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

Measurement of brain activation during an upright stepping reaction task using functional near-infrared spectroscopy

Functional near-infrared spectroscopy (fNIRS) is a non-invasive brain imaging technology that uses light to measure changes in cortical hemoglobin concentrations. FNIRS measurements are recorded through fiber optic cables, which allow the participant to wear the fNIRS sensors while standing upright. Thus, fNIRS technology is well suited to study cortical brain activity during upright balance, stepping, and gait tasks. In this study, fNIRS was used to measure changes in brain activation from the frontal, motor, and premotor brain regions during an upright step task that required subjects to step laterally in response to visual cues that required executive function control. We hypothesized that cognitive processing during complex stepping cues would elicit brain activation of the frontal cortex in areas involved in cognition. Our results show increased prefrontal activation associated with the processing of the stepping cues. Moreover, these results demonstrate the potential to use fNIRS to investigate cognitive processing during cognitively demanding balance and gait studies.

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.

The influence of individual motor imagery ability on cerebral recruitment during gait imagery

Motor imagery (MI) is often used in combination with neuroimaging techniques to study the cognitive control of gait. However, imagery ability (IA) varies widely across individuals, potentially influencing the pattern of cerebral recruitment during MI. The aim of the current study was to investigate this effect of IA on the neural correlates of gait control using functional magnetic resonance imaging (fMRI). Twenty healthy young subjects were subdivided into a good and bad imagers group, on the basis of their performance on two mental chronometry tests. For the whole group, MI activated a bilateral network of areas highly consistent with previous studies, encompassing primary motor cortex (BA 4), supplementary motor area, and other frontal and parietal areas, anterior insula, and cerebellum. Compared to bad imagers, good imagers showed higher activation in the right BA 4, left prefrontal cortex (BA 10), right thalamus, and bilateral cerebellum. Good imagers thus appear better able to recruit motor areas during MI, but also activate a prefrontal executive area (BA 10), which integrates information from the body and the environment and participates in higher-order gait control. These differences were found even though the two groups did not differ in other imagery abilities according to a standard questionnaire for vividness of motor and visual imagery. Future studies on MI should take into account these effects, and control for IA when comparing different populations, using appropriate measures. A better understanding of the neural mechanisms that underlie MI ability is crucial to accurately evaluate locomotor skills in clinical measures and neurorehabilitation techniques.

The influence of frontal sinus in brain activation measurements by near-infrared spectroscopy analyzed by realistic head models

Adequate modeling of light propagation in the head is important to predict the sensitivity of NIRS signal and the spatial sensitivity profile of source-detector pairs. The 3D realistic head models of which the geometry is based upon the anatomical images acquired by magnetic resonance imaging and x-ray computed tomography are constructed to investigate the influence of the frontal sinus on the NIRS signal and spatial sensitivity. Light propagation in the head is strongly affected by the presence of the frontal sinus. The light tends to propagate around the frontal sinus. The influence of the frontal sinus on the sensitivity of the NIRS signal to the brain activation is not consistent and depends on the depth of the frontal sinus, the optical properties of the superficial tissues and the relative position between the source-detector pair and the frontal sinus. The frontal sinus located in the shallow region of the skull tends to reduce the sensitivity of the NIRS signal while the deep frontal sinus can increase the sensitivity of the NIRS signal.

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.

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.

Plasticity of corticospinal neural control after locomotor training in human spinal cord injury

Spinal lesions substantially impair ambulation, occur generally in young and otherwise healthy individuals, and result in devastating effects on quality of life. Restoration of locomotion after damage to the spinal cord is challenging because axons of the damaged neurons do not regenerate spontaneously. Body-weight-supported treadmill training (BWSTT) is a therapeutic approach in which a person with a spinal cord injury (SCI) steps on a motorized treadmill while some body weight is removed through an upper body harness. BWSTT improves temporal gait parameters, muscle activation patterns, and clinical outcome measures in persons with SCI. These changes are likely the result of reorganization that occurs simultaneously in supraspinal and spinal cord neural circuits. This paper will focus on the cortical control of human locomotion and motor output, spinal reflex circuits, and spinal interneuronal circuits and how corticospinal control is reorganized after locomotor training in people with SCI. Based on neurophysiological studies, it is apparent that corticospinal plasticity is involved in restoration of locomotion after training. However, the neural mechanisms underlying restoration of lost voluntary motor function are not well understood and translational neuroscience research is needed so patient-orientated rehabilitation protocols to be developed.

