Poststroke arm and hand paresis: should we target the cervical spinal cord?

Elvira Pirondini¹, Erick Carranza², Josep-Maria Balaguer³, Erynn Sorensen³, Douglas J Weber⁴, John W Krakauer⁵, Marco Capogrosso⁶

Affiliations

¹ Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: elvirap@pitt.edu.
² Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
³ Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA; Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA.
⁵ Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; The Santa Fe Institute, Santa Fe, CA, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA. Electronic address: jkrakau1@jhmi.edu.
⁶ Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: mcapo@pitt.edu.

PMID: 35659414
DOI: 10.1016/j.tins.2022.05.002

Review

Poststroke arm and hand paresis: should we target the cervical spinal cord?

Elvira Pirondini et al. Trends Neurosci. 2022 Aug.

. 2022 Aug;45(8):568-578.

doi: 10.1016/j.tins.2022.05.002. Epub 2022 May 31.

Authors

Elvira Pirondini¹, Erick Carranza², Josep-Maria Balaguer³, Erynn Sorensen³, Douglas J Weber⁴, John W Krakauer⁵, Marco Capogrosso⁶

Affiliations

¹ Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: elvirap@pitt.edu.
² Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
³ Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA; Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA.
⁵ Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; The Santa Fe Institute, Santa Fe, CA, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA. Electronic address: jkrakau1@jhmi.edu.
⁶ Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: mcapo@pitt.edu.

PMID: 35659414
DOI: 10.1016/j.tins.2022.05.002

Abstract

Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have limited efficacy at the level of impairment. To address this problem, we make the conceptual case for a new treatment approach. We first summarize current understanding of motor control deficits in the arm and hand after stroke and their shared physiological mechanisms with spinal cord injury (SCI). We then review studies of spinal cord stimulation (SCS) for recovery of locomotion after SCI, which provide convincing evidence for enhancement of residual corticospinal function. By extrapolation, we argue for using cervical SCS to restore upper limb motor control after stroke.

Keywords: hemiplegia; motor control; rehabilitation; spinal cord stimulation; therapeutic approach.

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Conflict of interest statement

Declaration of interests M.C. and D.J.W. are cofounders of Reach Neuro Inc., a spin-off developing SCS technologies for stroke. The other authors declare no conflicts of interests in relation to this work.

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Poststroke arm and hand paresis: should we target the cervical spinal cord?

Affiliations

Poststroke arm and hand paresis: should we target the cervical spinal cord?

Authors

Affiliations

Abstract

Conflict of interest statement

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Medical