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Cortical Stimulation-Induced Structural Plasticity and Functional Recovery After Brain Damage

In: Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Boca Raton (FL): CRC Press/Taylor & Francis; 2015. Chapter 43.

Cortical Stimulation-Induced Structural Plasticity and Functional Recovery After Brain Damage

DeAnna L Adkins.


Experimental treatments for traumatic brain injury (TBI) often focus on reducing cognitive disorders; however, motor impairments are also common following TBI, but have received less attention. Over the last several decades, there has been growing support for the use of electric or magnetic stimulation of the cortex (CS), or cortical pathways, to enhance recovery of function after other brain injuries, such as stroke. CS studies in stroke patients and in animal models provide compelling evidence that CS can alter brain plasticity and that this likely supports the improved functional motor recovery. While there are only a few studies directly examining the use of CS following TBI, these studies suggest that CS is safe and may also be effective in experimental TBI models. This chapter will cover the evidence supporting the use of CS following brain damage as a means to drive functional recovery and that it can result in structural and functional plasticity of remaining brain areas following injury. TBI commonly results in physical, cognitive, emotional, and behavioral impairments (Hellawell et al., 1999; Vogenthaler, 1987). The Centers for Disease Control and Prevention has estimated that as a result of TBI, at least 5.3 million people in the United States need long-term or life-long aid in performing activities of daily living (Thurman et al., 1999). Many experimental treatments for TBI focus on neuroprotection during the acute period after injury. Although this approach holds promise, many people may either miss the small treatment window or may not fully benefit from it. Rehabilitative therapies and treatments that target the postacute period provide a larger window of opportunity. Although many experimental and clinical studies focus mainly on improving cognitive disorders in this period (Constantinidou et al., 2008; Goldstein, 1990; Griesbach et al., 2004; Kline et al., 2002; Mateer and Sira, 2006; Prins et al., 2003), TBI also frequently results in motor impairments (Langlois et al., 2006; Marshall et al., 2007; Pickett et al., 2007; Teasell et al., 2007; Walker and Pickett, 2007) and these have received less research attention. Rodent models of motor rehabilitative training are relatively well-developed, focusing on animal models of TBI with motor impairments provides a great opportunity to investigate the effects of rehabilitative training on behavioral recovery and the ability for adjuvant treatments, such as cortical stimulation, to enhance training efficacy and drive supportive brain reorganization/plasticity. Over the past several decades, cortical electrical and magnetic stimulation of the cortex, or cortical pathways, has gained support as a promising therapeutic tool to enhance recovery of function after brain damage and enhance structural and functional brain plasticity. Motor impairments are common but understudied in TBI patients. However, there is a wealth of both human and animal data supporting the efficacy of CS over the motor cortex as a safe and effective tool to improve motor skill learning in intact individuals and as a treatment to improve motor function after brain damage. This chapter will cover the evidence supporting that motor rehabilitation can drive functional recovery and that CS can further enhance behavioral recovery and result in structural and function plasticity of remaining brain areas after brain damage. Although there are only a few studies that have explored the use of brain stimulation techniques after TBI, there is a rapidly expanding body of evidence from stroke recovery research that lays the foundation for the safety and efficacy of using CS as an adjunctive treatment after TBI.

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