Functional foot symmetry and its relation to lower extremity physical performance in older adults: the Framingham Foot Study

BACKGROUND

While many studies use gait symmetry as a marker of healthy gait, the evidence that gait symmetry exists is limited. Because gait symmetry is thought to arise through laterality (i.e., limb preference) and affects gait retraining efforts, it is important to understand if symmetry exists during gait in older adults. Therefore, the purpose of this study was to evaluate foot and gait symmetry in the population-based Framingham Foot Study as well as to determine the effects of vertical force symmetry on physical performance measures.

METHODS

Members of the Framingham Foot Study were included in this analysis (N=1333). Foot function and force data were collected using the Tekscan Matscan during self-selected gait, with symmetry evaluated using the symmetry index. The short physical performance battery (SPPB) measures of balance, chair stands and gait speed assessed lower extremity physical function. Participants were evaluated using quartiles of gait speed and foot symmetry to determine the effects of symmetry on lower extremity physical function.

RESULTS

Individuals with faster gait speed displayed greater foot function asymmetry; individuals with -3.0% to -9.5% asymmetry in foot function performed better on the short physical performance battery (SPPB). Further, with aging, the degree of asymmetry was reduced.

CONCLUSIONS

While this research suggests that a moderate degree of foot asymmetry is associated with better lower extremity function, the causes of vertical force asymmetry are unknown. Future studies should evaluate the causes of foot asymmetry and should track the changes in symmetry that occur with aging.

Brain Activity Stimulated by Prism Adaptation Tasks Utilized for the Treatment of Unilateral Spatial Neglect: A Study with fNIRS

We investigated the neurological basis for efficacy of prism adaptation therapy, which is used for the treatment of poststroke unilateral spatial neglect (USN). Study subjects were 6 USN-positive (+), 6 USN-negative patients, and 6 healthy volunteer control subjects. USN was identified by the Behavioural Inattention Test (BIT). During the tasks, brain activity was assessed with fNIRS via changes in oxyHb concentration per unit length. There was no significant difference in the number of errors in the task between the 3 groups. However, in the USN(+) group there was a significantly greater reduction in oxyHb levels in the right parietal association cortex during the prism adaptation task than in the other 2 groups (P < 0.05). There was an immediate improvement in USN symptoms as well as a significant increase in oxyHb levels during the prism adaptation in the channels covering the right frontal and parietal lobes in 2 patients in the USN(+) group (P < 0.05). This result suggested that decreased activity in the right parietal association cortex, which is related to spatial perception, during the prism adaptation task and task-induced reorganization of the right frontal and parietal areas were involved in improvement in USN symptoms.

Quantitative assessment of diffuse optical tomography sensitivity to the cerebral cortex using a whole-head probe

We quantify the variability in diffuse optical tomography (DOT) sensitivity over the cortical surface in eight young adult subjects. We use the 10/5 electroencephalography system as a basis for our whole-head optical high-density probe design. The contrast-to-noise ratio (CNR) is calculated along with the percentage of the cortex that is above a CNR = 0 dB threshold. We also quantify the effect of including vasculature on the forward model and list our assumptions that allow us to estimate light penetration depth in the head. We show that using the 10/5 system for the optical probe design allows for the measurement of 37% of the cortical surface on average, with a mean CNR in the visible region of 5.5 dB. Certain anatomical regions, such as the lateral occipital cortex, had a very high percentage above the CNR threshold, while other regions such as the cingulate cortex were not measurable. Vasculature blocked optical sensitivity over 1% of the cortex. Cortical coverage was positively correlated with intracranial volume and relative cerebrospinal fluid volume, and negatively correlated with relative scalp volume and skull volume. These contributions allow experimenters to understand how anatomical variation in a subject population may impact DOT or functional near-infrared spectroscopy measurements.

A brief review on the history of human functional near-infrared spectroscopy (fNIRS) development and fields of application

This review is aimed at celebrating the upcoming 20th anniversary of the birth of human functional near-infrared spectroscopy (fNIRS). After the discovery in 1992 that the functional activation of the human cerebral cortex (due to oxygenation and hemodynamic changes) can be explored by NIRS, human functional brain mapping research has gained a new dimension. fNIRS or optical topography, or near-infrared imaging or diffuse optical imaging is used mainly to detect simultaneous changes in optical properties of the human cortex from multiple measurement sites and displays the results in the form of a map or image over a specific area. In order to place current fNIRS research in its proper context, this paper presents a brief historical overview of the events that have shaped the present status of fNIRS. In particular, technological progresses of fNIRS are highlighted (i.e., from single-site to multi-site functional cortical measurements (images)), introduction of the commercial multi-channel systems, recent commercial wireless instrumentation and more advanced prototypes.

