NEURAL PLASTICITY Part 2. Postnatal Maturation and Function-Induced Plasticity BEVERLY BISHOP At birth, the central nervous system has completed most of its early stages of cell division, migration, and specialization. Much of the neural circuitry has been laid down. Neuroblasts are continuing to divide only in limited brain regions. Hence, at birth, most mammals have a nearly full complement of neurons. Nonetheless, the functional capabilities of the central nervous system of the newborn have little resemblance to those of the adult. Postnatal maturation must proceed in the proper sequence and at the proper rate if central nervous system deficits in the adult are to be avoided. Many of the prenatal maturational phenomena described in the previous paper continue well into the postnatal period. The purpose of this paper is to describe some postnatal maturational mechanisms and to show, by selected examples, the important role that function and experience play in central nervous system development. Key Words: Nerve tissue, Nervous system, Neuronal plasticity. In the case of the afferent fibers from the primary endings of muscle spindles, the proliferation of the dorsal root collaterals increases the size of the motoMaturation of motoneurons. Postnatal changes in neuron pool toward which any one afferent fiber each motoneuron's monospinal motoneurons have been studied in kittens and projects and strengthens 7 synaptic reflex. Furthermore, these dorsal root fibers found to be correlated with functional and behavioral no longer project only toward homonymous moto1 changes. Following birth, the gray matter of the neurons, but their expanding collaterals project tospinal cord undergoes progressive expansion because ward synergistic motoneurons as well. Thus, even of an increase in the cellular volume of the growing though the phasic monosynaptic reflex can be elicited 2, 3 neurons. In addition to an increase in the size of the soma and the length of the axon, the membrane in kittens before birth, it undergoes maturational of the motoneuron undergoes additional maturational changes after birth. These changes occur in concert changes. In kittens, the resting membrane potential with maturation of the dorsal root collaterals, their (RMP) of a motoneuron at birth is about —48 mV, terminals, and their transmitter mechanisms. At the but when a kitten is two months old, the RMP has same time, the soma and dendrites of the motoneuincreased to about — 60mV, a value maintained rons are increasing in size and their membranes are8 throughout the life of the cell.4 Similarly, the ampli- assuming their adult permeability characteristics. tude of the action potential increases from —45mV to Tonic stretch reflexes do not 9make their appearance its adult value of —70mV within two to three months until a kitten is two weeks old. By this time, the small after birth. These changes in the membrane properties gamma motor axons have established contact with of the excitable cells are assumed to reflect changes the intrafusal muscle fibers of the muscle spindle. in the number or function of sodium and potassium Presumably by now, spindle sensitivity has come under gamma control, completing the neural subchannels within the cell membrane. strate for the tonic stretch reflexes. POSTNATAL MATURATION OF THE SPINAL CORD Proliferation of dorsal root collaterals. Another sign of maturation of spinal neurons is the proliferation of dorsal root collaterals.5, 6 Each collateral forms synapses on second-order neurons, thereby rapidly increasing the number of synaptic boutons on each target neuron. 1132 Synapse elimination. At birth, several synapses are found on the initial axonal segment of the cat spinal motoneuron.10-12 The initial segment is the unmyelinated region of the axon process as it projects from the soma.13, 14 During the second week of a kitten's life, the synapses on this region of the motoneuron begin PHYSICAL THERAPY PRACTICE to disappear, and after three weeks, synapses are no longer seen on this region of the motoneuron.15 In adult cats, this region of the motoneuron has become very specialized. It is free of synapses and has developed a high density of voltage-dependent sodium channels, making it the site of impulse generation. Studies reveal that the postnatal elimination of synapses on the initial segment occur by the phagocytotic action of glia cells thought to be immature astrocytes.16'17 Quantitative ultrastructural studies have shown that synapse elimination is not confined to the initial segment of the cat spinal motoneuron but includes synapses on the soma and dendrites as well.16, 17 The total number of synaptic teminals on the cell body decreases by about 50 percent during the postnatal period.17 Synaptic terminals on motoneurons can be divided into four types based on the shape of their synaptic vesicles or on their origin: F-type terminals have flattened vesicles; S-type terminals have spherical vesicles; C-type terminals also have spherical vesicles, but their terminals are large with a pronounced subsynaptic cistern; and M-type synapses are monosynaptic terminals of dorsal root origin. The Table shows the postnatal loss of each of these types of synapses. The F and S types of