Cortical mapping of gait in humans: a near-infrared spectroscopic topography study

Neural coupling between upper and lower limbs during recumbent stepping

During gait rehabilitation, therapists or robotic devices often supply physical assistance to a patient's lower limbs to aid stepping. The expensive equipment and intensive manual labor required for these therapies limit their availability to patients. One alternative solution is to design devices where patients could use their upper limbs to provide physical assistance to their lower limbs (i.e., self-assistance). To explore potential neural effects of coupling upper and lower limbs, we investigated neuromuscular recruitment during self-driven and externally driven lower limb motion. Healthy subjects exercised on a recumbent stepper using different combinations of upper and lower limb exertions. The recumbent stepper mechanically coupled the upper and lower limbs, allowing users to drive the stepping motion with upper and/or lower limbs. We instructed subjects to step with 1) active upper and lower limbs at an easy resistance level (active arms and legs); 2) active upper limbs and relaxed lower limbs at easy, medium, and hard resistance levels (self-driven); and 3) relaxed upper and lower limbs while another person drove the stepping motion (externally driven). We recorded surface electromyography (EMG) from six lower limb muscles. Self-driven EMG amplitudes were always higher than externally driven EMG amplitudes ( P < 0.05). As resistance and upper limb exertion increased, self-driven EMG amplitudes also increased. EMG bursts during self-driven and active arms and legs stepping occurred at similar times. These results indicate that active upper limb movement increases neuromuscular activation of the lower limbs during cyclic stepping motions. Neurologically impaired humans that actively engage their upper limbs during gait rehabilitation may increase neuromuscular activation and enhance activity-dependent plasticity.

Jogging improved performance of a behavioral branching task: implications for prefrontal activation

We studied the effect of habitual jogging on the performance of a frontal lobe functioning test. Fourteen subjects were divided into a jogging trained group (TG) or a jogging untrained group (NG). The TG jogged for 12 weeks, for 30 min, 2.6 times per week, while the NG did not. We administered a prefrontal branching task (BR) combining a Spatial Delayed-Response Test (DR) and a Go/No-Go Test (GNG). Each test alone and a Simple Reaction Time Test (SR) were given as controls. All tests were given three times at 6 week intervals over 12 weeks in both groups. In the TG, the tests were given two times after termination of the jogging. The maximal oxygen uptake (VO2max) was measured in the TG during the 12 weeks. After 12 weeks, the correct performance rates in the BR task were more improved in the TG than in the NG. The control and reaction time tests were unchanged in both groups. The improved performance in the BR task in the TG decreased after stopping the jogging. The VO2max increased significantly during the 12 weeks of jogging in the TG. Thus, the habitual jogging improved performance in a prefrontal BR.

Strategies for stroke rehabilitation

Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.

Brain activation patterns during imagined stance and locomotion in functional magnetic resonance imaging

Posture and gait are sensorimotor actions that involve peripheral, spinal, and supraspinal structures. To investigate brain activity during stance and locomotion, 13 healthy subjects were asked to stand, walk, run, and lie down; subsequently, they were trained to imagine standing, walking, running, and lying [imagined lying as rest condition in functional magnetic resonance imaging (fMRI)]. Separate and distinct activation/deactivation patterns were found for the three imagined conditions: (1) standing imagery was associated with activation in the thalamus, basal ganglia, and cerebellar vermis; (2) walking imagery was associated with activation in the parahippocampal and fusiform gyri (areas involved in visuospatial navigation), occipital visual areas, and in the cerebellum; (3) running imagery caused a predominantly cerebellar activation in the vermis and adjacent hemispheres (six times larger than during imagination of walking or standing), but activations in the parahippocampal and fusiform gyri were smaller than during walking. Deactivations were found for walking and running, but not for standing imagery. They were located in the vestibular (posterior insula, superior temporal gyrus, supramarginal gyrus) and somatosensory (postcentral gyrus) cortex with right-hemispheric dominance. These findings support the concept of a hierarchical organization of posture and locomotion. Automated locomotion, for example, running, is based on spinal generators whose pace is driven by the cerebellar locomotor region. Deactivation in the vestibular and somatosensory cortex prevents adverse interactions with the optimized spinal pattern and sensory signals; this confirms earlier findings of a multisensory inhibition during unhindered locomotion. During slow walking, spatial navigation, mediated by the parahippocampal cortex, becomes more important. Postural control during standing involves a low intensity cerebellar activity and sensorimotor control via the thalamus and basal ganglia.

