Developing personalized imaging biomarkers of neuroplasticity
Funded in: 2019, 2020, 2021
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Problem: How to use innate capability to reestablish functional links between the brain and body?
Target: Monitoring neuroplasticity in exoskeleton assisted walking training
Goal: Development of objective biomarkers to evaluate therapeutic strategies
Most people with spinal cord injury (SCI) retain neural connections through the injury site. Through neural mechanisms, called neuroplasticity, which remain poorly understood at the neural circuit level, the central nervous system (CNS) has the innate capability to reestablish functional links between the brain and body through these spared spinal fibers. Rehabilitation strives to facilitate this innate neuroplasticity to achieve functional recovery. For example, assisted walking rehabilitation to persons with SCI increases muscle mass, improves cardiovascular function, decreases spasticity and pain, and preserve bone density. Advances in robotic technology have produced powered exoskeletons that assist persons with SCI to walk, which potentially opens access to routine walking and the associated benefits to persons with paraplegia and low to mid tetraplegia with any level of completeness. Preliminary studies conducted at Icahn School of Medicine at Mount Sinai have demonstrated that some persons with paraplegia or tetraplegia can walk for up to an hour. The safety and feasibility of using these devices to assist them to walk has been demonstrated in these preliminary studies. These devices have also recently been implemented in SCI inpatient rehabilitation settings.
Leveraging these initial experiences of exoskeleton assisted walking (EAW) training in SCI, this imaging study aims to take detailed pictures of the structure and function of the brain of people with SCI shortly after their injury using advanced magnetic resonance imaging (MRI) techniques. The MRI scans will be performed before and after their EAW training during inpatient stay in the hospital, as well as at one-year follow-up. Behavioral and neurophysiology testing will also be measured at each time point to assess leg motor function. The results from this study will characterize neuroplasticity-induced CNS structural and functional changes following inpatient EAW training. A comprehensive neuroimaging approach proposed will establish a neuroanatomically rigorous foundation for further development of objective biomarkers to evaluate therapeutic strategies and predict recovery in SCI.