Recent advances in functional neuroimaging of gait

Brain Networks Modulation during Simple and Complex Gait: A "Mobile Brain/Body Imaging" Study

Walking encompasses a complex interplay of neuromuscular coordination and cognitive processes. Disruptions in gait can impact personal independence and quality of life, especially among the elderly and neurodegenerative patients. While traditional biomechanical analyses and neuroimaging techniques have contributed to understanding gait control, they often lack the temporal resolution needed for rapid neural dynamics. This study employs a mobile brain/body imaging (MoBI) platform with high-density electroencephalography (hd-EEG) to explore event-related desynchronization and synchronization (ERD/ERS) during overground walking. Simultaneous to hdEEG, we recorded gait spatiotemporal parameters. Participants were asked to walk under usual walking and dual-task walking conditions. For data analysis, we extracted ERD/ERS in α, β, and γ bands from 17 selected regions of interest encompassing not only the sensorimotor cerebral network but also the cognitive and affective networks. A correlation analysis was performed between gait parameters and ERD/ERS intensities in different networks in the different phases of gait. Results showed that ERD/ERS modulations across gait phases in the α and β bands extended beyond the sensorimotor network, over the cognitive and limbic networks, and were more prominent in all networks during dual tasks with respect to usual walking. Correlation analyses showed that a stronger α ERS in the initial double-support phases correlates with shorter step length, emphasizing the role of attention in motor control. Additionally, β ERD/ERS in affective and cognitive networks during dual-task walking correlated with dual-task gait performance, suggesting compensatory mechanisms in complex tasks. This study advances our understanding of neural dynamics during overground walking, emphasizing the multidimensional nature of gait control involving cognitive and affective networks.

Anodal transcranial direct current stimulation does not enhance the effects of motor imagery training of a sequential finger-tapping task in young adults

When applied over the primary motor cortex (M1), anodal transcranial direct current stimulation (a-tDCS) could enhance the effects of a single motor imagery training (MIt) session on the learning of a sequential finger-tapping task (SFTT). This study aimed to investigate the effect of a-tDCS on the learning of an SFTT during multiple MIt sessions. Two groups of 16 healthy young adults participated in three consecutive MIt sessions over 3 days, followed by a retention test 1 week later. They received active or sham a-tDCS during a MIt session in which they mentally rehearsed an eight-item complex finger sequence with their left hand. Before and after each session, and during the retention test, they physically repeated the sequence as quickly and accurately as possible. Both groups (i) improved their performance during the first two sessions, showing online learning; (ii) stabilised the level they reached during all training sessions, reflecting offline consolidation; and (iii) maintained their performance level one week later, showing retention. However, no significant difference was found between the groups, regardless of the MSL stage. These results emphasise the importance of performing several MIt sessions to maximise performance gains, but they do not support the additional effects of a-tDCS.

Assessing Neurokinematic and Neuromuscular Connectivity During Walking Using Mobile Brain-Body Imaging

Gait is a common but rather complex activity that supports mobility in daily life. It requires indeed sophisticated coordination of lower and upper limbs, controlled by the nervous system. The relationship between limb kinematics and muscular activity with neural activity, referred to as neurokinematic and neuromuscular connectivity (NKC/NMC) respectively, still needs to be elucidated. Recently developed analysis techniques for mobile high-density electroencephalography (hdEEG) recordings have enabled investigations of gait-related neural modulations at the brain level. To shed light on gait-related neurokinematic and neuromuscular connectivity patterns in the brain, we performed a mobile brain/body imaging (MoBI) study in young healthy participants. In each participant, we collected hdEEG signals and limb velocity/electromyography signals during treadmill walking. We reconstructed neural signals in the alpha (8–13 Hz), beta (13–30 Hz), and gamma (30–50 Hz) frequency bands, and assessed the co-modulations of their power envelopes with myogenic/velocity envelopes. Our results showed that the myogenic signals have larger discriminative power in evaluating gait-related brain-body connectivity with respect to kinematic signals. A detailed analysis of neuromuscular connectivity patterns in the brain revealed robust responses in the alpha and beta bands over the lower limb representation in the primary sensorimotor cortex. There responses were largely contralateral with respect to the body sensor used for the analysis. By using a voxel-wise analysis of variance on the NMC images, we revealed clear modulations across body sensors; the variability across frequency bands was relatively lower, and below significance. Overall, our study demonstrates that a MoBI platform based on hdEEG can be used for the investigation of gait-related brain-body connectivity. Future studies might involve more complex walking conditions to gain a better understanding of fundamental neural processes associated with gait control, or might be conducted in individuals with neuromotor disorders to identify neural markers of abnormal gait.