synapses are thought to be removed by a glial phagocytotic process similar to that occurring at the initial segment. Ultrastructural evidence seems to indicate however, that C-type synapses are eliminated by a different process. During the first postnatal week, some C-type terminals appear partially invaginated either in the soma or in the most proximal parts of the dendrites.18 Presumably, the motoneuron completely encompasses the terminal, and then lysosomes break down the inclusions. The phagocytosis appears to include those parts of the C-terminal associated with synaptic transmission, including the synaptic vesicles and mitochondria.18 What triggers or controls this interesting and unusual phagocytotic process is not known, but this process appears to be part of normal development. The question of whether or not this process takes place under other circumstances remains to be determined. It seems strange that a motoneuron can engulf and devour a particular type of presynaptic bouton terminating on its soma. Transient synapses. Another remodeling process of sensory and spinal neurons that is not completed until well after birth involves synaptic reorganization. In the rhesus monkey, sensory fibers enter the dorsal horn during the first quarter of the gestational period and form well-defined synaptic connections with cells occupying the most superficial border. Three weeks later, however, these superficial neurons have degenerated and are replaced by migrating cells that rep- Volume 62 / Number 8, August 1982 TABLE Estimated Postsynaptic Loss of Different Types of Synapses from Alpha Motoneurons17 Type S F C Total Loss as No. of Syna p s e s / 1 0 0 sq µm Loss as % of Synapses Present at Birth 13.8 13.5 0.2 27.5 55.9 50.0 20.0 52.2 resent the future laminae I and II neurons.19 This loss of central targets may contribute to the degeneration of sensory neurons as described in Part 1 under histogenic cell death.20 Not all sensory neurons deprived of their postsynaptic targets die; some survive and establish more permanent synapses on the new superficial dorsal horn neurons.19 Dendritic remodeling. During this period when afferent and efferent connections are being eliminated and reestablished, the spinal interneurons are also undergoing maturational changes. These include extensive morphological changes in their dendrites. In newborn mammals, dorsal horn neurons have stubby, radial dendrites randomly oriented. During the first two weeks after birth, some dendrites degenerate while others grow.21 Degenerating dendrites first assume a beaded appearance as vesicles form and then fuse to create cavities. Dendrites elongate by fusion of vesicles with existing dendritic membrane.22 The cues for triggering these morphological changes in dendritic structure and orientation are unknown. (Other examples of synapse replacement in adult vertebrates are given in the recent review by Cotman et al.23) If the neurobiologist can determine what controls these dendritic changes, then it may become possible to use this information to modify or control dendritic formation in nervous systems with congenitally abnormal dendrites. Resistance to respecification. Spinal reflex connections are established before birth and, once established, are quite devoid of plasticity. This unexpected absence of functional plasticity was revealed by experiments performed in the 1940s and 1950s by Sperry.24-27 He and his colleagues, using reflexes that coordinate foot movements in the rat, surgically redirected the hindlimb nerves to innervate the antagonistic muscles. The nerves were sectioned and crossed so that following their regeneration, extensor motoneurons innervated flexor muscles, and flexor motoneurons innervated extensor muscles. The result was reversed limb function. In response to a noxious stimulus, the foot extended toward the stimulus rather than withdrawing from it. No amount of training altered these inappropriate reflex responses. Similar 1133 in the CNS are also satellite cells of neurons, but they are a different variety of glia cell known as oligodendroglia.30 Any one oligodendroglia cell may send out its processes to invest 15 to 50 axons as shown in Figure 1. But each internodal region of any one axon in the CNS is myelinated by a different oligodendroglialcell.29, 30 With progressive myelination, conduction velocity in CNS nerve fibers progressively increases, presumably as a result of impulse propagation changing from continuous to saltatory conduction, analogous to the changes previously described for prenatal maturation Fig. 1. One oligodendroglia (the spherical cell) sends out of peripheral nerves.31, 32 extensions of its surface membrane to provide segments What triggers myelination is not known.29, 33 At the of myelin sheath for several axons. No two internodal site where the outgrowing membrane of an oligodenregions on the same axon are invested by the same droglial cell makes contact with the axon, there is a oligodendroglia. (Adapted from Morell and Norton.)29 concentration of glycoprotein.29 It has been suggested that the glycoprotein plays some role in triggering the experiments were performed on monkeys, in which rapid deposition of layers of myelin around the axon. the nerves