities using the Fugl–Meyer test; and balance assessment using the Berg scale. RESULTS: A significant positive correlation was found between the patient’s motivation and cognitive indicators: the integral level of the BTLD (r=0.653; p=0) and the integral indicator of the Mini-Mental State Examination (r=0.536; p=0.001). No convincing evidence supports the connection between the motivation level and indicators as such sex, age, body mass index, time since stroke, stroke type and location, pain level, functional independence level, and motor impairment. Although a trend toward greater positive changes in functional recovery of the arm, leg, balance, and overall independence was observed, no significant difference was found between groups. CONCLUSION: A significant relationship was found between motivation and cognitive functions, which can serve as predictors of the motivation level of patients when planning rehabilitation activities. A trend toward positive changes in functional recovery of the arm, leg, balance, and overall independence was found in patients with high motivation levels.

Virtual Analysis for Spinal Cord Injury Rehabilitation

Background Spinal cord injuries (SCI) are debilitating conditions affecting individuals worldwide annually, leading to physical, emotional, and cognitive challenges. Effective rehabilitation for SCI patients is crucial for restoring motor function and enhancing their overall quality of life. Advances in technology, including machine learning (ML) and computer vision, offer promising avenues for personalized SCI treatment. Aims This paper aimed to propose an automated and cost-effective system for spinal cord injury (SCI) rehabilitation using machine learning techniques, leveraging data from the Toronto Rehab Pose dataset and Mediapipe for real-time tracking. Objective The objective is to develop a system that predicts rehabilitation outcomes for upper body movements, highlighting the transformative role of ML in personalized SCI treatment and offering tailored strategies for improved outcomes. Methods The proposed system utilized data from the Toronto Rehab Pose dataset and Mediapipe for real-time tracking. Machine learning models, including Support Vector Machines (SVM), Logistic Regression, Naive Bayes, and XGBoost, were employed for outcome prediction. Features such as joint positions, angles, velocities, and accelerations were extracted from movement data to train the models. Results Statistical analysis revealed the ability of the system to accurately classify rehabilitation outcomes, with an average accuracy of 98.5%. XGBoost emerged as the top-performing algorithm, demonstrating superior accuracy and precision scores across all exercises. Conclusion This paper emphasizes the importance of continuous monitoring and adjustment of rehabilitation plans based on real-time progress data, highlighting the dynamic nature of SCI rehabilitation and the need for adaptive treatment strategies. By predicting rehabilitation outcomes with high accuracy, the system enables clinicians to devise targeted interventions, optimizing the efficacy of the rehabilitation process.

Advancements in brain-computer interfaces for the rehabilitation of unilateral spatial neglect: a concise review.

This short review examines recent advancements in neurotechnologies within the context of managing unilateral spatial neglect (USN), a common condition following stroke. Despite the success of brain-computer interfaces (BCIs) in restoring motor function, there is a notable absence of effective BCI devices for treating cerebral visual impairments, a prevalent consequence of brain lesions that significantly hinders rehabilitation. This review analyzes current non-invasive BCIs and technological solutions dedicated to cognitive rehabilitation, with a focus on visuo-attentional disorders. We emphasize the need for further research into the use of BCIs for managing cognitive impairments and propose a new potential solution for USN rehabilitation, by combining the clinical subtleties of this syndrome with the technological advancements made in the field of neurotechnologies.

3D hydrogel microfibers promote the differentiation of encapsulated neural stem cells and facilitate neuron protection and axon regrowth after complete transactional spinal cord injury

Spinal cord injury (SCI) can cause permanent impairment to motor or sensory functions. Pre-cultured neural stem cell (NSC) hydrogel scaffolds have emerged as a promising approach to treat SCI by promoting anti-inflammatory effects, axon regrowth, and motor function restoration. Here, in this study, we performed a coaxial extrusion process to fabricate a core-shell hydrogel microfiber with high NSC density in the core portion. Oxidized hyaluronic acid, carboxymethyl chitosan, and matrigel blend were used as a matrix for NSC growth and to facilitate the fabrication process. During the in vitro differentiation culture, it was found that NSC microfibers could differentiate into neurons and astrocytes with higher efficiency compared to NSC cultured in petri dishes. Furthermore, during in vivo transplantation, NSC microfibers were coated with polylactic acid nanosheets by electrospinning for reinforcement. The coated NSC nanofibers exhibited higher anti-inflammatory effect and lesion cavity filling rate compared with the control group. Meanwhile, more neuron- and oligodendrocyte-like cells were visualized at the lesion epicenter. Finally, axon regrowth across the whole lesion site was observed, demonstrating that the microfiber could guide renascent axon regrowth. Experiment results indicate that the NSC microfiber is a promising bioactive treatment for complete SCI treatment with superior outcomes.

