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

Testing the potential of a virtual reality neurorehabilitation system during performance of observation, imagery and imitation of motor actions recorded by wireless functional near-infrared spectroscopy (fNIRS)

BACKGROUND

Several neurorehabilitation strategies have been introduced over the last decade based on the so-called simulation hypothesis. This hypothesis states that a neural network located in primary and secondary motor areas is activated not only during overt motor execution, but also during observation or imagery of the same motor action. Based on this hypothesis, we investigated the combination of a virtual reality (VR) based neurorehabilitation system together with a wireless functional near infrared spectroscopy (fNIRS) instrument. This combination is particularly appealing from a rehabilitation perspective as it may allow minimally constrained monitoring during neurorehabilitative training.

METHODS

fNIRS was applied over F3 of healthy subjects during task performance in a virtual reality (VR) environment: 1) 'unilateral' group (N = 15), contralateral recording during observation, motor imagery, observation & motor imagery, and imitation of a grasping task performed by a virtual limb (first-person perspective view) using the right hand; 2) 'bilateral' group (N = 8), bilateral recording during observation and imitation of the same task using the right and left hand alternately.

RESULTS

In the unilateral group, significant within-condition oxy-hemoglobin concentration Δ[O2Hb] changes (mean ± SD μmol/l) were found for motor imagery (0.0868 ± 0.5201 μmol/l) and imitation (0.1715 ± 0.4567 μmol/l). In addition, the bilateral group showed a significant within-condition Δ[O2Hb] change for observation (0.0924 ± 0.3369 μmol/l) as well as between-conditions with lower Δ[O2Hb] amplitudes during observation compared to imitation, especially in the ipsilateral hemisphere (p < 0.001). Further, in the bilateral group, imitation using the non-dominant (left) hand resulted in larger Δ[O2Hb] changes in both the ipsi- and contralateral hemispheres as compared to using the dominant (right) hand.

CONCLUSIONS

This study shows that our combined VR-fNIRS based neurorehabilitation system can activate the action-observation system as described by the simulation hypothesis during performance of observation, motor imagery and imitation of hand actions elicited by a VR environment. Further, in accordance with previous studies, the findings of this study revealed that both inter-subject variability and handedness need to be taken into account when recording in untrained subjects. These findings are of relevance for demonstrating the potential of the VR-fNIRS instrument in neurofeedback applications.

A random-effects model for group-level analysis of diffuse optical brain imaging

Diffuse optical imaging is a non-invasive technique for measuring changes in blood oxygenation in the brain. This technique is based on the temporally and spatially resolved recording of optical absorption in tissue within the near-infrared range of light. Optical imaging can be used to study functional brain activity similar to functional MRI. However, group level comparisons of brain activity from diffuse optical data are difficult due to registration of optical sensors between subjects. In addition, optical signals are sensitive to inter-subject differences in cranial anatomy and the specific arrangement of optical sensors relative to the underlying functional region. These factors can give rise to partial volume errors and loss of sensitivity and therefore must be accounted for in combining data from multiple subjects. In this work, we describe an image reconstruction approach using a parametric Bayesian model that simultaneously reconstructs group-level images of brain activity in the context of a random-effects analysis. Using this model, we demonstrate that localization accuracy and the statistical effects size of group-level reconstructions can be improved when compared to individualized reconstructions. In this model, we use the Restricted Maximum Likelihood (ReML) method to optimize a Bayesian random-effects model.

Evaluation of a bimanual-coordinated upper-limbs training system based on the near infrared spectroscopic signals on brain

Various rehabilitation systems have been developed to deliver therapy for hemiplegic patients. Fugl- Meyer scale and Motor Power Score were common used methods to evaluate training effect and validate the developed systems. However, these assessments were involved with some inevitable subjective factors of therapists. In order to objectively evaluate the effect of a bimanual training that performed with a novel self-controlled system, this paper carried out assessment based on cerebral activation and motion-tracking precision. Four healthy subjects coordinated the forces of two arms and performed motion tracking training in active-assisted and active-resisted modes. After training, movement performance was enhanced and the brain became more active with an increased cerebral activation. Experimental results verified the positive training effect of the new system and the correlation between the cerebral cortical activation and motion capability.

Visual evoked responses during standing and walking

Human cognition has been shaped both by our body structure and by its complex interactions with its environment. Our cognition is thus inextricably linked to our own and others’ motor behavior. To model brain activity associated with natural cognition, we propose recording the concurrent brain dynamics and body movements of human subjects performing normal actions. Here we tested the feasibility of such a mobile brain/body (MoBI) imaging approach by recording high-density electroencephalographic (EEG) activity and body movements of subjects standing or walking on a treadmill while performing a visual oddball response task. Independent component analysis of the EEG data revealed visual event-related potentials that during standing, slow walking, and fast walking did not differ across movement conditions, demonstrating the viability of recording brain activity accompanying cognitive processes during whole body movement. Non-invasive and relatively low-cost MoBI studies of normal, motivated actions might improve understanding of interactions between brain and body dynamics leading to more complete biological models of cognition.

