Posts Tagged electroencephalography
[Abstract + References] eConHand: A Wearable Brain-Computer Interface System for Stroke Rehabilitation
2. E. Donchin , K. Spencer and R. Wijesinghe , “The mental prosthesis: assessing the speed of a P300-based brain-computer interface”, IEEE Transactions on Rehabilitation Engineering, vol. 8, no. 2, pp. 174-179, 2000.
3. D. McFarland and J. Wolpaw , “Brain-Computer Interface Operation of Robotic and Prosthetic Devices”, Computer, vol. 41, no. 10, pp. 52-56, 2008.
4. Xiaorong Gao , Dingfeng Xu , Ming Cheng and Shangkai Gao , “A bci-based environmental controller for the motion-disabled”, IEEE Transactions on Neural Systems and Rehabilitation Engineering, vol. 11, no. 2, pp. 137-140, 2003.
5. A. Ramos-Murguialday , D. Broetz , M. Rea et al “Brain-machine interface in chronic stroke rehabilitation: A controlled study”, Annals of Neurology, vol. 74, no. 1, pp. 100-108, 2013.
6. F. Pichiorri , G. Morone , M. Petti et al “Brain-computer interface boosts motor imagery practice during stroke recovery”, Annals of Neurology, vol. 77, no. 5, pp. 851-865, 2015.
7. M. A. Cervera , S. R. Soekadar , J. Ushiba et al “Brain-computer interfaces for post-stroke motor rehabilitation: a meta-analysis”, Annals of Clinical and Translational Neurology, vol. 5, no. 5, pp. 651-663, 2018.
8. K. Ang , K. Chua , K. Phua et al “A Randomized Controlled Trial of EEG-Based Motor Imagery Brain-Computer Interface Robotic Rehabilitation for Stroke”, Clinical EEG and Neuroscience, vol. 46, no. 4, pp. 310-320, 2014.
9. N. Bhagat , A. Venkatakrishnan , B. Abibullaev et al “Design and Optimization of an EEG-Based Brain Machine Interface (BMI) to an Upper-Limb Exoskeleton for Stroke Survivors”, Frontiers in Neuroscience, vol. 10, pp. 122, 2016.
10. J. Webb , Z. G. Xiao , K. P. Aschenbrenner , G. Herrnstadt , and C. Menon , “Towards a portable assistive arm exoskeleton for stroke patient rehabilitation controlled through a brain computer interface”, in Biomedical Robotics and Biomechatronics (BioRob), 2012 4th IEEE RAS & EMBS International Conference, pp. 1299-1304, 2012.
11. A. L. Coffey , D. J. Leamy , and T. E. Ward , “A novel BCI-controlled pneumatic glove system for home-based neurorehabilitation”, in Engineering in Medicine and Biology Society (EMBC), 2014 36th Annual International Conference of the IEEE, pp. 3622-3625, 2014.
12. D. Bundy , L. Souders , K. Baranyai et al “Contralesional Brain-Computer Interface Control of a Powered Exoskeleton for Motor Recovery in Chronic Stroke Survivors”, Stroke, vol. 48, no. 7, pp. 1908-1915, 2017.
13. X. Shu , S. Chen , L. Yao et al “Fast Recognition of BCI-Inefficient Users Using Physiological Features from EEG Signals: A Screening Study of Stroke Patients”, Frontiers in Neuroscience, vol. 12, pp. 93, 2018.
14. A. Delorme , T. Mullen , C. Kothe et al “EEGLAB, SIFT, NFT, BCILAB, and ERICA: New Tools for Advanced EEG Processing”, Computational Intelligence and Neuroscience, vol. 2011, pp. 1-12, 2011.
15. G. Schalk , D. McFarland , T. Hinterberger , N. Birbaumer and J. Wolpaw , “BCI2000: A General-Purpose Brain-Computer Interface (BCI) System”, IEEE Transactions on Biomedical Engineering, vol. 51, no. 6, pp. 1034-1043, 2004.
16. M. H. B. Azhar , A. Casey , and M. Sakel , “A cost-effective BCI assisted technology framework for neurorehabilitation”, The Seventh International Conference on Global Health Challenges, 18th-22nd November, 2018. (In Press)
17. C. M. McCrimmon , M. Wang , L. S. Lopes et al “A small, portable, battery-powered brain-computer interface system for motor rehabilitation”, Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 2776-2779, 2016.
18. J. Meng , B. Edelman , J. Olsoe et al “A Study of the Effects of Electrode Number and Decoding Algorithm on Online EEG-Based BCI Behavioral Performance”, Frontiers in Neuroscience, vol. 12, pp. 227, 2018.