The cortical control of cycling exercise in stroke patients: an fNIRS study

Stroke survivors suffering from deficits in motor control typically have limited functional abilities, which could result in poor quality of life. Cycling exercise is a common training paradigm for restoring locomotion rhythm in patients. The provision of speed feedback has been used to facilitate the learning of controlled cycling performance and the neuromuscular control of the affected leg. However, the central mechanism for motor relearning of active and passive pedaling motions in stroke patients has not been investigated as extensively. The aim of this study was to measure the cortical activation patterns during active cycling with and without speed feedback and during power-assisted (passive) cycling in stroke patients. A frequency-domain near-infrared spectroscopy (FD-NIRS) system was used to detect the hemodynamic changes resulting from neuronal activity during the pedaling exercise from the bilateral sensorimotor cortices (SMCs), supplementary motor areas (SMAs), and premotor cortices (PMCs). The variation in cycling speed and the level of symmetry of muscle activation of bilateral rectus femoris were used to evaluate cycling performance. The results showed that passive cycling had a similar cortical activation pattern to that observed during active cycling without feedback but with a smaller intensity of the SMC of the unaffected hemisphere. Enhanced PMC activation of the unaffected side with improved cycling performance was observed during active cycling with feedback, with respect to that observed without feedback. This suggests that the speed feedback enhanced the PMC activation and improved cycling performance in stroke patients.

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.

The motor cortex drives the muscles during walking in human subjects

Indirect evidence that the motor cortex and the corticospinal tract contribute to the control of walking in human subjects has been provided in previous studies. In the present study we used coherence analysis of the coupling between EEG and EMG from active leg muscles during human walking to address if activity arising in the motor cortex contributes to the muscle activity during gait. Nine healthy human subjects walked on a treadmill at a speed of 3.5–4 km h(-1). Seven of the subjects in addition walked at a speed of 1 km h(-1). Significant coupling between EEG recordings over the leg motor area and EMG from the anterior tibial muscle was found in the frequency band 24–40 Hz prior to heel strike during the swing phase of walking. This signifies that rhythmic cortical activity in the 24–40 Hz frequency band is transmitted via the corticospinal tract to the active muscles during walking. These findings demonstrate that the motor cortex and corticospinal tract contribute directly to the muscle activity observed in steady-state treadmill walking.

Neurofeedback using real-time near-infrared spectroscopy enhances motor imagery related cortical activation

Accumulating evidence indicates that motor imagery and motor execution share common neural networks. Accordingly, mental practices in the form of motor imagery have been implemented in rehabilitation regimes of stroke patients with favorable results. Because direct monitoring of motor imagery is difficult, feedback of cortical activities related to motor imagery (neurofeedback) could help to enhance efficacy of mental practice with motor imagery. To determine the feasibility and efficacy of a real-time neurofeedback system mediated by near-infrared spectroscopy (NIRS), two separate experiments were performed. Experiment 1 was used in five subjects to evaluate whether real-time cortical oxygenated hemoglobin signal feedback during a motor execution task correlated with reference hemoglobin signals computed off-line. Results demonstrated that the NIRS-mediated neurofeedback system reliably detected oxygenated hemoglobin signal changes in real-time. In Experiment 2, 21 subjects performed motor imagery of finger movements with feedback from relevant cortical signals and irrelevant sham signals. Real neurofeedback induced significantly greater activation of the contralateral premotor cortex and greater self-assessment scores for kinesthetic motor imagery compared with sham feedback. These findings suggested the feasibility and potential effectiveness of a NIRS-mediated real-time neurofeedback system on performance of kinesthetic motor imagery. However, these results warrant further clinical trials to determine whether this system could enhance the effects of mental practice in stroke patients.