Hierarchical Bayesian regularization of reconstructions for diffuse optical tomography using multiple priors

Diffuse optical tomography (DOT) is a non-invasive brain imaging technique that uses low-levels of near-infrared light to measure optical absorption changes due to regional blood flow and blood oxygen saturation in the brain. By arranging light sources and detectors in a grid over the surface of the scalp, DOT studies attempt to spatially localize changes in oxy- and deoxy-hemoglobin in the brain that result from evoked brain activity during functional experiments. However, the reconstruction of accurate spatial images of hemoglobin changes from DOT data is an ill-posed linearized inverse problem, which requires model regularization to yield appropriate solutions. In this work, we describe and demonstrate the application of a parametric restricted maximum likelihood method (ReML) to incorporate multiple statistical priors into the recovery of optical images. This work is based on similar methods that have been applied to the inverse problem for magnetoencephalography (MEG). Herein, we discuss the adaptation of this model to DOT and demonstrate that this approach provides a means to objectively incorporate reconstruction constraints and demonstrate this approach through a series of simulated numerical examples.

Understanding higher level gait disturbances in mild dementia in order to improve rehabilitation: 'last in-first out'

Predicting and anticipating disturbances in higher level gait is particularly relevant for patients with dementia as higher level gait appears to be closely related to higher level cognitive functioning. A phenomenon that could contribute to the understanding and prediction of disturbances in higher level gait and gait-related motor activity in the various subtypes of dementia is paraphrased as 'last in-first out'. 'Last in-first out' refers to the principle that neural circuits that mature late in development are the most vulnerable to neurodegeneration. The strength of relating symptoms to the 'last in-first out' principle is that a future symptom can be predicted and anticipated in a therapeutic way, even if the disease process has not already started. Therefore, the aim of this review is to provide new strategies for rehabilitation of higher level gait disturbances in dementia based upon the 'last in-first out' principle. These new strategies emerge from five neural networks: the superior longitudinal fasciculus, the uncinate fasciculus, the fronto-cerebellar and fronto-striatal connections, and the cingulum.

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.

More automation and less cognitive control of imagined walking movements in high- versus low-fit older adults

Using motor imagery, we investigated brain activation in simple and complex walking tasks (walking forward and backward on a treadmill) and analyzed if the motor status of older adults influenced these activation patterns. Fifty-one older adults (64-79 years of age) were trained in motor execution and imagery and then performed the imagination task and two control tasks (standing, counting backward) in a horizontal position within a 3T MRI scanner (first-person perspective, eyes closed). Walking backward as compared to walking forward required larger activations in the primary motor cortex, supplementary motor area, parietal cortex, thalamus, putamen, and caudatum, but less activation in the cerebellum and brainstem. Motor high-fit individuals showed more activations and larger BOLD signals in motor-related areas compared to low-fit participants but demonstrated lower activity in the dorsolateral prefrontal cortex. Moreover, parietal activation in high-fit participants remained stable throughout the movement period whereas low-fit participants revealed an early drop in activity in this area accompanied by increasing activity in frontal brain regions. Overall, walking forward seemed to be more automated (more activation in cerebellum and brainstem), whereas walking backward required more resources, e.g., for visual-spatial processing and sensorimotor control. Low-fit subjects in particular seemed to require more cognitive resources for planning and controlling. High-fit subjects, on the contrary, revealed more movement automation and a higher "attention span." Our results support the hypothesis that high fitness corresponds with more automation and less cognitive control of complex motor tasks, which might help to free up cognitive resources.

Eye movement performance and prefrontal hemodynamics during saccadic eye movements in the elderly

No previous study has investigated age-related changes in prefrontal hemodynamics during saccade tasks in a large number of elderly adults. The purpose of this study was to evaluate prefrontal activity related to the performance of anti-saccade in the elderly using near-infrared spectroscopy (NIRS). Ninety-six elderly adults and 22 young adults performed pro- and anti-saccade tasks. Measures included reaction times of both saccades, error rate during anti-saccade, and concentration of oxyhemoglobin (Deltaoxy-Hb) in the prefrontal cortex during both saccades. Saccade performance, especially error rate, was significantly poorer in the elderly than the young. In the elderly, error rates were widely distributed from 5% to 100%. In about half (48%) of the elderly, error rates were distributed under the mean+3 standard deviations (48%) for the young, and Deltaoxy-Hb did not differ significantly from that in the young. Elderly subjects whose anti-saccade reaction time was over the regression line (of reaction time in anti-saccade to that in pro-saccade in the young)+2 standard errors showed a strong positive correlation (r=0.79) between Deltaoxy-Hb and error rate, as did those whose error rate exceeded 48%. In the elderly subjects whose error rates exceeded 90%, Deltaoxy-Hb was extremely small and deviated greatly from the correlation between Deltaoxy-Hb and error rate. Based on these findings, we propose a method of evaluating inhibitory function and attention allocation in anti-saccade performance, which is mainly related to the prefrontal cortex, in the elderly, using NIRS.

