TY - JOUR
T1 - Enhancing nervous system recovery through neurobiologics, neural interface training, and neurorehabilitation
AU - Krucoff, Max O.
AU - Rahimpour, Shervin
AU - Slutzky, Marc W.
AU - Edgerton, V. Reggie
AU - Turner, Dennis A.
N1 - Funding Information:
MK is supported by a grant from the National Institute of Neurological Disorders and Stroke (NINDS; R25, 5R25NS065731-08). MS is supported by grants from the National Institute of Health (NIH; K08NS060223 and R01NS094748), Paralyzed Veterans of America, Brain Research Foundation, Doris Duke Charitable Foundation, and Northwestern Memorial Foundation (Dixon Translational Research Grant). VE is supported by a grants from the National Institute of Biomedical Imaging and Bioengineering (NIBIB; U01EB007615, U01EB015521, R43EB017641, and R43EB018232), Paralyzed Veterans of America, WalkAbout Foundation, Christopher & Dana Reeve Foundation, and Broccoli Foundation. DT is supported by grants from the NIH (R21, AG051103; RO1, NS079312; R21, NS084176; and R37, NS040894) and Veteran's Affairs (VA; VA I21, BX003023; and VA I21, RX002223). This work was inspired by the 2016 Research Update in Neuroscience for Neurosurgeons (RUNN) course, so a special thanks is due to course directors Allan Friedman, M.D. and Richard Friedlander, M.D. for organizing a stimulating curriculum. Thanks to course coordinator Karen Koenig for her hard work and display of hospitality. Another thanks to the distinguished lecturers, especially Andrew Schwartz, Ph.D., for their inspiration. Thanks also to Lee Miller, Ph.D., for his persistent willingness to collaborate and mentor, and to Larry Benowitz, Ph.D., for his inspiration and collaboration. And thanks to Miguel Nicolelis, M.D., Ph.D., Laura Oliveira, M.D., and Mikhail Lebedev, Ph.D., for their continued mentorship and support. Figures 1, 2, 4-6 were illustrated by Lauren Halligan at Duke University.
Publisher Copyright:
© 2016 Krucoff, Rahimpour, Slutzky, Edgerton and Turner.
PY - 2016
Y1 - 2016
N2 - After an initial period of recovery, human neurological injury has long been thought to be static. In order to improve quality of life for those suffering from stroke, spinal cord injury, or traumatic brain injury, researchers have been working to restore the nervous system and reduce neurological deficits through a number of mechanisms. For example, neurobiologists have been identifying and manipulating components of the intra- and extracellular milieu to alter the regenerative potential of neurons, neuro-engineers have been producing brain-machine and neural interfaces that circumvent lesions to restore functionality, and neurorehabilitation experts have been developing new ways to revitalize the nervous system even in chronic disease. While each of these areas holds promise, their individual paths to clinical relevance remain difficult. Nonetheless, these methods are now able to synergistically enhance recovery of native motor function to levels which were previously believed to be impossible. Furthermore, such recovery can even persist after training, and for the first time there is evidence of functional axonal regrowth and rewiring in the central nervous system of animal models. To attain this type of regeneration, rehabilitation paradigms that pair cortically-based intent with activation of affected circuits and positive neurofeedback appear to be required-a phenomenon which raises new and far reaching questions about the underlying relationship between conscious action and neural repair. For this reason, we argue that multi-modal therapy will be necessary to facilitate a truly robust recovery, and that the success of investigational microscopic techniques may depend on their integration into macroscopic frameworks that include task-based neurorehabilitation. We further identify critical components of future neural repair strategies and explore the most updated knowledge, progress, and challenges in the fields of cellular neuronal repair, neural interfacing, and neurorehabilitation, all with the goal of better understanding neurological injury and how to improve recovery.
AB - After an initial period of recovery, human neurological injury has long been thought to be static. In order to improve quality of life for those suffering from stroke, spinal cord injury, or traumatic brain injury, researchers have been working to restore the nervous system and reduce neurological deficits through a number of mechanisms. For example, neurobiologists have been identifying and manipulating components of the intra- and extracellular milieu to alter the regenerative potential of neurons, neuro-engineers have been producing brain-machine and neural interfaces that circumvent lesions to restore functionality, and neurorehabilitation experts have been developing new ways to revitalize the nervous system even in chronic disease. While each of these areas holds promise, their individual paths to clinical relevance remain difficult. Nonetheless, these methods are now able to synergistically enhance recovery of native motor function to levels which were previously believed to be impossible. Furthermore, such recovery can even persist after training, and for the first time there is evidence of functional axonal regrowth and rewiring in the central nervous system of animal models. To attain this type of regeneration, rehabilitation paradigms that pair cortically-based intent with activation of affected circuits and positive neurofeedback appear to be required-a phenomenon which raises new and far reaching questions about the underlying relationship between conscious action and neural repair. For this reason, we argue that multi-modal therapy will be necessary to facilitate a truly robust recovery, and that the success of investigational microscopic techniques may depend on their integration into macroscopic frameworks that include task-based neurorehabilitation. We further identify critical components of future neural repair strategies and explore the most updated knowledge, progress, and challenges in the fields of cellular neuronal repair, neural interfacing, and neurorehabilitation, all with the goal of better understanding neurological injury and how to improve recovery.
KW - Brain-machine interface (BMI)
KW - Neural interface
KW - Neural regeneration
KW - Neural repair
KW - Neural stimulation
KW - Neuroplasticity
KW - Neurorehabilitation
KW - Spinal cord stimulation
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UR - http://www.scopus.com/inward/citedby.url?scp=85009756624&partnerID=8YFLogxK
U2 - 10.3389/fnins.2016.00584
DO - 10.3389/fnins.2016.00584
M3 - Review article
C2 - 28082858
AN - SCOPUS:85009756624
SN - 1662-4548
VL - 10
JO - Frontiers in Neuroscience
JF - Frontiers in Neuroscience
IS - DEC
M1 - 584
ER -