A new tablet for writing and drawing during functional MRI

Investigating the neural substrate variations between easy and challenging creative association tasks during product design within an fMRI scanner

In practice, individuals strive to develop highly original and valuable creative products within specific limitations. However, previous functional Magnetic Resonance Imaging (fMRI) studies focused on divergent-thinking tasks without considering the "valuableness" of an idea. Additionally, different types of creative tasks (e.g., the easier association vs. the harder association task) may engage distinct cognitive processes. This study aimed to investigate the underlying neural mechanisms associated with different types of creative thinking, specifically focusing on the generation of the most original and valuable creative product within an fMRI scanner. Twenty-one college students participated in a block design study. During each trial, participants were instructed to draw the most original and valuable product inspired by a given figure. The findings revealed that, in comparison to the harder association task, the easier association task led to broader activation across multiple brain regions. However, this broader activation resulted in inefficient thinking and poorer creative performance. Notably, the orbitofrontal cortex exhibited activation across various creativity tasks and displayed connectivity with several seed brain regions, highlighting the importance of decision-making when only one original and valuable product design is allowed. Furthermore, the complex functional connectivity observed between different brain networks reflects the intricate nature of creative thinking. To conclude, widespread activation of brain regions does not necessarily indicate superior creativity. Instead, optimal creative performance within constraints is achieved through an efficient utilization of association for generating innovative ideas, inhibition for suppressing unoriginal ideas, and decision-making to select the most creative idea.

Complex executive functions assessed by the trail making test (TMT) part B improve more than those assessed by the TMT part A or digit span backward task during vagus nerve stimulation in patients with drug-resistant epilepsy

Introduction

There is a paucity of clinical studies examining the long-term effects of vagus nerve stimulation (VNS) on cognition, although a recent study of patients with drug-resistant epilepsy (DRE) treated with VNS therapy demonstrated significant improvement in executive functions as measured by the EpiTrack composite score. The present study aimed to investigate performance variability in three cognitive tests assessing executive functions and working memory in a cohort of DRE patients receiving VNS therapy during a follow-up duration of up to 5 years.

Methods

The study included 46 DRE patients who were assessed with the Trail Making Test (TMT) (Parts A and B) and Digit Span Backward (DB) task prior to VNS implantation, 6 months and 12 months after implantation, and yearly thereafter as a part of the clinical VNS protocol. A linear mixed-effects (LME) model was used to analyze changes in test z scores over time, accounting for variations in follow-up duration when predicting changes over 5 years. Additionally, we conducted descriptive analyses to illustrate individual changes.

Results

On average, TMT-A z scores improved by 0.024 units (95% confidence interval (CI): 0.006 to 0.042, p = 0.009), TMT-B z scores by 0.034 units (95% CI: 0.012 to 0.057, p = 0.003), and DB z scores by 0.019 units per month (95% CI: 0.011 to 0.028, p < 0.001). Patients with psychiatric comorbidities achieved the greatest improvements in TMT-B and DB z scores among all groups (0.0058 units/month, p = 0.036 and 0.028 units/month, p = 0.003, respectively). TMT-A z scores improved the most in patients taking 1-2 ASMs as well as in patients with psychiatric comorbidities (0.042 units/month, p = 0.002 and p = 0.003, respectively).

Conclusion

Performance in all three tests improved at the group level during the follow-up period, with the most robust improvement observed in TMT-B, which requires inhibition control and set-switching in addition to the visuoperceptual processing speed that is crucial in TMT-A and working-memory performance that is essential in DB. Moreover, the improvement in TMT-B was further enhanced if the patient had psychiatric comorbidities.

Lateralized Functional Connectivity of the Sensorimotor Cortex and its Variations During Complex Visuomotor Tasks

Previous studies have shown that the left hemisphere dominates motor function, often observed through homotopic activation measurements. Using a functional connectivity approach, this study investigated the lateralization of the sensorimotor cortex during handwriting and drawing, two complex visuomotor tasks with varying contextual demands. We found that both left- and right-lateralized connectivity in the primary motor cortex (M1), dorsal premotor cortex (PMd), somatosensory cortex, and visual regions were evident in adults (males and females), primarily in an interhemispheric integrative fashion. Critically, these lateralization tendencies remained highly invariant across task contexts, representing a task-invariant neural architecture for encoding fundamental motor programs consistently implemented in different task contexts. Additionally, the PMd exhibited a slight variation in lateralization degree between task contexts, reflecting the ability of the high-order motor system to adapt to varying task demands. However, connectivity-based lateralization of the sensorimotor cortex was not detected in 10-year-old children (males and females), suggesting that the maturation of connectivity-based lateralization requires prolonged development. In summary, this study demonstrates both task-invariant and task-sensitive connectivity lateralization in sensorimotor cortices that support the resilience and adaptability of skilled visuomotor performance. These findings align with the hierarchical organization of the motor system and underscore the significance of the functional connectivity-based approach in studying functional lateralization.

Brain Correlates of Chinese Handwriting and Their Relation to Reading Development in Children: An fMRI Study

Handwriting plays an important role in written communication, reading, and academic success. However, little is known about the neural correlates of handwriting in children. Using functional magnetic resonance imaging (fMRI) and a copying task, we investigated regional brain activation and functional lateralization associated with Chinese handwriting in children (N = 36, 9-11 years old), as well as their relations to reading skills. We found significant activation of the bilateral frontal motor cortices, somatosensory cortex, intraparietal sulcus (IPS), fusiform gyrus (FuG), and cerebellum during handwriting, suggesting that an adult-like brain activation pattern emerges by middle childhood. Moreover, children showed left-lateralized and bilateral activation of motor regions and right-lateralized activation of the FuG and cerebellum during handwriting, suggesting that functional lateralization of handwriting is not fully established by this age. Finally, the activation of Exner's area and the lateralization of the IPS and cerebellum during handwriting were correlated with reading skills, possibly representing a neural link between handwriting and reading in children. Collectively, this study reveals the brain correlates of handwriting and their relation to reading development in Chinese children, offering new insight into the development of handwriting and reading skills.

Personality traits modulate the neural responses to handwriting processing

Handwriting is a vital skill for everyday human activities. It has a wealth of information about writers' characteristics and can hint toward underlying neurological conditions, such as Parkinson's disease, autism, dyslexia, and attention-deficit/hyperactivity disorder (ADHD). Many previous studies have reported a link between personality and individual differences in handwriting, but the evidence for the relationship tends to be anecdotal in nature. Using functional magnetic resonance imaging (fMRI), we examined whether the association between personality traits and handwriting was instantiated at the neural level. Results showed that the personality trait of conscientiousness modulated brain activation in the left premotor cortex and right inferior/middle frontal gyrus, which may reflect the impact of personality on orthography-to-grapheme transformation and executive control involved in handwriting. Such correlations were not observed in symbol-drawing or word-reading tasks, suggesting the specificity of the link between conscientiousness and handwriting in these regions. Moreover, using a connectome-based predictive modeling approach, we found that individuals' conscientiousness scores could be predicted based on handwriting-related functional brain networks, suggesting that the influence of personality on handwriting may occur within a broader network. Our findings provide neural evidence for the link between personality and handwriting processing, extending our understanding of the nature of individual differences in handwriting.