Effects of anti-saccade training with neck flexion on eye movement performance, presaccadic potentials and prefrontal hemodynamics in the elderly

Anti-saccade performance, with strong contributions from frontal brain regions, reportedly deteriorates with age and maintenance of neck flexion and is known to cause brain activation. We investigated the effects of anti-saccade training on eye movement performance and frontal activity, and synergistic effects of training with neck flexion in the elderly. Thirty elderly individuals were divided into three equal groups: training group at neck resting position (NRT); training group at 20° neck flexion position (NFT); and untrained group. NRT and NFT performed approximately 200 anti-saccades (a block of 10-12 anti-saccades for 30 s × 20 blocks) per day over 3 weeks. Before and after training, horizontal eye movement, presaccadic potentials, and oxygenated hemoglobin concentration (oxy-Hb) in the prefrontal cortex during anti-saccades were tested in neck resting and 20° neck flexion conditions. In NRT and NFT, reaction time (-50 ms), percentage of erroneous saccades (-24%), and period between peak of presaccadic negativity and onset of spike potential (-16 ms) were significantly decreased through training. Only in NFT, after training, slight shortening of reaction time associated with neck flexion was recognized (-10 ms), and peak amplitude of presaccadic negativity was increased in both test neck conditions. Oxy-Hb was not significantly affected by trainings and test neck conditions. We demonstrated that in the elderly, anti-saccade training with both neck postures improved performance and facilitated related neural pathways. Moreover, training with neck flexion showed small but synergistic effects on performance and frontal activity. However, these trainings would be insufficient for elderly individuals to automatically control anti-saccade.

Step-by-step: the effects of physical practice on the neural correlates of locomotion imagery revealed by fMRI

Previous studies have shown that mental imagery is a suitable tool to study the progression of the effect of practice on brain activation. Nevertheless, there is still poor knowledge of changes in brain activation patterns during the very early stages of physical practice. In this study, early and late practice stages of different kinds of locomotion (i.e., balanced and unbalanced) have been investigated using functional magnetic resonance imaging during mental imagery of locomotion and stance. During the task, cardiac activity was also recorded. The cerebral network comprising supplementary motor area, basal ganglia, bilateral thalamus, and right cerebellum showed a stronger activation during the imagery of locomotion with respect to imagery of stance. The heart beat showed a significant increase in frequency during the imagery of locomotion with respect to the imagery of stance. Moreover, early stages of practice determined an increased activation in basal ganglia and thalamus with respect to late stages. In this way, it is proposed the modulation of the brain network involved in the imagery of locomotion as a function of physical practice time.

Noninvasive imaging of prefrontal activation during attention-demanding tasks performed while walking using a wearable optical topography system

Optical topography (OT) based on near-infrared spectroscopy is a noninvasive technique for mapping the relative concentration changes in oxygenated and deoxygenated hemoglobin (oxy- and deoxy-Hb, respectively) in the human cerebral cortex. In our previous study, we developed a small and light wearable optical topography (WOT) system that covers the entire forehead for monitoring prefrontal activation. In the present study, we examine whether the WOT system is applicable to OT measurement while walking, which has been difficult with conventional OT systems. We conduct OT measurements while subjects perform an attention-demanding (AD) task of balancing a ping-pong ball on a small card while walking. The measured time course and power spectra of the relative concentration changes in oxy- and deoxy-Hb show that the step-related changes in the oxy- and deoxy-Hb signals are negligible compared to the task-related changes. Statistical assessment of the task-related changes in the oxy-Hb signals show that the dorsolateral prefrontal cortex and rostral prefrontal area are significantly activated during the AD task. These results suggest that our functional imaging technique with the WOT system is applicable to OT measurement while walking, and will be a powerful tool for evaluating brain activation in a natural environment.

High-resolution optical functional mapping of the human somatosensory cortex

Non-invasive optical imaging of brain function has been promoted in a number of fields in which functional magnetic resonance imaging (fMRI) is limited due to constraints induced by the scanning environment. Beyond physiological and psychological research, bedside monitoring and neurorehabilitation may be relevant clinical applications that are yet little explored. A major obstacle to advocate the tool in clinical research is insufficient spatial resolution. Based on a multi-distance high-density optical imaging setup, we here demonstrate a dramatic increase in sensitivity of the method. We show that optical imaging allows for the differentiation between activations of single finger representations in the primary somatosensory cortex (SI). Methodologically our findings confirm results in a pioneering study by Zeff et al. (2007) and extend them to the homuncular organization of SI. After performing a motor task, eight subjects underwent vibrotactile stimulation of the little finger and the thumb. We used a high-density diffuse-optical sensing array in conjunction with optical tomographic reconstruction. Optical imaging disclosed three discrete activation foci one for motor and two discrete foci for vibrotactile stimulation of the first and fifth finger, respectively. The results were co-registered to the individual anatomical brain anatomy (MRI) which confirmed the localization in the expected cortical gyri in four subjects. This advance in spatial resolution opens new perspectives to apply optical imaging in the research on plasticity notably in patients undergoing neurorehabilitation.