19. T. Mullen , C. Kothe , Y. Chi et al “Real-time neuroimaging and cognitive monitoring using wearable dry EEG”, IEEE Transactions on Biomedical Engineering, vol. 62, no. 11, pp. 2553-2567, 2015.
[Abstract + References] Self-paced movement intention recognition from EEG signals during upper limb robot-assisted rehabilitation
This multidisciplinary research topic is a collection of contemporary advances in neuroimaging applied to mapping functional brain networks in epilepsy. With technology such as simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) now more readily available, it is possible to non-invasively map epileptiform activity throughout the entire brain at millimetre resolution. This research topic includes original research studies, technical notes and reviews of the field. Due to the multidisciplinary nature of the domain, the topic spans two journals: Frontiers in Neurology (Section: Epilepsy) and Frontiers in Neuroscience (Section: Brain Imaging Methods).
In this editorial we consider the outcomes of the multidisciplinary work presented in the topic. With the benefit of time elapsed since the original papers were published, we can see that the works are making a substantial impact in the field. At the time of writing, this topic had well over 27,000 full-paper downloads (including over 18,000 for the 15 papers in the Epilepsy section, and over 9,000 for the 8 papers in the Brain Imaging Methods section). Several papers in the topic have climbed the tier in Frontiers and received an associated invited commentary, demonstrating there is substantial interest in this research area.
The topic’s review papers set the scene for the original research papers and synthesise contemporary thinking in epilepsy research and neuroimaging methods. We see that Epilepsy, whether of a “generalised” or “focal” origin, is increasingly recognised as a disorder of large-scale brain networks. At one level it is self-evident that otherwise healthy functional networks are recruited during epileptic activity, as this is what generates patient perceptions of their epileptic aura. For example, the epileptic aura of mesial temporal lobe epilepsy can include an intense sensation of familiarity (déjà vu) associated with involvement of the hippocampus, and unpleasant olfactory auras which may reflect involvement of adjacent olfactory cortex. As seizures spread more widely throughout the brain, presumably along pre-existing neural pathways, patients lose control of certain functions; for example, their motor system in the case of generalised convulsions, or aspects of awareness in seizures that remain localised to non-motor brain regions. Yet these functions return when the seizure abates, implying involved brain regions are also responsible for normal brain function. What has been less clear, and difficult to investigate until the advent of functional neuroimaging, is precisely which brain networks are involved (especially in ‘generalised’ epilepsy syndromes), and the extent to which functional networks are perturbed during seizures, inter-ictal activity, and at other times.
Functional imaging evidence of brain abnormalities in temporal lobe epilepsy is explored in (Caciagli et al., 2014), including evidence of dysfunction in limbic and other specific brain networks, as well as global changes in network topography derived from resting-state fMRI. Archer et al systematically review the functional neuroimaging of a particularly severe epilepsy phenotype, Lennox-Gastaut Syndrome (LGS), illustrating well how different forms of brain pathology can manifest in a similar clinical phenotype, simply by the nature of the healthy networks that the underlying pathology perturbs (Archer et al., 2014). Similarly, the mechanisms of absence seizure generation are reviewed by (Carney and Jackson, 2014), revealing that it too has a signature pattern of large-scale functional brain network perturbation. The ability to make such observations has considerable clinical significance, as highlighted in the review by (Pittau et al., 2014).
The tantalising proposition that there may be a common treatment target for all focal epilepsy phenotypes is also explored in a review of the piriform cortex by (Vaughan and Jackson, 2014). The piriform cortex was first implicated as a common brain region associated with spread of interictal discharges in focal epilepsy in an experiment that analysed the spatially normalised functional imaging data of a heterogeneous group of focal epilepsy patients (Laufs et al., 2011). This finding, since replicated (Flanagan et al., 2014), led Vaughan & Jackson to explore in detail what is known of the piriform cortex. Their findings reveal the piriform has several features that likely predispose it to involvement in focal epilepsy, and features that also explain many of the peculiar symptoms experienced by patients, from olfactory auras to the characteristic nose-wiping that many patients perform postictally. This work points to the need for future studies to determine whether the piriform might be an effective target for deep brain stimulation or other targeted therapy to prevent the spread of epileptiform activity.