to the triceps and biceps muscles were During this period, the oligodendroglial cell is syncrossed. Like the rats, the monkeys failed to correct thesizing several times its own mass of myelin each these inappropriate reflex responses. Some monkeys day. Hence, nutritional deficiencies in the infant's did learn to suppress the awkward responses of the diet during this period can cause an insufficiency of cross-innervated limb, but none learned to perform a myelin formation. This insufficiency may be partially functionally appropriate response. When sensory compensated for later in life, but in some cases, the nerves were surgically crossed from one side of the deficit may be permanent.29, 34 body to the other and time was allowed for nerve Myelin membrane is assembled differently from regeneration, animals exhibited false reference of sen- membrane of other living cells.35 In most cells, the sation. For example, in response to a shock to the left protein and lipids are synthesized and assembled into foot, the right foot was flexed. Again, training was of a vesicle or sac, which then fuses with and becomes no help. part of the cell's surface membrane. Subsequently, The conclusion is that once neural connections other proteins are added primarily to the inner surface have been laid down in the spinal cord, they resist of the cell membrane. In the case of the oligodenrespecification. Established neural circuits in mam- droglia, newly synthesized myelin is added only near mals lack intrinsic plasticity. Therefore, when func- the cell body rather than in random patches as occurs tion is altered as a result of training, the neuronal in other cells.28 The precise way the myelin sheath is plasticity must be a result of mechanisms other than formed around the CNS axon remains unknown. respecification of the existing neural connections es- Turnover rates of the lipids and proteins of the myelin tablished during development. sheath are also unknown.36 These critical questions must be answered if the deleterious effects of demyelinating diseases are to be prevented or treated. Myelination of the CNS. Although myelin formation Schwann cells in the periphery, when injured by is largely complete in peripheral nerves at birth, disease or drugs, are capable of proliferating; howmyelination in the brain and spinal cord is not. ever, oligodendroglia responsible for CNS myelinaSubsequent myelination occurs at various times in tion lack the ability to proliferate. Consequently, in various regions of the CNS and is an important diseases such as multiple sclerosis, demyelination is process for maturation of the CNS. The proportion essentially irreversible.37 Some evidence suggests that of white matter of the total cross-sectional area in- surviving oligodendroglia may attempt to remyelinate creases in all segments of the spinal cord from birth demyelinated regions, but this compensatory response 37 to maturity. In the kitten, this increase is largest is usually too limited to restore function. It has been 2 proposed that central axons, like peripheral axons, during the first two months after birth. White matter in the adult brain and spinal cord once demyelinated, fail to conduct, but in time, as consists of closely packed cylinders of nerve fibers, sodium channels appear along the length of the axons, gradually revert to continuous slow most of which are myelinated. Myelin in the CNS is the axons may 38 28 propagation. Some investigators have proposed that different from myelin of peripheral nerves. As deaccount for partial remissions in scribed in Part 1, the myelin-forming cells in the this mechanism may 37, 39 periphery are Schwann cells.29 Myelin-forming cells multiple sclerosis. 1134 PHYSICAL THERAPY PRACTICE FUNCTION-INDUCED PLASTICITY IN THE BRAIN Formation of dendritic spines. Maturing neurons in the cerebral cortex develop small evaginations on their dendritic surfaces. These lateral extensions of dendritic neuroplasm are specific postsynaptic receptive structures called dendritic spines (Fig. 2).40 The dendrites of cortical neurons lack spines in neonatal rats or kittens, but spines make their appearance between the 7th and 10th day after birth. Each spine bears a closely adhering, presynaptic axon terminal. Usually the spine is convex with its outward curve fitting against the concave surface of the axon terminal. As a dendritic spine matures, special internal structures can be seen. These structures are called spine apparatus and consist of two, three, or more membrane-bound spaces separated from one another by dense bands. The spine apparatus is absent in dendritic spines of animals below mammals on the phylogenetic scale, suggesting this structure may play some role in higher brain functions. Dendritic spines are the last morphological detail to appear in the development of a nerve cell, and their appearance signals the functional maturity of a neuron. When compared with other cell parts, the dendritic spines display unique plastic properties, and their growth, at least on cortical pyramidal cells, can be influenced by the animal's environment. For example, the cortical neurons of rats raised in an enriched environment have a higher density of dendritic spines than do those of