Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation

White matter microstructural organization and gait stability in older adults

Understanding age-related decline in gait stability and the role of alterations in brain structure is crucial. Here, we studied the relationship between white matter microstructural organization using Diffusion Tensor Imaging (DTI) and advanced gait stability measures in 15 healthy young adults (range 18–30 years) and 25 healthy older adults (range 62–82 years). Among the different gait stability measures, only stride time and the maximum Lyapunov exponent (which quantifies how well participants are able to attenuate small perturbations) were found to decline with age. White matter microstructural organization (FA) was lower throughout the brain in older adults. We found a strong correlation between FA in the left anterior thalamic radiation and left corticospinal tract on the one hand, and step width and safety margin (indicative of how close participants are to falling over) on the other. These findings suggest that white matter FA in tracts connecting subcortical and prefrontal areas is associated with the implementation of an effective stabilization strategy during gait.

Noninvasive and painless magnetic stimulation of nerves improved brain motor function and mobility in a cerebral palsy case

Motor deficits in cerebral palsy disturb functional independence. This study tested whether noninvasive and painless repetitive peripheral magnetic stimulation could improve motor function in a 7-year-old boy with spastic hemiparetic cerebral palsy. Stimulation was applied over different nerves of the lower limbs for 5 sessions. We measured the concurrent aftereffects of this intervention on ankle motor control, gait (walking velocity, stride length, cadence, cycle duration), and function of brain motor pathways. We observed a decrease of ankle plantar flexors resistance to stretch, an increase of active dorsiflexion range of movement, and improvements of corticospinal control of ankle dorsiflexors. Joint mobility changes were still present 15 days after the end of stimulation, when all gait parameters were also improved. Resistance to stretch was still lower than prestimulation values 45 days after the end of stimulation. This case illustrates the sustained effects of repetitive peripheral magnetic stimulation on brain plasticity, motor function, and gait. It suggests a potential impact for physical rehabilitation in cerebral palsy.

MRI-compatible device for examining brain activation related to stepping

Repetitive and alternating lower limb movements are a specific component of human gait. Due to technical challenges, the neural mechanisms underlying such movements have not been previously studied with functional magnetic resonance imaging. In this study, we present a novel treadmill device employed to investigate the kinematics and the brain activation patterns involved in alternating and repetitive movements of the lower limbs. Once inside the scanner, 19 healthy subjects were guided by two visual cues and instructed to perform a motor task which involved repetitive and alternating movements of both lower limbs while selecting their individual comfortable amplitude on the treadmill. The device facilitated the performance of coordinated stepping while registering the concurrent lower-limb displacements, which allowed us to quantify some movement primary kinematic features such as amplitude and frequency. During stepping, significant blood oxygen level dependent signal increases were observed bilaterally in primary and secondary sensorimotor cortex, the supplementary motor area, premotor cortex, prefrontal cortex, superior and inferior parietal lobules, putamen and cerebellum, regions that are known to be involved in lower limb motor control. Brain activations related to individual adjustments during motor performance were identified in a right lateralized network including striatal, extrastriatal, and fronto-parietal areas.

Assessment of biofeedback rehabilitation in post-stroke patients combining fMRI and gait analysis: a case study

BACKGROUND

The ability to walk independently is a primary goal for rehabilitation after stroke. Gait analysis provides a great amount of valuable information, while functional magnetic resonance imaging (fMRI) offers a powerful approach to define networks involved in motor control. The present study reports a new methodology based on both fMRI and gait analysis outcomes in order to investigate the ability of fMRI to reflect the phases of motor learning before/after electromyographic biofeedback treatment: the preliminary fMRI results of a post stroke subject's brain activation, during passive and active ankle dorsal/plantarflexion, before and after biofeedback (BFB) rehabilitation are reported and their correlation with gait analysis data investigated.

METHODS

A control subject and a post-stroke patient with chronic hemiparesis were studied. Functional magnetic resonance images were acquired during a block-design protocol on both subjects while performing passive and active ankle dorsal/plantarflexion. fMRI and gait analysis were assessed on the patient before and after electromyographic biofeedback rehabilitation treatment during gait activities. Lower limb three-dimensional kinematics, kinetics and surface electromyography were evaluated. Correlation between fMRI and gait analysis categorical variables was assessed: agreement/disagreement was assigned to each variable if the value was in/outside the normative range (gait analysis), or for presence of normal/diffuse/no activation of motor area (fMRI).

RESULTS

Altered fMRI activity was found on the post-stroke patient before biofeedback rehabilitation with respect to the control one. Meanwhile the patient showed a diffuse, but more limited brain activation after treatment (less voxels). The post-stroke gait data showed a trend towards the normal range: speed, stride length, ankle power, and ankle positive work increased. Preliminary correlation analysis revealed that consistent changes were observed both for the fMRI data, and the gait analysis data after treatment (R > 0.89): this could be related to the possible effects BFB might have on the central as well as on the peripheral nervous system.

CONCLUSIONS

Our findings showed that this methodology allows evaluation of the relationship between alterations in gait and brain activation of a post-stroke patient. Such methodology, if applied on a larger sample subjects, could provide information about the specific motor area involved in a rehabilitation treatment.

Acupressure and task-related training after stroke: A case study

Background: Previous neurophysiological studies have provided empirical evidence explaining how afferent stimulation through acupuncture can improve motor function after stroke. Acupressure provides afferent stimulation through the application of appropriate pressure using the hands or fingers to spots of the body suitable for acupuncture. However, any therapeutic effects of using acupressure coupled with physical training for patients with stroke have not yet been studied.

Aim: This case report describes how an intervention protocol in which acupressure and task-related training were combined to improve lower limb motor functions of an individual 5 years post stroke.

Methods: The participant was a 65-year old man who had a stroke 5 years previously. After a 4-week observation period, the participant was given a 4-week (3 days per week) programme consisting of 20 minutes of acupressure to four acupoints in the affected lower leg, followed by 40 minutes of task-related training. Outcome measures included plantarflexor spasticity, isometric muscle strength in the lower limbs, walking speed, and functional mobility.

Results: After the 4-week programme, the strength of the participant's knee extensors, ankle dorsiflexors and plantarflexors, walking speed, and Up and Go times had improved. Those gains were maintained 4 weeks after the interventio]n ended. The spasticity level of the affected ankle plantarflexors remained unchanged throughout the study.

Conclusion: Combining acupressure with a task-related training programme is safe and effective in improving the lower limb motor function of an individual 5 years post stroke.