Frequency-dependent modulation of neural oscillations across the gait cycle

Balance and walking are fundamental to support common daily activities. Relatively accurate characterizations of normal and impaired gait features were attained at the kinematic and muscular levels. Conversely, the neural processes underlying gait dynamics still need to be elucidated. To shed light on gait‐related modulations of neural activity, we collected high‐density electroencephalography (hdEEG) signals and ankle acceleration data in young healthy participants during treadmill walking. We used the ankle acceleration data to segment each gait cycle in four phases: initial double support, right leg swing, final double support, left leg swing. Then, we processed hdEEG signals to extract neural oscillations in alpha, beta, and gamma bands, and examined event‐related desynchronization/synchronization (ERD/ERS) across gait phases. Our results showed that ERD/ERS modulations for alpha, beta, and gamma bands were strongest in the primary sensorimotor cortex (M1), but were also found in premotor cortex, thalamus and cerebellum. We observed a modulation of neural oscillations across gait phases in M1 and cerebellum, and an interaction between frequency band and gait phase in premotor cortex and thalamus. Furthermore, an ERD/ERS lateralization effect was present in M1 for the alpha and beta bands, and in the cerebellum for the beta and gamma bands. Overall, our findings demonstrate that an electrophysiological source imaging approach based on hdEEG can be used to investigate dynamic neural processes of gait control. Future work on the development of mobile hdEEG‐based brain–body imaging platforms may enable overground walking investigations, with potential applications in the study of gait disorders.

An Overview on Cognitive Function Enhancement through Physical Exercises

This review is extensively focused on the enhancement of cognitive functions while performing physical exercises categorized into cardiovascular exercises, resistance training, martial arts, racquet sports, dancing and mind-body exercises. Imaging modalities, viz. functional magnetic resonance imaging (fMRI), functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG), have been included in this review. This review indicates that differences are present in cognitive functioning while changing the type of physical activity performed. This study concludes that employing fNIRS helps overcome certain limitations of fMRI. Further, the effects of physical activity on a diverse variety of the population, from active children to the old people, are discussed.

Age-related differences in alpha and beta band activity in sensory association brain areas during challenging sensory tasks

Sensory challenges to postural balance are daily threats for elderly individuals. This study examined electroencephalography (EEG) in alpha and beta bands in sensory association areas during the Sensory Organization Test, involving withdrawal of visual or presenting misleading somatosensory inputs, in twelve young and twelve elderly participants. The results showed stepwise deterioration in behavioral performance in four conditions, with group effects that were amplified with combined sensory challenges. With eye closure, alpha and beta activities increased in all sensory association areas. Fast beta activity increased in the bilateral parietal-temporal-occipital areas. Misleading somatosensory information effects on EEG activity were of smaller amplitude than eye closure effects and in a different direction. Decreased alpha activity in left parietal-temporal-occipital areas and decreased beta and fast beta activities in bilateral parietal-temporal-occipital areas were significant. Elderly participants had increased fast beta activity in the left temporal-occipital and bilateral occipital areas, indicative of sustained efforts that they made in all sensory conditions. Similar to the young participants, elderly participants with eyes closed showed increased alpha activity, although to a smaller degree, in bilateral temporal-occipital and left occipital areas. This might indicate a lack of efficacy in redistributing relative sensory weights when elderly participants dealt with eye closure. In summary, EEG power changes did not match the stepwise deterioration in behavioral data, but reflected different sensory strategies adopted by young and elderly participants to cope with eye closure or misleading somatosensory information based on the efficacy of these different strategies.