Temporal lobe epilepsy is investigated in several papers in this topic. One of these studies also introduces a new exploratory method, Shared and specific independent component analysis (SSICA), that builds upon independent component analysis to perform between-group network comparison (Maneshi et al., 2014). In application to mesial temporal lobe epilepsy (MTLE) and healthy controls, three distinct reliable networks were revealed: two that exhibited increased activity in patients (a network including hippocampus and amygdala bilaterally, and a network including postcentral gyri and temporal poles), and a network identified as specific to healthy controls (i.e. effectively decreased in patients, consisting of bilateral precuneus, anterior cingulate, thalamus, and parahippocampal gyrus). These finding give mechanistic clues to the cognitive impairments often reported in patients with MTLE. Further clues are revealed in a study of the dynamics of fMRI and its functional connectivity (Laufs et al., 2014). Compared to healthy controls, temporal variance of fMRI was seen to be most increased in the hippocampi of TLE patients, and variance of functional connectivity to this region was increased mainly in the precuneus, the supplementary and sensorimotor, and the frontal cortices. More severe disruption of connectivity in these networks during seizures may explain patients’ cognitive dysfunction (Laufs et al., 2014). Yang and colleagues also show that it may be possible to use fMRI functional connectivity to lateralise TLE (Yang et al., 2015), which could be a useful clinical tool.
Mechanistic explanations of symptomatology beyond the seizure onset zone can also be revealed with conventional nuclear medicine techniques such as 18F-FDG-PET. This is demonstrated in a study of Occipital Lobe Epilepsy by Wong and colleagues, who observed that patients with automatisms have metabolic changes extending from the epileptogenic occipital lobe into the ipsilateral temporal lobe, whereas in patients without automatisms the 18F-FDG-PET was abnormal only in the occipital lobe (Wong et al., 2014).
The clinical significance of the ability to non-invasively study functional brain networks extends to understanding the impact of surgery on brain networks. This Frontiers research topic includes an investigation by Doucet and colleagues revealing that temporal lobe epilepsy and surgery selectively alter the dorsal, rather than the ventral, default-mode network (Doucet et al., 2014).
Another approach to better understand the mechanisms of seizure onset and broader symptomatology is computational modelling. It can track aspects of neurophysiology than cannot be readily measured: for example effective connectivity and mean membrane potential dynamics are shown by (Freestone et al., 2014) to be estimable using model inversion. In a proof-of-principle experiment with simulated data, they demonstrate that by tailoring the model to subject-specific data, it may be possible for the framework to identify a seizure onset site and the mechanism for seizure initiation and termination. Also in this topic, Petkov and colleagues utilise a computational model of the transition into seizure dynamics to explore how conditions favourable for seizures relate to changes in functional networks. They find that networks with higher mean node degree are more prone to generating seizure dynamics in the model, thus providing a mathematical mechanistic explanation for increasing node degree causing increased ictogenicity (Petkov et al., 2014).
Seizure prediction is an area of considerable research, and in this topic Cook and colleagues reveal intriguing characteristics in the long-term temporal pattern of seizure onset. They confirmed that human inter-seizure intervals follow a power law, and they found evidence of long-range dependence. Specifically, the dynamics that led to the generation of a seizure in most patients appeared to be affected by events that took place much earlier (as little as 30 minutes prior and up to 40 days prior in some patients) (Cook et al., 2014). The authors rightly note that this information could be valuable for individually-tuned seizure prediction algorithms.
Several methodological papers in this Frontiers Topic prove there remains considerable potential to improve neuroimaging methods as applied to the study of epilepsy. For example, (Mullinger et al., 2014) reveal the critical importance of the accuracy of physical models if one is to optimise lead positioning in functional MRI with simultaneous EEG. Confirming with computer modelling and phantom measurements that lead positioning can have a substantial effect on the amplitude of the MRI gradient artefact present on the EEG, they optimised the positions in a novel cap design. However, whilst this substantially reduced gradient artefact amplitude on the phantom, it made things worse when used on human subjects. Thus, improvement is required in model accuracy if one is to make accurate predictions for the human context.
Reduction of artefact, particularly cardioballistic and non-periodic motion artefact, remains a challenge for off-the-shelf MRI-compatible EEG systems. However, for over a decade, the Jackson group in Melbourne has dealt well with this issue using insulated carbon-fibre artefact detectors, physically but not electrically attached to the scalp (Masterton et al., 2007). In the present topic, they provide detailed instructions for building such detectors and interfacing them with a commercially available MRI-compatible EEG system (Abbott et al., 2015). This team also previously developed event-related ICA (eICA), to map fMRI activity associated with inter-ictal events observed on EEG (Masterton et al., 2013b). The method is capable of distinguishing separate sub-networks characterised by differences in spatio-temporal response (Masterton et al., 2013a). The eICA approach frees one from assumptions regarding the shape of the time-course of the neuronal and haemodynamic response associated with inter-ictal activity (which can vary according to spike type, can vary from conventional models and may include pre-spike activity (Masterton et al., 2010); issues explored further in the present topic by (Faizo et al., 2014) and (Jacobs et al., 2014)). However, the effectiveness of eICA can be affected by fMRI noise or artefact. In the present topic we see that application of a fully automated de-noising algorithm (SOCK) is now recommended, as it can substantially improve the quality of eICA results (Bhaganagarapu et al., 2014).