Decrease in prefrontal hemoglobin oxygenation during reaching tasks with delayed visual feedback: a near-infrared spectroscopy study

Visual feedback of hand movement is crucial to accurate reaching. Although previous studies have extensively examined spatial alteration of visual feedback (e.g., prism adaptation), temporal delay of visual feedback has been less explored. In the present study, we investigated the effect of delayed visual feedback of the moving hand in a reaching task. The prefrontal cortical activity was measured by near-infrared spectroscopy (NIRS). Twelve subjects performed reaching tasks under two conditions where visual feedback of their own hand was delayed by 200 ms (delay condition) or 0 ms (normal condition). Introducing the visual feedback delay significantly disrupted the reaching performance, although the subjects gradually adapted to the delay during the experiment. There was a clear tendency to overreach the target in the delay condition, even after the reaching movement had been practiced sufficiently in the normal condition. We observed marked oxy- and total-Hb decreases in the dorsal prefrontal area in the delay conditions. The decrease began shortly after task onset and diminished during the rest period, indicating that the decrease was task-induced. Furthermore, the oxy- and total-Hb decreases were significantly correlated with task performance--the degree of decrease was larger as the subject made more errors. We suggest that the decreases in oxy- and total-Hb at the dorsal prefrontal area are related with the visuomotor recalibration process.

Separability and cross talk: optimizing dual wavelength combinations for near-infrared spectroscopy of the adult head

By means of noninvasive near-infrared spectroscopy (NIRS), cerebral concentration changes in oxygenated and deoxygenated hemoglobin ([oxy-Hb] and [deoxy-Hb]) can be determined. The quality of the concentration changes' assessment critically depends on the wavelength combination used. Trying to optimize this combination, two spectroscopic effects must be taken into account: cross talk and separability. Cross talk between [oxy-Hb] and [deoxy-Hb] occurs because the assumption made in the analysis-that there is a homogeneous concentration change-does not hold true for the adult human head. Separability-to be introduced in this paper-is a measure for the degree of physical noise of the measurement that will influence the noise of the concentration changes' assessment. In other words, high separability corresponds to a low noise with respect to the concentration changes assessed. Here, we present analytical expressions for both measures and provide model-based estimates of cross talk and separability for any combination of two wavelengths between 610 and 920 nm. These theoretical considerations allow for two predictions: (a) if both wavelengths used are greater than approximately 780 nm, cross talk is high and separability is low resulting in erroneous and noisy concentration data. (b) If one wavelength is chosen below 720 nm while the other is greater than 730 nm, cross talk is low and separability is high resulting in accurate concentration changes. We show the relevance of these theoretical results for noninvasive NIRS by testing the predictions on experimental data obtained in adults undergoing visual stimulation.

Multimodal assessment of cortical activation during apple peeling by NIRS and fMRI

An intriguing application of neuroimaging is directly measuring actual human brain activities during daily living. To this end, we investigated cortical activation patterns during apple peeling. We first conducted a pilot study to assess the activation pattern of the whole lateral cortical surface during apple peeling by multichannel near-infrared spectroscopy (NIRS) and detected substantial activation in the prefrontal region in addition to expected activations extending over the motor, premotor and supplementary motor areas. We next examined cortical activation during mock apple peeling by simultaneous measurement using multichannel NIRS and functional magnetic resonance imaging (fMRI) in four subjects. We detected activations extending over the motor, premotor and supplementary motor areas, but not in the prefrontal cortex. Thus, we finally focused on the prefrontal cortex and examined its activation during apple peeling in 12 subjects using a multichannel NIRS. We subsequently found that regional concentrations of oxygenated hemoglobin significantly increased in the measured region, which encompassed portions of the dorsolateral, ventrolateral and frontopolar areas of the prefrontal cortex. The current study demonstrated that apple peeling as practiced in daily life recruited the prefrontal cortex but that such activation might not be detected for less laborious mock apple peeling that can be performed in an fMRI environment. We suggest the importance of cortical study of an everyday task as it is but not as a simplified form; we also suggest the validity of NIRS for this purpose. Studies on everyday tasks may serve as stepping stone toward understanding human activities in terms of cortical activations.