How aging affects the premotor control of lower limb movements in simulated gait

Gait control becomes more demanding in healthy older adults, yet what cognitive or motor process leads to this age-related change is unknown. The present study aimed to investigate whether it might depend on specific decay in the quality of gait motor representation and/or a more general reduction in the efficiency of lower limb motor control. Younger and older healthy participants performed in fMRI a virtual walking paradigm that combines motor imagery (MI) of walking and standing on the spot with the presence (Dynamic Motor Imagery condition, DMI) or absence (pure MI condition) of overtly executed ankle dorsiflexion. Gait imagery was aided by the concomitant observation of moving videos simulating a stroll in the park from a first-person perspective. Behaviorally, older participants showed no sign of evident depletion in the quality of gait motor representations, and absence of between-group differences in the neural correlates of MI. However, while younger participants showed increased frontoparietal activity during DMI, older participants displayed stronger activation of premotor areas when controlling the pure execution of ankle dorsiflexion, regardless of the imagery task. These data suggest that reduced automaticity of lower limb motor control in healthy older subjects leads to the recruitment of additional premotor resources even in the absence of basic gait functional disabilities.

Identifying the neural correlates of doorway freezing in Parkinson's disease

Freezing of gait (FOG) in Parkinson's disease (PD) is frequently triggered upon passing through narrow spaces such as doorways. However, despite being common the neural mechanisms underlying this phenomenon are poorly understood. In our study, 19 patients who routinely experience FOG performed a previously validated virtual reality (VR) gait paradigm where they used foot-pedals to navigate a series of doorways. Patients underwent testing randomised between both their "ON" and "OFF" medication states. Task performance in conjunction with blood oxygenation level dependent (BOLD) signal changes between "ON" and "OFF" states were compared within each patient. Specifically, as they passed through a doorway in the VR environment patients demonstrated significantly longer "footstep" latencies in the OFF state compared to the ON state. As seen clinically in FOG this locomotive delay was primarily triggered by narrow doorways rather than wide doorways. Functional magnetic resonance imaging revealed that footstep prolongation on passing through doorways was associated with selective hypoactivation in the presupplementary motor area (pSMA) bilaterally. Task-based functional connectivity analyses revealed that increased latency in response to doorways was inversely correlated with the degree of functional connectivity between the pSMA and the subthalamic nucleus (STN) across both hemispheres. Furthermore, increased frequency of prolonged footstep latency was associated with increased connectivity between the bilateral STN. These findings suggest that the effect of environmental cues on triggering FOG reflects a degree of impaired processing within the pSMA and disrupted signalling between the pSMA and STN, thus implicating the "hyperdirect" pathway in the generation of this phenomenon.

EEG-Based BCI Control Schemes for Lower-Limb Assistive-Robots

Over recent years, brain-computer interface (BCI) has emerged as an alternative communication system between the human brain and an output device. Deciphered intents, after detecting electrical signals from the human scalp, are translated into control commands used to operate external devices, computer displays and virtual objects in the real-time. BCI provides an augmentative communication by creating a muscle-free channel between the brain and the output devices, primarily for subjects having neuromotor disorders, or trauma to nervous system, notably spinal cord injuries (SCI), and subjects with unaffected sensorimotor functions but disarticulated or amputated residual limbs. This review identifies the potentials of electroencephalography (EEG) based BCI applications for locomotion and mobility rehabilitation. Patients could benefit from its advancements such as wearable lower-limb (LL) exoskeletons, orthosis, prosthesis, wheelchairs, and assistive-robot devices. The EEG communication signals employed by the aforementioned applications that also provide feasibility for future development in the field are sensorimotor rhythms (SMR), event-related potentials (ERP) and visual evoked potentials (VEP). The review is an effort to progress the development of user's mental task related to LL for BCI reliability and confidence measures. As a novel contribution, the reviewed BCI control paradigms for wearable LL and assistive-robots are presented by a general control framework fitting in hierarchical layers. It reflects informatic interactions, between the user, the BCI operator, the shared controller, the robotic device and the environment. Each sub layer of the BCI operator is discussed in detail, highlighting the feature extraction, classification and execution methods employed by the various systems. All applications' key features and their interaction with the environment are reviewed for the EEG-based activity mode recognition, and presented in form of a table. It is suggested to structure EEG-BCI controlled LL assistive devices within the presented framework, for future generation of intent-based multifunctional controllers. Despite the development of controllers, for BCI-based wearable or assistive devices that can seamlessly integrate user intent, practical challenges associated with such systems exist and have been discerned, which can be constructive for future developments in the field.