Ankle voluntary movement enhancement following robotic-assisted locomotor training in spinal cord injury

BACKGROUND

In incomplete spinal cord injury (iSCI), sensorimotor impairments result in severe limitations to ambulation. To improve walking capacity, physical therapies using robotic-assisted locomotor devices, such as the Lokomat, have been developed. Following locomotor training, an improvement in gait capabilities-characterized by increases in the over-ground walking speed and endurance-is generally observed in patients. To better understand the mechanisms underlying these improvements, we studied the effects of Lokomat training on impaired ankle voluntary movement, known to be an important limiting factor in gait for iSCI patients.

METHODS

Fifteen chronic iSCI subjects performed twelve 1-hour sessions of Lokomat training over the course of a month. The voluntary movement was qualified by measuring active range of motion, maximal velocity peak and trajectory smoothness for the spastic ankle during a movement from full plantar-flexion (PF) to full dorsi-flexion (DF) at the patient's maximum speed. Dorsi- and plantar-flexor muscle strength was quantified by isometric maximal voluntary contraction (MVC). Clinical assessments were also performed using the Timed Up and Go (TUG), the 10-meter walk (10MWT) and the 6-minute walk (6MWT) tests. All evaluations were performed both before and after the training and were compared to a control group of fifteen iSCI patients.

RESULTS

After the Lokomat training, the active range of motion, the maximal velocity, and the movement smoothness were significantly improved in the voluntary movement. Patients also exhibited an improvement in the MVC for their ankle dorsi- and plantar-flexor muscles. In terms of functional activity, we observed an enhancement in the mobility (TUG) and the over-ground gait velocity (10MWT) with training. Correlation tests indicated a significant relationship between ankle voluntary movement performance and the walking clinical assessments.

CONCLUSIONS

The improvements of the kinematic and kinetic parameters of the ankle voluntary movement, and their correlation with the functional assessments, support the therapeutic effect of robotic-assisted locomotor training on motor impairment in chronic iSCI.

Methodological aspects of EEG and body dynamics measurements during motion

EEG involves the recording, analysis, and interpretation of voltages recorded on the human scalp which originate from brain gray matter. EEG is one of the most popular methods of studying and understanding the processes that underlie behavior. This is so, because EEG is relatively cheap, easy to wear, light weight and has high temporal resolution. In terms of behavior, this encompasses actions, such as movements that are performed in response to the environment. However, there are methodological difficulties which can occur when recording EEG during movement such as movement artifacts. Thus, most studies about the human brain have examined activations during static conditions. This article attempts to compile and describe relevant methodological solutions that emerged in order to measure body and brain dynamics during motion. These descriptions cover suggestions on how to avoid and reduce motion artifacts, hardware, software and techniques for synchronously recording EEG, EMG, kinematics, kinetics, and eye movements during motion. Additionally, we present various recording systems, EEG electrodes, caps and methods for determinating real/custom electrode positions. In the end we will conclude that it is possible to record and analyze synchronized brain and body dynamics related to movement or exercise tasks.

Spatiotemporal independent component analysis combine general linear model applied to fMRI for eliminating neural noise

Functional magnetic resonance imaging (fMRI) has recently become an effective means to explore the mechanism of functional rehabilitation in stroke patients. Neural noise is an inevitable structural noise, and is an important factor caused individual differences in fMRI data, therefore, eliminating the neural noise is being regarded as one of the task that cannot be ignored. In this paper, a new algorithm combines spatiotemporal independent component analysis and general linear model (GLM) is proposed to eliminate the effect caused by excess neural activity. This new algorithm simultaneously maximizes the independence over time and space in fMRI data for establishing the spatiotemporal balance. The new technique was applied to extract the active regions of ankle dorsiflexion during fMRI scanning process. Compared to results of GLM, the results of new combined algorithm is more reasonable with an 8% improvement in correlation coefficient. It confirmed that this new algorithm is effective in eliminating system noise and neural disturbance.

Modular ankle robotics training in early subacute stroke: a randomized controlled pilot study

BACKGROUND. Modular lower extremity robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually guided and visually evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking.

OBJECTIVE

To assess the feasibility and efficacy of daily anklebot training during early subacute hospitalization poststroke.

METHODS

Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (n = 18) or passive manual stretching (n = 16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an "assist-as-needed" approach during >200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded.

RESULTS

Both groups walked faster at discharge; however, the robot group improved more in percentage change of temporal symmetry (P = .032) and also of step length symmetry (P = .038), with longer nonparetic step lengths in the robot (133%) versus stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (P ≤ .001) and mean (P ≤ .01) angular speeds, and increased movement smoothness (P ≤ .01). There were no adverse events.

CONCLUSION

Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early subacute hospitalization is well tolerated and improves ankle motor control and gait patterning.

Re-thinking the role of motor cortex: context-sensitive motor outputs?

The standard account of motor control considers descending outputs from primary motor cortex (M1) as motor commands and efference copy. This account has been challenged recently by an alternative formulation in terms of active inference: M1 is considered as part of a sensorimotor hierarchy providing top–down proprioceptive predictions. The key difference between these accounts is that predictions are sensitive to the current proprioceptive context, whereas efference copy is not. Using functional electric stimulation to experimentally manipulate proprioception during voluntary movement in healthy human subjects, we assessed the evidence for context sensitive output from M1. Dynamic causal modeling of functional magnetic resonance imaging responses showed that FES altered proprioception increased the influence of M1 on primary somatosensory cortex (S1). These results disambiguate competing accounts of motor control, provide some insight into the synaptic mechanisms of sensory attenuation and may speak to potential mechanisms of action of FES in promoting motor learning in neurorehabilitation.

•

Peripheral functional electrical stimulation provides altered proprioception.

•

Altered proprioception and volitional movement interaction is shown in M1 and S1.

•

M1–S1 connection is modulated by proprioception and therefore is context-sensitive.

•

Context-sensitive M1–S1 pathway supports an active inference motor control account.

Effects of volitional walking control on postexercise changes in motor cortical excitability

To explore the effects of qualitative or quantitative changes in walking on motor cortical excitability, a transcranial magnetic stimulation procedure was used to examine the alterations of motor-evoked potential (MEP) amplitude following walking. Eight healthy participants completed a series of two walking tasks on a treadmill at 2 km/h. The ratio of the left stance duration to the right stance duration was 1 : 2 in the asymmetrical walking task and 1 : 1 in the symmetrical walking task. In each task, walking for 10 min followed by MEP measurement for ∼4 min was repeated three times. MEP measurements were also performed before a walking task as a baseline and continued every 10 min for a further 30 min after the completion of the walking task. During slight voluntary contraction of the left tibialis anterior muscle, MEP measurements were conducted four times. Although a significant MEP depression was found after the asymmetrical walking task with increasing amount of walking, no significant decrease in MEP below baseline was observed after the symmetrical walking task throughout all measurement sessions. This MEP depression was the prominent response to the asymmetrical walking task compared with the symmetrical walking task. These findings indicate that the intentional control of walking pattern has both temporal and task-specific influences on excitability changes in the cerebral cortex, and suggest that motor cortical excitability may be altered by controlling the amount of central commands to the legs even during gait exercise.

