Rebuilding body–brain interaction from the vagal network in spinal cord injuries

Spinal cord injuries (SCIs) exert devastating effects on body awareness, leading to thedisruption of the transmission of sensory and motor inputs. Researchers have attempted to improveperceived body awareness post-SCI by intervening at the multisensory level, with the integrationof somatic sensory and motor signals. However, the contributions of interoceptive-visceral inputs,particularly the potential interaction of motor and interoceptive signals, remain largely unaddressed.The present perspective aims to shed light on the use of interoceptive signals as a significant resourcefor patients with SCI to experience a complete sense of body awareness. First, we describe intero-ceptive signals as a significant obstacle preventing such patients from experiencing body awareness.Second, we discuss the multi-level mechanisms associated with the homeostatic stability of the body,which creates a unified, coherent experience of one’s self and one’s body, including real-time updates.Body awareness can be enhanced by targeting the vagus nerve function by, for example, applyingtranscutaneous vagus nerve stimulation. This perspective offers a potentially useful insight forresearchers and healthcare professionals, allowing them to be better equipped in SCI therapy. Thiswill lead to improved sensory motor and interoceptive signals, a decreased likelihood of developingdeafferentation pain, and the successful implementation of modern robotic technologies.