Functional brain networks underlying the interaction between central and peripheral processes involved in Chinese handwriting in children and adults

The neural mechanisms that support handwriting, an important mode of human communication, are thought to be controlled by a central process (responsible for spelling) and a peripheral process (responsible for motor output). However, the relationship between central and peripheral processes has been debated. Using functional magnetic resonance imaging, this study examined the neural mechanisms underlying this relationship in Chinese handwriting in 36 children (mean age = 10.40 years) and 56 adults (mean age = 22.36 years) by manipulating character frequency (a central variable). Brain network analysis showed that character frequency reconfigured functional brain networks known to underlie motor processes, including the somatomotor and cerebellar network, in both children and adults, indicating that central processing cascades into peripheral processing. Furthermore, the network analysis characterized the interaction profiles between motor networks and linguistic-cognitive networks, fully mapping the neural architecture that supports the interaction of central and peripheral processes involved in handwriting. Taken together, these results reveal the neural interface underlying the interaction between central and peripheral processes involved in handwriting in a logographic writing system, advancing our understanding of the neural basis of handwriting.

Disruption of Functional Brain Networks Underlies the Handwriting Deficit in Children With Developmental Dyslexia

Developmental dyslexia (DD) is a neurological-based learning disorder that affects 5-17.5% of children. Handwriting difficulty is a prevailing symptom of dyslexia, but its neural mechanisms remain elusive. Using functional magnetic resonance imaging (fMRI), this study examined functional brain networks associated with handwriting in a copying task in Chinese children with DD (n = 17) and age-matched children (n = 36). We found that dyslexics showed reduced network connectivity between the sensory-motor network (SMN) and the visual network (VN), and between the default mode network (DMN) and the ventral attention network (VAN) during handwriting, but not during drawing geometric figures. Moreover, the connectivity strength of the networks showing group differences was correlated with handwriting speed, reading and working memory, suggesting that the handwriting deficit in DD is linked with disruption of a large-scale brain network supporting motoric, linguistic and executive control processes. Taken together, this study demonstrates the alternations of functional brain networks that underly the handwriting deficit in Chinese dyslexia, providing a new clue for the neural basis of DD.

Emergent Neuroimaging Findings for Written Expression in Children: A Scoping Review

Background: There is currently a dearth of research on the neural framework of writing tasks in children, as measured by neuroimaging techniques. Objective: This paper provides an overview of the current literature examining the neurological underpinnings of written expression in children. Design: Using a scoping review approach, with thorough searches of key databases, this paper presents the available literature comprising 13 different studies using both structural and functional neuroimaging techniques with the 0–18 English speaking population. Results: Studies largely presented small sample sizes, with most studies utilizing elementary or middle school-aged children. Emergent findings revealed a complex network of neural contributions to the writing process in children. There were associations between the left fusiform gyrus and orthographic coding (i.e., handwriting), and spelling and written composition measures were significantly correlated with activity in the left posterior cingulate, left precuneus, and right precuneus regions. Additionally, results revealed that good versus poor writers manifested differential brain activation patterns during many tasks associated with written expression, with good writers performing more efficiently than poor writers with respect to brain regions activated during a writing task across handwriting, spelling, and idea generation. Conclusions: The findings from this scoping review lay the foundation for future studies examining the interface between writing skills in children and underlying neural pathways that support the various components of the writing process. It will be important for future research to examine the neurological bases of the various components of written expression in children and adolescents.

Protracted Neural Development of Dorsal Motor Systems During Handwriting and the Relation to Early Literacy Skills

Handwriting is a complex visual-motor skill that affects early reading development. A large body of work has demonstrated that handwriting is supported by a widespread neural system comprising ventral-temporal, parietal, and frontal motor regions in adults. Recent work has demonstrated that this neural system is largely established by 8 years of age, suggesting that the development of this system occurs in young children who are still learning to read and write. We made use of a novel MRI-compatible writing tablet that allowed us to measure brain activation in 5-8-year-old children during handwriting. We compared activation during handwriting in children and adults to provide information concerning the developmental trajectory of the neural system that supports handwriting. We found that parietal and frontal motor involvement during handwriting in children is different from adults, suggesting that the neural system that supports handwriting changes over the course of development. Furthermore, we found that parietal and frontal motor activation correlated with a literacy composite score in our child sample, suggesting that the individual differences in the dorsal response during handwriting are related to individual differences in emerging literacy skills. Our results suggest that components of the widespread neural system supporting handwriting develop at different rates and provide insight into the mechanisms underlying the contributions of handwriting to early literacy development.

Functional brain networks underlying automatic and controlled handwriting in Chinese

This study aimed to identify the functional brain networks underlying the distinctions between automatic and controlled handwriting in Chinese. Network-based analysis was applied to functional magnetic resonance imaging data collected while adult participants performed a copying task under automatic and speed-controlled conditions. We found significant differences between automatic and speed-controlled handwriting in functional connectivity within and between the frontoparietal network, default mode network, dorsal attention network, somatomotor network and visual network; these differences reflect the variations in general attentional control and task-relevant visuomotor operations. However, no differences in brain activation were detected between the two handwriting conditions, suggesting that the reorganization of functional networks, rather than the modulation of local brain activation, underlies the dissociations between automatic and controlled handwriting in Chinese. Our findings illustrate the brain basis of handwriting automaticity, shedding new light on how handwriting automaticity may be disrupted in individuals with neurological disorders.

Neuroanatomical correlates of self-awareness of highly practiced visuomotor skills

Metacognition is the ability to introspect and control ongoing cognitive processes. Despite the extensive investigation of the brain architectures supporting metacognition for perception and memory, little is known about the neural basis of metacognitive capacity for motor function, a vital aspect of human behavior. Here, using functional and structural magnetic resonance imaging (MRI), we examined the brain substrates underlying self-awareness of handwriting, a highly practiced visuomotor skill. Results showed that experienced adult writers generally overestimated their handwriting quality, and such overestimation was more pronounced in men relative to women. Individual variations in self-awareness of handwriting quality were positively correlated with gray matter volume in the left fusiform gyrus, right middle frontal gyrus and right precuneus. The left fusiform gyrus and right middle frontal gyrus are thought to represent domain-specific brain mechanisms for handwriting self-awareness, while the right precuneus that has been reported in other domains likely represents a domain-general brain mechanism for metacognition. Furthermore, the activity of these structurally related regions in a handwriting task was not correlated with self-awareness of handwriting, suggesting the correlation with metacognition was independent of task performance. Together, this study reveals that metacognition for practiced motor skills relies on both domain-general and domain-specific brain systems, extending our understanding about the neural basis of human metacognition.

