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Relationship between structural brainstem and brain plasticity and lower-limb training in spinal cord injury: A longitudinal pilot study

Villiger, M; Grabher, P; Hepp-Reymond, M-C; Kiper, D; Curt, A; Bolliger, M; Hotz-Boendermaker, S; ... Freund, P; + view all (2015) Relationship between structural brainstem and brain plasticity and lower-limb training in spinal cord injury: A longitudinal pilot study. Frontiers in Human Neuroscience , 9 , Article 254. 10.3389/fnhum.2015.00254. Green open access

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Abstract

Rehabilitative training has shown to improve significantly motor outcomes and functional walking capacity in patients with incomplete spinal cord injury (iSCI). However, whether performance improvements during rehabilitation relate to brain plasticity or whether it is based on functional adaptation of movement strategies remain uncertain. This study assessed training improvement-induced structural brain plasticity in chronic iSCI patients using longitudinal MRI. We used tensor-based morphometry (TBM) to analyze longitudinal brain volume changes associated with intensive virtual reality (VR)-augmented lower limb training in nine traumatic iSCI patients. The MRI data was acquired before and after a 4-week training period (16–20 training sessions). Before training, voxel-based morphometry (VBM) and voxel-based cortical thickness (VBCT) assessed baseline morphometric differences in nine iSCI patients compared to 14 healthy controls. The intense VR-augmented training of limb control improved significantly balance, walking speed, ambulation, and muscle strength in patients. Retention of clinical improvements was confirmed by the 3–4 months follow-up. In patients relative to controls, VBM revealed reductions of white matter volume within the brainstem and cerebellum and VBCT showed cortical thinning in the primary motor cortex. Over time, TBM revealed significant improvement-induced volume increases in the left middle temporal and occipital gyrus, left temporal pole and fusiform gyrus, both hippocampi, cerebellum, corpus callosum, and brainstem in iSCI patients. This study demonstrates structural plasticity at the cortical and brainstem level as a consequence of VR-augmented training in iSCI patients. These structural changes may serve as neuroimaging biomarkers of VR-augmented lower limb neurorehabilitation in addition to performance measures to detect improvements in rehabilitative training.

Type: Article
Title: Relationship between structural brainstem and brain plasticity and lower-limb training in spinal cord injury: A longitudinal pilot study
Open access status: An open access version is available from UCL Discovery
DOI: 10.3389/fnhum.2015.00254
Publisher version: http://dx.doi.org/10.3389/fnhum.2015.00254
Language: English
Additional information: © 2015 Villiger, Grabher, Hepp-Reymond, Kiper, Curt, Bolliger, Hotz-Boendermaker, Kollias, Eng and Freund. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution and reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Keywords: Lower limb, Spinal cord injury, Structural plasticity, Tensor-based morphometry, Virtual reality-augmented neurorehabilitation, Voxel-based morphometry
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
URI: https://discovery.ucl.ac.uk/id/eprint/1471642
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