animals raised in a deprived environment.41, 42 Once developed, spines may degenerate and disappear if their presynaptic input is curtailed, either through disuse or lesion. For example, neonatal mice raised for 22 to 25 days in darkness, or after enucleation of one eye, have a significant reduction in the number of dendritic spines on the pyramidal cells of the visual cortex to which the removed eye would normally project.43'44 Rearing rabbits in darkness does not produce a change in the number of dendritic spines, but does cause structural changes in the spines of neurons in the visual cortex.45 Changes in appearance of dendritic spines have also, on occasion, been reported in response to chronic alcoholism, morphine use, chloroform intake, sleep loss, starvation, prolonged exposure to cold, and other physiological stresses. Roentgen ray irradiation produces progressive changes in and loss of dendritic spines concomitantly with a gradual emergence of EEG abnormalities. A marked loss of dendritic spines with distortion and deformation of the parent dendrites is often a sequel to those head injuries that result in epileptic syndromes. Surgical interruption of presynaptic inputs to dendritic spines causes degeneration of the presynaptic boutons as would be expected, but subsequent events Volume 62 / Number 8, August 1982 Fig. 2. Dendritic spines on cortical pyramidal cells from the brains of a normal 6-month-old infant (left) and a severely retarded 10-month-old infant (right). Three basic shapes of spines are seen on the normal dendrite: thin (TH), mushroom shaped (MS), and stubby (ST). In contrast, spines on the dendrite in the retarded brain are sparse, long, thin, and entangled. (Reproduced by permission of the author and the publisher.46 Copyright, 1974, by the American Association for the Advancement of Science.) at the postsynaptic site are less predictable. At least three differing effects of presynaptic lesions have been reported, depending on the brain region lesioned. One is the complete disappearance of the dendritic spines along with the degeneration of the presynaptic boutons. This degeneration suggests that the phagocytic process removes both the presynaptic and postsynaptic elements. In other studies, both the bouton and dendritic spine appear to be ingested by the parent dendrite through pinocytotic activity. In the third and less common situation, the dendritic spines seem uninvolved in the degenerative process, and only the presynaptic boutons disappear, with each vacated synapse on the spines becoming occupied by a glia cell. 1135 We lack an understanding of the full physiological significance of dendritic spines. In children with severe mental retardation, dendritic spines are fewer in number than in normal brains and display abnormal spine morphology as shown in Figure 2.46 Furthermore, the severity of retardation is closely correlated with the extent of dendritic spine abnormalities. Hence, the abnormal spines presumably reflect defective development and lend support to the presently accepted notion that axo-dendritic synapses on dendritic spines play an as-yet-undefined role in cognitive and behavioral brain function. Effects of prolonged repetitive activity. Permanent alteration in neural activity can occur as a result of abnormal repetitive activity. A dramatic example of this can easily be demonstrated in the cat brain. If a poison, such as strychnine, is applied to a very small region of the surface of the cortex (eg, to a square millimeter of the primary auditory area in the temporal lobe), the poisoned cells will soon be spontaneously producing spike activity somewhat similar to that seen in an EEG during a petit mal seizure.47, 48 This strychnine-induced spike activity is not confined to the poisoned site but is conducted over neural circuits to all regions to which the spiking neurons project. For example, the corresponding area on the contralateral surface of the cortex displays a similar spiking pattern. In time, this neurally induced spiking pattern in the contralateral cortex becomes an inherent property of these cortical neurons as demonstrated by the persistence of the spiking activity following extirpation of the cortical tissue in contact with the poison. Presumably, in an analogous way, involuntary reiterative activity by a brain-injured patient can, in time, induce undesirable activity patterns on distant target neurons. Hence, therapists strive to prevent unwanted motor postures and patterns in their patients. Other adaptive changes occur in neural networks exposed to sustained high-frequency neural activity. Synapses may swell as a result of high-frequency activity. Synaptic swelling may enhance neural transmission because of a closer apposition of the presynaptic and postsynaptic membranes. Some neural networks, particularly in tonic systems, are metabolically equipped to keep pace with a high-frequency drive. This ability can be demonstrated experimentally by measuring a postsynaptic response to nerve stimulation before and after a short period of high-frequency stimulation. Many nerves will evoke a larger postsynaptic response immediately after the high-frequency activity than they do before this activity. This phenomenon is