Trail Making Test Performance Using a Touch-Sensitive Tablet: Behavioral Kinematics and Electroencephalography

The Trail Making Test (TMT) is widely used to probe brain function and is performed with pen and paper, involving Parts A (linking numbers) and B (alternating between linking numbers and letters). The relationship between TMT performance and the underlying brain activity remains to be characterized in detail. Accordingly, sixteen healthy young adults performed the TMT using a touch-sensitive tablet to capture enhanced performance metrics, such as the speed of linking movements, during simultaneous electroencephalography (EEG). Linking and non-linking periods were derived as estimates of the time spent executing and preparing movements, respectively. The seconds per link (SPL) was also used to quantify TMT performance. A strong effect of TMT Part A and B was observed on the SPL value as expected (Part B showing increased SPL value); whereas the EEG results indicated robust effects of linking and non-linking periods in multiple frequency bands, and effects consistent with the underlying cognitive demands of the test.

Functional Use of Eye Movements for an Acting System

Movements of the eyes assist vision and support hand and body movements in a cooperative way. Despite their strong functional coupling, different types of movements are usually studied independently. We integrate knowledge from behavioral, neurophysiological, and clinical studies on how eye movements are coordinated with goal-directed hand movements and how they facilitate motor learning. Understanding the coordinated control of eye and hand movements can provide important insights into brain functions that are essential for performing or learning daily tasks in health and disease. This knowledge can also inform applications such as robotic manipulation and clinical rehabilitation.

Tablet Technology for Writing and Drawing during Functional Magnetic Resonance Imaging: A Review

Functional magnetic resonance imaging (fMRI) is a powerful modality to study brain activity. To approximate naturalistic writing and drawing behaviours inside the scanner, many fMRI-compatible tablet technologies have been developed. The digitizing feature of the tablets also allows examination of behavioural kinematics with greater detail than using paper. With enhanced ecological validity, tablet devices have advanced the fields of neuropsychological tests, neurosurgery, and neurolinguistics. Specifically, tablet devices have been used to adopt many traditional paper-based writing and drawing neuropsychological tests for fMRI. In functional neurosurgery, tablet technologies have enabled intra-operative brain mapping during awake craniotomy in brain tumour patients, as well as quantitative tremor assessment for treatment outcome monitoring. Tablet devices also play an important role in identifying the neural correlates of writing in the healthy and diseased brain. The fMRI-compatible tablets provide an excellent platform to support naturalistic motor responses and examine detailed behavioural kinematics.

Ecological validity of experimental set-up affects parietal involvement during letter production

Studies of symbol production using fMRI often use techniques that introduce an artificial pairing between motor production and visual perception. These techniques allow participants to see their own output by recording their pen trajectories using a touchscreen-only tablet and displaying these productions on a mirror placed above their head. We recently developed an MR-safe writing tablet with video display that allows participants to see their own hand and their own productions while producing symbols in real time on the surface where they are producing them-allowing for more ecologically valid fMRI studies of production. We conducted a study to determine whether the participation of posterior parietal cortex during symbol production was affected by the pairing of motor production and visual feedback associated with the two types of tablets. We performed ROI analyses in intraparietal sulcus while adult participants produced letters to dictation using either a touchscreen-only tablet (no visual guidance of the hand) (n = 14) or using a touchscreen-and-video-display tablet (visual guidance of the hand) (n = 14). We found that left posterior intraparietal sulcus was more active during production with the touchscreen-only tablet than during production with the touchscreen-and-video-display tablet. These results suggest that posterior parietal involvement during production tasks is associated with the somewhat artificial visual-motor pairing that is introduced by the techniques used in some studies of symbol production.

In Search of a New Paradigm for Functional Magnetic Resonance Experimentation With Language

Human language can convey a broad range of entities and relationships through processes that are highly complex and structured. All of these processes are happening somewhere inside our brains, and one way of precising these locations is through the usage of the functional magnetic resonance imaging. The great obstacle when experimenting with complex processes, however, is the need to control them while still having data that are representative of reality. When it comes to language, an interactional phenomenon in its nature, and that integrates a wide range of processes, a question emerges concerning how compatible it is with the current experimental methodology, and how much of it is lost in order to fit the controlled experimental environment. Because of its particularities, the fMRI technique imposes several limitations to the expression of language during experimentation. This paper discusses the different conceptions of language as a research object, the hardships of combining this object with the requirements of fMRI, and what are the current perspectives for this field of research.

Men and women differ in the neural basis of handwriting

There is an ongoing debate about whether, and to what extent, males differ from females in their language skills. In the case of handwriting, a composite language skill involving language and motor processes, behavioral observations consistently show robust sex differences but the mechanisms underlying the effect are unclear. Using functional magnetic resonance imaging (fMRI) in a copying task, the present study examined the neural basis of sex differences in handwriting in 53 healthy adults (ages 19–28, 27 males). Compared to females, males showed increased activation in the left posterior middle frontal gyrus (Exner's area), a region thought to support the conversion between orthographic and graphomotor codes. Functional connectivity between Exner's area and the right cerebellum was greater in males than in females. Furthermore, sex differences in brain activity related to handwriting were independent of language material. This study identifies a novel neural signature of sex differences in a hallmark of human behavior, and highlights the importance of considering sex as a factor in scientific research and clinical applications involving handwriting.

Functional MRI of Letter Cancellation Task Performance in Older Adults

The Letter Cancellation Task (LCT) is a widely used pen-and-paper probe of attention in clinical and research settings. Despite its popularity, the neural correlates of the task are not well understood. The present study uses functional magnetic resonance imaging (fMRI) and specialized tablet technology to identify the neural correlates of the LCT in 32 healthy older adults between 50-85 years of age, and further investigates the effect of healthy aging on performance. Subjects performed the LCT in its standard pen-and-paper administration and with the tablet during fMRI. Performance on the tablet was significantly slower than on pen-and-paper, with both response modes showing slower performance as a function of age. Across all ages, bilateral brain activation was observed in the cerebellum, superior temporal lobe, precentral gyrus, frontal gyrus, and occipital and parietal areas. Increasing age correlated with reduced brain activity in the supplementary motor area, middle occipital gyrus, medial and inferior frontal gyrus, cerebellum and putamen. Better LCT performance was correlated with increased activity in the middle frontal gyrus, and reduced activity in the cerebellum. The brain regions activated are associated with visuospatial attention and motor control, and are consistent with the neural correlates of LCT performance previously identified in lesion studies.

Broca's area is jointly activated during speech and gesture production

Despite the frequent suggestion in the literature that Broca's area is a common link between vocal and gestural models of the origins of language, this has never been established within a single motor-production study. In the present functional MRI experiment, participants were asked to describe the spatial properties of objects (e.g. a motorcycle) using speech, pantomime, and drawing. Pairwise conjunction analyses revealed that the left inferior gyrus - in combination with the left basal ganglia and ventral anterior thalamus - was jointly activated for the production of speech and pantomime but not for the conjunctions with drawing. Drawing and pantomime instead showed strong overlap in the intraparietal sulcus and superior parietal region bilaterally. These results provide the first demonstration in a production study that Broca's area is jointly activated by speech and gesture when depicting the same semantic content.

The Neural Correlates of the Clock-Drawing Test in Healthy Aging

Importance: The clock-drawing test (CDT) is an important neurocognitive assessment tool, widely used as a screening test for dementia. Behavioral performance on the test has been studied extensively, but there is scant literature on the underlying neural correlates.