Three-dimensional probabilistic anatomical cranio-cerebral correlation via the international 10-20 system oriented for transcranial functional brain mapping

The recent advent of multichannel near-infrared spectroscopy (NIRS) has expanded its technical potential for human brain mapping. However, NIRS measurement has a technical drawback in that it measures cortical activities from the head surface without anatomical information of the object to be measured. This problem is also found in transcranial magnetic stimulation (TMS) that transcranially activates or inactivates the cortical surface. To overcome this drawback, we examined cranio-cerebral correlation using magnetic resonance imaging (MRI) via the guidance of the international 10-20 system for electrode placement, which had originally been developed for electroencephalography. We projected the 10-20 standard cranial positions over the cerebral cortical surface. After examining the cranio-cerebral correspondence for 17 healthy adults, we normalized the 10-20 cortical projection points of the subjects to the standard Montreal Neurological Institute (MNI) and Talairach stereotactic coordinates and obtained their probabilistic distributions. We also expressed the anatomical structures for the 10-20 cortical projection points probabilistically. Next, we examined the distance between the cortical surface and the head surface along the scalp and created a cortical surface depth map. We found that the locations of 10-20 cortical projection points in the standard MNI or Talairach space could be estimated with an average standard deviation of 8 mm. This study provided an initial step toward establishing a three-dimensional probabilistic anatomical platform that enables intra- and intermodal comparisons of NIRS and TMS brain imaging data.

Optical tomographic mapping of cerebral haemodynamics by means of time-domain detection: methodology and phantom validation

One of the primary applications of diffuse optical imaging is to localize and quantify the changes in the cerebral oxygenation during functional brain activation. Up to now, data from an optical imager are simply presented as a two-dimensional (2D) topographic map using the modified Beer-Lambert law that assumes homogeneous optical properties beneath each optode. Due to the highly heterogeneous nature of the optical properties in the brain, the assumption is evidently invalid, leading to both low spatial resolution and inaccurate quantification in the assessment of haemodynamic changes. To cope with these difficulties, we propose a nonlinear tomographic image reconstruction algorithm for a two-layered slab geometry that uses time-resolved reflected light. The algorithm is based on the previously developed generalized pulse spectrum technique, and implemented within a semi-three-dimensional (3D) framework to conform to the topographic visualization and to reduce computational load. We demonstrate the advantages of the algorithm in quantifying simulated changes in haemoglobin concentrations and investigate its robustness to the uncertainties in the cortical structure and optical properties, as well as the effects of random noises on image quality. The methodology is also validated by experiments using a solid layered phantom.

Towards an understanding of gait control: brain activation during the anticipation, preparation and execution of foot movements

While a detailed understanding of brain activity with hand movements has developed, less is known about the functional anatomy of motor control for foot movements. Here we have used fMRI to define brain activity associated with unilateral foot extension and flexion, component movements of gait. We studied brain responses to visually cued active and passive movements and periods of either preparation (before active movement) or anticipation (before passive movement) with a pseudo-randomized block design. A mixed-effects (n = 12) contrast of the active movement condition vs. rest identified brain activation in regions including the medial wall of the primary sensorimotor cortex, consistent with expected somatotopy. Medial wall activation during passive movement vs. rest was less intense and localized to the same region. Frontal and association cortices were more active during preparation or anticipation periods than during the movements themselves. A contrast of preparation to move vs. active movement showed significant activation in the medial frontal and frontopolar gyri and the precuneus. Contrast of the anticipation of movement with the passive movement condition revealed activation in the dorsal premotor cortex and precuneus. Our study thus provides evidence for somatotopy in multiple functional regions in the motor control network. The anterior prefrontal activity is involved in the preparation for cued movement with distinct regions of the medial motor cortex (including SMA and CMA) preferentially involved in motor program planning and execution. This direct characterization of brain activation patterns associated with foot movements promises use of fMRI for the functional analysis of pathologies of gait.

Absorber's Effect Projected Directly Above Improves Spatial Resolution in Near Infrared Backscattered Imaging

The spatial resolution of near infrared spectroscopic imaging in brain function mapping studies needs to be improved. Most near infrared spectroscopic imaging systems use optical fibers that are arranged like a lattice. The light source and the detector have one-on-one correspondence at intervals of about 3 cm. In this study, we apply several detectors against one source to improve spatial resolution. We assume that a local absorber within a strong scattering medium is a model for local cerebral activation. When we calculate absorbance, which is used to spectroscopically calculate hemoglobin concentration, the peak position shifts away from above the position where an absorber is located. As far as absorbance is calculated, we cannot obtain spatial information about the absorber even if many detectors are used against one source. When we calculate the difference between detected light intensities, however, we demonstrate that an absorber projected onto the measuring surface has an influence directly above it. We predict this property from a light diffusion equation and also prove it experimentally through measurements of a uniform resinous phantom with an absorber. This is one of the basic principles supporting the achievement of higher spatial resolutions with near infrared spectroscopic imaging.