Imaging Posture Veils Neural Signals

Whereas modern brain imaging often demands holding body positions incongruent with everyday life, posture governs both neural activity and cognitive performance. Humans commonly perform while upright; yet, many neuroimaging methodologies require participants to remain motionless and adhere to non-ecological comportments within a confined space. This inconsistency between ecological postures and imaging constraints undermines the transferability and generalizability of many a neuroimaging assay. Here we highlight the influence of posture on brain function and behavior. Specifically, we challenge the tacit assumption that brain processes and cognitive performance are comparable across a spectrum of positions. We provide an integrative synthesis regarding the increasingly prominent influence of imaging postures on autonomic function, mental capacity, sensory thresholds, and neural activity. Arguing that neuroimagers and cognitive scientists could benefit from considering the influence posture wields on both general functioning and brain activity, we examine existing imaging technologies and the potential of portable and versatile imaging devices (e.g., functional near infrared spectroscopy). Finally, we discuss ways that accounting for posture may help unveil the complex brain processes of everyday cognition.

Beta activity in the premotor cortex is increased during stabilized as compared to normal walking

Walking on two legs is inherently unstable. Still, we humans perform remarkable well at it, mostly without falling. To gain more understanding of the role of the brain in controlling gait stability we measured brain activity using electro-encephalography (EEG) during stabilized and normal walking. Subjects walked on a treadmill in two conditions, each lasting 10 min; normal, and while being laterally stabilized by elastic cords. Kinematics of trunk and feet, electro-myography (EMG) of neck muscles, as well as 64-channel EEG were recorded. To assess gait stability the local divergence exponent, step width, and trunk range of motion were calculated from the kinematic data. We used independent component (IC) analysis to remove movement, EMG, and eyeblink artifacts from the EEG, after which dynamic imaging of coherent sources beamformers were determined to identify cortical sources that showed a significant difference between conditions. Stabilized walking led to a significant increase in gait stability, i.e., lower local divergence exponents. Beamforming analysis of the beta band activity revealed significant sources in bilateral pre-motor cortices. Projection of sensor data on these sources showed a significant difference only in the left premotor area, with higher beta power during stabilized walking, specifically around push-off, although only significant around contralateral push-off. It appears that even during steady gait the cortex is involved in the control of stability.

Subthalamic nucleus stimulation improves Parkinsonian gait via brainstem locomotor centers

BACKGROUND

Subthalamic deep brain stimulation (STN-DBS) can ameliorate gait disturbances in Parkinson's disease (PD). Using motor imagery and positron emission tomography (PET), we investigated how STN-DBS interacts with supraspinal locomotor centers in PD.

METHODS

Ten PD patients with bilateral STN-DBS actually walked or stood still under STN-DBS ON or OFF conditions. Directly thereafter, subjects imagined walking or standing while changes in regional cerebral blood flow were measured by PET.

RESULTS

Independent of STN-DBS, imagined walking distance correlated with imagery duration. Compared with STN-DBS OFF, STN-DBS ON improved actual gait and increased imagined walking distance. Imagery of gait (vs. stance) induced activity in the supplementary motor area and the right superior parietal lobule for both STN-DBS conditions. The improvement of imagined gait during STN-DBS ON led to activity changes in the pedunculopontine nucleus/mesencephalic locomotor region (PPN/MLR).

CONCLUSIONS

Data suggest that STN-DBS improves Parkinsonian gait by modulating PPN/MLR activity.

