Existing strategies to enhance motor function following brain and spinal cord injury are suboptimal, leaving patients with considerable disability. A greater understanding of motor recovery, refinement of existing strategies, and development of new methods is warranted. Our laboratory uses established and developing technologies to understand control of human voluntary movement, and functional recovery following neurological damage. Available evidence suggests that motor training can improve function, greater than spontaneous recovery alone. As well, the mechanisms underlying brain plasticity can be specifically targeted, using noninvasive brain stimulation and pharmacologic intervention.
We are presently conducting a trial of controlled physical rehabilitation (robotics) combined with non-invasive brain stimulation of motor areas, to augment motor recovery following stroke and spinal cord injury. The robotic movement devices represent the most sophisticated interactive rehabilitation systems available, and are additionally appealing for their ability to quantify various aspects of movement. Transcranial Magnetic Stimulation (TMS) is an accepted tool to probe changes in the brain that might occur with training. Both TMS (applied repetitively, rTMS) and Transcranial Direct Current Stimulation (tDCS), are promising neuromodulation methods that can independently lead to transient improvements in motor behavior. We are investigating if rTMS or tDCS might enhance the practice-dependent plasticity resulting from behavioral training, and thus promote long-lasting improvements in function.