Longitudinal Optical Imaging Study for Locomotor Recovery After Stroke

Background and Purpose— We sought to investigate cerebral mechanisms underlying locomotor recovery after stroke.

Methods— We measured cortical activities during hemiparetic gait on the treadmill before and after 2 months of inpatient rehabilitation in 8 patients with initial stroke (5 men, 3 women; 4 with right and 4 with left hemiparesis; aged 57 years; 3 months after stroke on average), using an optical imaging system.

Results— On the initial evaluation, hemiparetic gait was associated with increased oxygenated hemoglobin levels in the medial primary sensorimotor cortex (SMC) that were greater in the unaffected hemisphere than in the affected hemisphere as well as in the premotor cortex (PMC) and supplementary motor area. On the second examination, the asymmetry in SMC activation significantly improved, and there was enhanced PMC activation in the affected hemisphere. Improvement of the asymmetrical SMC activation significantly correlated with improvement of gait parameters.

Conclusions— Locomotor recovery after stroke may be associated with improvement of asymmetry in SMC activation and enhanced PMC activation in the affected hemisphere.

Human walking along a curved path. II. Gait features and EMG patterns

We recorded basic gait features and associated patterns of leg muscle activity, occurring during continuous body progression when humans walked along a curved trajectory, in order to gain insight into the nervous mechanisms underlying the control of the asymmetric movements of the two legs. The same rhythm was propagated to both legs, in spite of inner and outer strides diverging in length (P < 0.001). There was a phase lag in limb displacement between the inner and outer leg of 7% of the total cycle duration (P = 0.0001). Swing velocity was greater for outer than inner foot (P < 0.001). The duration of the stance phase diminished and increased in the outer and inner leg (P < 0.01), respectively, and was associated with trunk leaning toward the inside of the path. Muscle activity was not dramatically altered during curved walking. The amplitude of soleus burst during stance increased in the outer (P < 0.05) and decreased in the inner leg (P < 0.05), without changes in timing. Tibialis anterior activity increased in both legs during the swing phase (P < 0.05); it was advanced on the outer and delayed on the inner side (P < 0.01; 2% of the cycle). The peroneus longus burst decreased in both legs, but more in the inner than the outer leg, and lasted longer in the inner leg at the onset of swing. Closing the eyes did not affect the gait pattern and muscle activity during turning. The command to walk along a curved path may exploit the basic mechanisms of the spinal locomotor generator, thereby limiting the computational cost of turning.

Acute effects of alcohol on hemodynamic changes during visual stimulation assessed using 24-channel near-infrared spectroscopy

The purpose of this study was to evaluate the effects of alcohol on hemodynamic changes induced by visual stimulation. Ten healthy human subjects were examined using Optical Topography((R)) (Hitachi Medical Corporation: ETG-100). Each subject gradually drank 0.4 ml/kg alcohol over 10 min. Changes in oxy-hemoglobin (Hb), deoxy-Hb and total-Hb concentration were measured five times: 20 min before alcohol intake, immediately after alcohol intake, and at 20, 40 and 60 min after alcohol intake. A questionnaire was used to assess subjective feelings of alcohol. Blood-alcohol concentration (BAC) was estimated from ethanol concentration in expired air four times: immediately after alcohol intake and at 20, 40 and 60 min after alcohol intake. The visual stimulation tool was a checkerboard. It showed alternations of black and red patterns at a frequency of 8 Hz. The stimulus was displayed for 10 s after a rest of 30 s. The stimulus was repeated 10 times. Oxy-Hb concentration increased and deoxy-Hb concentration decreased during visual stimulation before and after alcohol intake, despite changes in the score of subjective feelings of alcohol and BAC. Alcohol intake does not significantly affect hemodynamic changes caused by visual stimulation in the visual cortex.