Motor imagery of gait in non-demented older community-dwellers: performance depends on serum 25-hydroxyvitamin D concentrations

Hypovitaminosis D has been associated with poorer physical and cognitive performances in older adults. The objectives of this study were (1) to measure and compare the time to perform (pTUG) and to imagine (iTUG) the Timed "Up & Go" test (TUG) test, and the time difference between these two performances (i.e., TUG delta time) in non-demented community-dwelling older adults with and without lower serum 25-hydroxyvitamin D (25OHD) concentrations and (2) to examine the association between the TUG delta time and serum 25OHD concentrations. Durations of pTUG, iTUG and TUG delta time, and serum 25OHD concentrations (severe insufficiency <10 ng/mL; moderate insufficiency: 10-30 ng/mL; normal status >30 ng/mL) were measured in 359 non-demented participants (mean age 70.4 ± 4.8 years; 40.7 % women). Participants with severe 25OHD insufficiency (15.6 %) had higher TUG delta time compared to those with moderate insufficiency (P = 0.010) and normal status (P = 0.048). TUG delta time was negatively associated with serum 25OHD concentrations (P < 0.010). Accurate motor imagery of gait was explained in part by serum 25OHD concentrations, increased discrepancy between pTUG and iTUG being associated with lower serum 25OHD concentrations.

White matter microstructural organization and gait stability in older adults

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

Motor phenotype of decline in cognitive performance among community-dwellers without dementia: population-based study and meta-analysis

Background

Decline in cognitive performance is associated with gait deterioration. Our objectives were: 1) to determine, from an original study in older community-dwellers without diagnosis of dementia, which gait parameters, among slower gait speed, higher stride time variability (STV) and Timed Up & Go test (TUG) delta time, were most strongly associated with lower performance in two cognitive domains (i.e., episodic memory and executive function); and 2) to quantitatively synthesize, with a systematic review and meta-analysis, the association between gait performance and cognitive decline (i.e., mild cognitive impairment (MCI) and dementia).

Methods

Based on a cross-sectional design, 934 older community-dwellers without dementia (mean±standard deviation, 70.3±4.9years; 52.1% female) were recruited. A score at 5 on the Short Mini-Mental State Examination defined low episodic memory performance. Low executive performance was defined by clock-drawing test errors. STV and gait speed were measured using GAITRite system. TUG delta time was calculated as the difference between the times needed to perform and to imagine the TUG. Then, a systematic Medline search was conducted in November 2013 using the Medical Subject Heading terms “Delirium,” “Dementia,” “Amnestic,” “Cognitive disorders” combined with “Gait” OR “Gait disorders, Neurologic” and “Variability.”

Findings

A total of 294 (31.5%) participants presented decline in cognitive performance. Higher STV, higher TUG delta time, and slower gait speed were associated with decline in episodic memory and executive performances (all P-values <0.001). The highest magnitude of association was found for higher STV (effect size  =  −0.74 [95% Confidence Interval (CI): −1.05;−0.43], among participants combining of decline in episodic memory and in executive performances). Meta-analysis underscored that higher STV represented a gait biomarker in patients with MCI (effect size  =  0.48 [95% CI: 0.30;0.65]) and dementia (effect size  = 1.06 [95% CI: 0.40;1.72]).

Conclusion

Higher STV appears to be a motor phenotype of cognitive decline.

MRI-compatible device for examining brain activation related to stepping

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

Functional MR imaging of a simulated balance task

Human postural control, which relies on information from vestibular, visual, and proprioceptive inputs, degrades with aging, and falls are the leading cause of injury in older adults. In the last decade, functional neuroimaging studies have been performed in order to gain a greater understanding of the supraspinal control of balance and walking. It is known that active balancing involves cortical and subcortical structures in the brain, but neuroimaging of the brain during these tasks has been limited. The study of the effect of aging on the functional neuroimaging of posture and gait has only recently been undertaken. In this study, an MRI-compatible force platform was developed to simulate active balance control. Eleven healthy participants (mean age 75±5 yr) performed an active balance simulation task by using visual feedback to control anterior-posterior center of pressure movements generated by ankle dorsiflexor (DF) and plantarflexor (PF) movements, in a pattern consistent with upright stance control. An additional ankle DF/PF exertion task was performed. During both the active balance simulation and the ankle DF/PF tasks, the bilateral fusiform gyrus and middle temporal gyrus, right inferior, middle, and superior frontal gyrii were activated. No areas were found to be more active during the ankle DF/PF task when compared with the active balance simulation task. When compared to the ankle DF/PF task, the active balance simulation task elicited greater activation in the middle and superior temporal gyrii, insula, and a large cluster that covered the corpus callosum, superior and medial frontal gyrii, as well as the anterior cingulate and caudate nucleus. This study demonstrates the utility in using a force platform to simulate active balance control during MR imaging that elicits activity in cortical regions consistent with studies of active balance and mental imagery of balance.