Towards effective non-invasive brain-computer interfaces dedicated to gait rehabilitation systems

In the last few years, significant progress has been made in the field of walk rehabilitation. Motor cortex signals in bipedal monkeys have been interpreted to predict walk kinematics. Epidural electrical stimulation in rats and in one young paraplegic has been realized to partially restore motor control after spinal cord injury. However, these experimental trials are far from being applicable to all patients suffering from motor impairments. Therefore, it is thought that more simple rehabilitation systems are desirable in the meanwhile. The goal of this review is to describe and summarize the progress made in the development of non-invasive brain-computer interfaces dedicated to motor rehabilitation systems. In the first part, the main principles of human locomotion control are presented. The paper then focuses on the mechanisms of supra-spinal centers active during gait, including results from electroencephalography, functional brain imaging technologies [near-infrared spectroscopy (NIRS), functional magnetic resonance imaging (fMRI), positron-emission tomography (PET), single-photon emission-computed tomography (SPECT)] and invasive studies. The first brain-computer interface (BCI) applications to gait rehabilitation are then presented, with a discussion about the different strategies developed in the field. The challenges to raise for future systems are identified and discussed. Finally, we present some proposals to address these challenges, in order to contribute to the improvement of BCI for gait rehabilitation.

Preserved foot motor cortex in patients with complete spinal cord injury: a functional near-infrared spectroscopic study

BACKGROUND

Since the brain is intact, persons with a spinal cord injury (SCI) might benefit from a brain-computer interface (BCI) to improve mobility by making use of functional near-infrared spectroscopy (fNIRS).

OBJECTIVE

We aimed to use fNIRS to detect contralateral primary motor cortex activity during attempted foot movements in participants with complete SCI.

METHODS

A 6-channel fNIRS, including 2 reference channels, measured relative concentration changes of oxy- (HbO) and deoxy-hemoglobin (HbR) in the contralateral motor cortex for the right foot. Seven subjects, studied within 18 months after injury, performed 12 trials of attempted right foot and real hand movements.

RESULTS

T tests revealed significant HbO and HbR responses of the left motor cortex for attempted foot movements, but not for right hand movements. A 2-way repeated-measures analysis of variance revealed a larger decrease in HbR for attempted foot movements compared to hand movements. Individual results show major interindividual differences in (number of) channels activated and the sensitive chromophore (HbR or HbO).

CONCLUSIONS

On group level, activity in the motor cortex of the foot can be measured with fNIRS in patients with complete SCI during attempted foot movements and might in principle be used in future BCI studies and applications.

Enhanced activation of motor execution networks using action observation combined with imagination of lower limb movements

The combination of first-person observation and motor imagery, i.e. first-person observation of limbs with online motor imagination, is commonly used in interactive 3D computer gaming and in some movie scenes. These scenarios are designed to induce a cognitive process in which a subject imagines himself/herself acting as the agent in the displayed movement situation. Despite the ubiquity of this type of interaction and its therapeutic potential, its relationship to passive observation and imitation during observation has not been directly studied using an interactive paradigm. In the present study we show activation resulting from observation, coupled with online imagination and with online imitation of a goal-directed lower limb movement using functional MRI (fMRI) in a mixed block/event-related design. Healthy volunteers viewed a video (first-person perspective) of a foot kicking a ball. They were instructed to observe-only the action (O), observe and simultaneously imagine performing the action (O-MI), or imitate the action (O-IMIT). We found that when O-MI was compared to O, activation was enhanced in the ventralpremotor cortex bilaterally, left inferior parietal lobule and left insula. The O-MI and O-IMIT conditions shared many activation foci in motor relevant areas as confirmed by conjunction analysis. These results show that (i) combining observation with motor imagery (O-MI) enhances activation compared to observation-only (O) in the relevant foot motor network and in regions responsible for attention, for control of goal-directed movements and for the awareness of causing an action, and (ii) it is possible to extensively activate the motor execution network using O-MI, even in the absence of overt movement. Our results may have implications for the development of novel virtual reality interactions for neurorehabilitation interventions and other applications involving training of motor tasks.

Functional neuroimaging of the interference between working memory and the control of periodic ankle movement timing

Background

Limited information processing capacity in the brain necessitates task prioritisation and subsequent adaptive behavioural strategies for the dual-task coordination of locomotion with severe concurrent cognitive loading. Commonly observed strategies include prioritisation of gait at the cost of reduced performance in the cognitive task. Alternatively alterations of gait parameters such as gait velocity have been reported presumably to free processing capacity for the benefit of performance in the cognitive task. The aim of this study was to describe the neuroanatomical correlates of adaptive behavioural strategies in cognitive-motor dual-tasking when the competition for information processing capacity is severe and may exceed individuals’ capacity limitations.

Methods

During an fMRI experiment, 12 young adults performed slow continuous, auditorily paced bilateral anti-phase ankle dorsi-plantarflexion movements as an element of normal gait at .5 Hz in single and dual task modes. The secondary task involved a visual, alphabetic N-back task with presentation rate jittered around .7 Hz. The N-back task, which randomly occurred in 0-back or 2-back form, was modified into a silent counting task to avoid confounding motor responses at the cost of slightly increasing the task′s general coordinative complexity. Participants’ ankle movements were recorded using an optoelectronic motion capture system to derive kinematic parameters representing the stability of the movement timing and synchronization. Participants were instructed to perform both tasks as accurately as possible.

Results

Increased processing complexity in the dual-task 2-back condition led to significant changes in movement parameters such as the average inter-response interval, the coefficient of variation of absolute asynchrony and the standard deviation of peak angular velocity. A regions-of-interest analysis indicated correlations between these parameters and local activations within the left inferior frontal gyrus (IFG) such that lower IFG activations coincided with performance decrements.