The ability to detect activity associated with inter-ictal events can also be improved with faster image acquisition. Magnetic Resonance Encephalography (MREG) is a particularly fast fMRI acquisition method (TR=100ms) that achieves its speed using an under-sampled k-space trajectory (Assländer et al., 2013; Zahneisen et al., 2012). This has now been applied in conjunction with simultaneous EEG, to reveal that the negative fMRI response in the default-mode network is larger in temporal compared to extra-temporal epileptic spikes (Jacobs et al., 2014).
The default mode network and its relationship to epileptiform activity is also examined in several other papers in this topic. In a pilot fMRI connectivity study of Genetic Generalised Epilepsy and Temporal Lobe Epilepsy patients, (Lopes et al., 2014) observed that intrinsic connectivity in portions of the default mode network appears to increase several seconds prior to the onset of inter-ictal discharges. The authors suggest that the default mode network connectivity may facilitate IED generation. This is plausible, although causality is difficult to establish and it is possible that something else drives both the connectivity and EEG changes (Abbott, 2015).
Complicating matters further is the question of what connectivity means. There are many ways in which connectivity can be assessed. Jones and colleagues have discovered that some of these do not necessarily correlate well with each other. They examined connectivity between measurements made with intracranial electrodes, connectivity assessed using simultaneous BOLD fMRI and intracranial electrode stimulation, connectivity between low-frequency voxel measures of fMRI activity, and a diffusion MRI measure of connectivity – an integrated diffusivity measure along a connecting pathway (Jones et al., 2014). They found only mild correlation between these four measures, implying they assess quite different features of brain networks. More research in this domain would therefore be valuable.
Whatever the measure of connectivity utilised, most evidence of alterations in connectivity in epilepsy has been obtained from comparison of a group of patients with a group of healthy controls. However, a new method called Detection of Abnormal Networks in Individuals (DANI) is now proposed by (Dansereau et al., 2014). This method is designed to detect the organisation of brain activity in stable networks, which the authors call modularity. The conventional definition of modularity refers to the degree to which networks can be segregated into distinct communities, usually estimated by maximising within-group nodal links, and minimising between group links (Girvan and Newman, 2002; Rubinov and Sporns, 2010). Dansereau take a novel approach to this concept, instead evaluating the stability of each resting state network across replications of a bootstrapped clustering method (Bellec et al., 2010). In the DANI approach, the degree to which an individual’s functional connectivity modular pattern deviates from a population of controls is quantified. Whilst application of the method to epilepsy patients is preliminary, significant changes were reported likely related to the epileptogenic focus in 5 of the 6 selected focal epilepsy patients studied. In several patients, modularity changes in regions distant from the focus were also observed, adding further evidence that the pervasive network effects of focal epilepsy can extend well beyond the seizure onset zone.
When it comes to application of EEG-fMRI to detect the seizure onset zone, there is typically a trade-off between specificity and sensitivity, with the added complication that activity or network changes may also occur in brain regions other than the ictal onset zone. The distant activity may be due to activity propagation from the onset zone, pervasive changes in functional networks creating a ‘permissive state’, or in some cases might be the brain’s attempt to prevent seizures. Specificity and sensitivity of EEG-fMRI to detect the ictal onset zone is explored by (Tousseyn et al., 2014). They determined how rates of true and false positives and negatives varied with voxel height and cluster size thresholds, both for the full statistical parametric map, and for the single cluster that contained the voxel of maximum statistical significance. The latter conferred the advantage of reducing positives remote from the seizure onset zone. As a result, it appeared to be more robust to variations in statistical threshold than analysis of the entire map. One needs to be cautious however, given the small numbers of patients studied, and the fact that the “optimal” settings were determined using receiver operator characteristic curves of the same study data. It remains to be seen how well this might generalise to a different study.
Perhaps the greatest potential for future advancement in EEG-fMRI is in methods to make the most of the all the information captured by each modality. This is highlighted by the work of Deligianni et al, demonstrating with a novel analysis framework the potential to obtain more information on the human functional connectome by utilising EEG and fMRI together (Abbott, 2016; Deligianni et al., 2014).
We hope that you enjoy this collection of papers providing a broad snapshot of advances in brain mapping methods and application to better understand epilepsy.
[ARTICLE] Transcranial direct current stimulation for the treatment of motor impairment following traumatic brain injury – Full Text
After traumatic brain injury (TBI), motor impairment is less common than neurocognitive or behavioral problems. However, about 30% of TBI survivors have reported motor deficits limiting the activities of daily living or participation. After acute primary and secondary injuries, there are subsequent changes including increased GABA-mediated inhibition during the subacute stage and neuroplastic alterations that are adaptive or maladaptive during the chronic stage. Therefore, timely and appropriate neuromodulation by transcranial direct current stimulation (tDCS) may be beneficial to patients with TBI for neuroprotection or restoration of maladaptive changes.