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

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

Single-trial classification of gait and point movement preparation from human EEG

Neuroimaging studies provide evidence of cortical involvement immediately before and during gait and during gait-related behaviors such as stepping in place or motor imagery of gait. Here we attempt to perform single-trial classification of gait intent from another movement plan (point intent) or from standing in place. Subjects walked naturally from a starting position to a designated ending position, pointed at a designated position from the starting position, or remained standing at the starting position. The 700 ms of recorded electroencephalography (EEG) before movement onset was used for single-trial classification of trials based on action type and direction (left walk, forward walk, right walk, left point, right point, and stand) as well as action type regardless of direction (stand, walk, point). Classification using regularized LDA was performed on a principal components analysis (PCA) reduced feature space composed of coefficients from levels 1 to 9 of a discrete wavelet decomposition using the Daubechies 4 wavelet. We achieved significant classification for all conditions, with errors as low as 17% when averaged across nine subjects. LDA and PCA highly weighted frequency ranges that included movement related potentials (MRPs), with smaller contributions from frequency ranges that included mu and beta idle motor rhythms. Additionally, error patterns suggested a spatial structure to the EEG signal. Future applications of the cortical gait intent signal may include an additional dimension of control for prosthetics, preemptive corrective feedback for gait disturbances, or human computer interfaces (HCI).

Exploring the cortical and subcortical functional magnetic resonance imaging changes associated with freezing in Parkinson's disease

Freezing of gait is a devastating symptom of advanced Parkinson's disease yet the neural correlates of this phenomenon remain poorly understood. In this study, severity of freezing of gait was assessed in 18 patients with Parkinson's disease on a series of timed 'up and go' tasks, in which all patients suffered from episodes of clinical freezing of gait. The same patients also underwent functional magnetic resonance imaging with a virtual reality gait paradigm, performance on which has recently been shown to correlate with actual episodes of freezing of gait. Statistical parametric maps were created that compared the blood oxygen level-dependent response associated with paroxysmal motor arrests (freezing) to periods of normal motor output. The results of a random effects analysis revealed that these events were associated with a decreased blood oxygen level-dependent response in sensorimotor regions and an increased response within frontoparietal cortical regions. These signal changes were inversely correlated with the severity of clinical freezing of gait. Motor arrests were also associated with decreased blood oxygen level-dependent signal bilaterally in the head of caudate nucleus, the thalamus and the globus pallidus internus. Utilizing a mixed event-related/block design, we found that the decreased blood oxygen level-dependent response in the globus pallidus and the subthalamic nucleus persisted even after controlling for the effects of cognitive load, a finding which supports the notion that paroxysmal increases in basal ganglia outflow are associated with the freezing phenomenon. This method also revealed a decrease in the blood oxygen level-dependent response within the mesencephalic locomotor region during motor arrests, the magnitude of which was positively correlated with the severity of clinical freezing of gait. These results provide novel insights into the pathophysiology underlying freezing of gait and lend support to models of freezing of gait that implicate dysfunction across coordinated neural networks.

Non-linear adaptive controllers for an over-actuated pneumatic MR-compatible stepper

Pneumatics is one of the few actuation principles that can be used in an MR environment, since it can produce high forces without affecting imaging quality. However, pneumatic control is challenging, due to the air high compliance and cylinders non-linearities. Furthermore, the system's properties may change for each subject. Here, we present novel control strategies that adapt to the subject's individual anatomy and needs while performing accurate periodic gait-like movements with an MRI compatible pneumatically driven robot. In subject-passive mode, an iterative learning controller (ILC) was implemented to reduce the system's periodic disturbances. To allow the subjects to intend the task by themselves, a zero-force controller minimized the interaction forces between subject and robot. To assist patients who may be too weak, an assist-as-needed controller that adapts the assistance based on online measurement of the subject's performance was designed. The controllers were experimentally tested. The ILC successfully learned to reduce the variability and tracking errors. The zero-force controller allowed subjects to step in a transparent environment. The assist-as-needed controller adapted the assistance based on individual needs, while still challenged the subjects to perform the task. The presented controllers can provide accurate pneumatic control in MR environments to allow assessments of brain activation.