Effects of motor imagery on intermanual transfer: a near-infrared spectroscopy and behavioural study

Intermanual transfer is the ability that previous studies by one limb promote the later learning by the other limb. This ability has been demonstrated in various effectors and types of training. Motor imagery, the mental simulation of motor execution, is believed to be strongly associated with the cognitive aspects of motor execution, and the pattern of brain activity during motor imagery is similar to that of motor execution, although the activation pattern is smaller, and the level is lower. If the cognitive component of motor execution strongly contributes to transfer, the training effect of motor imagery would be expected to transfer to the contralateral limb. In the present study, we used the tapping sequence paradigm to evaluate the occurrence of intermanual transfer through motor imagery and to compare differences of transfer effects to motor execution learning. We divided participants into three groups: an execution group, a motor imagery group and a no-training control group. Before and after a nondominant left hand training session, ipsilateral hand tests were conducted. After the post-test, a contralateral right-hand test was also conducted. In order to investigate the relationship between transfer effect and neural activation during the learning phase, we measured motor-related brain area activity using near-infrared spectroscopy (NIRS). Execution was effective especially for trained movement, imagery was effective for both trained movement and intermanual transfer. Brain activity suggesting predictive transfer differed between two groups, suggesting that motor execution and motor imagery training have different behavioural effects and neural contributions.

Removal of movement artifact from high-density EEG recorded during walking and running

Although human cognition often occurs during dynamic motor actions, most studies of human brain dynamics examine subjects in static seated or prone conditions. EEG signals have historically been considered to be too noise prone to allow recording of brain dynamics during human locomotion. Here we applied a channel-based artifact template regression procedure and a subsequent spatial filtering approach to remove gait-related movement artifact from EEG signals recorded during walking and running. We first used stride time warping to remove gait artifact from high-density EEG recorded during a visual oddball discrimination task performed while walking and running. Next, we applied infomax independent component analysis (ICA) to parse the channel-based noise reduced EEG signals into maximally independent components (ICs) and then performed component-based template regression. Applying channel-based or channel-based plus component-based artifact rejection significantly reduced EEG spectral power in the 1.5- to 8.5-Hz frequency range during walking and running. In walking conditions, gait-related artifact was insubstantial: event-related potentials (ERPs), which were nearly identical to visual oddball discrimination events while standing, were visible before and after applying noise reduction. In the running condition, gait-related artifact severely compromised the EEG signals: stable average ERP time-courses of IC processes were only detectable after artifact removal. These findings show that high-density EEG can be used to study brain dynamics during whole body movements and that mechanical artifact from rhythmic gait events may be minimized using a template regression procedure.

Mental practice for relearning locomotor skills

Over the past 2 decades, much work has been carried out on the use of mental practice through motor imagery for optimizing the retraining of motor function in people with physical disabilities. Although much of the clinical work with mental practice has focused on the retraining of upper-extremity tasks, this article reviews the evidence supporting the potential of motor imagery for retraining gait and tasks involving coordinated lower-limb and body movements. First, motor imagery and mental practice are defined, and evidence from physiological and behavioral studies in healthy individuals supporting the capacity to imagine walking activities through motor imagery is examined. Then the effects of stroke, spinal cord injury, lower-limb amputation, and immobilization on motor imagery ability are discussed. Evidence of brain reorganization in healthy individuals following motor imagery training of dancing and of a foot movement sequence is reviewed, and the effects of mental practice on gait and other tasks involving coordinated lower-limb and body movements in people with stroke and in people with Parkinson disease are examined. Lastly, questions pertaining to clinical assessment of motor imagery ability and training strategies are discussed.

Brain aging and gait

Aging is associated with a reduction in several functions including gait. The preservation of gait is important in order to prevent falls and consequent injury as one gets older. Poorer gait may also be an important marker for health status and a determinant of quality of life in later life. It is now recognized that specific regions of the brain such as the frontal motor, prefrontal and parietal cortices, the basal ganglia and cerebellum play an important role in the initiation, planning, execution and maintenance of gait, in tandem with other neuromuscular factors. Aging and age-related disease may affect areas of the brain that are involved in the regulation of gait. Recent technological advances in brain imaging have enabled the identification of age-related changes occurring in the brain, such as cortical atrophy, brain infarctions or cerebral white matter lesions. There is a small, but growing, amount of research examining the association between these changes and gait. The objective of this review is to summarize the current state of knowledge on the impact of the aging brain on gait, and to identify directions for future research. Such research may lead to the development of interventions aimed at preventing or reducing the effect of brain aging on gait.