Functional near-infrared spectroscopy (fNIRS) of brain function during active balancing using a video game system

Functional near-infrared spectroscopy (fNIRS) is a portable, non-invasive, brain imaging technology that uses low levels of non-ionizing light to record changes in cerebral blood flow in the brain through optical sensors placed on the surface of the scalp. These signals are recorded via flexible fiber optic cables, which allow neuroimaging experiments to be conducted on participants while performing tasks such as standing or walking. FNIRS has the potential to provide new insights into the evolution of brain activation during ambulatory motor learning tasks and standing tasks to probe balance and vestibular function. In this study, a 32 channel fNIRS system was used to record blood flow changes in the frontal, motor, sensory, and temporal cortices during active balancing associated with playing a video game simulating downhill skiing (Nintendo Wii™; Wii-fit™). Using fNIRS, we found activation of superior temporal gyrus, which was modulated by the difficulty of the balance task. This region had been previously implicated in vestibular function from other animal and human studies.

Trial-to-trial variability differentiates motor imagery during observation between low versus high responders: a functional near-infrared spectroscopy study

Trial-to-trial variability is a well-known issue in brain signals measured using functional near-infrared spectroscopy (fNIRS). We aimed to investigate whether trial-to-trial variability does provide information about individual performance. Seventeen subjects observed a virtual reality grasping task in first-person view while either imagining (motor imagery during observation, MIO) or imitating (motor execution, ME) the movements. Each condition was performed with the display in one of two positions, a conventional vertical position and a mirrored horizontal position which placed the virtual arm in the correct position relative to the viewpoint. Averaged oxy-hemoglobin concentration Δ[O(2)Hb] showed that the responses could be differentiated into two distinct groups: low responders (LR) and high responders (HR). Within groups, two main sources of trial-to-trial variability were identified: (a) the Δ[O(2)Hb] amplitude, with largest amplitudes in ME conditions (group HR) and smallest amplitudes in MIO conditions (group LR), and (b) the sign of Δ[O(2)Hb], with positive responses occurring most frequently during ME (group HR) and negative responses most frequently during MIO (group LR). Furthermore, the trial-to-trial dynamics differed between groups and could be described in group LR as inverted polynomial U-shaped curve in the mirror conditions (ME-mirror, MIO-mirror). Last, trial-to-trial variability was significantly dependent on task modality, i.e. ME (group HR) versus MIO (group LR), and/or the mirrored display positions (group LR). Our results show a relationship of trial-to-trial variability to individual MI performance, which may be of significance for neurorehabilitation applications. Although the sources of trial-to-trial variability remain unknown, we suggest that they may contribute to future neurofeedback applications.

Impact of subcortical hyperintensities on dual-tasking in Alzheimer disease and aging

Subcortical hyperintensities (SHs) on brain magnetic resonance imaging are associated with cognitive and gait impairment in elderly but their impact on dual-tasking (performing cognitive tasks while walking) in patients with Alzheimer disease (AD) is unknown. This study explored the costs of dual-tasking in relation to SH severity in AD and normal controls (NCs). Cadence while walking on a treadmill, and speed-accuracy-tradeoff (SAT), on 3 working memory tasks, were measured during single-task and dual-task conditions. Dual-task costs (DTC) on SAT, cadence, and overall DTC were measured for each of these tasks. On visual rating of SH severity, AD and NC groups were subdivided into high-SH and low-SH subgroups. Compared with the NC, the AD group performed poorly on all working memory tasks across both conditions, decreased cadence on dual-tasking, and showed a decrement in overall DTC (all P<0.01). When grouped according to SH severity, the low-SH-NC group performed superiorly on working memory tasks (P<0.001) and the high-SH-AD group (P=0.001) showed a decrease in dual-task costs of cadence. Although the AD group showed a decrement in overall DTC (P<0.01) compared with NC, when assessed in terms of SH severity, the high-SH-AD group showed the largest decrement in DTC (P<0.01). Greater SH severity is associated with a decrement in overall dual-tasking ability in AD.

An exploratory fNIRS study with immersive virtual reality: a new method for technical implementation

For over two decades Virtual Reality (VR) has been used as a useful tool in several fields, from medical and psychological treatments, to industrial and military applications. Only in recent years researchers have begun to study the neural correlates that subtend VR experiences. Even if the functional Magnetic Resonance Imaging (fMRI) is the most common and used technique, it suffers several limitations and problems. Here we present a methodology that involves the use of a new and growing brain imaging technique, functional Near-infrared Spectroscopy (fNIRS), while participants experience immersive VR. In order to allow a proper fNIRS probe application, a custom-made VR helmet was created. To test the adapted helmet, a virtual version of the line bisection task was used. Participants could bisect the lines in a virtual peripersonal or extrapersonal space, through the manipulation of a Nintendo Wiimote ® controller in order for the participants to move a virtual laser pointer. Although no neural correlates of the dissociation between peripersonal and extrapersonal space were found, a significant hemodynamic activity with respect to the baseline was present in the right parietal and occipital areas. Both advantages and disadvantages of the presented methodology are discussed.

