Crania trainee’s research opens the door for potential new stroke rehab treatments

Dr. Gustavo Balbinot recently published a paper which deepens the understanding of upper extremity recovery for stroke patients

CRANIA Post Doctoral Researcher Dr. Gustavo Balbinot recently published a paper in Stroke that reveals the mechanisms by which enriched rehabilitation enhances recovery from severe strokes in animal models. 

Enriched rehabilitation is the delivery of intense and targeted rehabilitation in a rich environment. This may involve social interaction, stimulating and interactive environments, and activities tailored to the patient’s preferences.

Dr. Balbinot is a member of CRANIA scientist Dr. Michael Fehlings’ laboratory where he works to promote stem cell-mediated true recovery of movements and functional graft integration following cervical spinal cord injury through intense rehabilitation.

We caught up with Dr. Balbinot to discuss the implications of his paper.

Why did you conduct this study? 

Understanding how rehabilitation restores upper extremity (shoulder, arm, and hand) function in stroke patients is crucial to not only optimizing its effects but also discovering new routes for treatments like neuromodulation.

 What does the results of this paper mean for stroke patients? 

Although enriched rehabilitation has been effective in laboratory settings we have been unable to translate that success into clinical practice. This paper could assist us with that translation which could improve stroke survivors’ ability to complete tasks that rely on upper extremity function.

How will the findings of impact future stroke rehabilitation research? 

This means more advocacy for the translation of this enhanced form of rehabilitation to the clinic – it is all about the quality and intensity of the rehabilitation delivered.

In a bolder and exciting stream, we can reflect on how the findings of the study can indicate novel targets for functional neurosurgery in the future. For example, we found that the activity of midbrain circuits is tightly linked to the upper extremity recovery seen after rehabilitation.

In the future, the combination of targeted rehabilitation with deep-brain stimulation of these newly found sites in the ipsilateral midbrain may boost recovery of the shoulder, arm and hand after severe strokes.

What methods did you use to reach this conclusion? 

We used a method to induce very large strokes in animal models, both in cortical and subcortical areas. After the lesion, almost nothing was left in the motor cortex controlling forelimb movements. Using electrophysiology to map the cortical plasticity induced by rehabilitation, we observed an expansion of the cortical areas controlling hand function.

We also used immunohistochemistry to observe the brain circuits which were most activated with rehabilitation. Using this approach, we were able to unveil a cluster of cells in the midbrain displaying increased use-dependent activity.

The activity of this small group of cells was directly related to the restitution of upper extremity movements. In other words, rehabilitation improves upper extremity movements after severe strokes by activating this small population of cells to help with the weak descending cortical commands.

What are your next steps? 

I am currently applying for faculty positions to continue this work. My future laboratory will test if deep brain stimulation of this newly discovered midbrain circuit can enhance upper extremity function after severe strokes. I am planning to apply closed-loop neuromodulation strategies during rehabilitation- while animals pull a lever or simply by providing additional input to these cells during rehabilitation.

In the meantime, I am a postdoctoral researcher working on the combination of rehabilitation and stem cell transplants to treat upper extremity impairments seen after spinal cord injuries.

You can read the full paper here.