Effects of visual gain on force control at the elbow and ankle

Visual feedback is essential when minimizing force fluctuations. Varying degrees of somatotopic organization have been shown in different regions of the brain for the upper and lower extremities, and visual feedback may be processed differently based on the body effector where feedback-based corrections are used. This study compared the effect of changes in visual gain on the control of steady-state force at the elbow and ankle. Ten subjects produced steady-state isometric force to targets at 5 and 40% of their maximum voluntary contraction at seven visual gain levels. Visual gain was used effectively at both joints to reduce variability of the force signal and to improve accuracy, with a greater effect of visual gain at the elbow than the ankle. Visual gain significantly decreased the regularity of force output, and this effect was more pronounced at the elbow than the ankle. There were accompanying changes in the proportion of power in the 0-4, 4-8, and 8-12 Hz frequency bins of the force signal across visual gain at the elbow. Changes in visual gain were accompanied by changes in both agonist and antagonist electromyographic (EMG) activation at the elbow. At the ankle joint, there were only changes in agonist EMG. The results suggest better use of visual information in the control of elbow force than ankle force and this improved control may be related to the changes in the pattern of agonist and antagonist activation.

Real versus imagined locomotion: a [18F]-FDG PET-fMRI comparison

The cortical, cerebellar and brainstem BOLD-signal changes have been identified with fMRI in humans during mental imagery of walking. In this study the whole brain activation and deactivation pattern during real locomotion was investigated by [(18)F]-FDG-PET and compared to BOLD-signal changes during imagined locomotion in the same subjects using fMRI. Sixteen healthy subjects were scanned at locomotion and rest with [(18)F]-FDG-PET. In the locomotion paradigm subjects walked at constant velocity for 10 min. Then [(18)F]-FDG was injected intravenously while subjects continued walking for another 10 min. For comparison fMRI was performed in the same subjects during imagined walking. During real and imagined locomotion a basic locomotion network including activations in the frontal cortex, cerebellum, pontomesencephalic tegmentum, parahippocampal, fusiform and occipital gyri, and deactivations in the multisensory vestibular cortices (esp. superior temporal gyrus, inferior parietal lobule) was shown. As a difference, the primary motor and somatosensory cortices were activated during real locomotion as distinct to the supplementary motor cortex and basal ganglia during imagined locomotion. Activations of the brainstem locomotor centers were more prominent in imagined locomotion. In conclusion, basic activation and deactivation patterns of real locomotion correspond to that of imagined locomotion. The differences may be due to distinct patterns of locomotion tested. Contrary to constant velocity real locomotion (10 min) in [(18)F]-FDG-PET, mental imagery of locomotion over repeated 20-s periods includes gait initiation and velocity changes. Real steady-state locomotion seems to use a direct pathway via the primary motor cortex, whereas imagined modulatory locomotion an indirect pathway via a supplementary motor cortex and basal ganglia loop.

Functional near infrared spectroscopy (NIRS) signal improvement based on negative correlation between oxygenated and deoxygenated hemoglobin dynamics

Near infrared spectroscopy (NIRS) is a promising technology for functional brain imaging which measures hemodynamic signals from the cortex, similar to functional magnetic resonance imaging (fMRI), but does not require the participant to lie motionless in a confined space. NIRS can therefore be used for more naturalistic experiments, including face to face communication, or natural body movements, and is well suited for real-time applications that may require lengthy training. However, improving signal quality and reducing noise, especially noise induced by head motion, is challenging, particularly for real time applications. Here we study the properties of head motion induced noise, and find that motion noise causes the measured oxygenated and deoxygenated hemoglobin signals, which are typically strongly negatively correlated, to become more positively correlated. Next, we develop a method to reduce noise based on the principle that the concentration changes of oxygenated and deoxygenated hemoglobin should be negatively correlated. We show that despite its simplicity, this method is effective in reducing noise and improving signal quality, for both online and offline noise reduction.

Seated Bilateral Leg Exercise Effects on Hemiparetic Lower Extremity Function in Chronic Stroke

Background. Bilateral arm training with rhythmic auditory cueing (BATRAC) improves hemiparetic upper extremity (UE) function in stroke. It is unknown whether a similar exercise for the hemiparetic lower extremity (LE) is effective. Objective. The authors sought to test whether the BATRAC strategy would transfer to the legs by improving LE motor function following ten 30-minute sessions of bilateral leg training with rhythmic auditory cueing (BLETRAC). Methods. Twenty-four chronic stroke participants, recruited from the community, were randomized to either the BLETRAC or the BATRAC intervention. Assessments were performed before (week 0) and after (week 6) training as well as 3 months later (week 18). Change in the Fugl-Meyer LE and UE subscales served as primary outcomes. Timed 10-m walk, movement parameters during treadmill walking, and a repetitive aiming task for both feet and hands were the secondary outcomes. Results . Following an intention-to-treat approach, data from 21 subjects were analyzed. After training, improvements in the Fugl-Meyer LE and UE subscales tended to be better for the corresponding intervention group. The BLETRAC group also showed increases in step length during treadmill walking and performance in the repetitive foot and hand aiming tasks. No differences between the intervention groups were found at follow-up. Conclusions. This exploratory trial demonstrates that transfer of the BATRAC approach to the legs is feasible. Transient improvements of limb motor function in chronic stroke participants were induced by targeted exercise (BATRAC for the UE and BLETRAC for the LE). It may be that further periods of training would increase and maintain effects.