called posttetanic potentiation (PTP). Careful experimental analysis has revealed that the presynaptic ending releases more 1136 neurotransmitter per impulse after the high-frequency stimulation than it does before the stimulation. In other words, the presynaptic neuron has increased its synthesis and release of transmitter, thereby keeping pace with the high-frequency firing. This increase in transmitter release persists for a short time after cessation of the high-frequency activity. Not all neurons possess this PTP capability, and so each population of neurons must be tested. Nonetheless, PTP may be one important consequence of unwanted, sustained motor activity. The duration of PTP in most neural networks is short-lived as shown by the rapid disappearance of PTP once the high-frequency drive is terminated. Effects of early experience on sensory development. Following birth, experience plays a very important role in the subsequent development of the nervous system. Furthermore, the role of experience varies from one brain region to another. The visual system has been studied in great detail and found to be extremely dependent on normal activity for proper development.49 Hubel and Wiesel, 1981 Nobel laureates, performed some of the earliest and most extensive and refined investigations on the effects of sensory deprivation on the postnatal development of the visual cortex in cats50-55 and monkeys.56-61 They prevented newborn animals from having normal visual experiences and then correlated structural deficits with electrophysiological changes in the visual centers of the CNS. Prior to Hubel and Wiesel's work, it was assumed that the visual cortex was laid down as a precisely arranged structure before the animal was exposed to any visual experience. But it is now known that at birth, less than 17 percent of the synapses in the visual cortex have developed before eye-opening.62, 63 In fact, normal development of neurons in the visual system of an adult cat depends on what the cat's visual experiences were as a kitten between the ages of three weeks and three months. Vast numbers of experiments since Hubel and Wiesel's pioneer studies have led to the currently accepted theory that early visual experiences determine the synaptic organization of neurons in the visual cortex and correlate with behavioral deficits. Figure 3 is a simplified schema showing the visual pathway from the retina through the lateral geniculate to the cortex in cat, monkey, and man.64 It shows that the left retina of each eye projects to the left cortex, and both right retinas project to the right cortex. Therefore, each cortical hemisphere receives input from both eyes. At the lateral geniculate, these bilateral inputs remain anatomically separated; that is, any one neuron receives input from only one eye, but at the visual cortex in normal animals, 90 percent of the cells receive input from both eyes with correPHYSICAL THERAPY PRACTICE sponding points on the two retinas projecting to the same cortical cell. Over the years, investigators have used ingenious experimental techniques to control the early visual experiences of newborn kittens. Examples are intervening to prevent binocular vision65-67 or produce a convergent squint54, 68 and rearing animals in special environments to control particular attributes of their visual experience. These latter experiments include rearing in the dark,69, 70 with a strobe light to eliminate movement from the visual experience,71 in an environment with all visual stimuli having a preselected orientation,72 or some combination of these.73-74 Results from these types of experiments have provided a tremendous fund of information about the development of the visual system both in normal and experimental circumstances. The findings have shown that more or less permanent visual abnormalities develop if an experimental deprivation is imposed during a limited but quite specific period during development. This period, called the critical period, is species-specific and varies among the multiple attributes of the visual sensation (eg, binocularity, movement detection, acuity, direction detection, orientation sensitivity).75 This new knowledge about critical periods in the development of the visual system has important clinical implications. It has prompted earlier treatment of visual abnormalities in the newborn, thereby preventing permanent visual deficits in many cases.76 Effects of monocular deprivation. One experimental approach that has been commonly used is to suture the lid of one eye of a newborn kitten shut so the animal sees with only one eye for the first three months of life.50-52, 77 Monocular deprivation leads to gross functional abnormalities. In the visual cortex of a normal animal, 90 percent of the cortical cells respond to input from either eye, but in an animal with a sutured lid, essentially all neurons of the visual cortex respond only to stimulation of the unsutured eye. In other words, three months of monocular deprivation early in the kitten's life render the sutured eye incapable of driving cortical visual cells. In these monocularly deprived animals, the cells in the retina and lateral geniculate bodies appear to respond quite normally, suggesting