Sensorimotor Cortical Activation in Patients With Cervical Spinal Cord Injury With Persisting Paralysis

Background. It is well documented that cortical sensorimotor representations are altered following nervous system pathology. However, little is known about these representations over time and, more specifically, in paralyzed individuals. Objective . To investigate the temporal changes in sensorimotor cortical activation in paralyzed individuals following spinal cord injury (SCI). Methods. Functional MRI (fMRI) was used to study 4 tetraplegic individuals repeatedly over the first year following traumatic SCI as well as 7 healthy individuals, 3 repeatedly. During fMRI, controls performed ankle movements, and patients attempted them. Standard clinical measures of SCI were used to assess movement ability. Results. Shortly after SCI, activation within the primary motor cortex (M1) was present at levels similar to those in controls. Extensive associated cortical sensorimotor activation, not seen in controls, was present. Over time, as paralysis persisted, activation in M1 was significantly reduced and progressively decreased in associated cortical sensorimotor areas. No session-specific dependence in M1 or associated sensorimotor cortical activation was found in healthy individuals. Conclusions. These findings provide the first report of the temporal evolution of cortical sensorimotor fMRI activation following traumatic SCI in humans who do not recover movement. Coupled with findings in patients who recover post-SCI, our results suggest an association between motor task—related fMRI activation and degree of motor function postinjury. Understanding the time course of plasticity and the relationship between cortical sensorimotor activation and motor ability following SCI could allow assessment of rehabilitation potential, monitoring of therapeutic efficacy, and improvement in therapeutic intervention along the course of recovery.

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Dynamic Reorganization of Motor Networks During Recovery from Partial Spinal Cord Injury in Monkeys

Cerebral Cortex ◽

10.1093/cercor/bhy172 ◽

2018 ◽

Vol 29 (7) ◽

pp. 3059-3073 ◽

Cited By ~ 6

Author(s):

Zenas C Chao ◽

Masahiro Sawada ◽

Tadashi Isa ◽

Yukio Nishimura

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Recovery ◽

Time Course ◽

Primary Motor Cortex ◽

Premotor Cortex ◽

Motor Preparation ◽

Compensatory Mechanism ◽

Primate Model ◽

Cord Injury

Abstract After spinal cord injury (SCI), the motor-related cortical areas can be a potential substrate for functional recovery in addition to the spinal cord. However, a dynamic description of how motor cortical circuits reorganize after SCI is lacking. Here, we captured the comprehensive dynamics of motor networks across SCI in a nonhuman primate model. Using electrocorticography over the sensorimotor areas in monkeys, we collected broadband neuronal signals during a reaching-and-grasping task at different stages of recovery of dexterous finger movements after a partial SCI at the cervical levels. We identified two distinct network dynamics: grasping-related intrahemispheric interactions from the contralesional premotor cortex (PM) to the contralesional primary motor cortex (M1) in the high-γ band (>70 Hz), and motor-preparation-related interhemispheric interactions from the contralesional to ipsilesional PM in the α and low-β bands (10–15 Hz). The strengths of these networks correlated to the time course of behavioral recovery. The grasping-related network showed enhanced activation immediately after the injury, but gradually returned to normal while the strength of the motor-preparation-related network gradually increased. Our findings suggest a cortical compensatory mechanism after SCI, where two interdependent motor networks redirect activity from the contralesional hemisphere to the other hemisphere to facilitate functional recovery.

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Transcranial direct current stimulation (tDCS) of the primary motor cortex and robot-assisted arm training in chronic incomplete cervical spinal cord injury: A proof of concept sham-randomized clinical study

Neurorehabilitation ◽

10.3233/nre-161371 ◽

2016 ◽

Vol 39 (3) ◽

pp. 401-411 ◽

Cited By ~ 18

Author(s):

Nuray Yozbatiran ◽

Zafer Keser ◽

Matthew Davis ◽

Argyrios Stampas ◽

Marcia. K. O’Malley ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Study ◽

Motor Cortex ◽

Primary Motor Cortex ◽

Cervical Spinal Cord ◽

Proof Of Concept ◽

Robot Assisted ◽

Randomized Clinical Study ◽

Cord Injury

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Inversion Table Fall Injury, the Phantom Menace: Three Case Reports on Cervical Spinal Cord Injury