Technologically, combination of imaging-based modelling or simultaneous brain signal monitoring with tDCS could result in greater individualized optimal targeting allowing a more favorable neuroplasticity after TBI. Moreover, a combination of task-oriented training using virtual reality with tDCS can be considered as a potent tele-rehabilitation tool in the home setting, increasing the dose of rehabilitation and neuromodulation, resulting in better motor recovery.
This review summarizes the pathophysiology and possible neuroplastic changes in TBI, as well as provides the general concepts and current evidence with respect to the applicability of tDCS in motor recovery. Through its endeavors, it aims to provide insights on further successful development and clinical application of tDCS in motor rehabilitation after TBI.
Traumatic brain injury (TBI) is defined as “an alteration in brain function (loss of consciousness, post-traumatic amnesia, and neurologic deficits) or other evidence of brain pathology (visual, neuroradiologic, or laboratory confirmation of damage to the brain) caused by external force” . The incidence and prevalence of TBI are substantial and increasing in both developing and developed countries. TBI in older age groups due to falling has been on the rise in recent years, becoming the prevalent condition in all age groups [2, 3]. TBI causes broad spectrum of impairments, including cognitive, psychological, sensory or motor impairments [4, 5], which may increase the socioeconomic burdens and reduce the quality of life [6, 7]. Although motor impairment, such as limb weakness, gait disturbance, balance problem, dystonia or spasticity, is less common than neurocognitive or behavioral problems after TBI, about 30% of TBI survivors have reported motor deficits that severely limited activities of daily living or participation .
Motor impairment after TBI is caused by both focal and diffuse damages, making it difficult to determine the precise anatomo-clinical correlations [9, 10]. According to previous clinical studies, recovery after TBI also seems worse than that after stroke, although the neuroplasticity after TBI may also play an important role for recovery . Therefore, a single unimodal approach for motor recovery, including conventional rehabilitation, may be limiting, and hence, requiring a novel therapeutic modality to improve the outcome after TBI.
Transcranial direct current stimulation (tDCS) – one of the noninvasive brain stimulation (NIBS) methods – can increase or decrease the cortical excitability according to polarity (anodal vs. cathodal) and be used to modulate the synaptic plasticity to promote long-term functional recovery via long-term depression or potentiation [12, 13]. Recent clinical trials evaluating patients with stroke have reported the potential benefits of tDCS for motor recovery . Neuroplastic changes after TBI and results from animal studies also suggest that tDCS could improve the motor deficit in TBI, although clinical trials using tDCS for motor recovery in TBI are currently lacking .
In this review, we will cover (1) the pathophysiology and possible neuroplastic changes in TBI; (2) physiology of tDCS; (3) current clinical evidence of tDCS in TBI for motor recovery; (4) general current concept of tDCS application for motor recovery; and (5) the future developments and perspectives of tDCS for motor recovery after TBI. Although the scope of motor recovery is wide, this review will focus primarily on the recovery of limb function, especially that of the upper limb. We expect that this review can provide insights on further successful development and clinical application of tDCS in motor rehabilitation after TBI.[…]
[Abstract] Mozart’s music and multidrug-resistant epilepsy: a potential EEG index of therapeutic effectiveness.
[ARTICLE] Transcranial direct current stimulation (tDCS) for upper limb rehabilitation after stroke: future directions. – Full Text
Transcranial Direct Current Stimulation (tDCS) is a potentially useful tool to improve upper limb rehabilitation outcomes after stroke, although its effects in this regard have shown to be limited so far. Additional increases in effectiveness of tDCS in upper limb rehabilitation after stroke may for example be achieved by
(1) applying a more focal stimulation approach like high definition tDCS (HD-tDCS),
(2) involving functional imaging techniques during stimulation to identify target areas more exactly,
(3) applying tDCS during Electroencephalography (EEG) (EEG-tDCS),
(4) focusing on an effective upper limb rehabilitation strategy as an effective base treatment after stroke.
Perhaps going even beyond the application of tDCS and applying alternative stimulation techniques such as transcranial Alternating Current Stimulation (tACS) or transcranial Random Noise Stimulation (tRNS) will further increase effectiveness of upper limb rehabilitation after stroke.
Impaired arm function after stroke is both frequent and a considerable burden for people with stroke and their caregivers. An emerging approach for enhancing neural plasticity after acute and chronic brain damage, thus enhancing rehabilitation outcomes in the upper limb rehabilitation after stroke, is non-invasive brain stimulation (NIBS), for example delivered by transcranial direct current stimulation (tDCS) . tDCS is a potentially useful tool for facilitating neural plasticity, because it is relatively inexpensive, easy to administer and safe.
