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Neurotherapeutic technologies represent a diverse group of very promising treatment approaches with a common purpose of improving neurological function. Decades of basic science research has paved the path for these novel technologies that have the potential to transform the lives of patients with neurological diseases. A key goal is to minimize the consequences of lost abilities, whether it is motor, sensory, or cognitive. A common objective is to also harness the inherent plasticity of the nervous system, regardless of age, and even in the face of a degenerative process.
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The technologies described below are the culmination of both an increased understanding of neural plasticity mechanisms in both the intact and the injured nervous system as well as advances in technology and computational power. There has been important progress in understanding neural plasticity at the level of the microscale (e.g., cellular and molecular processes), the mesoscale (e.g., between distinct cortical and subcortical areas), and the macroscale (e.g., at the level of brain networks). While it is also clear that there may be fundamental limits on plasticity (e.g., the closing of developmental windows) and repair mechanisms, the brain remains highly plastic regardless of age and even in the face of ongoing injury and/or degenerative processes. Collectively, there is now growing evidence to support neurological restorative efforts for both “static” (e.g., stroke) and progressive neurological disorders.
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Importantly, while these technologies may not appear, at first glance, directly relevant to traditional medical care, it is worth noting that clinicians have the most knowledge and experience about the specific disease process, the treatments available, and the expected course of illnesses affecting the nervous system. It is thus critical that neurologic specialists and other clinicians can and should play an important role in the future adoption of these technologies for neurological rehabilitation. The sections below outline emerging diagnostic and therapeutic approaches that have the potential to transform the lives of patients with neurological disorders. These include technologies to harness plasticity, neuroimaging, neurostimulation, and brain–machine interfaces (BMIs).
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TECHNOLOGIES TO HARNESS PLASTICITY
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Neurological rehabilitation aims to harness activity-dependent plasticity mechanisms to maximize functional restoration. This principle can be applied to a diverse range of functional domains such as movement control, sensory processing, language, pain, and cognition. For example, recent randomized controlled clinical trials for motor recovery after stroke have suggested that intensity of training may be particularly important for sustained long-term improvements. Moreover, studies of the effects of such training in rodent and nonhuman primate models further suggest that plasticity of cortical “motor maps” might underlie the observed functional improvements. The incorporation of technology for neurological rehabilitation has the great potential to revolutionize the delivery of care by significantly increasing access, reducing the burden for adherence to high intensity regimens, and by maximizing engagement. Below are three examples of how emerging technology can be used to harness neural plasticity and to maximize functional restoration.