The human execution/observation matching system investigated with a complex everyday task: a functional near-infrared spectroscopy (fNIRS) study

The investigation of brain areas involved in the human execution/observation matching system (EOM) has been limited to restricted motor actions when using common neuroimaging techniques such as functional magnetic resonance imaging (fMRI). A method which overcomes this limitation is functional near-infrared spectroscopy (fNIRS). In the present study, we explored the cerebral responses underlying action execution and observation during a complex everyday task. We measured brain activation of 39 participants during the performance of object-related reaching, grasping and displacing movements, namely setting and clearing a table, and observation of the same task from different perspectives. Observation of the table-setting task activated parts of a network matching those activated during execution of the task. Specifically, observation from an egocentric perspective led to a higher activation in the inferior parietal cortex than observation from an allocentric perspective, implicating that the viewpoint also influences the EOM during the observation of complex everyday tasks. Together these findings suggest that fNIRS is able to overcome the restrictions of common imaging methods by investigating the EOM with a naturalistic task.

Rehabilitation of gait after stroke: a review towards a top-down approach

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity.The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI).From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process.

Somatosensory activation of two fingers can be discriminated with ultrahigh-density diffuse optical tomography

Topographic non-invasive near infrared spectroscopy (NIRS) has become a well-established tool for functional brain imaging. Applying up to 100 optodes over the head of a subject, allows achieving a spatial resolution in the centimeter range. This resolution is poor compared to other functional imaging tools. However, recently it was shown that diffuse optical tomography (DOT) as an extension of NIRS based on high-density (HD) probe arrays and supplemented by an advanced image reconstruction procedure allows describing activation patterns with a spatial resolution in the millimeter range. Building on these findings, we hypothesize that HD-DOT may render very focal activations accessible which would be missed by the traditionally used sparse arrays. We examined activation patterns in the primary somatosensory cortex, since its somatotopic organization is very fine-grained. We performed a vibrotactile stimulation study of the first and fifth finger in eight human subjects, using a 900-channel continuous-wave DOT imaging system for achieving a higher resolution than conventional topographic NIRS. To compare the results to a well-established high-resolution imaging technique, the same paradigm was investigated in the same subjects by means of functional magnetic resonance imaging (fMRI). In this work, we tested the advantage of ultrahigh-density probe arrays and show that highly focal activations would be missed by classical next-nearest neighbor NIRS approach, but also by DOT, when using a sparse probe array. Distinct activation patterns for both fingers correlated well with the expected neuroanatomy in five of eight subjects. Additionally we show that activation for different fingers is projected to different tissue depths in the DOT image. Comparison to the fMRI data yielded similar activation foci in seven out of ten finger representations in these five subjects when comparing the lateral localization of DOT and fMRI results.

Non-invasive optical imaging of stroke

The acute onset of a neurological deficit is the key clinical feature of stroke. In most cases, however, pathophysiological changes in the cerebral vasculature precede the event, often by many years. Persisting neurological deficits may also require long-term rehabilitation. Hence, stroke may be considered a chronic disease, and diagnostic and therapeutic efforts must include identification of specific risk factors, and the monitoring of and interventions in the acute and subacute stages, and should aim at a pathophysiologically based approach to optimize the rehabilitative effort. Non-invasive optical techniques have been experimentally used in all three stages of the disease and may complement the established diagnostic and monitoring tools. Here, we provide an overview of studies using the methodology in the context of stroke, and we sketch perspectives of how they may be integrated into the assessment of the highly dynamic pathophysiological processes during the acute and subacute stages of the disease and also during rehabilitation and (secondary) prevention of stroke.