Multifunctional Hierarchical Nanoplatform with Anisotropic Bimodal Mesopores for Effective Neural Circuit Reconstruction after Spinal Cord Injury.

A persistent inflammatory response, intrinsic limitations in axonal regenerative capacity, and widespread presence of extrinsic axonal inhibitors impede the restoration of motor function after a spinal cord injury (SCI). A versatile treatment platform is urgently needed to address diverse clinical manifestations of SCI. Herein, we present a multifunctional nanoplatform with anisotropic bimodal mesopores for effective neural circuit reconstruction after SCI. The hierarchical nanoplatform features of a Janus structure consist of dual compartments of hydrophilic mesoporous silica (mSiO2) and hydrophobic periodic mesoporous organosilica (PMO), each possessing distinct pore sizes of 12 and 3 nm, respectively. Unlike traditional hierarchical mesoporous nanomaterials with dual-mesopores interlaced with each other, the two sets of mesopores in this Janus nanoplatform are spatially independent and possess completely distinct chemical properties. The Janus mesopores facilitate controllable codelivery of dual drugs with distinct properties: the hydrophilic macromolecular enoxaparin (ENO) and the hydrophobic small molecular paclitaxel (PTX). Anchoring with CeO2, the resulting mSiO2&PMO-CeO2-PTX&ENO nanoformulation not only effectively alleviates ROS-induced neuronal apoptosis but also enhances microtubule stability to promote intrinsic axonal regeneration and facilitates axonal extension by diminishing the inhibitory effect of extracellular chondroitin sulfate proteoglycans. We believe that this functional dual-mesoporous nanoplatform holds significant potential for combination therapy in treating severe multifaceted diseases.

Acellular spinal cord scaffold containing quercetin-encapsulated nanoparticles plays an anti-inflammatory role in functional recovery from spinal cord injury in rats.

Inflammatory responses play a crucial role in the pathophysiology of spinal cord injury (SCI) and developing new approaches to establish an anti-inflammatory environment for the promotion of neuroregeneration holds promise as a potential approach. In this study, our aim was to investigate the potential of combining an acellular spinal cord scaffold (ASCS) with quercetin-loaded bovine serum albumin (Qu/BSA) nanoparticles (NPs) for the treatment of SCI. The ASCS was prepared using physical and chemical methods, while the Qu/BSA NPs were prepared through a desolvation technique. The NPs exhibited favorable characteristics, including a mean size of 203nm, a zeta potential of -38, and an encapsulation efficiency of 96%. Microscopic evaluation confirmed the successful distribution of NPs on the walls of ASCS. Animal studies revealed that Qu/BSA NPs group exhibited a significant decrease in NLRP3, ASC, and Casp1 gene expression compared to the SCI group (p < 0.0001). The findings indicated a significant decrease in the NLRP3, ASC, and Casp1 protein level between the Qu/BSA/ASCS group and the SCI group (p < 0.0001). Moreover, treatment with ASCS containing either blank BSA (B/BSA) NPs or Qu/BSA NPs effectively promoted functional recovery via increasing the amount of nestin- and glial fibrillary acidic protein (GFAP)-positive cells in the site of injury. Notably, Qu/BSA/ASCS exhibited superior outcomes compared to B/BSA/ASCS. Overall, the combination of ASCS with the Qu delivery system presents a promising therapeutic approach for SCI by inhibiting inflammatory responses and promoting neuroregeneration, leading to the restoration of motor function in animals. This study demonstrates the potential of utilizing biomaterials and NPs to enhance the effectiveness of SCI treatment.

Comparative evaluation of bone marrow and dental pulp mesenchymal stem cells for motor functional recovery in rat sciatic nerve injury.