that the visual cortex is the major site of the functional deficit. Although neither the retina nor the cortex shows gross anatomical changes, the lateral geniculate has smaller cells and is thinner than normal, as if it had an arrested growth or had undergone atrophy. The visual neurons develop more normally if the sutured eye is exposed to as little as one hour of light up to the age of four weeks. Monocular deprivation during the first three months of life produces behavioral deficits as well. The animals develop a severe and irreversible moVolume 62 / Number 8, August 1982 Fig. 3. A diagram of the visual pathway from the retina through the lateral geniculate to the cortex in cat, monkey, and man. Note that fibers from both nasal retinas cross the optic chiasm and thereby project to the contralateral cortex; fibers from the temporal retinas project unilaterally to their ipsilateral cortex. Therefore, a visual stimulus presented only in the left visual field of the right eye will excite cells in the right visual cortex. nocular dominance. For all practical purposes, the eye that was sutured shut during the critical period is functionally blind. Some recovery from the effects of monocular deprivation occurs if the animal is forced to use the deprived eye.78"83 Effects of early selective exposure. In other experimental paradigms, kittens have been reared in a special environment where they see only one orientation of visual stimuli. The neurophysiological results of this rearing are shown in Figure 4. As discussed previously, in normally reared cats, 90 percent of the total cells in the visual cortex are binocular units in that they can be excited by input from either eye. The bar graphs in Figure 4 indicate the number of units that are preferentially stimulated by lines of a specific orientation with respect to the horizontal plane. Note that in normally reared animals, about equal numbers of cells respond to each orientation of the stimulus. The other graphs of Figure 4 show the results from animals selectively reared in environments in which they saw only lines oriented as indicated in the insets. In the selectively reared cats, the units are monocular. In animals permitted to see only horizontal lines, the visual neurons respond only to horizontal stimuli, 1137 whose neurons detected only vertical lines. The behavioral result was a cat who could maneuver around the vertical legs of furniture but never attempted to jump onto the horizontal seat of a chair or onto a tabletop. Animals reared in an environment of horizontal stripes never jumped onto a table or chair seat but would bump into the vertical legs of the same furniture as if blind to them. These remarkable behavioral changes, imposed by the unusual sensory experience, were permanent and resulted from the permanent alterations in the synaptic organization of the visual cortex. Furthermore, for these visual abnormalities to occur, the sensory deprivation had to be imposed during a limited but specific period in development—the critical period. Effects of binocular deprivation. Deficits in binocular depth perception can be created experimentally in cats by preventing them as young kittens from seeing with both eyes at the same time.65, 67 If an opaque lens is placed alternately over one eye, then the other, the number of cortical cells that can be activated through both eyes is greatly reduced. Cats reared without binocular input suffer lifelong deficits in stereoscopic depth perception while retaining normal acuity in the two eyes. From these results, it is concluded that binocular neurons become binocular during a critical period, and if binocular neurons are not formed during the critical period, a permanent deficit in binocular depth perception persists. In summary, it is now well-established that many of the functional connections of single cells in the Fig. 4. Effects of early selective exposure. Number of visual cortex of newborn kittens are susceptible to neurons with preferred orientation within each of four disruption by abnormal visual experiences during the ranges. The shaded areas in each histogram indicate the first few months of life.74 Monocular deprivation orientation of the lines (± 22.5%) to which the animals were exposed during their first four months of life. The causes functional blindness in the deprived eye and lines inscribed in each circle illustrate the patterns pre- disturbed depth perception. Binocular deprivation sented during rearing. Upper: A full range of orientationcauses disturbed stereoscopic depth perception. Expreferences was found in animals raised in a normal posure to visual stimuli of selected orientation results visual environment. Lower: 1) In animals that viewed onlyin abnormal frequency distributions of orientationhorizontal and vertical lines, most orientation-sensitive neurons responded preferentially to horizontal or to ver- sensitive neurons. The development of functional abtical stimuli. 