Effects of Assist-as-needed Robotic Training Paradigms on the Locomotor Recovery of Adult Spinal Mice

This paper introduces a new “assist-as needed” (AAN) training paradigm for rehabilitation of spinal cord injuries via robotic training devices. In the pilot study reported in this paper, nine female adult Swiss-Webster mice were divided into three groups, each experiencing a different robotic training control strategy: a fixed training trajectory (Fixed Group, A), an AAN training method without inter-limb coordination (Band Group, B), and an AAN training method with bilateral hindlimb coordination (Window Group, C). Fourteen days after complete transection at the mid-thoracic level, the mice were robotically trained to step in the presence of an acutely administered serotonin agonist, quipazine, for a period of six weeks. The mice that received AAN training (Groups B and C) show higher levels of recovery than Group A mice, as measured by the number, consistency, and periodicity of steps realized during testing sessions. Group C displays a higher incidence of alternating stepping than Group B. These results indicate that this training approach may be more effective than fixed trajectory paradigms in promoting robust post-injury stepping behavior. Furthermore, the constraint of inter-limb coordination appears to be an important contribution to successful training. Presented in this paper are also some preliminary results from a recent full-scale study that complements the conclusions from this pilot study

Implications of assist-as-needed robotic step training after a complete spinal cord injury on intrinsic strategies of motor learning

Robotic training paradigms that enforce a fixed kinematic control might be suboptimal for rehabilitative training because they abolish variability, an intrinsic property of neuromuscular control (Jezernik et al., 2003). In the present study we introduce “assist-as-needed” (AAN) robotic training paradigms for rehabilitation of spinal cord injury subjects. To test the efficacy of these robotic control strategies to teach spinal mice to step, we divided 27 adult female Swiss–Webster mice randomly into three groups. Each group was trained robotically by using one of three control strategies: a fixed training trajectory (Fixed group), an AAN training paradigm without interlimb coordination (Band group), and an AAN training paradigm with bilateral hindlimb coordination (Window group). Beginning at 14 d after a complete midthoracic spinal cord transection, the mice were trained daily (10 min/d, 5 d/week) to step on a treadmill 10 min after the administration of quipazine (0.5 mg/kg), a serotonin agonist, for a period of 6 weeks. During weekly performance evaluations, the mice trained with the AAN window paradigm generally showed the highest level of recovery as measured by the number, consistency, and periodicity of steps during the testing sessions. In all three measurements there were no significant differences between the Band and the Fixed training groups. These results indicate that the window training approach, which includes loose alternating interlimb coordination, is more effective than a fixed trajectory paradigm with rigid alternating interlimb coordination or an AAN paradigm without any interlimb constraints in promoting robust postinjury stepping behavior

Training locomotor networks

For a complete adult spinal rat to regain some weight-bearing stepping capability, it appears that a sequence of specific proprioceptive inputs that are similar, but not identical, from step to step must be generated over repetitive step cycles. Furthermore, these cycles must include the activation of specific neural circuits that are intrinsic to the lumbosacral spinal cord segments. For these sensorimotor pathways to be effective in generating stepping, the spinal circuitry must be modulated to an appropriate excitability level. This level of modulation is sustained from supraspinal input in intact, but not spinal, rats. In a series of experiments with complete spinal rats, we have shown that an appropriate level of excitability of the spinal circuitry can be achieved using widely different means. For example, this modulation level can be acquired pharmacologically, via epidural electrical stimulation over specific lumbosacral spinal cord segments, and/or by use-dependent mechanisms such as step or stand training. Evidence as to how each of these treatments can “tune” the spinal circuitry to a “physiological state” that enables it to respond appropriately to proprioceptive input will be presented. We have found that each of these interventions can enable the proprioceptive input to actually control extensive details that define the dynamics of stepping over a range of speeds, loads, and directions. A series of experiments will be described that illustrate sensory control of stepping and standing after a spinal cord injury and the necessity for the “physiological state” of the spinal circuitry to be modulated within a critical window of excitability for this control to be manifested. The present findings have important consequences not only for our understanding of how the motor pattern for stepping is formed, but also for the design of rehabilitation intervention to restore lumbosacral circuit function in humans following a spinal cord injury

Common Patterns of Regional Brain Injury Detectable by Diffusion Tensor Imaging in Otherwise Normal-Appearing White Matter in Patients with Early Moderate to Severe Traumatic Brain Injury

Traumatic brain injury (TBI) alters the lives of millions of people every year. Although mortality rates have improved, attributed to better pre-hospital care and reduction of secondary injury in the critical care setting, improvements in functional outcomes post-TBI have been difficult to achieve. Diffusion-tensor imaging (DTI) allows detailed measurement of microstructural damage in regional brain tissue post-TBI, thus improving our understanding of the extent and severity of TBI. Twenty subjects were recruited from a neurological intensive care unit and compared to 18 healthy control subjects. Magnetic resonance imaging (MRI) scanning was performed on a 3.0-Tesla Siemens TIM Trio Scanner (Siemens Medical Solutions, Erlangen, Germany) including T1- and T2-weighted sequences and DTI. Images were processed using DTIStudio software. SAS (SAS Institute Inc., Cary, NC) was used for statistical analysis of group differences in 14 brain regions (25 regions of interests [ROIs]). Seventeen TBI subjects completed scanning. TBI and control subjects did not differ in age or sex. All TBI subjects had visible lesions on structural MRI. TBI subjects had seven brain regions (nine ROIs) that showed significant group differences on DTI metrics (fractional anisotropy, radial diffusion, or mean diffusion) compared to noninjured subjects, including the corpus callosum (genu and splenium), superior longitudinal fasciculus, internal capsule, right retrolenticular internal capsule, posterior corona radiata, and thalamus. However, 16 ROIs showed relatively normal DTI measures. Quantitative DTI demonstrates multiple areas of microstructual injury in specific normal-appearing white matter brain regions. DTI may be useful for assessing the extent of brain injury in patients with early moderate to severe TBI

Distribution and Localization of 5-HT1A Receptors in the Rat Lumbar Spinal Cord after Transection and Deafferentation

The serotonergic system is highly plastic, capable of adapting to changing afferent information in diverse mammalian systems. We hypothesized that removing supraspinal and/or peripheral input would play an important role in defining the distribution of one of the most prevalent serotonergic receptors, the 5-HT1A receptor (R), in the spinal cord. We investigated the distribution of this receptor in response to a complete thoracic (T7–T8) spinal cord transection (eliminating supraspinal input), or to spinal cord isolation (eliminating both supraspinal and peripheral input) in adult rats. Using two antibodies raised against either the second extracellular region (ECL2) or the third intracellular region (ICL3) of the 5-HT1AR, we compared the 5-HT1AR levels and distributions in specific laminae of the L3–L5 segments among the control, spinal cord–transected, and spinal cord–isolated groups. Each antibody labeled different populations of 5-HT1AR: ECL2 labeled receptors in the axon hillock, whereas ICL3 labeled receptors predominantly throughout the soma and proximal dendrites. Spinal cord transection increased the number of ECL2-positive cells in the medial region of laminae III–IV and lamina VII, and the mean length of the labeled axon hillocks in lamina IX. The number of ICL3-labeled cells was higher in lamina VII and in both the medial and lateral regions of lamina IX in the spinal cord–transected compared to the control group. In contrast, the length and number of ECL2-immunolabeled processes and ICL3-immunolabeled cells were similar in the spinal cord–isolated and control groups. Combined, these data demonstrate that the upregulation in 5-HT1AR that occurs with spinal cord transection alone is dependent on the presence of sensory input