title: Post-infarct cortical plasticity and behavioral recovery using concurrent cortical stimulation and rehabilitative training: a feasibility study in primates.
abstract: Stroke is often characterized by incomplete recovery and chronic motor impairments. A nonhuman primate model of cortical ischemia was used to evaluate the feasibility of using device-assisted cortical stimulation combined with rehabilitative training to enhance behavioral recovery and cortical plasticity. Following pre-infarct training on a unimanual motor task, maps of movement representations in primary motor cortex were derived. Then, an ischemic infarct was produced which destroyed the hand representation. Several weeks later, a second cortical map was derived to guide implantation of a surface electrode over peri-infarct motor cortex. After several months of spontaneous recovery, monkeys underwent subthreshold electrical stimulation combined with rehabilitative training for several weeks. Post-therapy behavioral performance was tracked for several additional months. A third cortical map was derived several weeks post-therapy to examine changes in motor representations. Monkeys showed significant improvements in motor performance (success, speed, and efficiency) following therapy, which persisted for several months. Cortical mapping revealed large-scale emergence of new hand representations in peri-infarct motor cortex, primarily in cortical tissue underlying the electrode. Results support the feasibility of using a therapy approach combining peri-infarct electrical stimulation with rehabilitative training to alleviate chronic motor deficits and promote recovery from cortical ischemic injury.
authors.affiliation: Department of Molecular and Integrative Physiology, Smith Mental Retardation Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA. eplautz@kumc.edu
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Plautz
authors.forename: Scott
authors.initials: S
authors.lastname: Barbay
authors.forename: Shawn B
authors.initials: SB
authors.lastname: Frost
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Friel
authors.forename: Numa
authors.initials: N
authors.lastname: Dancause
authors.forename: Elena V
authors.initials: EV
authors.lastname: Zoubina
authors.forename: Ann M
authors.initials: AM
authors.lastname: Stowe
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Quaney
authors.forename: Randolph J
authors.initials: RJ
authors.lastname: Nudo
mesh_terms: D000818:Animals; D001522:Behavior, Animal; D002545:Brain Ischemia / Q000150:complications; D001931:Brain Mapping; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology / Q000534:rehabilitation / Q000628:therapy*; D004195:Disease Models, Animal; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D004576:Electromyography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000502:physiology; D010805:Physical Conditioning, Animal; D011597:Psychomotor Performance / Q000502:physiology; D020127:Recovery of Function; D012453:Saimiri; D013997:Time Factors