Purpose: To administer the CDT naturalistically to a healthy older aging population in an MRI environment, and characterize the brain activity associated with test completion.

Main Outcome and Measure: Blood-oxygen-level dependent (BOLD) functional MRI was conducted as participants completed the CDT using novel tablet technology. Brain activity during CDT performance was contrasted to rest periods of visual fixation. Performance on the CDT was evaluated using a standardized scoring system (Rouleau score) and time to test completion. To assess convergent validity, performance during fMRI was compared to performance on a standard paper version of the task, administered in a psychometric testing room.

Results: Study findings are reported for 33 cognitively healthy older participants aged 52–85. Activation was observed in the bilateral frontal, occipital and parietal lobes as well as the supplementary motor area and precentral gyri. Increased age was significantly correlated with Rouleau scores on the clock number drawing (R2) component (rho = -0.55, p < 0.001); the clock hand drawing (R3) component (rho = -0.50, p < 0.005); and the total clock (rho = -0.62, p < 0.001). Increased age was also associated with decreased activity in the bilateral parietal and occipital lobes as well as the right temporal lobe and right motor areas.

Conclusion and Relevance: This imaging study characterizes the brain activity underlying performance of the CDT in a healthy older aging population using the most naturalistic version of the task to date. The results suggest that the functions of the occipital and parietal lobe are significantly altered by the normal aging process, which may lead to performance decrements.

Neural Correlates of Orthographic Access in Mandarin Chinese Writing: An fMRI Study of the Word-Frequency Effect

Writing is an essential tool for human communication and involves multiple linguistic, cognitive, and motor processes. Chinese, a logographic writing system, differs remarkably from the writing systems of alphabetic languages. The neural substrates of Chinese writing are largely unknown. Using functional magnetic resonance imaging (fMRI) in a copying task, this study probed the neural underpinnings of orthographic access during Mandarin Chinese writing by employing the word-frequency effect. The results showed that writing low-frequency characters evoked greater activation in the bilateral superior/middle/inferior frontal gyrus, superior/inferior parietal lobule, and fusiform gyrus than writing high-frequency characters. Moreover, psychophysiological interaction (PPI) analysis demonstrated that the word-frequency effect modulated functional connectivity within the frontal-occipital networks and the parietal-occipital networks. Together, these findings illustrate the neural correlates of orthographic access for Mandarin Chinese writing, shedding new light on the cognitive architecture of writing across various writing systems.

An Analysis of the Brain Systems Involved with Producing Letters by Hand

Complex visual-motor behaviors dominate human-environment interactions. Letter production, writing individual letters by hand, is an example of a complex visual-motor behavior composed of numerous behavioral components, including the required motor movements and the percepts that those motor movements create. By manipulating and isolating components of letter production, we provide experimental evidence that this complex visual-motor behavior is supported by a widespread neural system that is composed of smaller subsystems related to different sensorimotor components. Adult participants hand-printed letters with and without "ink" on an MR-safe digital writing tablet, perceived static and dynamic representations of their own handwritten letters, and perceived typeface letters during fMRI scanning. Our results can be summarized by three main findings: (1) Frontoparietal systems were associated with the motor component of letter production, whereas temporo-parietal systems were more associated with the visual component. (2) The more anterior regions of the left intraparietal sulcus were more associated with the motor component, whereas the more posterior regions were more associated with the visual component, with an area of visual-motor overlap in the posterior intraparietal sulcus. (3) The left posterior intraparietal sulcus and right fusiform gyrus responded similarly to both visual and motor components, and both regions also responded more during the perception of one's own handwritten letters compared with perceiving typed letters. These findings suggest that the neural systems recruited during complex visual-motor behaviors are composed of a set of interrelated sensorimotor subsystems that support the full behavior in different ways and, furthermore, that some of these subsystems can be rerecruited during passive perception in the absence of the full visual-motor behavior.

The MRItab: A MR-compatible touchscreen with video-display

BACKGROUND

A touchscreen interface permits rich user interactions for research in many fields, but is rarely found within a Magnetic Resonance Imaging (MRI) environment due to difficulties adapting conventional technologies to the strong electromagnetic fields. Conventional MR-compatible video display technology uses either large-screen displays that are placed outside of the bore of the MRI itself, or projectors located beyond the participant's reach, making touch interfaces impossible.

NEW METHOD

Here, we describe the MR-compatibility of the 'MRItab' in terms of MR safety and image quality. The MRItab adapts inexpensive off-the-shelf components with special signal-driver circuitry and shielding to bring the touchscreen interface into the MR environment, without adversely affecting MRI image quality, thereby making touch interfaces possible.

RESULTS

Our testing demonstrated that the functioning of the MRItab was not affected by the functioning of the MRI scanner and that the MRItab did not adversely affect the image data acquired. Participants were able to interact naturally with the MRItab during MRI scanning.

COMPARISON WITH OTHER METHOD (S)

The MRItab is the first MR-compatible touchscreen device with video-display screen capabilities designed for use in the MRI environment. This interactive digital device is the first to allow participants to see their hands directly as they interact with a touch-sensitive display screen, resulting in high ecological validity.

CONCLUSIONS

The MRItab provides a methodological advantage for research in many fields, given the realistic human-computer interaction it supports.

Storytelling Is Intrinsically Mentalistic: A Functional Magnetic Resonance Imaging Study of Narrative Production across Modalities

People utilize multiple expressive modalities for communicating narrative ideas about past events. The three major ones are speech, pantomime, and drawing. The current study used functional magnetic resonance imaging to identify common brain areas that mediate narrative communication across these three sensorimotor mechanisms. In the scanner, participants were presented with short narrative prompts akin to newspaper headlines (e.g., "Surgeon finds scissors inside of patient"). The task was to generate a representation of the event, either by describing it verbally through speech, by pantomiming it gesturally, or by drawing it on a tablet. In a control condition designed to remove sensorimotor activations, participants described the spatial properties of individual objects (e.g., "binoculars"). Each of the three modality-specific subtractions produced similar results, with activations in key components of the mentalizing network, including the TPJ, posterior STS, and posterior cingulate cortex. Conjunction analysis revealed that these areas constitute a cross-modal "narrative hub" that transcends the three modalities of communication. The involvement of these areas in narrative production suggests that people adopt an intrinsically mentalistic and character-oriented perspective when engaging in storytelling, whether using speech, pantomime, or drawing.

Quantitative assessment of drawing tests in children with dyslexia and dysgraphia

Drawing tests in children diagnosed with dyslexia and dysgraphia were quantitatively compared. Fourteen children with dysgraphia, 19 with dyslexia and 13 normally developing were asked to copy 3 figures: a circle, a square and a cross. An optoelectronic system allowed the acquisition of the drawing track in three-dimensions. The participants' head position and upper limb movements were measured as well. A set of parameters including movement duration, velocity, length of the trace, Range of Motion of the upper limb, was computed and compared among the 3 groups. Children with dyslexia traced the circle faster than the other groups. In the cross test, dyslexic participants showed a reduced execution time and increased velocity while drawing the horizontal line. Children with dyslexia were also faster in drawing certain sides of square with respect to the other groups.