Many small trials regarding the effects of tDCS on arm motor function poststroke were undertaken in the past with partly promising but not conclusive results [2, 3]. Based on these trials a lot of research interest increased in the last 10 to 15 years which still persists. This considerable research interest is a bit surprising first, given the fact that this type of therapy is not used across the board in clinical routine and second, the largest multicenter randomized clinical trial with appropriate methodology including 96 patients did not find clear results in favor of this type of stimulation . A recent network meta-analysis of randomised controlled trials about the effectiveness of tDCS suggested only limited evidence for effectiveness of tDCS after stroke for arm rehabilitation . The optimal stimulation paradigm regarding polarisation, electrode location, amount of direct current applied and stimulation duration still has to be established in order to maximize clinical effectiveness of tDCS . Additionally, doubts emerged that the underlying rationale, the interhemispheric competition model, may be oversimplified or even incorrect . The interhemispheric competition model postulates that a stroke leads to an inhibition of the ipsilateral and to an (over-) excitation of the contralateral brain hemisphere. Hence its clinical implications are to inhibit the contralateral hemisphere and to excited ipsilateral hemisphere. Moreover, electrode positioning and the resulting direction of electric fields as well as variation in head anatomy also modulate stimulation effects [7, 8]. Hence, further approaches may be warranted beyond the approach of neuronavigation prior to stimulation: Additional increases in effectiveness of tDCS in upper limb rehabilitation after stroke may for example be achieved by (1) applying a more focal stimulation approach like high definition tDCS (HD-tDCS), (2) involving functional imaging techniques during stimulation to identify target areas more exactly, (3) applying tDCS during EEG (EEG-tDCS), (4) focusing on an effective upper limb rehabilitation strategy as an effective base treatment after stroke. Perhaps going even beyond the application of tDCS and applying alternative stimulation techniques such as transcranial Alternating Current Stimulation (tACS)  or transcranial Random Noise Stimulation (tRNS)  will further increase effectiveness of upper limb rehabilitation after stroke.[…]
[Abstract + References] Design of Isometric and Isotonic Soft Hand for Rehabilitation Combining with Noninvasive Brain Machine Interface
In recent years, stroke has became one of the major health problems which significantly affect the daily life of the elderly, and hand rehabilitation is introduced as an auxiliary treatment. Though various kinds of mechanical devices for hand rehabilitation have been developed, some deficiencies still exist in the current rigid rehabilitation hand, such as the degrees of freedom is not enough, complexity, unsafe status, overweight, being uncomfortable, unfitness and so on. Therefore, with the growth of aging population, it is highly needed to develop some new devices to satisfy the comprehensive rehabilitation requirements. Meanwhile, inspired by the mollusks in nature, soft robot is made of soft materials that can withstand large strains. It is a new type of continuum robot with high flexibility and environmental adaptability. The soft robot has a broad application prospects in military detection techniques, such as instance search, rescue, medical application and other fields.
[Abstract] EEG predicts upper limb motor improvement after robotic rehabilitation in chronic stroke patients
Robotic rehabilitation is known to be at least as effective as conventional training for upper limb motor recovery after stroke; nevertheless, which patients could benefit from this treatment is unknown and finding markers that could predict rehabilitation outcome is a challenge.
We aimed at understanding the neural mechanisms of motor function recovery after upper limb robotic rehabilitation in chronic stroke patients using neurophysiological markers obtained by electroencephalography recording (EEG).
Material and method
Fourteen chronic stroke patients (M/F: 11/3; 59.5 ± 13 yrs) with mild to moderate upper limb paresis were subjected to 10 sessions of upper limb rehabilitation with a planar mobile robotic device (MOTORE, Humanware). Fugl–Meyer Assessment Scale (FMAS) and Wolf Motor Function Test (WMFT) were administered before (t0), at the end (t1) and at 1 month follow-up (t2); at the same timing 64-channals EEG was recorded.
We analyzed power spectrum density in different frequency bands of the affected and unaffected hemispheres with 64-ch EEG and their correlation with motor impairment as measured by clinical scales. Correlation analyses were performed to identify the indicators of good rehabilitative outcome.
Clinical assessment indicated a significant functional improvement in upper limb motor function at the end of rehabilitation as assessed with FMAS and WMFT score that is maintained at follow-up. We found a positive correlation between global Alpha activity at t0 and WMFT score variation (t0–t1) and between global Beta activity at t0 and WMFT time variation (t0–t1) and a positive correlation between Beta activity at t0 in the unaffected hemisphere and FMAS variation (t0–t1 and t0–t2).