Brain activity changes associated with treadmill training after stroke

BACKGROUND AND PURPOSE

The mechanisms underlying motor recovery after stroke are not fully understood. Several studies used functional MRI longitudinally to relate brain activity changes with performance gains of the upper limb after therapy, but research into training-induced recovery of lower limb function has been relatively neglected thus far.

METHODS

We investigated functional reorganization after 4 weeks of treadmill training with partial body weight support in 18 chronic patients (mean age, 59.9+/-13.5 years) with mild to moderate paresis (Motricity Index affected leg: 77.7+/-10.5; range, 9 to 99) and gait impairment (Functional Ambulation Category: 4.4+/-0.6; range, 3 to 5) due to a single subcortical ischemic stroke using repeated 3.0-T functional MRI and an ankle-dorsiflexion paradigm.

RESULTS

Walking endurance improved after training (2-minute timed walking distance: 121.5+/-39.0 versus pre: 105.1+/-38.1 m; P=0.0001). For active movement of the paretic foot versus rest, greater walking endurance correlated with increased brain activity in the bilateral primary sensorimotor cortices, the cingulate motor areas, and the caudate nuclei bilaterally and in the thalamus of the affected hemisphere.

CONCLUSIONS

Despite the strong subcortical contributions to gait control, rehabilitation-associated walking improvements are associated with cortical activation changes. This is similar to findings in upper limb rehabilitation with some differences in the involved cortical areas. We observed bihemispheric activation increases with greater recovery both in cortical and subcortical regions with movement of the paretic foot. However, although the dorsal premotor cortex appears to play an important role in recovery of hand movements, evidence for the involvement of this region in lower extremity recovery was not found.

Predictability of investment behavior from brain information measured by functional near-infrared spectroscopy: a bayesian neural network model

In line with previous studies using fMRI and as is apparent from experimental results, cerebral blood flow (oxygenated hemoglobin (oxyHb) concentration) in the medial prefrontal cortex (MPFC) and orbital cortex (OFC) as is observed with fNIRS (functional near-infrared spectroscopy) is presumed to be closely related to reward prediction and risk prediction as part of decision-making under risk. Results of analysis using a predictive model with a three-layer perceptron revealed that changes in the oxyHb concentration in cerebral blood as indicated by fNIRS observation include information to effectively predict investment behavior. This paper indicates that adding oxyHb concentration at the aforementioned sites in the brain as a predictive factor allows prediction of subjects' investment behavior with a considerable degree of precision. This fact indicates that information provided by fNIRS allows valid analysis of investment behavior and it also suggests a wide-ranging practical applicability for this information like investment assistance using fNIRS.

Correlation between BOLD fMRI and theta-band local field potentials in the human hippocampal area

The relation between the blood-oxygen-level-dependent (BOLD) signal, which forms the basis of functional magnetic resonance imaging (fMRI), and underlying neural activity is not well understood. We performed high-resolution fMRI in patients scheduled for implantation with depth electrodes for seizure monitoring while they navigated a virtual environment. We then recorded local field potentials (LFPs) and neural firing rate directly from the hippocampal area of the same subjects during the same task. Comparing BOLD signal changes with 396 LFP and 185 neuron recordings in the hippocampal area, we found that BOLD signal changes correlated positively with LFP power changes in the theta-band (4-8 Hz). This correlation, however, was largely present for parahippocampal BOLD signal changes; BOLD changes in the hippocampus correlated weakly or not at all with LFP power changes. We did not find a significant relationship between BOLD activity and neural firing rate in either region, which could not be accounted for by a lesser tendency for neurons to respond or a greater tendency for neurons to habituate to the task. Strengthening the idea of a dissociation between LFP power and neural firing rate in their relation to the BOLD signal, simultaneously recorded LFP power and neural firing rate changes were uncorrelated across electrodes. Together, our results suggest that the BOLD signal in the human hippocampal area has a more heterogenous relationship with underlying neural activity than has been described previously in other brain regions.

Consensus paper: combining transcranial stimulation with neuroimaging

In the last decade, combined transcranial magnetic stimulation (TMS)-neuroimaging studies have greatly stimulated research in the field of TMS and neuroimaging. Here, we review how TMS can be combined with various neuroimaging techniques to investigate human brain function. When applied during neuroimaging (online approach), TMS can be used to test how focal cortex stimulation acutely modifies the activity and connectivity in the stimulated neuronal circuits. TMS and neuroimaging can also be separated in time (offline approach). A conditioning session of repetitive TMS (rTMS) may be used to induce rapid reorganization in functional brain networks. The temporospatial patterns of TMS-induced reorganization can be subsequently mapped by using neuroimaging methods. Alternatively, neuroimaging may be performed first to localize brain areas that are involved in a given task. The temporospatial information obtained by neuroimaging can be used to define the optimal site and time point of stimulation in a subsequent experiment in which TMS is used to probe the functional contribution of the stimulated area to a specific task. In this review, we first address some general methodologic issues that need to be taken into account when using TMS in the context of neuroimaging. We then discuss the use of specific brain mapping techniques in conjunction with TMS. We emphasize that the various neuroimaging techniques offer complementary information and have different methodologic strengths and weaknesses.