Freezing of gait is associated with a mismatch between motor imagery and motor execution in narrow doorways, not with failure to judge doorway passability

BACKGROUND

Many patients with Parkinson's disease (PD) develop freezing of gait (FoG), which may manifest as a hesitation or "getting stuck" when they attempt to pass through a doorway. In two experiments, we asked whether FoG is associated with (1) a deficit in internal representation of one's body size with respect to a doorway and (2) a mismatch between imagined and actual walking times when passing through a doorway.

METHODS

23 subjects with PD (11 with and 13 without FoG) and 10 control subjects of similar age completed two experiments. In the Passability experiment, subjects judged the passability of doorways with different apertures scaled to their body widths. We compared passability estimates across groups. In the Imagery experiment, subjects timed themselves while: (1) imagining walking through doorways of different apertures and from different distances and (2) actually walking in the same conditions they had just imagined. We compared imagined and actual walking durations across groups and conditions.

RESULTS

In the Passability experiment, the estimated just-passable doorway was wider, relative to body width, in PD subjects than in control subjects, but there was no difference between PD subjects with and without FoG. In the Imagery experiment, subjects in all groups walked more slowly through narrow doorways than though wide doorways, and subjects with FoG walked much more slowly through the narrowest doorways. PD subjects with FoG showed a large discrepancy between actual and imagined time to pass through narrow doorways, unlike PD subjects without FoG and control subjects.

CONCLUSIONS

The equivalent passability judgments in PD subjects with and without FoG indicate that FoG is not specifically associated with a deficit in ability to internally represent space with reference to body size. However, the large difference in duration between actual and imagined walking through narrow doorways in subjects with FoG suggests that PD subjects with FoG did not know how much they would slow down to pass through narrow doorways. The observed discrepancy between imagined and actual walking times may point to a specific problem that contributes to the occurrence of FoG. These results also suggest that caution should be used when interpreting brain imaging results from locomotor imagery studies with PD subjects who have FoG.

Functional near infrared spectroscopy study of age-related difference in cortical activation patterns during cycling with speed feedback

Functional decline of lower-limb affects the ability of locomotion and the age-related brain differences have been elucidated among the elderly. Cycling exercise is a common training program for restoring motor function in the deconditioned elderly or stroke patients. The provision of speed feedback has been commonly suggested to clinical therapists for facilitating learning of controlled cycling performance and maintaining motivation in training programs with elderly participants. However, the cortical control of pedaling movements and the effect of external feedback remain poorly understanding. This study investigated the regional cortical activities detected by functional near infrared spectroscopy (fNIRS) in 12 healthy young and 13 healthy elderly subjects under conditions of cycling without-(free cycling) and with feedback (target cycling). The elderly exhibited predominant activation of the sensorimotor cortex during free cycling similar to young subjects but with poorer cycling performance. The cycling performance improved in both groups, and the elderly showed increased brain activities of the supplementary motor area and premotor cortex under target cycling condition. These findings demonstrated age-related changes in the cortical control in processing external feedback and pedaling movements. Use of fNIRS to evaluate brain activation patterns after training may facilitate brain-based design of tailored therapeutic rehabilitation strategies.

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.

Impaired Motor Learning by a Pursuit Rotor Test Reduces Functional Outcomes During Rehabilitation of Poststroke Ataxia

Background. Motor learning is essential to gain skills with neurorehabilitation. Objective. To investigate whether capacity for motor learning affects rehabilitation outcome and its relevant brain activation in ataxic patients with stroke. Methods. Twelve patients presenting with ataxia admitted for inpatient rehabilitation 2 to 3 months after infratentorial stroke and 6 control subjects performed 8 repetitions of 30-second pursuit rotor (PR) task. Cortical oxygenated hemoglobin (oxyHb) signals were measured using functional near-infrared spectroscopy. Results. Both patients and controls learned the PR skill, although the gains in PR performance were significantly lower in patients. In patients, the less learning significantly correlated with smaller rehabilitation gains assessed by the Functional Independence Measure. The Fugl-Meyer score for coordination and balance did not change. Center of task-related increase of cortical oxyHb signals shifted from the presupplementary motor area (preSMA) to the supplementary motor area (SMA) with task repetitions in controls but not in patients. Accordingly, serial changes of ratio of oxyHb increase in the preSMA to SMA (preSMA/SMA ratio) were significantly different between the groups. In patients and controls, gains in PR performance and changes of the preSMA/SMA ratio correlated. Conclusions. Impaired motor sequence learning by the PR task was correlated with reduced rehabilitation gains for ataxic patients with stroke.