2) In animals that viewed only diagonal lines,normalities and the development of normal visual most orientation-sensitive neurons responded preferen- function require appropriate use of both eyes tially to horizontal or to vertical lines. The rest were throughout critical periods. activated most strongly by lines with an orientation matching that of the patterns presented during rearing. (Repro- Do these findings have any relevance for humans? duced by permission of the author and the publisher.72 Children with strabismus (cross-eyes) or astigmatism Copyright, 1975, by the American Association for the (blurred focus in a specific direction) must have this Advancement of Science.) abnormal function corrected before or during the critical period if the visual system is to develop normally.76 Although precise information about the rate with essentially no cells responding to oblique or of development of human visual deficits is lacking, the data about cats and monkeys serve as model vertical stimuli. In other words, units responding to the experienced orientation predominate, and units systems. Ultimately, precise information about the critical periods of man's visual system may become tuned to orthogonal orientations that were absent in available. their visual environment are absent. A kitten reared The work on the effects of deprivation on the in the environment of only vertical lines (Fig. 4— structure and function of the visual cortex demonright eye) matured into a cat with a visual cortex 1138 PHYSICAL THERAPY PRACTICE strates the importance of early experience for proper development of the visual system. In an analogous manner, early auditory deprivation (ie, monaural deprivation of sound) has been shown to greatly disturb binaural interaction at the level of the inferior colliculus.84 These identified abnormalities in binaural interaction were found to have a critical period between 10 and 60 days after birth in rats.85 It seems highly likely that many, if not all, sensory systems of the brain are shaped by early experience. Stimulation has long been recognized as a requirement for growth and function in behavioral development.86 Effects of experience on motor development. Differentiation of the contractile properties of fast-twitch and slow-twitch muscle is a gradual process that continues well into the postnatal period and has been extensively studied in the limb muscles of newborn kittens.87, 88 At birth, all limb muscles in the kitten have similar slow-twitch times of about 80 msec; however, in the adult animal, the fast muscles (eg, gastrocnemius) have a twitch time three-times shorter than that of the slow muscles (eg, soleus).87 This differentiation occurs over the first 16 weeks of postnatal life, as shown in the upper graph of Figure 5. The difference in speed of contraction between the fast and slow muscle is apparent within a few days after birth. By the end of the first month, the fast muscle has attained a contraction time that remains virtually unaltered thereafter. The slow muscle initially shows an increased speed of contraction but eventually undergoes a slowing process requiring about 12 weeks to complete. Effects of disuse. The difference in the time course of differentiation of the speeds of contraction for fast and slow muscles led investigators to question the nature of the controlling influence. To determine whether the controlling influence was inherent in the muscle or was the result of some neurotrophic influence, the following experiments were performed. The spinal cords of one group of newborn kittens were transected between L1 and L2 to isolate the motoneurons innervating the limb muscles from descending excitatory influences.87, 89 In another group of animals, not only were the spinal cords transected, but also the lumbar dorsal roots were cut bilaterally as a means of isolating the lumbar motoneurons from incoming as well as descending signals. These experimental procedures produced disuse atrophy, as would be expected, but no denervation effects. In animals with the functionally isolated lumbar motoneurons, differentiation of slow muscles failed to occur. At the end of 14 weeks, both muscles had equally fast contraction times, with the fast muscles being little different from those in intact animals, as Volume 62 / Number 8, August 1982 Fig. 5. Upper: Time course of development of adult speed of contraction in A) slow (soleus and crureus) and B) fast (flexor digitorum longus, flexor hallucis longus and medial gastrocnemius) muscles of kittens (solid lines). Lower: Postulated curves for the same muscles in the absence of neural influences (as a result of spinal transection and dorsal rhizotomy) are shown by the dashed curves. The crosshatched areas reflect the contribution of neural influences. (Adapted from Buller et al.87) shown in the lower graph of Figure 5. Speeding up of contraction time in fast muscle occurred whether or not the fast motoneurons were active, suggesting that their progressive decrease in contraction time was a genetically determined property inherent in fast muscle independent of neurotrophic influences. In contrast, in the absence of neural activity, slow muscles failed to slow, suggesting that the slowing process must be dependent upon influences exerted either by motoneuron activity, or muscle activity, or by both. These experiments of the 1960s sparked interest and controversy regarding the mechanisms of muscle differentiation. Despite two decades of intensive investigation, it is still