Conclusions

Dual-task interference effects show that the production of periodically timed ankle movements, taken as modelling elements of the normal gait cycle, draws on higher-level cognitive resources involved in working memory. The interference effect predominantly concerns the timing accuracy of the ankle movements. Reduced activations within regions of the left IFG, and in some respect also within the superior parietal lobule, were identified as one factor affecting the timing of periodic ankle movements resulting in involuntary ‘hastening’ during severe dual-task working memory load. This ‘hastening’ phenomenon may be an expression of re-automated locomotor control when higher-order cognitive processing capacity can no longer be allocated to the movements due to the demands of the cognitive task. The results of our study also propose the left IFG as a target region to improve performance during dual-task walking by techniques for non-invasive brain stimulation.

•

Neural correlates of involuntary ‘hastening’ of movements during cognitive-motor dual-tasking.

•

Role of left inferior frontal gyrus and left superior parietal lobe in the temporal regulation of dual-task bilateral movements.

•

Dissociation between left-hemisphere parietal involvement in external timing of bilateral movements and right hemisphere parietal involvement in interlimb coordination.

Temporal motor coordination in the ankle joint following upper motor neuron lesions

[Purpose] We compared ankle temporal motor coordination between stroke, spinal disease and healthy elderly groups, and investigated the relationship between motor impairments and gait speed. [Subjects] Twenty-four patients with stroke, 19 post-operative spinal disease patients and 17 healthy elderly subjects participated. [Methods] Ankle temporal motor coordination of the three groups was assessed using the simple reaction time, the foot-tapping test, and a rhythm task. Rhythm error and rhythm variation were analyzed using the results of the rhythm task. Isometric muscle strength, spasticity, muscle stiffness, somatosensory and 10-m gait speed of the stroke and spinal disease subjects were also measured. [Results] Only the stroke group showed significant reductions in temporal accuracy and consistency in the rhythm task. Simple reaction time and the rhythm task were significantly poorer in the stroke group, whereas the foot-tapping test was not. Stepwise multiple regression analysis indicated gait speed was explained by rhythm error and plantarflexor strength in the stroke group, and rhythm error and simple reaction time in the spinal disease group. [Conclusion] Poor performance in simple reaction time and the rhythm task in the stroke group suggest these tasks are controlled by the supraspinal central nervous system. Negative features, particularly motor coordination, are more associated with gait speed than positive features.

EEG during pedaling: evidence for cortical control of locomotor tasks

OBJECTIVE

This study characterized the brain electrical activity during pedaling, a locomotor-like task, in humans. We postulated that phasic brain activity would be associated with active pedaling, consistent with a cortical role in locomotor tasks.

METHODS

Sixty four channels of electroencephalogram (EEG) and 10 channels of electromyogram (EMG) data were recorded from 10 neurologically-intact volunteers while they performed active and passive (no effort) pedaling on a custom-designed stationary bicycle. Ensemble averaged waveforms, 2 dimensional topographic maps and amplitude of the β (13-35 Hz) frequency band were analyzed and compared between active and passive trials.

RESULTS

The peak-to-peak amplitude (peak positive-peak negative) of the EEG waveform recorded at the Cz electrode was higher in the passive than the active trials (p < 0.01). β-band oscillations in electrodes overlying the leg representation area of the cortex were significantly desynchronized during active compared to the passive pedaling (p < 0.01). A significant negative correlation was observed between the average EEG waveform for active trials and the composite EMG (summated EMG from both limbs for each muscle) of the rectus femoris (r = -0.77, p < 0.01) the medial hamstrings (r = -0.85, p < 0.01) and the tibialis anterior (r = -0.70, p < 0.01) muscles.

CONCLUSIONS

These results demonstrated that substantial sensorimotor processing occurs in the brain during pedaling in humans. Further, cortical activity seemed to be greatest during recruitment of the muscles critical for transitioning the legs from flexion to extension and vice versa.

SIGNIFICANCE

This is the first study demonstrating the feasibility of EEG recording during pedaling, and owing to similarities between pedaling and bipedal walking, may provide valuable insight into brain activity during locomotion in humans.

Design of an active-passive device for human ankle movement during functional magnetic resonance imaging analysis

Functional magnetic resonance imaging analysis has made major strides in recent years, both because of the development of new scanners and owing to magnetic resonance compatible systems that make it possible to stimulate parts of the human body during analysis. The significant gains in our knowledge of the brain that can thus be achieved justify efforts to construct machines with control circuits suitable for this purpose. This paper presents a magnetic resonance compatible mechatronic device with electropneumatic control that can be used to move one or both feet during functional magnetic resonance imaging analysis of the cerebral motor zones. The system is innovative and original. The results obtained at the end of the investigation were good, and demonstrated that the design is feasible.

Level of participation in robotic-assisted treadmill walking modulates midline sensorimotor EEG rhythms in able-bodied subjects

In robot assisted gait training, a pattern of human locomotion is executed repetitively with the intention to restore the motor programs associated with walking. Several studies showed that active contribution to the movement is critical for the encoding of motor memory. We propose to use brain monitoring techniques during gait training to encourage active participation in the movement. We investigated the spectral patterns in the electroencephalogram (EEG) that are related to active and passive robot assisted gait. Fourteen healthy participants were considered. Infomax independent component analysis separated the EEG into independent components representing brain, muscle, and eye movement activity, as well as other artifacts. An equivalent current dipole was calculated for each independent component. Independent components were clustered across participants based on their anatomical position and frequency spectra. Four clusters were identified in the sensorimotor cortices that accounted for differences between active and passive walking or showed activity related to the gait cycle. We show that in central midline areas the mu (8-12 Hz) and beta (18-21 Hz) rhythms are suppressed during active compared to passive walking. These changes are statistically significant: mu (F(1, 13)=11.2 p ≤ 0.01) and beta (F(1, 13)=7.7, p ≤ 0.05). We also show that these differences depend on the gait cycle phases. We provide first evidence of modulations of the gamma rhythm in the band 25 to 40 Hz, localized in central midline areas related to the phases of the gait cycle. We observed a trend (F(1, 8)=11.03, p ≤ 0.06) for suppressed low gamma rhythm when comparing active and passive walking. Additionally we found significant suppressions of the mu (F(1, 11)=20.1 p ≤ 0.01), beta (F(1, 11)=11.3 p ≤ 0.05) and gamma (F(1, 11)=4.9 p ≤ 0.05) rhythms near C3 (in the right hand area of the primary motor cortex) during phases of active vs. passive robot assisted walking. To our knowledge this is the first study showing EEG analysis during robot assisted walking. We provide evidence for significant differences in cortical activation between active and passive robot assisted gait. Our findings may help to define appropriate features for single trial detection of active participation in gait training. This work is a further step toward the evaluation of brain monitoring techniques and brain-computer interface technologies for improving gait rehabilitation therapies in a top-down approach.