Robotic rehabilitation improves upper limb motor performance in stroke patients even in the chronic phase. The amount of Alpha and Beta band power at t0 is suggestive of rehabilitation-related motor outcome. Our results suggest that EEG recording preliminarily to robotic rehabilitation could help identifying good responders to treatment thus optimizing results.
[ARTICLE] Using Corticomuscular Coherence to Reflect Function Recovery of Paretic Upper Limb after Stroke: A Case Study – Full Text
Purpose: Motor deficits after stroke are supposed to arise from the reduced neural drive from the brain to muscles. This study aimed to demonstrate the feasibility of reflecting the motor function improvement after stroke with the measurement of corticomuscular coherence (CMC) in an individual subject.
Method: A stroke patient was recruited to participate in an experiment before and after the function recovery of his paretic upper limb, respectively. An elbow flexion task with a constant muscle contraction level was involved in the experiment. Electromyography and electroencephalography signals were recorded simultaneously to estimate the CMC. The non-parameter statistical analysis was used to test the significance of CMC differences between the first and second times of experiments.
Result: The strongest corticomuscular coupling emerged at the motor cortex contralateral to the contracting muscles for both the affected and unaffected limbs. The strength of the corticomuscular coupling between activities from the paretic limb muscles and the contralateral motor cortex for the second time of experiment increased significantly compared with that for the first time. However, the CMC of the unaffected limb had no significant changes between two times of experiments.
Conclusion: The results demonstrated that the increased corticomuscular coupling strength resulted from the motor function restoration of the paretic limb. The measure of CMC can reflect the recovery of motor function after stroke by quantifying interactions between activities from the motor cortex and controlled muscles.
Stroke is one of the major diseases that cause long-term motor deficits of adults (1). However, our poor understanding of the mechanisms underlying motor impairments after stroke limits greatly the development of effective intervention and evaluation methods. In general, motor impairments after stroke are deemed to arise from changes in both neural and muscle properties. Poststroke changes in the neural system have been studied from different points of view such as the decreased excitability of the affected cortex (2, 3) and the increased inhibitory effect from the unaffected hemisphere on the affected hemisphere (4). Spasm and flaccid paresis of muscles are believed to result from the loss of control input from the brain at different phases after stroke. Even though stroke survivors have been demonstrated to have significant descending information flow in the affected side during the chronic period (5), there is evidence that poststroke impairments reflect the reduced central neural drive to muscles. Mima et al. and Fang et al. found that the functional coupling between cortical commands and consequent muscle activities of stroke subjects were weaker than that of healthy controls (6, 7). The conduction time from the central cortical rhythm to peripheral oscillations in the affected side was significantly prolonged compared with that of the unaffected side after stroke (8).
It is believed that stroke interrupts the motor-related neural network and then reduces the neural drive to the muscles. The coherent activities between the motor cortex and the muscles are believed to reflect the synchronized discharge of corticospinal cells (9). It can be estimated by analyzing the frequency domain coherence (10) between electromyography (EMG) and electroencephalography (EEG) signals termed as corticomuscular coherence (CMC). Although previous studies have demonstrated that the CMC strength of poststroke subjects was weaker than that of healthy controls, it is still not clear whether the corticomuscular coupling will enhance along with the motor function recovery to directly reflect the motor function state of paretic limbs after stroke. In the current study, a poststroke patient was recruited to participate in two times of experiments involving an elbow flexion task. The time interval between two times of experiments was determined to guarantee that the patient had obtained an obvious motor function recovery of the affected upper extremity. CMC from two times of experiments was estimated and compared to verify whether motor function recovery can be reflected by the change of corticomuscular coupling strength.
Experiment and Subject
An elbow flexion task was designed for the stroke patient because only poor rehabilitation outcomes can be generally obtained for hand. The force applied by the elbow flexion was monitored by a strain gage and fed back to the patient visually to help him finish the task with moderate and constant muscle contractions (11), because coherence analyses (12, 13) have demonstrated that the coupling is most pronounced in the beta-band range during steady muscle contractions and the beta-band CMC is assumed to be associated with strategies for controlling submaximal muscle forces (12, 14, 15). The designed motion task and the visual feedback information on screen are illustrated in Figures 1A,B, respectively. A trial was initiated when a circle and a target ring showed on screen and was over when they disappeared. Each trial lasted 11 s and there was a 2-s long interval between adjacent trials. Each run contained 20 trials and each side of upper limbs performed two runs, respectively. The subject practiced before data recording until the target force could be reached within the first 2 s of each trial.
[ARTICLE] Effects of somatosensory electrical stimulation on motor function and cortical oscillations – Full Text
Few patients recover full hand dexterity after an acquired brain injury such as stroke. Repetitive somatosensory electrical stimulation (SES) is a promising method to promote recovery of hand function. However, studies using SES have largely focused on gross motor function; it remains unclear if it can modulate distal hand functions such as finger individuation.