Neural signatures of Trail Making Test performance: Evidence from lesion-mapping and neuroimaging studies

The Trail Making Test (TMT) is an extensively used neuropsychological instrument for the assessment of set-switching ability across a wide range of neurological conditions. However, the exact nature of the cognitive processes and associated brain regions contributing to the performance on the TMT remains unclear. In this review, we first introduce the TMT by discussing its administration and scoring approaches. We then examine converging evidence and divergent findings concerning the brain regions related to TMT performance, as identified by lesion-symptom mapping studies conducted in brain-injured patients and functional magnetic resonance imaging studies conducted in healthy participants. After addressing factors that may account for the heterogeneity in the brain regions reported by these studies, we identify future research endeavours that may permit disentangling the different processes contributing to TMT performance and relating them to specific brain circuits.

Functional MRI of Handwriting Tasks: A Study of Healthy Young Adults Interacting with a Novel Touch-Sensitive Tablet

Handwriting is a complex human activity that engages a blend of cognitive and visual motor skills. Current understanding of the neural correlates of handwriting has largely come from lesion studies of patients with impaired handwriting. Task-based fMRI studies would be useful to supplement this work. To address concerns over ecological validity, previously we developed a fMRI-compatible, computerized tablet system for writing and drawing including visual feedback of hand position and an augmented reality display. The purpose of the present work is to use the tablet system in proof-of-concept to characterize brain activity associated with clinically relevant handwriting tasks, originally developed to characterize handwriting impairments in Alzheimer’s disease patients. As a prelude to undertaking fMRI studies of patients, imaging was performed of twelve young healthy subjects who copied sentences, phone numbers, and grocery lists using the fMRI-compatible tablet. Activation maps for all handwriting tasks consisted of a distributed network of regions in reasonable agreement with previous studies of handwriting performance. In addition, differences in brain activity were observed between the test subcomponents consistent with different demands of neural processing for successful task performance, as identified by investigating three quantitative behavioral metrics (writing speed, stylus contact force and stylus in air time). This study provides baseline behavioral and brain activity results for fMRI studies that adopt this handwriting test to characterize patients with brain impairments.

Tablet-Based Functional MRI of the Trail Making Test: Effect of Tablet Interaction Mode

The Trail Making Test (TMT) is widely used for assessing executive function, frontal lobe abilities, and visual motor skills. Part A of this pen-and-paper test (TMT-A) involves linking numbers randomly distributed in space, in ascending order. Part B (TMT-B) alternates between linking numbers and letters. TMT-B is more demanding than TMT-A, but the mental processing that supports the performance of this test remains incompletely understood. Functional MRI (fMRI) may help to clarify the relationship between TMT performance and brain activity, but providing an environment that supports real-world pen-and-paper interactions during fMRI is challenging. Previously, an fMRI-compatible tablet system was developed for writing and drawing with two modes of interaction: the original cursor-based, proprioceptive approach, and a new mode involving augmented reality to provide visual feedback of hand position (VFHP) for enhanced user interaction. This study characterizes the use of the tablet during fMRI of young healthy adults (n = 22), with half of the subjects performing TMT with VFHP and the other half performing TMT without VFHP. Activation maps for both TMT-A and TMT-B performance showed considerable overlap between the two tablet modes, and no statistically differences in brain activity were detected when contrasting TMT-B vs. TMT-A for the two tablet modes. Behavioral results also showed no statistically different interaction effects for TMT-B vs. TMT-A for the two tablet modes. Tablet-based TMT scores showed reasonable convergent validity with those obtained by administering the standard pen-and-paper TMT to the same subjects. Overall, the results suggest that despite the slightly different mechanisms involved for the two modes of tablet interaction, both are suitable for use in fMRI studies involving TMT performance. This study provides information for using tablet-based TMT methods appropriately in future fMRI studies involving patients and healthy individuals.

A computerized tablet system for evaluating treatment of essential tremor by magnetic resonance guided focused ultrasound

Background

Transcranial magnetic resonance guided focused ultrasound is an emerging technology under evaluation for treatment of essential tremor, a prevalent movement disorder. A qualitative evaluation is performed by a clinician periodically during the procedure to maximize treatment effects and minimize adverse effects. The present work demonstrates a magnetic resonance-compatible method to enable more precise, quantitative measurement of tremor severity.

Methods

Tremor severity was measured in 12 patients pre-, post-, and intra-operatively, using a magnetic resonance-compatible tablet and a computerized adaptation of drawing tasks from the widely-used Fahn-Tolosa-Marin Tremor Rating Scale. Tremor metrics based on spectral analysis were calculated for each drawing and compared using Wilcoxon signed rank tests.

Results

Tremor metrics in the dominant (treated) hand were significantly and consistently lower post-operatively compared to pre-operatively, but there was no significant difference in the non-dominant (untreated) hand, as expected. Intra-operative metrics were intermediate between pre- and post-operative metrics.

Conclusions

Use of the tablet for quantitative tremor measurement was demonstrated pre-, post-, and intra-operatively during treatment of essential tremor, complementing standard qualitative assessment. With additional work, the system has potential to add objectivity to clinical trials and to aid treatment decision-making by providing a metric for optimization during the procedure, which may eventually lead to more optimal treatment. Enhancements and further studies are suggested, and extensions to fMRI studies of essential tremor and Parkinson’s disease are also likely.

Optimizing fMRI preprocessing pipelines for block-design tasks as a function of age

Functional Magnetic Resonance Imaging (fMRI) is a powerful neuroimaging tool, which is often hampered by significant noise confounds. There is evidence that our ability to detect activations in task fMRI is highly dependent on the preprocessing steps used to control noise and artifact. However, the vast majority of studies examining preprocessing pipelines in fMRI have focused on young adults. Given the widespread use of fMRI for characterizing the neurobiology of aging, it is critical to examine how the impact of preprocessing choices varies as a function of age. In this study, we employ the NPAIRS cross-validation framework, which optimizes pipelines based on metrics of prediction accuracy (P) and spatial reproducibility (R), to compare the effects of pipeline optimization between young (21-33 years) and older (61-82 years) cohorts, for three different block-design contrasts. Motion is shown to be a greater issue in the older cohort, and we introduce new statistical approaches to control for potential biases due to head motion during pipeline optimization. In comparison, data-driven methods of physiological noise correction show comparable benefits for both young and old cohorts. Using our optimization framework, we demonstrate that the optimal pipelines tend to be highly similar across age cohorts. In addition, there is a comparable, significant benefit of pipeline optimization across age cohorts, for (P, R) metrics and independent validation measures of activation overlap (both between-subject, within-session and within-subject, between-session). The choice of task contrast consistently shows a greater impact than the age cohort, for (P, R) metrics and activation overlap. Finally, adaptive pipeline optimization per task run shows improved sensitivity to age-related changes in brain activity, particularly for weaker, more complex cognitive contrasts. The current study provides the first detailed examination of preprocessing pipelines across age cohorts, demonstrating a significant benefit of adaptive pipeline optimization across age groups.