Reliability of the motor learning strategy rating instrument for children and youth with acquired brain injury

PURPOSE

To evaluate reliability and feasibility of the Motor Learning Strategy Rating Instrument (MLSRI) in children with acquired brain injury (ABI). The MLSRI quantifies the extent to which motor learning strategies (MLS) are used within physiotherapy (PT) interventions.

METHODS

PT sessions conducted by ABI team physiotherapists with a convenience sample of children with ABI (4-18 years) were videotaped and independently scored later by two raters trained in MLSRI use. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) estimated intra- and inter-rater reliability.

RESULTS

Eighteen PT sessions were evaluated. Intra- and inter-rater reliability ICCs for total score were 0.86 (95% CI: 0.66-0.94) and 0.50 (95% CI: 0.08-0.78), respectively. MLSRI category ICCs were 0.56-0.86 (intra-rater) and 0.16-0.84 (inter-rater).

CONCLUSIONS

Intra-rater reliability of MSLRI total score was excellent. Moderate inter-rater reliability may partially be due to inconsistent item interpretation between raters. Revisions and further reliability testing are required before recommending the MLSRI for clinical and research use.

Decoding intra-limb and inter-limb kinematics during treadmill walking from scalp electroencephalographic (EEG) signals

Brain-machine interface (BMI) research has largely been focused on the upper limb. Although restoration of gait function has been a long-standing focus of rehabilitation research, surprisingly very little has been done to decode the cortical neural networks involved in the guidance and control of bipedal locomotion. A notable exception is the work by Nicolelis' group at Duke University that decoded gait kinematics from chronic recordings from ensembles of neurons in primary sensorimotor areas in rhesus monkeys. Recently, we showed that gait kinematics from the ankle, knee, and hip joints during human treadmill walking can be inferred from the electroencephalogram (EEG) with decoding accuracies comparable to those using intracortical recordings. Here we show that both intra- and inter-limb kinematics from human treadmill walking can be achieved with high accuracy from as few as 12 electrodes using scalp EEG. Interestingly, forward and backward predictors from EEG signals lagging or leading the kinematics, respectively, showed different spatial distributions suggesting distinct neural networks for feedforward and feedback control of gait. Of interest is that average decoding accuracy across subjects and decoding modes was ~0.68±0.08, supporting the feasibility of EEG-based BMI systems for restoration of walking in patients with paralysis.

Multi-channel NIRS of the primary motor cortex to discriminate hand from foot activity

The poor spatial resolution of near-infrared spectroscopy (NIRS) makes it difficult to distinguish two closely located cortical areas from each other. Here, a combination of multi-channel NIRS and a centre of gravity (CoG) approach (widely accepted in the field of transcranial magnetic stimulation; TMS) was used to discriminate between closely located cortical areas activated during hand and foot movements. Similarly, the possibility of separating the more anteriorly represented discrete movements from rhythmic movements was studied. Thirteen healthy right-handed subjects performed rhythmic or discrete ('task') hand or foot ('extremity') tapping. Hemodynamic responses were measured using an 8-channel NIRS setup. For oxyhemoglobin (OHb) and deoxyhemoglobin (HHb), a CoG was determined for each condition using the mean hemodynamic responses and the coordinates of the channels. Significant hemodynamic responses were found for hand and foot movements. Based on the HHb responses, the NIRS-CoG of hand movements was located 0.6 cm more laterally compared to the NIRS-CoG of foot movements. For OHb responses no difference in NIRS-CoG was found for 'extremity' nor for 'task'. This is the first NIRS study showing hemodynamic responses for isolated foot movements. Furthermore, HHb responses have the potential to be used in multi-channel NIRS experiments requiring differential activation of motor cortex areas linked to either hand or foot movements.

Advancing measurement of locomotor rehabilitation outcomes to optimize interventions and differentiate between recovery versus compensation

Progress in locomotor rehabilitation has created an increasing need to understand the factors that contribute to motor behavior, to determine whether these factors are modifiable, and if so, to determine how best to modify them in a way that promotes improved function. Currently available clinical measures do not have the capacity to distinguish between neuromotor recovery and compensation for impaired underlying body structure/functions. This Special Interest article examines the state of outcomes measurement in physical therapy in regard to locomotor rehabilitation, and suggests approaches that may improve assessment of recovery and clinical decision-making capabilities. We examine historical approaches to measurement of locomotor rehabilitation outcomes, including rating scales, timed movement tasks, and laboratory-based outcome measures, and we discuss the emerging use of portable technology to assess walking in a free-living environment. The ability to accurately measure outcomes of rehabilitation, both in and away from the clinical/laboratory setting, allows assessment of skill acquisition, retention, and long-term carryover in a variety of environments. Accurate measurement allows behavioral changes to be observed, and assessments to be made, regarding an individual's ability to adapt during interventions and to incorporate new skills into real-world behaviors. The result of such an approach to assessment may be that interventions truly translate from clinical/laboratory to real-world environments. Future locomotor measurement tools must be based on a theoretical framework that can guide their use to accurately quantify treatment effects and provide a basis upon which to develop and refine therapeutic interventions.

Neural control of rhythmic arm cycling after stroke

Disordered reflex activity and alterations in the neural control of walking have been observed after stroke. In addition to impairments in leg movement that affect locomotor ability after stroke, significant impairments are also seen in the arms. Altered neural control in the upper limb can often lead to altered tone and spasticity resulting in impaired coordination and flexion contractures. We sought to address the extent to which the neural control of movement is disordered after stroke by examining the modulation pattern of cutaneous reflexes in arm muscles during arm cycling. Twenty-five stroke participants who were at least 6 mo postinfarction and clinically stable, performed rhythmic arm cycling while cutaneous reflexes were evoked with trains (5 × 1.0-ms pulses at 300 Hz) of constant-current electrical stimulation to the superficial radial (SR) nerve at the wrist. Both the more (MA) and less affected (LA) arms were stimulated in separate trials. Bilateral electromyography (EMG) activity was recorded from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted on averaged reflexes in 12 equidistant phases of the movement cycle. Phase-modulated cutaneous reflexes were present, but altered, in both MA and LA arms after stroke. Notably, the pattern was "blunted" in the MA arm in stroke compared with control participants. Differences between stroke and control were progressively more evident moving from shoulder to wrist. The results suggest that a reduced pattern of cutaneous reflex modulation persists during rhythmic arm movement after stroke. The overall implication of this result is that the putative spinal contributions to rhythmic human arm movement remain accessible after stroke, which has translational implications for rehabilitation.

