The Texarkana Gazette is the premier source for local news and sports in Texarkana and the surrounding Arklatex areas. Eleven leading Republican candidates for president gathered at the Ronald Reagan library in California for the second GOP debate on Wednesday night. Bystanders to Genocide. The author's exclusive interviews with scores of the participants in the decision-making, together with her analysis of newly declassified. Infowars.com the home of the #1 Internet News Show in the World. Long- Term Training with a Brain- Machine Interface- Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients : Scientific Reports. As far as we can tell, this is the first clinical study to report the occurrence of consistent, reproducible, and significant partial neurological recovery in multiple chronic SCI patients. Tech news and expert opinion from The Telegraph's technology team. Read articles and watch video on the tech giants and innovative startups. Iraq War; Part of the War on Terror: Clockwise from top: U.S. This partial recovery was manifested by improvements in both somatic sensations and voluntary motor control, below the level of the spinal cord lesions. This sensorimotor improvement was also paralleled by autonomic improvements, such as bowel function. Moreover, this is also the first report demonstrating partial clinical neurological improvements in SCI patients subjected to long- term training with a BMI- based gait protocol. Up to now, all previous clinical reports involving BMIs focused on decoding and control strategies of artificial prosthetic devices using the subject. In these studies, patients were able to control the movements of artificial devices using their brain activity. Yet, none of these studies described any type of neurological recovery as a consequence of BMI training. A total of eight chronic SCI patients were trained over the course of 1. This protocol required that patients brain- control both virtual and mechanical actuators while receiving rich visuo- tactile feedback, aimed at restoring autonomous locomotion. Common to all periods of the WA- NR was the employment of both: (1) an EEG- based BMI, which required patients to produce motor imagery related to walking, was responsible for controlling the initiation of a series of lower limb motor behaviors (standing, walking and kicking a soccer ball), and (2) a multi- channel sensory substitution (remapping)4. Such real- time tactile/proprioceptive feedback of autonomous bipedal walking was combined with visual feedback (3) during physical training using a robotic Body Weight Support (BWS) system on a treadmill (Lokomat. Pro), an overground BWS system (Zero. G), and a robotic exoskeleton. For all our patients, clinical diagnosis of total (ASIA A) or partial (ASIA B) paralysis was confirmed, over multiple years, by routine clinical neurological examination, performed by different neurologists belonging to the clinical staff of the hospital in which these patients were followed. Previously, these patients were enrolled in a traditional physical rehabilitation program that mainly aimed at increasing independence in daily living activities, while seated in a wheelchair. Two patients (P2 and P6) had routine training in a standing orthostatic position (stand in table device). Six patients (P1, P3, P4, P5, P6, P7) had walking training using parallel bars or using a walker. None of these subjects exhibited any level of sensory or motor improvement or recovery in the many years they were followed prior to enrollment in our study. At the onset of our protocol, the ASIA status of all eight patients was confirmed by our own initial neurological evaluation. That further supports our contention that the neurological improvement observed here resulted only from the new WA- NR introduced in the present study. Overall, all eight patients involved in the study experienced a significant improvement in tactile, proprioceptive, vibration, and nociceptive (but not temperature) perception. Such improvement was already noticeable after 7 months, but reached its peak at the 1. On average, such a sensory recovery spanned multiple dermatomes below the SCI level, being more vigorous and consistent for altered nociceptive perception (more than five dermatomes on average) than for tactile, vibration or proprioception (between one- two dermatomes). Thus, as a rule, the pattern of sensory recovery documented in all eight patients indicated a larger effect mediated by small myelinated or non- myelinated fibers, which normally convey nociceptive and high- threshold tactile information, than through the large myelinated fibers that normally mediate fine tactile discrimination and proprioception. This suggests that axons running through the spinothalamic tract were the main mediators of this somatosensory recovery. As such, this observation may imply that the spinothalamic tract may be more resistant to the initial SCI and/or remain more amenable than dorsal column- medial lemniscal fibers to underlie plastic recovery, even many years after a spinal cord lesion. Interestingly, this is consistent with previous studies in which somatosensory plasticity was documented in animals. It is important to mention that, although we have not documented any significant recovery in thermo sensation, this negative result may reflect primarily the lack of specificity of the clinical method employed to evaluate temperature sensing. Explore the world of iPad. Check out iPad Pro, now in two sizes, iPad Air 2, and iPad mini. Visit the Apple site to learn, buy, and get support. The association also began