This study delves into the impact of mesenchymal stem cells derived from bone marrow (BM-MSCs) and those sourced from dental pulp (DP-MSCs) on the recovery of motor function and morphological aspects of the rat's sciatic nerve after crush injuries. The findings highlight that the groups treated with BM-MSCs, DP-MSCs or a combination of both (BM + DP-MSCs) displayed enhanced sciatic functional index values when juxtaposed with the sham group. This points to bettered motor functionalities. A deeper morphological analysis showed that all the groups had retained perineurium structure and fascicular arrangement. Notably, the sham and BM-MSCs groups had very few inconsistencies. All groups showed standard vascular density. Remarkably, the combined treatment group (BM + DP-MSCs) presented diminished oedema and a lower count of inflammatory cells. Through immunohistochemical methods, the presence of S100 expression was noted in the groups that underwent treatment. In summation, the study suggests that both BM-MSCs and DP-MSCs, whether used singly or in combination, can significantly aid in motor function restoration and morphological enhancements. An interesting observation from our research and earlier studies is that stem cells from dental pulp, which are sourced with less discomfort from milk and wisdom teeth, show a heightened propensity to evolve into nerve cells. This is in contrast to the more uncomfortably acquired BM-MSCs.

Neuroprotective Effect of Sterculia setigera Leaves Hydroethanolic Extract.

Plants are a valuable source of information for pharmacological research and new drug discovery. The present study aimed to evaluate the neuroprotective potential of the leaves of the medicinal plant Sterculia setigera. In vitro, the effect of Sterculia setigera leaves dry hydroethanolic extract (SSE) was tested on cultured cerebellar granule neurons (CGN) survival when exposed to hydrogen peroxide (H2O2) or 6-hydroxydopamine (6-OHDA), using the viability probe fluorescein diacetate (FDA), a lactate dehydrogenase (LDH) activity assay, an immunocytochemical staining against Gap 43, and the quantification of the expression of genes involved in apoptosis, necrosis, or oxidative stress. In vivo, the effect of intraperitoneal (ip) injection of SSE was assessed on the developing brain of 8-day-old Wistar rats exposed to ethanol neurotoxicity by measuring caspase-3 activity on cerebellum homogenates, the expression of some genes in tissue extracts, the thickness of cerebellar cortical layers and motor coordination. In vitro, SSE protected CGN against H2O2 and 6-OHDA-induced cell death at a dose of 10µg/mL, inhibited the expression of genes Casp3 and Bad, and upregulated the expression of Cat and Gpx7. In vivo, SSE significantly blocked the deleterious effect of ethanol by reducing the activity of caspase-3, inhibiting the expression of Bax and Tp53, preventing the reduction of the thickness of the internal granule cell layer of the cerebellar cortex, and restoring motor functions. Sterculia setigera exerts neuroactive functions as claimed by traditional medicine and should be a good candidate for the development of a neuroprotective treatment against neurodegenerative diseases.

P2X7 regulates ependymo-radial glial cell proliferation in adult Danio rerio following spinal cord injury.

In contrast to mammals, zebrafish undergo successful neural regeneration following spinal cord injury. Spinal cord ependymo-radial glia (ERG) undergo injury-induced proliferation and neuronal differentiation to replace damaged cells and restore motor function. However, the molecular cues driving these processes remain elusive. Here, we demonstrate that the evolutionarily conserved P2X7 receptors are widely distributed on neurons and ERG within the zebrafish spinal cord. At the protein level, the P2X7 receptor expressed in zebrafish is a truncated splice variant of the full-length variant found in mammals. The protein expression of this 50 kDa isoform was significantly downregulated at 7 days post-injury (dpi) but returned to basal levels at 14 dpi when compared to naïve controls. Pharmacological activation of P2X7 following SCI resulted in a greater number of proliferating cells around the central canal by 7 dpi but did not affect neuronal differentiation at 14 dpi. Our findings suggest that unlike in mammals, P2X7 signaling may not play a maladaptive role following SCI in adult zebrafish and may also work to curb the proliferative response of ERG following injury.

Enhancing Neuroprosthetic Control through AI-Powered Adaptive Learning: A Simulation Study

Neuroprosthetic devices have the potential to restore motor function and improve the quality of life for individuals with limb loss or motor impairments. However, the control of these devices remains challenging due to the complex nature of brain-machine interfaces and the variability in individual brain wave patterns. This study presents a simulation framework that combines electroencephalogram (EEG) analysis with artificial intelligence (AI) to enhance the control and adaptation of neuroprosthetic devices. We simulate brain wave patterns across key motor regions, including the motor cortex, premotor cortex, supplementary motor area, parietal lobe, and cerebellum, during a simplified arm movement task. The simulation demonstrates the synchronization of brain waves over time, representing the neural dynamics underlying motor control. I propose an AI-powered approach that leverages machine learning algorithms to continuously learn from the user's brain wave patterns and adapt the control strategies of the neuroprosthetic device. The AI system enables personalized calibration, continuous learning, and improved movement control, leading to more intuitive and efficient use of the prosthesis. Furthermore, I discuss the potential for personalized feedback and training, as well as continuous upgrades and enhancements to the AI-powered neuroprosthetic devices. My simulation study highlights the promising role of AI in advancing neuroprosthetic control and lays the foundation for future research and development in this field. By harnessing the power of AI and adaptive learning, I envision a future where individuals with motor impairments can regain a higher level of independence and functionality through seamless integration with intelligent neuroprosthetic devices.