Self-paced and externally triggered rhythmical lower limb movements: a functional MRI study

Self-paced rhythmical lower limb movement is an important component of locomotive motion in humans. External stimuli are known to facilitate the generation of rhythmical motion. The importance of such self-paced and externally triggered movements is widely recognized, and these movements of the upper limbs have been studied in detail. However, the difference in neural mechanisms between the self-paced and externally triggered movements of the lower limbs is not clear even in healthy subjects. The present study investigated the neural regions involved in the lower limb movements by using functional magnetic resonance imaging (fMRI). The subjects were fixed face-up to an MRI bed and performed lower limb movements that mimicked walking under self-paced and externally triggered conditions. The results showed that the supplementary motor area, sensorimotor cortex and cerebellum were involved in both types of movement, but the basal ganglia and the thalamus were selectively recruited for the self-paced lower limb movement. These results are compatible with those of previous studies on the control of the lower limbs, and on upper limb movement under self-paced and externally triggered conditions.

Should body weight-supported treadmill training and robotic-assistive steppers for locomotor training trot back to the starting gate?

Body weight-supported treadmill training (BWSTT) and robotic-assisted step training (RAST) have not, so far, led to better outcomes than a comparable dose of progressive over-ground training (OGT) for disabled persons with stroke, spinal cord injury, multiple sclerosis, Parkinson's disease, or cerebral palsy. The conceptual bases for these promising rehabilitation interventions had once seemed quite plausible, but the results of well-designed, randomized clinical trials have been disappointing. The authors reassess the underpinning concepts for BWSTT and RAST, which were derived from mammalian studies of treadmill-induced hind-limb stepping associated with central pattern generation after low thoracic spinal cord transection, as well as human studies of the triple crown icons of task-oriented locomotor training, massed practice, and activity-induced neuroplasticity. The authors retrospectively consider where theory and practice may have fallen short in the pilot studies that aimed to produce thoroughbred interventions. Based on these shortcomings, the authors move forward with recommendations for the future development of workhorse interventions for walking. In the absence of evidence for physical therapists to employ these strategies, however, BWSTT and RAST should not be provided routinely to disabled, vulnerable persons in place of OGT outside of a scientifically conducted efficacy trial.

A combined robotic and cognitive training for locomotor rehabilitation: evidences of cerebral functional reorganization in two chronic traumatic brain injured patients

It has been demonstrated that automated locomotor training can improve walking capabilities in spinal cord-injured subjects but its effectiveness on brain damaged patients has not been well established. A possible explanation of the discordant results on the efficacy of robotic training in patients with cerebral lesions could be that these patients, besides stimulation of physiological motor patterns through passive leg movements, also need to train the cognitive aspects of motor control. Indeed, another way to stimulate cerebral motor areas in paretic patients is to use the cognitive function of motor imagery. A promising possibility is thus to combine sensorimotor training with the use of motor imagery. The aim of this paper is to assess changes in brain activations after a combined sensorimotor and cognitive training for gait rehabilitation. The protocol consisted of the integrated use of a robotic gait orthosis prototype with locomotor imagery tasks. Assessment was conducted on two patients with chronic traumatic brain injury and major gait impairments, using functional magnetic resonance imaging. Physiatric functional scales were used to assess clinical outcomes. Results showed greater activation post-training in the sensorimotor and supplementary motor cortices, as well as enhanced functional connectivity within the motor network. Improvements in balance and, to a lesser extent, in gait outcomes were also found.

Persistence of locomotor-related interlimb reflex networks during walking after stroke

OBJECTIVE

Cutaneous nerve stimulation evokes coordinated and phase-modulated reflex output widely distributed to muscles of all four limbs during walking. Accessibility to this distributed network after stroke offers insight into the pathological changes and suggests utility for therapeutic applications. Here we examined muscles in both the more (MA) and less affected (LA) legs evoked by stimulation at the ankle and wrist during walking in chronic (>6 months post CVA) stroke.

METHODS

Stroke and control participants walked on a treadmill with a harness support system. Reflexes were evoked with trains of electrical stimuli delivered separately to the cutaneous superficial peroneal (SP; at the ankle) and superficial radial (SR; at the wrist) nerves. Background locomotor and reflex EMG were phase-averaged across the gait cycle and analyzed off line.

RESULTS

Locomotor background muscle activation patterns were altered bilaterally in stroke, as compared with control. Phase-dependent modulation of interlimb cutaneous reflexes was found in both stroke and control subjects with stimulation of each nerve, but responses were blunted in stroke. Reflex reversal in tibialis anterior (TA) at heel strike with SP nerve stimulation was present in both groups. Notably, SR nerve stimulation produced facilitation during the swing-to-stance transition in the TA and suppression of MG in the MA leg during stance.

CONCLUSIONS

Interlimb cutaneous inputs may access coordinated reflex pathways in the MA limb during walking after stroke. Importantly activation in these pathways could provoke responses to counter foot drop during swing phase of walking. Additionally, our data support the perspective that there is no "unaffected" side after stroke and that caution should be used when interpreting the LA side as "control" after stroke.

SIGNIFICANCE

The presence of functionally-relevant interlimb cutaneous reflexes in the MA leg presents a substrate that may be strengthened by rehabilitation.

Neural decoding of treadmill walking from noninvasive electroencephalographic signals

Chronic recordings from ensembles of cortical neurons in primary motor and somatosensory areas in rhesus macaques provide accurate information about bipedal locomotion (Fitzsimmons NA, Lebedev MA, Peikon ID, Nicolelis MA. Front Integr Neurosci 3: 3, 2009). Here we show that the linear and angular kinematics of the ankle, knee, and hip joints during both normal and precision (attentive) human treadmill walking can be inferred from noninvasive scalp electroencephalography (EEG) with decoding accuracies comparable to those from neural decoders based on multiple single-unit activities (SUAs) recorded in nonhuman primates. Six healthy adults were recorded. Participants were asked to walk on a treadmill at their self-selected comfortable speed while receiving visual feedback of their lower limbs (i.e., precision walking), to repeatedly avoid stepping on a strip drawn on the treadmill belt. Angular and linear kinematics of the left and right hip, knee, and ankle joints and EEG were recorded, and neural decoders were designed and optimized with cross-validation procedures. Of note, the optimal set of electrodes of these decoders were also used to accurately infer gait trajectories in a normal walking task that did not require subjects to control and monitor their foot placement. Our results indicate a high involvement of a fronto-posterior cortical network in the control of both precision and normal walking and suggest that EEG signals can be used to study in real time the cortical dynamics of walking and to develop brain-machine interfaces aimed at restoring human gait function.