Sources of Variation Influencing Concordance between Functional MRI and Direct Cortical Stimulation in Brain Tumor Surgery

Object: Preoperative functional magnetic resonance imaging (fMRI) remains a promising method to aid in the surgical management of patients diagnosed with brain tumors. For patients that are candidates for awake craniotomies, surgical decisions can potentially be improved by fMRI but this depends on the level of concordance between preoperative brain maps and the maps provided by the gold standard intraoperative method, direct cortical stimulation (DCS). There have been numerous studies of the concordance between fMRI and DCS using sensitivity and specificity measures, however the results are variable across studies and the key factors influencing variability are not well understood. Thus, the present work addresses the influence of technical factors on fMRI and DCS concordance. Methods: Motor and language mapping data were collected for a group of glioma patients (n = 14) who underwent both preoperative fMRI and intraoperative DCS in an awake craniotomy procedure for tumor removal. Normative fMRI data were also acquired in a healthy control group (n = 12). The fMRI and DCS mapping data were co-registered; true positive (TP), true negative (TN), false positive (FP), and false negative (FN) occurrences were tabulated over the exposed brain surface. Sensitivity and specificity were measured for the total group, and for the motor and language sub-groups. The influence of grid placement, fMRI statistical thresholding, and task standardization were assessed. Correlations between proportions of agreement and error were also carefully scrutinized to evaluate concordance in more detail. Results: Concordance was significantly better for motor vs. language mapping. There was an inverse relationship between TP and TN with increasing statistical threshold, and FP dominated the total error. Sensitivity and specificity were reduced when tasks were not standardized across fMRI and DCS. Conclusions: Although the agreement between fMRI and DCS is good, variability is introduced by technical factors that can diminish the quality of patient data. Neurosurgeons should evaluate the usefulness of fMRI data while considering that (a) discordance arises primarily from FP fMRI results; (b) there is an inherent trade-off between sensitivity and specificity with fMRI statistical threshold; and

Reliability of Task-Based fMRI for Preoperative Planning: A Test-Retest Study in Brain Tumor Patients and Healthy Controls

Background

Functional magnetic resonance imaging (fMRI) continues to develop as a clinical tool for patients with brain cancer, offering data that may directly influence surgical decisions. Unfortunately, routine integration of preoperative fMRI has been limited by concerns about reliability. Many pertinent studies have been undertaken involving healthy controls, but work involving brain tumor patients has been limited. To develop fMRI fully as a clinical tool, it will be critical to examine these reliability issues among patients with brain tumors. The present work is the first to extensively characterize differences in activation map quality between brain tumor patients and healthy controls, including the effects of tumor grade and the chosen behavioral testing paradigm on reliability outcomes.

Method

Test-retest data were collected for a group of low-grade (n = 6) and high-grade glioma (n = 6) patients, and for matched healthy controls (n = 12), who performed motor and language tasks during a single fMRI session. Reliability was characterized by the spatial overlap and displacement of brain activity clusters, BOLD signal stability, and the laterality index. Significance testing was performed to assess differences in reliability between the patients and controls, and low-grade and high-grade patients; as well as between different fMRI testing paradigms.

Results

There were few significant differences in fMRI reliability measures between patients and controls. Reliability was significantly lower when comparing high-grade tumor patients to controls, or to low-grade tumor patients. The motor task produced more reliable activation patterns than the language tasks, as did the rhyming task in comparison to the phonemic fluency task.

Conclusion

In low-grade glioma patients, fMRI data are as reliable as healthy control subjects. For high-grade glioma patients, further investigation is required to determine the underlying causes of reduced reliability. To maximize reliability outcomes, testing paradigms should be carefully selected to generate robust activation patterns.

A novel tablet computer platform for advanced language mapping during awake craniotomy procedures

A computerized platform has been developed to enhance behavioral testing during intraoperative language mapping in awake craniotomy procedures. The system is uniquely compatible with the environmental demands of both the operating room and preoperative functional MRI (fMRI), thus providing standardized testing toward improving spatial agreement between the 2 brain mapping techniques. Details of the platform architecture, its advantages over traditional testing methods, and its use for language mapping are described. Four illustrative cases demonstrate the efficacy of using the testing platform to administer sophisticated language paradigms, and the spatial agreement between intraoperative mapping and preoperative fMRI results. The testing platform substantially improved the ability of the surgeon to detect and characterize language deficits. Use of a written word generation task to assess language production helped confirm areas of speech apraxia and speech arrest that were inadequately characterized or missed with the use of traditional paradigms, respectively. Preoperative fMRI of the analogous writing task was also assistive, displaying excellent spatial agreement with intraoperative mapping in all 4 cases. Sole use of traditional testing paradigms can be limiting during awake craniotomy procedures. Comprehensive assessment of language function will require additional use of more sophisticated and ecologically valid testing paradigms. The platform presented here provides a means to do so.

Bimanual non-congruent actions in motor neglect syndrome: a combined behavioral/fMRI study

In Motor Neglect (MN) syndrome, a specific impairment in non-congruent bimanual movements has been described. In the present case-control study, we investigated the neuro-functional correlates of this behavioral deficit. Two right-brain-damaged (RBD) patients, one with (MN+) and one without (MN−) MN, were evaluated by means of functional Magnetic Resonance Imaging (fMRI) in a bimanual Circles-Lines (CL) paradigm. Patients were requested to perform right-hand movements (lines-drawing) and, simultaneously, congruent (lines-drawing) or non-congruent (circles-drawing) left-hand movements. In the behavioral task, MN− patient showed a bimanual-coupling-effect, while MN+ patient did not. The fMRI study showed that in MN−, a fronto-parietal network, mainly involving the pre-supplementary motor area (pre-SMA) and the posterior parietal cortex (PPC), was significantly more active in non-congruent than in congruent conditions, as previously shown in healthy subjects. On the contrary, MN+ patient showed an opposite pattern of activation both in pre-SMA and in PPC. Within this fronto-parietal network, the pre-SMA is supposed to exert an inhibitory influence on the default coupling of homologous muscles, thus allowing the execution of non-congruent movements. In MN syndrome, the described abnormal pre-SMA activity supports the hypothesis that a failure to inhibit ipsilesional motor programs might determine a specific impairment of non-congruent movements.

An Automated, Adaptive Framework for Optimizing Preprocessing Pipelines in Task-Based Functional MRI

BOLD fMRI is sensitive to blood-oxygenation changes correlated with brain function; however, it is limited by relatively weak signal and significant noise confounds. Many preprocessing algorithms have been developed to control noise and improve signal detection in fMRI. Although the chosen set of preprocessing and analysis steps (the “pipeline”) significantly affects signal detection, pipelines are rarely quantitatively validated in the neuroimaging literature, due to complex preprocessing interactions. This paper outlines and validates an adaptive resampling framework for evaluating and optimizing preprocessing choices by optimizing data-driven metrics of task prediction and spatial reproducibility. Compared to standard “fixed” preprocessing pipelines, this optimization approach significantly improves independent validation measures of within-subject test-retest, and between-subject activation overlap, and behavioural prediction accuracy. We demonstrate that preprocessing choices function as implicit model regularizers, and that improvements due to pipeline optimization generalize across a range of simple to complex experimental tasks and analysis models. Results are shown for brief scanning sessions (<3 minutes each), demonstrating that with pipeline optimization, it is possible to obtain reliable results and brain-behaviour correlations in relatively small datasets.