The specific goal of this study was to monitor the effects of SES on individuation as well as on cortical oscillations measured using EEG, with the additional goal of identifying neurophysiological biomarkers.
Eight participants with a history of acquired brain injury and distal upper limb motor impairments received a single two-hour session of SES using transcutaneous electrical nerve stimulation. Pre- and post-intervention assessments consisted of the Action Research Arm Test (ARAT), finger fractionation, pinch force, and the modified Ashworth scale (MAS), along with resting-state EEG monitoring.
SES was associated with significant improvements in ARAT, MAS and finger fractionation. Moreover, SES was associated with a decrease in low frequency (0.9-4 Hz delta) ipsilesional parietomotor EEG power. Interestingly, changes in ipsilesional motor theta (4.8–7.9 Hz) and alpha (8.8–11.7 Hz) power were significantly correlated with finger fractionation improvements when using a multivariate model.
We show the positive effects of SES on finger individuation and identify cortical oscillations that may be important electrophysiological biomarkers of individual responsiveness to SES. These biomarkers can be potential targets when customizing SES parameters to individuals with hand dexterity deficits. Trial registration: NCT03176550; retrospectively registered.
Despite recent advances in rehabilitation, a substantial fraction of stroke patients continue to experience persistent upper-limb deficits . At best, up to 1 out of 5 patients will recover full arm function, while 50% will not recover any functional use of the affected arm.  Improvement in upper limb function specifically depends on sensorimotor recovery of the paretic hand . Yet, there remains a lack of effective therapies readily available to the patient with acquired brain injury for recovery of hand and finger function; a systematic review found that conventional repetitive task training may not be consistently effective for the upper extremity . It is thus critical to explore inexpensive and scalable approaches to restore hand and finger dexterity, reduce disability and increase participation after stroke and other acquired brain injuries.
Sensory threshold somatosensory electrical stimulation (SES) is a promising therapeutic modality for targeting hand motor recovery . It is known to be a powerful tool to focally modulate sensorimotor cortices in both healthy and chronic stroke participants [5, 6, 7, 8]. Devices such as transcutaneous nerve stimulation (TENS) units can deliver SES and are commercially available, inexpensive, low risk, and easily applied in the home setting . Previous studies have demonstrated short-term and long-term improvements in hand function after SES [5, 10, 11, 12, 13, 14, 15]. However, the effect of SES on regaining the ability to selectively move a given digit independently from other digits (i.e. finger fractionation) has not been investigated. Poor finger individualization is an important therapeutic target because it is commonly present even after substantial recovery and may account for chronic hand dysfunction . Further, it is unclear if SES is associated with compensatory or restorative mechanisms. Prior studies have largely relied on relatively subjective clinical evaluations of impairment, such as the Fugl-Meyer Assessment, or timed and task-based assessments, such as the Jebson-Taylor Hand Function Test. Biomechanical analyses, on the other hand, can provide important objective and quantitative evidence of improvement in neurologic function and normative motor control [17, 18]. Therefore, we aimed to determine not only the functional effects, but also the kinematic effects, of SES on chronic hand dysfunction.
Simultaneously, it should be noted that although SES can potentially be an effective therapy, not all individuals who are administered SES experience positive effects. While improvement levels as high as 31–36% compared to baseline function have been reported, [11, 19] about half of one cohort demonstrated minimal or no motor performance improvement after a single session of SES . One method to shed more light on this discrepancy is to identify neurophysiological biomarkers associated with motor responses to SES. Neurophysiological biomarkers are increasingly used to predict treatment effects [20, 21]. Although some studies have examined biomarkers associated with treatment-induced motor recovery, to our knowledge none have been performed for SES [22, 23]. A recent study using electroencephalography (EEG) found that changes in patterns of connectivity predicted motor recovery after stroke . At present, little is known about the effect of peripheral neuromodulation on EEG activity, how existing neural dynamics interacts with peripheral stimulation, and whether this interaction is associated with improvements in motor function. Associating EEG activity with treatment response may also provide mechanistic insight regarding the effects of SES on neural plasticity. EEG activity can also potentially be used as a cost-effective real-time metric of the time-varying efficacy of SES. This novel application of EEG information may help tailor treatment efforts while reducing the variability in outcome.
The main goal of this pilot study was to evaluate both changes in finger fractionation in response to SES and identify the associated neural biomarkers through analyses of EEG dynamics. Outcomes from this study have potential in designing targeted SES therapy based on neural biomarkers to modulate and improve hand function after acquired brain injury such as stroke (e.g. enrollment in long-term studies of the efficacy of SES).