Talk Title: “Neurorehabilitation in the 21st Century; New Science, New Strategies, New Possibilities”
Abstract: Neurorehabilitation is among the most vibrant areas of biomedical research. Its main strategy has been skill-specific practice, which often fails to produce adequate recovery. Now, new recognition of central
nervous system (CNS) plasticity, new understanding of skills, and new technologies provide new strategies
that enhance the efficacy of practice. The substrate of a skill is a network of neurons and synapses that
extends from cortex to spinal cord and is now called a heksor. A heksor changes continually to maintain
the key features of its skill, the attributes that make the skill satisfactory. Muscle activity and kinematics
may change; key features are maintained. Heksors share neurons and synapses. Through their concurrent
changes, they keep the CNS in a negotiated equilibrium that enables each to maintain its skill. When CNS
damage occurs, the goal is to enable damaged heksors to repair themselves. Two new strategies enhance
the efficacy of skill-specific practice. One increases plasticity. A damaged heksor shapes the additional
plasticity through practice. The other targets beneficial plasticity to a critical site in a damaged heksor. This
improves practice, enabling the heksor to achieve wider beneficial plasticity. In animals and humans,
protocols that combine these strategies with practice enhance lasting recovery. The challenge is to
develop, optimize, and validate these combined protocols. Computational modeling can accelerate the
process. Controlled trials and comprehensive outcome assessments are essential. Pre-morbid factors and
physiological measures may identify biomarkers that can predict efficacy or guide patient-specific protocol
design. Many combined protocols will be noninvasive and suitable for home use.
References: doi:10.1113/JP283291 & doi:10.1177/15459683251412309
Bio: Dr. Wolpaw is a neurologist who has spent 50 years exploring spinal cord and brain plasticity in animals
and humans. His lab originated the protocol for operant conditioning of spinal stretch reflexes. Together
with Drs. Xiang Yang Chen, Jonathan Carp, and Yu Wang, he led extensive physiological and anatomical
studies that revealed the complex plasticity in spinal cord and brain associated with this ostensibly simple
learning. They showed that appropriate reflex conditioning improves walking in rats with spinal cord
injuries. With Dr. Aiko Thompson, they found that reflex conditioning improves walking in people with spinal
cord injury. This work has led to a new paradigm for how skilled behaviors are acquired and maintained in
what is now understood to be a ubiquitously plastic CNS. This new paradigm leads to new therapeutic
strategies that are proving successful in clinical studies. Dr. Wolpaw has also been deeply involved in
brain-computer interface (BCI) research. He and Dr. Dennis McFarland first showed the value of EEG
sensorimotor rhythms for BCI-based communication and control, including multidimensional control. Their
group oversaw the first multicenter trial of a BCI for independent home use by people with severe
disabilities. They developed and disseminated the general-purpose software platform BCI2000, which has
supported nearly 3,000 peer-reviewed studies world-wide. They organized the first four international BCI
conferences, contributed greatly to the first BCI textbook (Wolpaw & Wolpaw 2012), and are now involved
in editing the second edition. Dr. Wolpaw’s research has been supported for over 40 years by NIH, the VA,
DARPA, and private foundations. He is Director of the NIBIB/NIH-funded National Center for Adaptive
Neurotechnologies (NCAN) and Professor of Biomedical Sciences at the State University of New York. His
group’s work has been described in many papers, invited presentations, and lectureships, and recognized
by national and international awards. Many students and postdocs have participated and received
appropriate recognition. He has contributed to the national and international scientific communities by
serving on many advisory committees and review panels and was the first president of the BCI Society.