Altered functional organization of the motor system related to ankle movements in Parkinson's disease: insights from functional MRI

Bradykinesia represents one of the cardinal and most incapacitating features of Parkinson's disease (PD). In this context, investigating the cerebral control mechanisms for limb movements and defining the associated functional neuroanatomy is important for understanding the impaired motor activity in PD. So far, most studies have focused on motor control of upper limb movements in PD. Ankle movement functional MRI (fMRI) paradigms have been used to non-invasively investigate supraspinal control mechanisms relevant for lower limb movements in healthy subjects, patients with Multiple sclerosis, and stroke. Using such an active and passive paradigm in 20 PD patients off medication (mean age 66.8 ± 7.2 years) and 20 healthy controls (HC; mean age 62.3 ± 6.9 years), we here wished to probe for possible activation differences between PD and HC and define functional correlates of lower limb function in PD. Active ankle movement versus rest was associated with a robust activation pattern in expected somatotopy involving key motor areas both in PD and HC. However, contrasting activation patterns in patients versus controls revealed excess activation in the patients in frontal regions comprising pre-supplementary motor areas (pre-SMA) and SMA proper. The extent of SMA activation did not correlate with behavioural parameters related to gait or motor function, and no differences were seen with the passive paradigm. This finding might be indicative of higher demand and increased effort in PD patients to ensure adequate motor function despite existing deficits. The missing correlation with behavioural variables and lack of differences with the passive paradigm suggests that this excess activation is not exclusively compensatory and also not hard-wired.

Hemispheric specialization during mental imagery of brisk walking

OBJECTIVES

Brisk walking, a sensitive test to evaluate gait capacity in normal and pathological aging such as parkinsonism, is used as an alternative to classical fitness program for motor rehabilitation and may help to decrease the risk of cognitive deterioration observed with aging. In this study, we aimed to identify brain areas normally involved in its control.

METHODS

We conducted a block-design blood oxygen level dependent function magnetic resonance imaging (BOLD fMRI) experiment in 18 young healthy individuals trained to imagine themselves in three main situations: brisk walking in a 25-m-long corridor, standing or lying. Imagined walking time (IWT) was measured as a control of behavioral performance during fMRI.

RESULTS

The group mean IWT was not significantly different from the actual walking time measured during a training session prior to the fMRI study. Compared with other experimental conditions, mental imagery (MI) of brisk walking was associated with stronger activity in frontal and parietal regions mainly on the right, and cerebellar hemispheres, mainly on the left. Presumed imagined walking speed (2.3 ± 0.4 m/s) was positively correlated with activity levels in the right dorsolateral prefrontal cortex and posterior parietal lobule along with the vermis and the left cerebellar hemisphere.

INTERPRETATIONS

A new finding in this study is that MI of brisk walking in young healthy individuals strongly involves processes lateralized in right fronto-parietal regions along with left cerebellum. These results show that brisk walking might be a non automatic locomotor activity requiring a high-level supraspinal control.

Combined transcranial direct current stimulation and robot-assisted gait training in patients with chronic stroke: a preliminary comparison

Objective: To evaluate whether robot-assisted gait training combined with transcranial direct current stimulation is more effective than robot-assisted gait training alone or conventional walking rehabilitation for improving walking ability in stroke patients.

Design: Pilot randomized clinical trial.

Setting: Rehabilitation unit of a university hospital.

Subjects: Thirty patients with chronic stroke.

Interventions: All patients received ten 50-minute treatment sessions, five days a week, for two consecutive weeks. Group 1 (n = 10) underwent a robot-assisted gait training combined with transcranial direct current stimulation; group 2 (n = 10) underwent a robot-assisted gait training combined with sham transcranial direct current stimulation; group 3 (n = 10) performed overground walking exercises.

Main measures: Patients were evaluated before, immediately after and two weeks post treatment. Primary outcomes: six-minute walking test, 10-m walking test.

Results: No differences were found between groups 1 and 2 for all primary outcome measures at the after treatment and follow-up evaluations. A statistically significant improvement was found after treatment in performance on the six-minute walking test and the 10-m walking test in favour of group 1 (six-minute walking test: 205.20 ± 61.16 m; 10-m walking test: 16.20 ± 7.65 s) and group 2 (six-minute walking test: 182.5 ± 69.30 m; 10-m walking test: 17.71 ± 8.20 s) compared with group 3 (six-minute walking test: 116.30 ± 75.40 m; 10-m walking test: 26.30 ± 14.10 s). All improvements were maintained at the follow-up evaluation.

Conclusions: In the present pilot study transcranial direct current stimulation had no additional effect on robot-assisted gait training in patients with chronic stroke. Larger studies are required to confirm these preliminary findings.

Transcutaneous electrical stimulation on acupoints combined with task-related training to improve motor function and walking performance in an individual 7 years poststroke: a case study

BACKGROUND AND PURPOSE

Impaired walking function and spasticity are common sequelae of stroke. Prior studies have shown that a rehabilitation program combining transcutaneous electrical stimulation (TES) with task-related training (TRT) improves motor function in individuals with stroke. However, it is unclear if this approach is beneficial for individuals with long-standing stroke.

CASE DESCRIPTION

The subject of this case study was a 61-year-old man who was 7 years poststroke. He exhibited limitations of walking function, impaired strength of the ankle muscles, and severe plantarflexor spasticity.

INTERVENTIONS

For 4 weeks, the patient performed a 5-day/wk home program consisting of 60 minutes of TES (below motor threshold) to the acupoints in the affected lower leg, followed by 60 minutes of TRT. He documented his daily home program activities in a log, and 3 times a week he received a call from the therapist to verify his adherence. The patient also had 8 clinic visits, which focused on instruction to ensure adherence to the (TES + TRT) protocol and progression of the program.

OUTCOMES

After the 4-week program, plantarflexor spasticity decreased and ankle dorsi- and plantarflexor strength improved. More important, there were notable improvements in gait velocity, walking endurance, and functional mobility. These gains were maintained at 4 weeks posttreatment.

DISCUSSION

This accessible home program was safe and effective for decreasing impairment and improving function in an individual with long-term, chronic stroke. The gains were maintained 4 weeks posttreatment. Details are provided for developing a home program integrating somatosensory TES and TRT.