HomER: a review of time-series analysis methods for near-infrared spectroscopy of the brain

Near-infrared spectroscopy (NIRS) is a noninvasive neuroimaging tool for studying evoked hemodynamic changes within the brain. By this technique, changes in the optical absorption of light are recorded over time and are used to estimate the functionally evoked changes in cerebral oxyhemoglobin and deoxyhemoglobin concentrations that result from local cerebral vascular and oxygen metabolic effects during brain activity. Over the past three decades this technology has continued to grow, and today NIRS studies have found many niche applications in the fields of psychology, physiology, and cerebral pathology. The growing popularity of this technique is in part associated with a lower cost and increased portability of NIRS equipment when compared with other imaging modalities, such as functional magnetic resonance imaging and positron emission tomography. With this increasing number of applications, new techniques for the processing, analysis, and interpretation of NIRS data are continually being developed. We review some of the time-series and functional analysis techniques that are currently used in NIRS studies, we describe the practical implementation of various signal processing techniques for removing physiological, instrumental, and motion-artifact noise from optical data, and we discuss the unique aspects of NIRS analysis in comparison with other brain imaging modalities. These methods are described within the context of the MATLAB-based graphical user interface program, HomER, which we have developed and distributed to facilitate the processing of optical functional brain data.

Frontal and motor cortex oxygenation during maximal exercise in normoxia and hypoxia

Reductions in prefrontal oxygenation near maximal exertion may limit exercise performance by impairing executive functions that influence the decision to stop exercising; however, whether deoxygenation also occurs in motor regions that more directly affect central motor drive is unknown. Multichannel near-infrared spectroscopy was used to compare changes in prefrontal, premotor, and motor cortices during exhaustive exercise. Twenty-three subjects performed two sequential, incremental cycle tests (25 W/min ramp) during acute hypoxia [79 Torr inspired Po(2) (Pi(O(2)))] and normoxia (117 Torr Pi(O(2))) in an environmental chamber. Test order was balanced, and subjects were blinded to chamber pressure. In normoxia, bilateral prefrontal oxygenation was maintained during low- and moderate-intensity exercise but dropped 9.0 +/- 10.7% (mean +/- SD, P < 0.05) before exhaustion (maximal power = 305 +/- 52 W). The pattern and magnitude of deoxygenation were similar in prefrontal, premotor, and motor regions (R(2) > 0.94). In hypoxia, prefrontal oxygenation was reduced 11.1 +/- 14.3% at rest (P < 0.01) and fell another 26.5 +/- 19.5% (P < 0.01) at exhaustion (maximal power = 256 +/- 38 W, P < 0.01). Correlations between regions were high (R(2) > 0.61), but deoxygenation was greater in prefrontal than premotor and motor regions (P < 0.05). Prefrontal, premotor, and motor cortex deoxygenation during high-intensity exercise may contribute to an integrative decision to stop exercise. The accelerated rate of cortical deoxygenation in hypoxia may hasten this effect.

Functional prefrontal reorganization accompanies learning-associated refinements in surgery: a manifold embedding approach

The prefrontal cortex (PFC) is known to be vital for acquisition of visuomotor skills, but its role in the attainment of complex technical skills which comprise both perceptual and motor components, such as those associated with surgery, remains poorly understood. We hypothesized that the prefrontal response to a surgical knot-tying task would be highly dependent on technical expertise, and that activation would wane in the context of learning success following extended practice. The present series of experiments investigated this issue, using functional Near Infrared Spectroscopy (fNIRS) and dexterity analysis to compare the PFC responses and technical skill of expert and novice surgeons performing a surgical knot-tying task in a block design experiment. Applying a data-embedding technique known as Isomap and Earth Mover's Distance (EMD) analysis, marked differences in cortical hemodynamic responses between expert and novice surgeons have been found. To determine whether refinement in technical skill was associated with reduced PFC demands, a second experiment assessed the impact of pre- and post-training on the PFC responses in novices. Significant improvements (p < 0.01) were observed in all performance parameters following training. Smaller EMD distances were observed between expert surgeons and novices following training, suggesting an evolving pattern of cortical responses. A random effect model demonstrated a statistically significant decrease in relative changes of total hemoglobin (Delta HbT) [coefficient = -3.825, standard error (s.e.) = 0.8353, z = -4.58, p < 0.001] and oxygenated hemoglobin (Delta HbO(2)) [coefficient = -4.6815, s.e = 0.6781, z = -6.90, p < 0.001] and a significant increase in deoxygenated hemoglobin (Delta HHb) [coefficient = 0.8192, s.e = 0.3034, z = 2.66, p < 0.01] across training. The results indicate that learning-related refinements in technical performance are mediated by temporal reductions in prefrontal activation.