Freezing of gait: moving forward on a mysterious clinical phenomenon

Freezing of gait (FoG) is a unique and disabling clinical phenomenon characterised by brief episodes of inability to step or by extremely short steps that typically occur on initiating gait or on turning while walking. Patients with FoG, which is a feature of parkinsonian syndromes, show variability in gait metrics between FoG episodes and a substantial reduction in step length with frequent trembling of the legs during FoG episodes. Physiological, functional imaging, and clinical-pathological studies point to disturbances in frontal cortical regions, the basal ganglia, and the midbrain locomotor region as the probable origins of FoG. Medications, deep brain stimulation, and rehabilitation techniques can alleviate symptoms of FoG in some patients, but these treatments lack efficacy in patients with advanced FoG. A better understanding of the phenomenon is needed to aid the development of effective therapeutic strategies.

Accelerometer-based method for correcting signal baseline changes caused by motion artifacts in medical near-infrared spectroscopy

In medical near-infrared spectroscopy (NIRS), movements of the subject often cause large step changes in the baselines of the measured light attenuation signals. This prevents comparison of hemoglobin concentration levels before and after movement. We present an accelerometer-based motion artifact removal (ABAMAR) algorithm for correcting such baseline motion artifacts (BMAs). ABAMAR can be easily adapted to various long-term monitoring applications of NIRS. We applied ABAMAR to NIRS data collected in 23 all-night sleep measurements and containing BMAs from involuntary movements during sleep. For reference, three NIRS researchers independently identified BMAs from the data. To determine whether the use of an accelerometer improves BMA detection accuracy, we compared ABAMAR to motion detection based on peaks in the moving standard deviation (SD) of NIRS data. The number of BMAs identified by ABAMAR was similar to the number detected by the humans, and 79% of the artifacts identified by ABAMAR were confirmed by at least two humans. While the moving SD of NIRS data could also be used for motion detection, on average 2 out of the 10 largest SD peaks in NIRS data each night occurred without the presence of movement. Thus, using an accelerometer improves BMA detection accuracy in NIRS.

fNIRS study of walking and walking while talking in young and old individuals

BACKGROUND

Evidence suggests that gait is influenced by higher order cognitive and cortical control mechanisms. However, less is known about the functional correlates of cortical control of gait.

METHODS

Using functional near-infrared spectroscopy, the current study was designed to evaluate whether increased activations in the prefrontal cortex (PFC) were detected in walking while talking (WWT) compared with normal pace walking (NW) in 11 young and 11 old participants. Specifically, the following two hypotheses were evaluated: (a) Activation in the PFC would be increased in WWT compared with NW. (b) The increase in activation in the PFC during WWT as compared with NW would be greater in young than in old participants.

RESULTS

Separate linear mixed effects models with age as the two-level between-subject factor, walking condition (NW vs WWT) as the two-level repeated within-subject factor, and HbO2 levels in each of the 16 functional near-infrared spectroscopy channels as the dependent measure revealed significant task effects in 14 channels, indicating a robust bilateral increased activation in the PFC in WWT compared with NW. Furthermore, the group-by-task interaction was significant in 11 channels with young participants showing greater WWT-related increase in HbO2 levels compared with the old participants.

CONCLUSIONS

This study provided the first evidence that oxygenation levels are increased in the PFC during WWT compared with NW in young and old individuals. This effect was modified by age suggesting that older adults may under-utilize the PFC in attention-demanding locomotion tasks.

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.

Assessment of the cerebral cortex during motor task behaviours in adults: a systematic review of functional near infrared spectroscopy (fNIRS) studies

Functional near infrared spectroscopy (fNIRS) is an emerging tool for non-invasively monitoring the haemodynamic response to brain activation. The technique has been widely adopted to investigate cortical responses during motor tasks in health and disease. This systematic review provides a critical analysis of the research findings in the hope of summating relevant information, identifying consistent outcomes acquired using different spectrometers, clarifying data inconsistencies, and learning from the common challenges across disciplines. The spatiotemporal characteristics, reliability, repeatability and modulation of typical cortical response evoked by motor stimulation are all evaluated in detail. The review assesses the contribution of the technique to advancing our understanding of motor skill learning and control in the context of tasks of everyday living, athletic performance, and recovery from neurological illness. Finally, the limitations of current fNIRS technologies are examined and a series of recommendations for future studies are provided based upon the reviewed literature.

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.