Beyond the visible--imaging the human brain with light

Optical approaches to investigate cerebral function and metabolism have long been applied in invasive studies. From the neuron cultured to the exposed cortex in the human during neurosurgical procedures, high spatial resolution can be reached and several processes such as membrane potential, cell swelling, metabolism of mitochondrial chromophores, and vascular response can be monitored, depending on the respective preparation. The authors focus on an extension of optical methods to the noninvasive application in the human. Starting with the pioneering work of Jöbsis 25 years ago, near-infrared spectroscopy (NIRS) has been used to investigate functional activation of the human cerebral cortex. Recently, several groups have started to use imaging systems that allow the generation of images of a larger area of the subject's head and, thereby, the production of maps of cortical oxygenation changes. Such images have a much lower spatial resolution compared with the invasively obtained optical images. The noninvasive NIRS images, however, can be obtained in undemanding set-ups that can be easily combined with other functional methods, in particular EEG. Moreover, NIRS is applicable to bedside use. The authors briefly review some of the abundant literature on intrinsic optical signals and the NIRS imaging studies of the past few years. The weaknesses and strengths of the approach are critically discussed. The authors conclude that NIRS imaging has two major advantages: it can address issues concerning neurovascular coupling in the human adult and can extend functional imaging approaches to the investigation of the diseased brain.

Comparing brain activation associated with isolated upper and lower limb movement across corresponding joints

It was shown recently that functional activation across brain motor areas during locomotion and foot movements are similar but differ substantially from activation related to upper extremity movement (Miyai [2001]: Neuroimage 14:1186-1192). The activation pattern may be a function of the behavioral context of the movement rather than of its mechanical properties. We compare motor system activation patterns associated with isolated single-joint movement of corresponding joints in arm and leg carried out in equal frequency and range. Eleven healthy volunteers underwent BOLD-weighted fMRI while performing repetitive elbow or knee extension/flexion. To relate elbow and knee activation to the well-described patterns of finger movement, serial finger-to-thumb opposition was assessed in addition. After identifying task-related voxels using statistical parametric mapping, activation was measured in five regions of interest (ROI; primary motor [M1] and somatosensory cortex [S1], premotor cortex, supplementary motor area [SMA] divided into preSMA and SMA-proper, and cerebellum). Differences in the degree of activation across ROIs were found between elbow and knee movement. SMA-proper activation was prominent for knee, but almost absent for elbow movement (P < 0.05); finger movement produced small but constant SMA-proper activation. Ipsilateral M1 activation was detected during knee and finger movement, but was absent for the elbow task (P < 0.05). Knee movement showed less lateralization in M1 and S1 than other tasks (P < 0.05). The data demonstrate that central motor structures contribute differently to isolated elbow and knee movement. Activation during knee movement shows similarities to gait-related activation patterns.

Premotor cortex is involved in restoration of gait in stroke

Cortical activation during hemiplegic gait was assessed in six nonambulatory patients with severe stroke (four men, two women; four with right and two with left hemiplegia; 57 years old and 3 months after stroke on average), using a near-infrared spectroscopic imaging system. Each patient performed tasks of treadmill walking (0.2km/hr), alternated with rest every 30 seconds for four repetitions, under partial body weight support, either with mechanical assistance in swinging the paretic leg control (CON) or with a facilitation technique that enhanced swinging of the paretic leg (FT), provided by physical therapists. Gait performance was associated with increased oxygenated hemoglobin levels in the medial primary sensorimotor cortex in the unaffected hemisphere greater than in the affected hemisphere. Both cortical mappings and quantitative data showed that the premotor activation in the affected hemisphere was enhanced during hemiplegic gait. There was also a prominent activation in the presupplementary motor area. Overall cortical activations and gait performance were greater in walking with FT than with CON. These indicate that multiple motor areas including the premotor cortex and presupplementary motor area might play important roles in restoration of gait in patients with severe stroke.

Intermanual coordination: from behavioural principles to neural-network interactions

Locomotion in vertebrates and invertebrates has a long history in research as the most prominent example of interlimb coordination. However, the evolution towards upright stance and gait has paved the way for a bewildering variety of functions in which the upper limbs interact with each other in a context-specific manner. The neural basis of these bimanual interactions has been investigated in recent years on different scales, ranging from the single-cell level to the analysis of neuronal assemblies. Although the prevailing viewpoint has been to assign bimanual coordination to a single brain locus, more recent evidence points to a distributed network that governs the processes of neural synchronization and desynchronization that underlie the rich variety of coordinated functions. The distributed nature of this network accounts for disruptions of interlimb coordination across various movement disorders.