Association between gait asymmetry and brain lesion location in stroke patients

BACKGROUND AND PURPOSE

Associations between the site of brain injury and poststroke gait impairment are poorly understood. Temporal gait asymmetry after stroke is a salient index of gait dysfunction that has important functional consequences. The current study investigated whether subtraction lesion analysis could distinguish brain regions associated with persisting temporal gait asymmetry in chronic stroke patients.

METHODS

Analysis was conducted on 37 chronic ambulatory stroke patients (17 symmetrical gait, 20 asymmetrical gait). Spatiotemporal gait parameters were recorded using an instrumented walking surface. Lesions were traced from 3D T1-MRI, and region of interest images were generated. The lesion overlay of patients with symmetrical gait was subtracted from patients with asymmetrical gait to highlight voxels more frequently lesioned in asymmetrical patients and relatively spared in symmetrical patients.

RESULTS

Demographic data were comparable between the 2 groups. Asymmetrical patients exhibited significantly higher National Institute of Health Stroke Scale neglect scores and more severe motor impairment. Gait asymmetry was significantly correlated to Chedoke-McMaster Stroke Scale leg (r=-0.767, P<0.001) and foot (r=-0.759, P<0.001) scores, whereas gait speed correlated less strongly. After subtraction analysis, injury to the posterolateral putamen was evident 60% to 80% more frequently in the asymmetrical group compared to the symmetrical group.

CONCLUSIONS

In this sample of ambulatory chronic stroke patients, damage to the posterolateral putamen was associated with temporal gait asymmetry. Further advances in our understanding of the neural correlates of gait asymmetry may provide prognostic markers for future persistent gait dysfunction and lead to early targeted rehabilitation when key regions are damaged.

Brain imaging in patients with freezing of gait

Freezing of gait (FOG) is a disabling gait disturbance with unknown cerebral pathophysiology. In this review, we discuss the functional brain imaging studies that address gait physiology and pathophysiology of FOG. Radiotracer metabolic studies show basal ganglia-cortical circuitry involvement in different aspects of gait control. FOG patients showed orbitofrontal and posterior parietal deficits and possibly predominant involvement of right-sided circuitry. We suggest that FOG results from neuronal circuitry dysfunction in right-sided parietal-lateral premotor circuits. These circuits incorporate sensory information into the control of gait. Furthermore, abnormal function of frontostriatal loops, which probably sheer cognitive and attentional activities is also a main factor in FOG. Gait-induced brain circuitry activation can not adequately be achieved when investigated subjects are in a supine rest position, as is the case in most present day imaging studies. Some radiotracer activation studies were performed after walking. Imagination of gait has been used in some radiotracer activation studies with positron emission tomography (PET) and in studies with functional magnetic resonance imaging (fMRI), showing cortical activation patterns involved in several aspects of gait control. For future investigation of FOG, it is suggested to design PET and fMRI studies which concentrate on activation of neuropsychological and sensory integration circuits.

Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial

BACKGROUND AND PURPOSE

Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability. Gait is a complex sensorimotor function controlled by integrated cortical, subcortical, and spinal networks. The mechanisms of gait recovery after stroke are not well understood. This study examines the hypothesis that progressive task-repetitive treadmill exercise (T-EX) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain (plasticity).

METHODS

A randomized controlled trial determined the effects of 6-month T-EX (n=37) versus comparable duration stretching (CON, n=34) on walking, aerobic fitness and in a subset (n=15/17) on brain activation measured by functional MRI.

RESULTS

T-EX significantly improved treadmill-walking velocity by 51% and cardiovascular fitness by 18% (11% and -3% for CON, respectively; P<0.05). T-EX but not CON affected brain activation during paretic, but not during nonparetic limb movement, showing 72% increased activation in posterior cerebellar lobe and 18% in midbrain (P<0.005). Exercise-mediated improvements in walking velocity correlated with increased activation in cerebellum and midbrain.

CONCLUSIONS

T-EX improves walking, fitness and recruits cerebellum-midbrain circuits, likely reflecting neural network plasticity. This neural recruitment is associated with better walking. These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes.

Functional imaging of stroke recovery: what have we learnt and where do we go from here?

Functional brain imaging techniques have been used to visualise patterns of activity following stroke and to characterise how these patterns change with recovery or rehabilitation. Some consensus is now emerging on patterns that are predictive of improved outcome, and therapeutic strategies are beginning to be guided by such findings. However, patient heterogeneity predicts that the same approach will not be appropriate for all. Future studies should aim to characterise the factors that influence this heterogeneity, and to individualise rehabilitation strategies based in part on early imaging findings. Functional imaging studies of stroke should also embrace recent methodological and conceptual advances that allow for fuller characterisation of the structural and functional properties of distributed brain networks.