Neuromodulation with Dr. Monica Perez

June Bruno has an appointment at The Miami Project from 8:30-11am five days a week in the lab of Dr. Monica Perez, who is studying neuromodulation.  Accompanied every day by her husband, Jim, she has never missed a session.  Even though they don’t live very far away in neighboring Fort Lauderdale, the short drive can sometimes take up to two hours in rush hour traffic, so the Brunos leave their house at 7am and pay extra tolls to drive in the “express lanes”.  When June started volunteering as a research participant, she tripped and fell frequently and had terrible balance, resulting from an incomplete spinal cord injury (SCI).  Now, after a few months of participation in research protocols, she is walking better, her balance has improved, and her (and her husband’s) outlook on the future is becoming sunnier every day.

June is part of an ongoing research study using neuromodulation at The Miami Project to Cure Paralysis in the laboratory of Monica Perez, PT, PhD, Professor of Neurological Surgery.   Dr. Perez leads an impressive group of post-doctoral researchers, from all over the world, studying the mechanisms involved in the control of movement.  Most people would assume that researchers who are interested in motor control could only study people who have SCI classified as “motor incomplete”, or people who are able to move muscles below the level of injury.  However, researchers have known for many years that most people with SCI classified clinically as “complete” have preserved tissue within the injured areas of the spinal cord.  In fact, many people with “motor complete” injuries are able to produce small electrical signals, which can be detected by electrode recordings, in muscles that they cannot actively use, suggesting that connections between the brain and spinal cord still exist in many cases.

Dr. Perez’ laboratory uses a specialized experimental protocol that is customized to each individual participant to take advantage of these spared connections. Here, magnetic stimulation is delivered to the motor cortex, the area of the brain that controls movement, using a minimally invasive method known as transcranial magnetic stimulation.  Small electrical pulses are also applied to nerves to activate muscles from the periphery.  The key factor is the timing when the brain and the nerve are activated in order to strengthen synaptic connections (please see related articles below).  Audrey Wilson, Engineer, Hounsh Munshi, Research Associate, and Dr. Hang Jin Jo work with Dr. Perez to combine this neuromodulatory approach with exercise training to further activate and strengthen these spared connections, with the goal of enhancing voluntary output in weak or paralyzed muscles.  This protocol is pioneered by Dr. Perez’ group in SCI and is currently used in only two places in the world, The Miami Project and in Sydney, Australia.

June and Jim Bruno say that they are incredibly thankful for the opportunity to participate in the cutting-edge research being done in Dr. Perez’ laboratory.  These active grandparents are planning their next international trip thanks to June’s improved mobility.  The researchers June works with on a daily basis are also grateful for the Brunos, because of their dedication and positive attitudes.  The improvement that June is experiencing, along with the data obtained during her daily sessions, is helping the scientists understand more about the circuitry between the brain and spinal cord and develop innovative strategies for strengthening connections, which may result in functional improvements for many others in the SCI community.

Bunday KL, Perez MA. Motor recovery after spinal cord injury enhanced by strengthening corticospinal synaptic transmission. Current Biology 22(24):2355-2361, 2012.

Urbin MA, Ozdemir RA, Tazoe T, Perez MA. Spike-timing-dependent plasticity in lower-limb motoneurons after human spinal cord injury. Journal of Neurophysiology 118:2171-2180, 2017.

Bunday KL, Urbin MA, Perez MA. Potentiating paired corticospinal-motoneuronal plasticity after spinal cord injury. Brain Stimulation 2018 (in press).

Christiansen L, Perez MA .Targeted-Plasticity in the Corticospinal Tract After Human Spinal Cord Injury. Neurotherapeutics 2018 (in press).