Post-infarct cortical plasticity and behavioral recovery using concurrent cortical stimulation and rehabilitative training: a feasibility study in primates.
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.
Plautz
Erik J
EJ
Department of Molecular and Integrative Physiology, Smith Mental Retardation Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA. eplautz@kumc.edu
Barbay
Scott
S
Frost
Shawn B
SB
Friel
Kathleen M
KM
Dancause
Numa
N
Zoubina
Elena V
EV
Stowe
Ann M
AM
Quaney
Barbara M
BM
Nudo
Randolph J
RJ
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