Passive and active exercise improve regeneration and muscle reinnervation after peripheral nerve injury in the rat

INTRODUCTION

Lesions of peripheral nerves cause loss of motor and sensory function and also lead to hyperreflexia and hyperalgesia. Activity-dependent therapies promote axonal regeneration and functional recovery and may improve sensory-motor coordination and restoration of adequate circuitry at the spinal level.

METHODS

We compared the effects of passive (bicycle) and active (treadmill) exercise on nerve regeneration and modulation of the spinal H reflex after transection and repair of the rat sciatic nerve. Animals were evaluated during 2 months using electrophysiological, functional, and histological methods.

RESULTS

Moderate exercise for 1 hour/day, either active treadmill walking or passive cycling, improved muscle reinnervation, increased the number of regenerated axons in the distal nerve, and reduced the increased excitability of spinal reflexes after nerve lesion.

DISCUSSION

Maintenance of denervated muscle activity and afferent input, by active or passive exercise, may increase trophic factor release to act on regenerating axons and to modulate central neuronal plasticity.

Involvement of the corticospinal tract in the control of human gait

Given the inherent mechanical complexity of human bipedal locomotion, and that complete spinal cord lesions in human leads to paralysis with no recovery of gait, it is often suggested that the corticospinal tract (CST) has a more predominant role in the control of walking in humans than in other animals. However, what do we actually know about the contribution of the CST to the control of gait? This chapter will provide an overview of this topic based on the premise that a better understanding of the role of the CST in gait will be essential for the design of evidence-based approaches to rehabilitation therapy, which will enhance gait ability and recovery in patients with lesions to the central nervous system (CNS). We review evidence for the involvement of the primary motor cortex and the CST during normal and perturbed walking and during gait adaptation. We will also discuss knowledge on the CST that has been gained from studies involving CNS lesions, with a particular focus on recent data acquired in people with spinal cord injury.

Understanding gait control in post-stroke: implications for management

The role of the brain in post-stroke gait is not understood properly, although the ability to walk becomes impaired in more than 80% of post-stroke patients. Most, however, regain some ability to walk with either limited mobility or inefficient, asymmetrical or unsafe gait. Conventional intervention focuses on support of weak muscles or body part by use of foot orthosis and walking aids. This review provides an overview of available evidence of neuro-kinesiology & neurophysiology of normal and post-stroke gait. The role of the spinal cord has been explored, more in animals than humans. Mammalian locomotion is based on a rhythmic, "pacemaker" activity of the spinal stepping generators. Bipedal human locomotion is different from quadripedal animal locomotion. However, knowledge derived from the spinal cord investigation of animals, is being applied for management of human gait dysfunction. The potential role of the brain is now recognized in the independent activation of muscles during walking. The brain modifies the gait pattern during the complex demands of daily activities. Though the exact role of the motor cortex in control of gait is unclear, available evidence may be applied to gait rehabilitation of post-stroke patients.

Simultaneous measurements of kinematics and fMRI: compatibility assessment and case report on recovery evaluation of one stroke patient

BACKGROUND

Correlating the features of the actual executed movement with the associated cortical activations can enhance the reliability of the functional Magnetic Resonance Imaging (fMRI) data interpretation. This is crucial for longitudinal evaluation of motor recovery in neurological patients and for investigating detailed mutual interactions between activation maps and movement parameters.Therefore, we have explored a new set-up combining fMRI with an optoelectronic motion capture system, which provides a multi-parameter quantification of the performed motor task.

METHODS

The cameras of the motion system were mounted inside the MR room and passive markers were placed on the subject skin, without any risk or encumbrance. The versatile set-up allows 3-dimensional multi-segment acquisitions including recording of possible mirror movements, and it guarantees a high inter-sessions repeatability.We demonstrated the integrated set-up reliability through compatibility tests. Then, an fMRI block-design protocol combined with kinematic recordings was tested on a healthy volunteer performing finger tapping and ankle dorsal- plantar-flexion. A preliminary assessment of clinical applicability and perspectives was carried out by pre- and post rehabilitation acquisitions on a hemiparetic patient performing ankle dorsal- plantar-flexion. For all sessions, the proposed method integrating kinematic data into the model design was compared with the standard analysis.

RESULTS

Phantom acquisitions demonstrated the not-compromised image quality. Healthy subject sessions showed the protocols feasibility and the model reliability with the kinematic regressor. The patient results showed that brain activation maps were more consistent when the images analysis included in the regression model, besides the stimuli, the kinematic regressor quantifying the actual executed movement (movement timing and amplitude), proving a significant model improvement. Moreover, concerning motor recovery evaluation, after one rehabilitation month, a greater cortical area was activated during exercise, in contrast to the usual focalization associated with functional recovery. Indeed, the availability of kinematics data allows to correlate this wider area with a higher frequency and a larger amplitude of movement.

CONCLUSIONS

The kinematic acquisitions resulted to be reliable and versatile to enrich the fMRI images information and therefore the evaluation of motor recovery in neurological patients where large differences between required and performed motion can be expected.

Electrocortical activity is coupled to gait cycle phase during treadmill walking

Recent findings suggest that human cortex is more active during steady-speed unperturbed locomotion than previously thought. However, techniques that have been used to image the brain during locomotion lack the temporal resolution necessary to assess intra-stride cortical dynamics. Our aim was to determine if electrocortical activity is coupled to gait cycle phase during steady-speed human walking. We used electroencephalography (EEG), motion capture, and a force-measuring treadmill to record brain and body dynamics while eight healthy young adult subjects walked on a treadmill. Infomax independent component analysis (ICA) parsed EEG signals into maximally independent component (IC) processes representing electrocortical sources, muscle sources, and artifacts. We calculated a spatially fixed equivalent current dipole for each IC using an inverse modeling approach, and clustered electrocortical sources across subjects by similarities in dipole locations and power spectra. We then computed spectrograms for each electrocortical source that were time-locked to the gait cycle. Electrocortical sources in the anterior cingulate, posterior parietal, and sensorimotor cortex exhibited significant (p<0.05) intra-stride changes in spectral power. During the end of stance, as the leading foot was contacting the ground and the trailing foot was pushing off, alpha- and beta-band spectral power increased in or near the left/right sensorimotor and dorsal anterior cingulate cortex. Power increases in the left/right sensorimotor cortex were more pronounced for contralateral limb push-off (ipsilateral heel-strike) than for ipsilateral limb push-off (contralateral heel-strike). Intra-stride high-gamma spectral power changes were evident in anterior cingulate, posterior parietal, and sensorimotor cortex. These data confirm cortical involvement in steady-speed human locomotion. Future applications of these techniques could provide critical insight into the neural mechanisms of movement disorders and gait rehabilitation.