A computerized tablet with visual feedback of hand position for functional magnetic resonance imaging

Neuropsychological tests behavioral tasks that very commonly involve handwriting and drawing are widely used in the clinic to detect abnormal brain function. Functional magnetic resonance imaging (fMRI) may be useful in increasing the specificity of such tests. However, performing complex pen-and-paper tests during fMRI involves engineering challenges. Previously, we developed an fMRI-compatible, computerized tablet system to address this issue. However, the tablet did not include visual feedback of hand position (VFHP), a human factors component that may be important for fMRI of certain patient populations. A real-time system was thus developed to provide VFHP and integrated with the tablet in an augmented reality display. The effectiveness of the system was initially tested in young healthy adults who performed various handwriting tasks in front of a computer display with and without VFHP. Pilot fMRI of writing tasks were performed by two representative individuals with and without VFHP. Quantitative analysis of the behavioral results indicated improved writing performance with VFHP. The pilot fMRI results suggest that writing with VFHP requires less neural resources compared to the without VFHP condition, to maintain similar behavior. Thus, the tablet system with VFHP is recommended for future fMRI studies involving patients with impaired brain function and where ecologically valid behavior is important.

A preliminary fMRI study of a novel self-paced written fluency task: observation of left-hemispheric activation, and increased frontal activation in late vs. early task phases

Neuropsychological tests of verbal fluency are very widely used to characterize impaired cognitive function. For clinical neuroscience studies and potential medical applications, measuring the brain activity that underlies such tests with functional magnetic resonance imaging (fMRI) is of significant interest—but a challenging proposition because overt speech can cause signal artifacts, which tend to worsen as the duration of speech tasks becomes longer. In a novel approach, we present the group brain activity of 12 subjects who performed a self-paced written version of phonemic fluency using fMRI-compatible tablet technology that recorded responses and provided task-related feedback on a projection screen display, over long-duration task blocks (60 s). As predicted, we observed robust activation in the left anterior inferior and medial frontal gyri, consistent with previously reported results of verbal fluency tasks which established the role of these areas in strategic word retrieval. In addition, the number of words produced in the late phase (last 30 s) of written phonemic fluency was significantly less (p < 0.05) than the number produced in the early phase (first 30 s). Activation during the late phase vs. the early phase was also assessed from the first 20 s and last 20 s of task performance, which eliminated the possibility that the sluggish hemodynamic response from the early phase would affect the activation estimates of the late phase. The last 20 s produced greater activation maps covering extended areas in bilateral precuneus, cuneus, middle temporal gyrus, insula, middle frontal gyrus and cingulate gyrus. Among these areas, greater activation was observed in the bilateral middle frontal gyrus (Brodmann area BA 9) and cingulate gyrus (BA 24, 32) likely as part of the initiation, maintenance, and shifting of attentional resources. Consistent with previous pertinent fMRI literature involving overt and covert verbal responses, these findings highlight the promise and practicality of fMRI of written phonemic fluency.

The neural basis of mark making: a functional MRI study of drawing

Compared to most other forms of visually-guided motor activity, drawing is unique in that it "leaves a trail behind" in the form of the emanating image. We took advantage of an MRI-compatible drawing tablet in order to examine both the motor production and perceptual emanation of images. Subjects participated in a series of mark making tasks in which they were cued to draw geometric patterns on the tablet's surface. The critical comparison was between when visual feedback was displayed (image generation) versus when it was not (no image generation). This contrast revealed an occipito-parietal stream involved in motion-based perception of the emerging image, including areas V5/MT+, LO, V3A, and the posterior part of the intraparietal sulcus. Interestingly, when subjects passively viewed animations of visual patterns emerging on the projected surface, all of the sensorimotor network involved in drawing was strongly activated, with the exception of the primary motor cortex. These results argue that the origin of the human capacity to draw and write involves not only motor skills for tool use but also motor-sensory links between drawing movements and the visual images that emanate from them in real time.

Functional specificity in the motor system: Evidence from coupled fMRI and kinematic recordings during letter and digit writing

A few intriguing neuropsychologial studies report dissociations where agraphic patients are severely impaired for writing letters whereas they write digits nearly normally. Here, using functional magnetic resonance imaging (fMRI) together with graphic tablet recordings, we tested the hypothesis that the motor patterns for writing letters are coded in specific regions of the cortex. We found a set of three regions that were more strongly activated when participants wrote letters than when they wrote digits and whose response was not explained by low-level kinematic features of the graphic movements. Two of these regions (left dorsal premotor cortex and supplementary motor complex) are part of a motor control network. The left premotor activation belongs to what is considered in the literature a key area for handwriting. Another significant activation, likely related to phoneme-to-grapheme conversion, was found in the right anterior insula. This constitutes the first neuroimaging evidence of functional specificity derived from experience in the cortical motor system.

Design of an fMRI-compatible optical touch stripe based on frustrated total internal reflection

Previously we developed a low-cost, multi-configurable handheld response system, using a reflective-type intensity modulated fiber-optic sensor (FOS) to accurately gather participants' behavioral responses during functional magnetic resonance imaging (fMRI). Inspired by the popularity and omnipresence of the fingertip-based touch sensing user interface devices, in this paper we present the design of a prototype fMRI-compatible optical touch stripe (OTS) as an alternative configuration. The prototype device takes advantage of a proven frustrated total internal reflection (FTIR) technique. By using a custom-built wedge-shaped optically transparent acrylic prism as an optical waveguide, and a plano-concave lens to provide the required light beam profile, the position of a fingertip touching the surface of the wedge prism can be determined from the deflected light beams that become trapped within the prism by total internal reflection. To achieve maximum sensitivity, the optical design of the wedge prism and lens were optimized through a series of light beam simulations using WinLens 3D Basic software suite. Furthermore, OTS performance and MRI-compatibility were assessed on a 3.0 Tesla MRI scanner running echo planar imaging (EPI) sequences. The results show that the OTS can detect a touch signal at high spatial resolution (about 0.5 cm), and is well suited for use within the MRI environment with average time-variant signal-to-noise ratio (tSNR) loss < 3%.

Drawing lines while imagining circles: Neural basis of the bimanual coupling effect during motor execution and motor imagery

When people simultaneously draw lines with one hand and circles with the other hand, both trajectories tend to assume an oval shape, showing that hand motor programs interact (the so-called "bimanual coupling effect"). The aim of the present study was to investigate how motor parameters (drawing trajectories) and the related brain activity vary during bimanual movements both in real execution and in motor imagery tasks. In the 'Real' modality, subjects performed right hand movements (lines) and, simultaneously, Congruent (lines) or Non-congruent (circles) left hand movements. In the 'Imagery' modality, subjects performed only right hand movements (lines) and, simultaneously, imagined Congruent (lines) or Non-congruent (circles) left hand movements. Behavioral results showed a similar interference of both the real and the imagined circles on the actually executed lines, suggesting that the coupling effect also pertains to motor imagery. Neuroimaging results showed that a prefrontal-parietal network, mostly involving the pre-Supplementary Motor Area (pre-SMA) and the posterior parietal cortex (PPC), was significantly more active in Non-congruent than in Congruent conditions, irrespective of task (Real or Imagery). The data also confirmed specific roles of the right superior parietal lobe (SPL) in mediating spatial interference, and of the left PPC in motor imagery. Collectively, these findings suggest that real and imagined Non-congruent movements activate common circuits related to the intentional and predictive operation generating bimanual coupling, in which the pre-SMA and the PPC play a crucial role.