141 Motor and Somatosensory Applications for Nerve Cuff Electrodes in Clinical Neuroprosthesis and Neurorehabilitation

INTRODUCTION: Surgically implanted neuroprosthetics aim to restore motor and somatosensory function by delivering controlled electrical impulses to paralyzed nerves. Recently, nerve cuff electrodes (NCEs) have been increasingly studied and may eventually offer the potential to recover somatomotor function in patients with neurologic injury. METHODS: The PubMed, Google Scholar, and Web of Science databases were searched to identify relevant articles published between 2012 – 2022 describing use of neuroprosthetic NCEs for clinical somatomotor rehabilitation. Data from all relevant articles retrieved were collected and summarized. RESULTS: NCE-neural interfaces can restore both upper and lower extremity motor function in spinal cord injury patients and may provide a treatment modality superior to that of muscle-based electrodes. The search yielded 137 studies, and of those reviewed, 18 were original research articles that used peripheral nerve stimulation to elicit motor actions and/or somatosensory perceptions through NCEs. 10 studies looked at restoring motor function in patients with spinal cord injuries or stroke-related paralysis and 7 studies looked at somatosensory applications of NCEs in patients with amputations. Currently, sensory NCE interfacing can restore and improve multiple aspects of sensation in amputees. While there is room for further study in various applications, technological improvements and wider clinical adoption, NCEs have been demonstrated to provide a clinically acceptable option in reducing intraoperative duration and morbidity, while preserving long-term functional stability, threshold charge maintenance, and acceptable mechanical failure rates. CONCLUSIONS: NCEs appear to be a promising avenue for future research in the field of neuroprosthetics. As the translational avenue continues to mature and more clinical studies become avaiable, the utility of NCEs will be better understood.

Restoration of motor function using magnetoelectric metamaterials.

Implantable magnetic materials can be used for wireless neural stimulation and restoration of motor function.

Nerve transfer for restoration of lower motor neuron-lesioned bladder, urethral and anal sphincter function. Part 4: Effectiveness of the motor reinnervation.

In pilot work, we showed that somatic nerve transfers can restore motor function in long-term decentralized dogs. We continue to explore the effectiveness of motor reinnervation in 30 female dogs. After anesthesia, 12 underwent bilateral transection of coccygeal and sacral (S) spinal roots, dorsal roots of lumbar (L)7, and hypogastric nerves. Twelve months postdecentralization, eight underwent transfer of obturator nerve branches to pelvic nerve vesical branches, and sciatic nerve branches to pudendal nerves, followed by 10 mo recovery (ObNT-ScNT Reinn). The remaining four were euthanized 18 mo postdecentralization (Decentralized). Results were compared with 18 Controls. Squat-and-void postures were tracked during awake cystometry. None showed squat-and-void postures during the decentralization phase. Seven of eight ObNT-ScNT Reinn began showing such postures by 6 mo postreinnervation; one showed a return of defecation postures. Retrograde dyes were injected into the bladder and urethra 3 wk before euthanasia, at which point, roots and transferred nerves were electrically stimulated to evaluate motor function. Upon L2-L6 root stimulation, five of eight ObNT-ScNT Reinn showed elevated detrusor pressure and four showed elevated urethral pressure, compared with L7-S3 root stimulation. After stimulation of sciatic-to-pudendal transferred nerves, three of eight ObNT-ScNT Reinn showed elevated urethral pressure; all showed elevated anal sphincter pressure. Retrogradely labeled neurons were observed in L2-L6 ventral horns (in laminae VI, VIII, and IX) of ObNT-ScNT Reinn versus Controls in which labeled neurons were observed in L7-S3 ventral horns (in lamina VII). This data supports the use of nerve transfer techniques for the restoration of bladder function.NEW & NOTEWORTHY This data supports the use of nerve transfer techniques for the restoration of bladder function.