not known whether the differentiation of slow muscle is due to neurotrophic regulation by the motoneuron or to muscle activity per se. There is experimental evidence supporting both mechanisms as described below. Effects of cross-reinnervation. A useful experimental approach for studying the neurotrophic action of nerve on skeletal muscle is the cross-reinnervation technique: the nerve from a fast muscle (eg, flexor digitorum longus) is cut and redirected to reinnervate a slow muscle (eg, soleus), and the nerve from the slow muscle is cut and redirected to reinnervate a fast 1139 muscle. In cats, this cross-reinnervation causes the twitch time of the fast muscle to become indistinguishable from that of the slow muscle and that of the slow muscle to change in the direction of the fast muscle, but the transformation is not complete.89 These experimental observations not only have been confirmed repeatedly90, 91 but have been extended to show that a motoneuron regulates many aspects of gene expression in the muscle it innervates.92, 93 In addition to changing a muscle's contractile speed, cross-reinnervation induces changes in the profile of the muscle's metabolic enzymes,94-96 the structure of its myosin molecules,97, 98 the distribution of acetylcholine receptors along its length,99 and the properties of the sarcoplasmic reticulum100 and sarcolemma.101, 102 These experimental results made it all the more imperative to determine the mechanisms by which a motor nerve exerts regulation over the physiological, morphological, and biochemical characteristics of the muscle it innervates. Effects of disrupting axoplasmic flow. Local application of colchicine to a motor nerve, by disrupting microtubules, blocks axoplasmic flow103, 104 without interfering with the propagation of nerve impulses or the release of neural transmitter.105, 106 Yet the muscles innervated by colchicine-treated axons develop many, but not all, signs of denervation.105, 106 The muscle membrane becomes chemosensitive, develops tetrodotoxin-resistant action potentials, and becomes partially depolarized with no appearance of fibrillation potentials nor increase in input resistance of the muscle membrane. 107 These results suggest that colchicine, by blocking axonal transport, deprives the muscle of some "trophic" substance ordinarily delivered by the nerve.107, 108 Not everyone accepts this interpretation, however, because an unanswered question is whether or not colchicine may have a direct effect on muscle as well as on axoplasmic flow.109 Effects of muscle activity. Experimental evidence suggesting that the pattern of muscle activity may control the contractile properties of muscle is shown in Figure 6.110 In the experiments giving rise to these results, a fast muscle—the extensor digitorum longus—in rabbits was continuously stimulated for 20 weeks with repetitive electric shocks delivered to the motor nerve through chronically implanted electrodes. Comparison of records B and C of Figure 6 shows that the twitch of the fast muscle is dramatically slowed at the end of 20 weeks of stimulation. A comparison of A and C of Figure 6 shows that, in fact, the stimulated fast muscle (C) contracts as slowly as the slow soleus (A), if not more slowly. In addition, the stimulated fast muscle (C) has increased its resistance to fatigue and has altered its myosin molecules. These results suggest that the pattern of activity imposed by the motor nerve upon a muscle may determine the muscle's time course of contraction. Similar results have been reported for cat fast muscle (flexor digitorum longus).111 Subsequent experiments have shown that long-term, low-frequency stimulation of rabbit fast-twitch muscle induces the production of myosin light chains characteristic of slow muscle.112 Despite these interesting observations, it remains controversial whether the altered mechanical responses of the chronically stimulated muscle are the direct result of the pattern of activity, the indirect Fig. 6. Effects of prolonged electrical stimulation on iso- consequence of an alteration in axonal transport (and, metric twitch of rabbit extensor digitorum longus (EDL) hence, in the delivery of some as-yet-unknown neumuscle. Records A, B, and C are isometric twitch con- rotrophic substance), or both. tractions from the normal, slow soleus muscle, from the Whatever the mechanism, the fact remains that the fast EDL muscle of the right, nonstimulated limb, and fromcontractile properties of skeletal muscle are altered as the left EDL muscle, which had been stimulated continuously for 20 weeks, respectively. (Adapted from Salmons a result of the activity pattern. Have therapists ever asked the questions, What changes are occurring in and Vrbova.110) 1140 PHYSICAL THERAPY PRACTICE a spastic muscle as a result of its prolonged, uncon­ trolled activity? and Do these changes further com­ pound the patient's motor problems? In summary, the maturation of skeletal muscle depends not only on the muscle's inherent properties but also on the effects imposed by its motor nerve. Slow-twitch muscle must be used in the early post­ natal period if it is to acquire its adult slow contractile properties. 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