An optoelectronic based approach for handwriting capture

Clinical practice for the evaluation of motor and cognitive capabilities often relies upon writing and drawing tests. A non-invasive method to capture handwriting and analyze data is therefore needed. In this work a method to capture motion of a pen through a mo-cap optoelectronic system was developed, which could solve the limits of systems based on graphic tablets. Four IR passive markers were placed on a pen cap. Once a pen was equipped with the cap, track of tip was computed through a numeric algorithm using the 3D coordinates of markers provided by the optoelectronic system. Some tests were performed to estimate the error in track reconstruction and to compare the new protocol with previous reconstruction methods. The results showed a higher accuracy of the new method. The new protocol also overcomes the problems related to pen grasping and marker covering that affected other methods described in the literature and permits the evaluation of writing and drawing kinematics as well as postural behaviour related to them.

PHYCAA+: an optimized, adaptive procedure for measuring and controlling physiological noise in BOLD fMRI

The presence of physiological noise in functional MRI can greatly limit the sensitivity and accuracy of BOLD signal measurements, and produce significant false positives. There are two main types of physiological confounds: (1) high-variance signal in non-neuronal tissues of the brain including vascular tracts, sinuses and ventricles, and (2) physiological noise components which extend into gray matter tissue. These physiological effects may also be partially coupled with stimuli (and thus the BOLD response). To address these issues, we have developed PHYCAA+, a significantly improved version of the PHYCAA algorithm (Churchill et al., 2011) that (1) down-weights the variance of voxels in probable non-neuronal tissue, and (2) identifies the multivariate physiological noise subspace in gray matter that is linked to non-neuronal tissue. This model estimates physiological noise directly from EPI data, without requiring external measures of heartbeat and respiration, or manual selection of physiological components. The PHYCAA+ model significantly improves the prediction accuracy and reproducibility of single-subject analyses, compared to PHYCAA and a number of commonly-used physiological correction algorithms. Individual subject denoising with PHYCAA+ is independently validated by showing that it consistently increased between-subject activation overlap, and minimized false-positive signal in non gray-matter loci. The results are demonstrated for both block and fast single-event task designs, applied to standard univariate and adaptive multivariate analysis models.

A low-cost, computer-interfaced drawing pad for FMRI studies of dysgraphia and dyslexia

We have developed a pen and writing tablet for use by subjects during fMRI scanning. The pen consists of two jacketed, multi-mode optical fibers routed to the tip of a hollowed-out ball-point pen. The pen has been further modified by addition of a plastic plate to maintain a perpendicular pen-tablet orientation. The tablet is simply a non-metallic frame holding a paper print of continuously varying color gradients. The optical fibers are routed out of the MRI bore to a light-tight box in an adjacent control room. Within the box, light from a high intensity LED is coupled into one of the fibers, while the other fiber abuts a color sensor. Light from the LED exits the pen tip, illuminating a small spot on the tablet, and the resulting reflected light is routed to the color sensor. Given a lookup table of position for each color on the tablet, the coordinates of the pen on the tablet may be displayed and digitized in real-time. While simple and inexpensive, the system achieves sufficient resolution to grade writing tasks testing dysgraphic and dyslexic phenomena.

Working memory training is associated with lower prefrontal cortex activation in a divergent thinking task

Working memory (WM) training has been shown to lead to improvements in WM capacity and fluid intelligence. Given that divergent thinking loads on WM and fluid intelligence, we tested the hypothesis that WM training would improve performance and moderate neural function in the Alternate Uses Task (AUT)-a classic test of divergent thinking. We tested this hypothesis by administering the AUT in the functional magnetic resonance imaging scanner following a short regimen of WM training (experimental condition), or engagement in a choice reaction time task not expected to engage WM (active control condition). Participants in the experimental group exhibited significant improvement in performance in the WM task as a function of training, as well as a significant gain in fluid intelligence. Although the two groups did not differ in their performance on the AUT, activation was significantly lower in the experimental group in ventrolateral prefrontal and dorsolateral prefrontal cortices-two brain regions known to play dissociable and critical roles in divergent thinking. Furthermore, gain in fluid intelligence mediated the effect of training on brain activation in ventrolateral prefrontal cortex. These results indicate that a short regimen of WM training is associated with lower prefrontal activation-a marker of neural efficiency-in divergent thinking.

Neuropsychological features of asymptomatic c.709-1G>A progranulin mutation carriers

Mutations in the progranulin (PGRN) gene have been identified as a cause of frontotemporal dementia (FTD). However, little is known about the neuropsychological abilities of asymptomatic carriers of these mutations. The aim of the study was to assess cognitive functioning in asymptomatic c.709-1G>A PGRN mutation carriers. We hypothesized that poorer neuropsychological performance could be present before the development of clinically significant FTD symptoms. Thirty-two asymptomatic first-degree relatives of FTD patients carrying the c.709-1G>A mutation served as study participants, including 13 PGRN mutation carriers (A-PGRN+) and 19 non-carriers (PGRN-). A neuropsychological battery was administered. We found that the A-PGRN+ participants obtained significantly poorer scores than PGRN- individuals on tests of attention (Trail-Making Test Part A), mental flexibility (Trail-Making Test Part B), and language (Boston Naming Test). Poorer performance on these tests in asymptomatic PGRN mutation carriers may reflect a prodromal phase preceding the onset of clinically significant symptoms of FTD.

Electrophysiological correlates of planning and monitoring in first episode schizophrenia

The aim of this study was to investigate the functional basis of frequently described cognitive deficits in schizophrenia patients by exploring the electrophysiological correlates of planning processes during performance of the Trail-Making Test-B (TMT-B). Via concurrent recording of behavioral test performance, exploratory eye movements and electrical brain activity functional components critical for task performance were extracted and characterized. Participants comprised 12 first episode patients and 12 matched healthy controls who were examined with concurrent infrared oculography and electroencephalography (EEG) while they carried out a computerized TMT-B. The performance process was segmented into planning and monitoring phases based on the interaction of eye and hand movements. Brain electrical activity was analyzed using low-resolution electromagnetic brain tomography (LORETA). During planning fixations compared to monitoring fixations, both groups showed enhanced current density in dorsolateral prefrontal cortex, cingulate gyrus and inferior parietal lobe. Concurrent with poorer performance, schizophrenia patients exhibited hypoactivity within prefrontal brain areas during planning. Thus, poorer performance in schizophrenia seems to be attributable to impaired planning behavior based on hypoactivity of prefrontal areas, involved in the temporal scheduling of deliberate actions as well as visuomotor integration.