The contribution of postural control and bilateral coordination to the impact of dual tasking on gait

The simultaneous performance of a cognitive task while walking typically alters the gait pattern. In some populations, these alterations have been associated with an increased risk of falls, motivating study of this response from the clinical perspective. The mechanisms responsible for these effects are not fully understood. The concurrent requirement to control upright posture and stepping, a bilaterally coordinated rhythmic task, may be the cause of this so-called dual-tasking effect. To evaluate this possibility, the present study was designed to isolate the individual contribution of these two demands by assessing the effects of cognitive loading on standing (i.e., postural control without bilateral coordination of stepping), cycling (i.e., bilateral coordination similar to stepping, but with minimal postural demands), and walking. We also investigated the effects of aging and parkinsonism on the performance of these three tasks in response to cognitive loading, also referred to as a dual task. Twenty-one healthy young adults, 15 healthy older adults, and 18 patients with Parkinson's disease were assessed while walking, standing, and cycling, with and without an additional cognitive load. In the young adults, the performance on the two motor tasks that involved bilateral coordination deteriorated significantly in response to the dual task, while standing was not impacted. Similar results, although less robust, were observed among the healthy older adults. In contrast, among the patients with Parkinson's disease, the dual-task costs, i.e., the impact of the simultaneously performed cognitive task on the gait pattern, were high in all motor tasks. These findings suggest that walking is especially vulnerable to cognitive loading, in part, because of the unique sensitivity of bilateral coordination of limb movements to the effects of dual tasking.

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

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

Enhanced locomotor adaptation aftereffect in the "broken escalator" phenomenon using anodal tDCS

The everyday experience of stepping onto a stationary escalator causes a stumble, despite our full awareness that the escalator is broken. In the laboratory, this "broken escalator" phenomenon is reproduced when subjects step onto an obviously stationary platform (AFTER trials) that was previously experienced as moving (MOVING trials) and attests to a process of motor adaptation. Given the critical role of M1 in upper limb motor adaptation and the potential for transcranial direct current stimulation (tDCS) to increase cortical excitability, we hypothesized that anodal tDCS over leg M1 and premotor cortices would increase the size and duration of the locomotor aftereffect. Thirty healthy volunteers received either sham or real tDCS (anodal bihemispheric tDCS; 2 mA for 15 min at rest) to induce excitatory effects over the primary motor and premotor cortex before walking onto the moving platform. The real tDCS group, compared with sham, displayed larger trunk sway and increased gait velocity in the first AFTER trial and a persistence of the trunk sway aftereffect into the second AFTER trial. We also used transcranial magnetic stimulation to probe changes in cortical leg excitability using different electrode montages and eyeblink conditioning, before and after tDCS, as well as simulating the current flow of tDCS on the human brain using a computational model of these different tDCS montages. Our data show that anodal tDCS induces excitability changes in lower limb motor cortex with resultant enhancement of locomotor adaptation aftereffects. These findings might encourage the use of tDCS over leg motor and premotor regions to improve locomotor control in patients with neurological gait disorders.

Cognitive function is associated with the development of mobility impairments in community-dwelling elders

OBJECTIVE

To examine the association of cognitive function with the risk of incident mobility impairments and the rate of declining mobility in older adults.

DESIGN

Prospective, observational cohort study.

SETTING

Retirement communities across metropolitan Chicago.

PARTICIPANTS

A total of 1,154 ambulatory elders from two longitudinal studies without baseline clinical dementia or history of stroke or Parkinson disease.

MEASUREMENTS

All participants underwent baseline cognitive testing and annual mobility examinations. Mobility impairments were based on annual timed walking performance. A composite mobility measure, which summarized gait and balance measures, was used to examine the annual rate of mobility change.

RESULTS

During follow-up of 4.5 years, 423 of 836 (50.6%) participants developed impaired mobility. In a proportional hazards model controlled for age, sex, education, and race, each 1-unit higher level of baseline global cognition was associated with a reduction to about half in the risk of mobility impairments (hazard ratio = 0.51, 95% confidence interval: 0.40-0.66) and was similar to a participant being about 13 years younger at baseline. These results did not vary by sex or race and were unchanged in analyses controlling for body mass index, physical activity, vascular diseases, and risk factors. The level of cognition in five different cognitive abilities was also related to incident mobility impairment. Cognition showed similar associations with incident loss of the ability to ambulate. Linear mixed-effects models showed that global cognition at baseline was associated with the rate of declining mobility.