running a new commercial characterizing Mrs. Clinton as “one of the wealthiest women in politics” and calling her a. Toondoo lets you create comic strips and cartoons easily with just a few clicks, drags and drops. Get the latest Chicago local news and US & World news. See recent updates on politics, sports, health, tech, and weird news on NBC Chicago. In the future, we intend to repeat this analysis using a more sensitive technique. In addition to significant sensory recovery, we also observed widespread improvement in voluntary muscle control below the level of SCI, even in patients clinically classified as having a complete SCI. Such a recovery in motor function, which progressed from proximal to distal muscles over time (Fig. A) and was more intense at the level of anti- gravitation (extensor) and flexor muscles involved in hip movements . B,C), and direct measurements of L- force generated by patients (Table 2). Such a pattern of motor recovery suggests mediation by intact fibers of the vestibulo- spinal tract (extensor muscles) that run in the ventrolateral portion of the spinal cord, next to the spino- thalamic tract. Motor recovery at flexor muscles suggests that some fibers of the rubro- spinal tract may have also remained intact in some of our patients. Altogether, the partial neurological improvement observed meant that 5. ASIA A to C and one from ASIA B to C) in less than a year of training with our neurorehabilitation protocol. Prior to the present study, the literature contains only a single case report indicating that a patient with tetraplegia was reclassified from ASIA A to ASIA C after 3 years of being subjected to functional electrical stimulation bicycle therapy. As far as we can tell, no independent study has reproduced this result so far. Heretofore, partial neurological recovery after an SCI has been mainly reported in subacute incomplete SCI patients. For instance, repetitive transcranial magnetic stimulation (r. TMS), applied over the arm and leg representations of the primary somatosensory cortex of incomplete SCI patients, led to limited and variable improvements in sensory and motor functions. TMS intensities were employed. Recently, the use of epidural stimulation at the lumbosacral level, combined with standing and stepping training, has allowed chronic ASIA A and B SCI patients to voluntary control paralyzed leg muscles. However, such motor control could only occur in the presence of the epidural stimulation. In other words, these patients did not recover the ability to control their muscles without the assistive device. As such, none of the four subjects described by Angeli et al. ASIA classification. Interestingly, the study methodology also included a pre- implantation phase with extensive locomotor training (8. Neurological evaluations, neurophysiological measurements and ASIA exams, were performed before and after assisted gait training and implantation phases and no significant neurological recovery was observed suggesting that an isolated gait trainer with a BWS system on a treadmill does not produce meaningful neurological recovery in complete SCI patients. Moreover, no neurological recovery was described in a recent case report of a single SCI patient who was able to walk again using a BMI gait protocol that employed functional electrical stimulation of the lower limbs. Since our patients suffered their spinal cord lesions many years before enrolling in our protocol, the likelihood that the sensorimotor improvements observed here were due to spontaneous recovery can be basically ruled out. Indeed, a review by the International Campaign for Cures of Spinal Cord Injury Paralysis. SCI, based on pharmaceutical clinical trials that focused on acute neuroprotection in SCI6. SCI. Small residual clinical improvements can persist for up to 1. Thus, 1 year after an SCI, 8. ASIA A cases remain A, about 1. ASIA B and about 1. ASIA C. A survey of 9. SCI patients showed that, between 1 and 5 years after the lesion, a conversion from ASIA A to a higher grade occurs in only 6. B, 1. 0. 5% to C and 1. D)6. 3. Since some of the patients that moved from ASIA A to ASIA C in the present study had suffered their SCI more than a decade ago, it is highly unlikely that spontaneous recovery accounts for our findings. In complete motor lesions (ASIA A and B), the majority of functional recovery occurs within the ZPP, following a craniocaudal sequence. Recovery within the ZPP appears to be due to both CNS and peripheral plasticity, while recovery beyond the ZPP would probably demand some CNS repair, likely involving axon regeneration. Concerning partial motor recovery, the same review indicates that it likely occurs in myotomes with sensory preservation. Overall, the chances of a recovery of more than two spinal levels below the initial ASIA level are very small. Our findings revealed that motor recovery was indeed more significant within the ZPP. However, we also observed patients. Although these findings are not directly comparable to ours, by the differences in patient samples, the fact that we were able to document a 5. ASIA classification after many years of SCI raises the hypothesis that further motor clinical improvement could be seen with longer training. The clear functional significance of the sensorimotor recovery observed here was further demonstrated by both the major overall improvement in the patients. In other words, the observed partial sensorimotor recovery was translated into a meaningful improvement in the patients? Kakulas et al. 1.
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