Healthcare ◽

10.3390/healthcare9050492 ◽

2021 ◽

Vol 9 (5) ◽

pp. 492

Author(s):

Seung-Hwan Jung ◽

Jong-Moon Hwang ◽

Chul-Hyun Kim

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Case Reports ◽

Neurological Sequelae ◽

Fall Injuries ◽

Cord Injury ◽

Spine Injuries ◽

Exercise Environment ◽

Over Time

Background: An inversion device, which is used to suspend one’s body and perform traction therapy, was introduced as an inversion table under the name of “Geokkuri” in South Korea. Fall injuries while hanging on inversion tables are among the most devastating spine injuries, as the likelihood of severe neurological sequelae such as tetraplegia increases. However, its enormous danger has been overlooked and this devastating injury has become a common clinical entity over time. The limited number of studies reported imply the lack of interest of researchers in these injuries. We reviewed three cases of spinal cord injury sustained on inversion tables in different environments and report the potential danger associated with the use of inversion tables to facilitate a safer exercise environment.

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Pharyngeal Dysphagia in Individuals With Cervical Spinal Cord Injury: A Prospective Observational Cohort Study

Topics in Spinal Cord Injury Rehabilitation ◽

10.1310/sci2504-322 ◽

2019 ◽

Vol 25 (4) ◽

pp. 322-330

Author(s):

Kazuko Shem ◽

Joseph Wong ◽

Ben Dirlikov ◽

Kathleen Castillo

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Cohort Study ◽

Time Course ◽

Cervical Spinal Cord ◽

Inpatient Rehabilitation ◽

Rehabilitation Unit ◽

Cord Injury

Objectives: To identify and describe the types and time course of dysphagia following cervical spinal cord injury (SCI). Methods: This was a prospective cohort study conducted in an SCI inpatient rehabilitation unit. Seventy-six individuals with SCI were enrolled. Inclusion criteria were age 18 years or older, admitted into SCI inpatient rehabilitation unit, and medically stable for participation in bedside swallow evaluation (BSE) and videofluoroscopic swallow study (VFSS). All participants first underwent a BSE, of whom 33 completed a VFSS. A follow-up BSE was conducted on individuals who tested positive on the initial BSE and continued to show signs of dysphagia. Diagnosis and type of dysphagia as well risk factors were collected. Results: Twenty-three out of 76 individuals with cervical SCI were diagnosed with dysphagia using the BSE. All participants with positive BSE and VFSS had pharyngeal dysfunction. For participants with a positive initial BSE and persisting dysphagia ( n = 14), a follow-up BSE demonstrated resolution within 34 days. Risk factors associated with dysphagia were older age, nasogastric tube, invasive mechanical ventilation, tracheostomy, and pneumonia. Posterior spinal surgery was associated with a decreased risk of dysphagia. Conclusion: Dysphagia was present in 30% of individuals based on the initial BSE. All individuals with dysphagia demonstrated pharyngeal phase dysfunction on the VFSS. No participants experiencing dysphagia were missed on the BSE as confirmed by VFSS. In the subset of individuals who received a follow-up BSE, the time course of resolution of dysphagia was at most 34 days from initial BSE.

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Alterations in Motor Cortical Representation of Muscles Following Incomplete Spinal Cord Injury in Humans

Brain Sciences ◽

10.3390/brainsci8120225 ◽

2018 ◽

Vol 8 (12) ◽

pp. 225 ◽

Cited By ~ 1

Author(s):

