Institute of Neuroscience, Henry Wellcome Building, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE2 4HH, UK. andrew.jackson@ ncl.ac.uk
Nat Rev Neurol. 2012 Dec;8(12):690-9. doi: 10.1038/nrneurol.2012.219. Epub 2012 Nov 13.
Regaining motor function is of high priority to patients with spinal cord injury (SCI). A variety of electronic devices that interface with the brain or spinal cord, which have applications in neural prosthetics and neurorehabilitation, are in development. Owing to our advancing understanding of activity-dependent synaptic plasticity, new technologies to monitor, decode and manipulate neural activity are being translated to patient populations, and have demonstrated clinical efficacy. Brain-machine interfaces that decode motor intentions from cortical signals are enabling patient-driven control of assistive devices such as computers and robotic prostheses, whereas electrical stimulation of the spinal cord and muscles can aid in retraining of motor circuits and improve residual capabilities in patients with SCI. Next-generation interfaces that combine recording and stimulating capabilities in so-called closed-loop devices will further extend the potential for neuroelectronic augmentation of injured motor circuits. Emerging evidence suggests that integration of closed-loop interfaces into intentional motor behaviours has therapeutic benefits that outlast the use of these devices as prostheses. In this Review, we summarize this evidence and propose that several known plasticity mechanisms, operating in a complementary manner, might underlie the therapeutic effects that are achieved by closing the loop between electronic devices and the nervous system.
恢复运动功能是脊髓损伤 (SCI) 患者的首要任务。目前正在开发各种与大脑或脊髓接口的电子设备,这些设备在神经假体和神经康复方面有应用。由于我们对活动依赖性突触可塑性的理解不断加深,用于监测、解码和操纵神经活动的新技术正在被应用于患者群体,并已显示出临床疗效。从皮层信号中解码运动意图的脑机接口使患者能够驱动辅助设备(如计算机和机器人假肢),而脊髓和肌肉的电刺激可以帮助重新训练运动回路,并提高 SCI 患者的残留能力。将记录和刺激功能结合在所谓的闭环设备中的下一代接口将进一步扩展神经电子增强受损运动回路的潜力。新出现的证据表明,将闭环接口整合到有意的运动行为中具有治疗益处,其效果超过了这些设备作为假体的使用时间。在这篇综述中,我们总结了这方面的证据,并提出了几种已知的可塑性机制,这些机制以互补的方式运作,可能是通过在电子设备和神经系统之间闭环来实现治疗效果的基础。