CONCLUSIONS

Among ambulatory elders, cognition is associated with incident mobility impairment and mobility decline.

Hemispheric specialization during mental imagery of brisk walking

OBJECTIVES

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

METHODS

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

RESULTS

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

INTERPRETATIONS

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

Gait-related cerebral alterations in patients with Parkinson's disease with freezing of gait

Freezing of gait is a common, debilitating feature of Parkinson's disease. We have studied gait planning in patients with freezing of gait, using motor imagery of walking in combination with functional magnetic resonance imaging. This approach exploits the large neural overlap that exists between planning and imagining a movement. In addition, it avoids confounds introduced by brain responses to altered motor performance and somatosensory feedback during actual freezing episodes. We included 24 patients with Parkinson's disease: 12 patients with freezing of gait, 12 matched patients without freezing of gait and 21 matched healthy controls. Subjects performed two previously validated tasks--motor imagery of gait and a visual imagery control task. During functional magnetic resonance imaging scanning, we quantified imagery performance by measuring the time required to imagine walking on paths of different widths and lengths. In addition, we used voxel-based morphometry to test whether between-group differences in imagery-related activity were related to structural differences. Imagery times indicated that patients with freezing of gait, patients without freezing of gait and controls engaged in motor imagery of gait, with matched task performance. During motor imagery of gait, patients with freezing of gait showed more activity than patients without freezing of gait in the mesencephalic locomotor region. Patients with freezing of gait also tended to have decreased responses in mesial frontal and posterior parietal regions. Furthermore, patients with freezing of gait had grey matter atrophy in a small portion of the mesencephalic locomotor region. The gait-related hyperactivity of the mesencephalic locomotor region correlated with clinical parameters (freezing of gait severity and disease duration), but not with the degree of atrophy. These results indicate that patients with Parkinson's disease with freezing of gait have structural and functional alterations in the mesencephalic locomotor region. We suggest that freezing of gait might emerge when altered cortical control of gait is combined with a limited ability of the mesencephalic locomotor region to react to that alteration. These limitations might become particularly evident during challenging events that require precise regulation of step length and gait timing, such as turning or initiating walking, which are known triggers for freezing of gait.

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.

Cortical control of gait in healthy humans: an fMRI study

This study examined the cortical control of gait in healthy humans using functional magnetic resonance imaging (fMRI). Two block-designed fMRI sessions were conducted during motor imagery of a locomotor-related task. Subjects watched a video clip that showed an actor standing and walking in an egocentric perspective. In a control session, additional fMRI images were collected when participants observed a video clip of the clutch movement of a right hand. In keeping with previous studies using SPECT and NIRS, we detected activation in many motor-related areas including supplementary motor area, bilateral precentral gyrus, left dorsal premotor cortex, and cingulate motor area. Smaller additional activations were observed in the bilateral precuneus, left thalamus, and part of right putamen. Based on these findings, we propose a novel paradigm to study the cortical control of gait in healthy humans using fMRI. Specifically, the task used in this study--involving both mirror neurons and mental imagery--provides a new feasible model to be used in functional neuroimaging studies in this area of research.

Assessing the interplay between cognition and gait in the clinical setting

In this review, we outline how the influence of cognitive processes on gait or balance can be appreciated in a clinical setting. Careful history taking of the patient or direct carer provides information about multiple task problems in daily life and the presence of cognitive impairment, depression or fear of falling. Physical examination may reveal abnormalities such as an inappropriately high walking speed or an inability to handle secondary tasks while walking. Assessment of frontal executive function helps to understand the nature of these multiple task problems and to detect "risky" behaviour caused by frontal disinhibition. Examples of clinically useable techniques include pressure-sensitive insoles or an electronic walkway (to record strides) or accelerometers (to measure body motion while walking). Combining these assessments may lead to a better appreciation of the fascinating but complex interplay between cognition and gait.