Hunter Fassett ◽

Claudia Turco ◽

Jenin El-Sayes ◽

Aimee Nelson

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Primary Motor Cortex ◽

Cervical Spinal Cord ◽

Incomplete Spinal Cord Injury ◽

Abductor Pollicis Brevis ◽

Functional Deficits ◽

Resting Motor Threshold ◽

Cord Injury ◽

Arm Muscles

(1) Background: The primary motor cortex (M1) experiences reorganization following spinal cord injury (SCI). However, there is a paucity of research comparing bilateral M1 organization in SCI and questions remain to be answered. We explored the presence of somatotopy within the M1 representation of arm muscles, and determined whether anatomical shifts in these representations occur, and investigated the symmetry in organization between the two hemispheres.; (2) Methods: Transcranial magnetic stimulation (TMS) was used to map the representation of the biceps, flexor carpi radialis and abductor pollicis brevis (APB) bilaterally in nine individuals with chronic incomplete cervical spinal cord injury and nine aged- and handed-matched uninjured controls. TMS was delivered over a 6 × 5 point grid that encompassed M1 using an intensity specific to the resting motor threshold for each muscle tested.; (3) Results: Results indicate that, compared to controls, muscle representations in SCI are shifted medially but preserve a general somatotopic arrangement, and that territory dedicated to the APB muscle is greater.; (4) Conclusions: These findings demonstrate differences in the organization of M1 between able-bodied controls and those with incomplete cervical SCI. This altered organization may have future implications in understanding the functional deficits observed in SCI and rehabilitation techniques aimed at restoring function.

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Time Course of Respiratory Dysfunction and Motor Paralysis for 12 Weeks in Cervical Spinal Cord Injury without Bone Injury

Spine Surgery and Related Research ◽

10.22603/ssrr.2018-0009 ◽

2019 ◽

Vol 3 (1) ◽

pp. 37-42

Author(s):

Chikara Ushiku ◽

Kota Suda ◽

Satoko Matsumoto ◽

Miki Komatsu ◽

Masahiko Takahata ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Time Course ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Respiratory Dysfunction ◽

Bone Injury ◽

Motor Paralysis ◽

Cord Injury

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Reduced Functional Recovery by Delaying Motor Training After Spinal Cord Injury

Journal of Neurophysiology ◽

10.1152/jn.00970.2004 ◽

2005 ◽

Vol 94 (1) ◽

pp. 255-264 ◽

Cited By ~ 49

Author(s):

B. A. Norrie ◽

J. M. Nevett-Duchcherer ◽

M. A. Gorassini

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Performance Improvement ◽

Error Rate ◽

Time Course ◽

Motor Task ◽

Lesion Size ◽

Motor Training ◽

Trained Group ◽

Cord Injury

The purpose of this study was to examine if a delay in rehabilitative motor training after spinal cord injury affects functional motor recovery. We studied a skilled motor task in which rats traversed a raised horizontal ladder and we quantified errors in accurate stepping, i.e., foot slips between rungs. After lesions to the dorsal quadrant of the thoracic (T8) spinal cord that aimed to unilaterally sever the corticospinal and rubrospinal tracts, rats were re-trained to walk across the ladder, either immediately after injury or after a 3-mo delay. Before training, the error rate in accurate stepping of the affected hindlimb was similar in the immediately (69.4 ± 5.3%) and delay (62.7 ± 4.1%; means ± SE)-trained animals (not significantly different), suggesting that accurate stepping did not improve spontaneously if rats were not exposed to the ladder. After a 3-wk course of training (30 runs across the ladder per day, 5 day/wk), improvements in accurate stepping performance were greater if training was implemented immediately after injury. On average, immediately trained animals improved stepping performance by 61.5 ± 28.2%, whereas the delay trained group improved by only 34.9 ± 28.8% (significantly different). The degree of damage to the corticospinal and rubrospinal tracts was very similar in the two groups of animals, indicating that differences in lesion size did not contribute to the differences in performance improvement. Animals with large lesions to the corticospinal and rubrospinal tracts (>70%) displayed poor recovery from training (especially for delay-trained animals), suggesting that these two pathways were important in mediating improvements in accurate stepping. In addition, recovery of stepping-like reflexes appeared not to contribute to the recovery of accurate stepping given that the time course of reflex recovery was not related to the time course of recovery of accurate stepping. We conclude that training of a skilled motor task that relies on descending control is more beneficial when initiated immediately after a partial spinal cord injury.

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