Functional corticomuscular connection during reaching is weakened following stroke

Context-dependent reduction in corticomuscular coupling for balance control in chronic stroke survivors

Balance control is an important indicator of mobility and independence in activities of daily living. How the functional coupling between the cortex and the muscle for balance control is affected following stroke remains to be known. We investigated the changes in coupling between the cortex and leg muscles during a challenging balance task over multiple frequency bands in chronic stroke survivors. Fourteen participants with stroke and ten healthy controls performed a challenging balance task. They stood on a computerized support surface that was either fixed (low difficulty condition) or sway-referenced with varying gain (medium and high difficulty conditions). We computed corticomuscular coherence between electrodes placed over the sensorimotor area (electroencephalography) and leg muscles (electromyography) and assessed balance performance using clinical and laboratory-based tests. We found significantly lower delta frequency band coherence in stroke participants when compared with healthy controls under medium difficulty condition, but not during low and high difficulty conditions. These differences were found for most of the distal but not for proximal leg muscle groups. No differences were found at other frequency bands. Participants with stroke showed poor balance clinical scores when compared with healthy controls, but no differences were found for laboratory-based tests. The observation of effects at distal but not at proximal muscle groups suggests differences in the (re)organization of the descending connections across two muscle groups for balance control. We argue that the observed group difference in delta band coherence indicates balance context-dependent alteration in mechanisms for the detection of somatosensory modulation resulting from sway-referencing of the support surface for balance maintenance following stroke.

Improvements in motor control are associated with improved quality of life following an at-home muscle biofeedback program for chronic stroke

Introduction

Chronic stroke survivors with severe arm impairment have limited options for effective rehabilitation. High intensity, repetitive task practice (RTP) is known to improve upper limb function among stroke survivors who have some volitional muscle activation. However, clients without volitional movement of their arm are ineligible for RTP-based interventions and require hands-on facilitation from a clinician or robotic therapy to simulate task practice. Such approaches can be expensive, burdensome, and have marginal effects. Alternatively, supervised at-home telerehabilitation using muscle biofeedback may provide a more accessible, affordable, and effective rehabilitation option for stroke survivors with severe arm impairment, and could potentially help people with severe stroke regain enough volitional activation to be eligible for RTP-types of therapies. Feedback of muscle activity via electromyography (EMG) has been previously used with clients who have minimal or no movement to improve functional performance. Specifically, training to reduce unintended co-contractions of the impaired hand using EMG biofeedback may modestly improve motor control in people with limited movement. Importantly, these modest and covert functional changes may influence the perceived impact of stroke-related disability in daily life. In this manuscript, we examine whether physical changes following use of a portable EMG biofeedback system (Tele-REINVENT) for severe upper limb hemiparesis also relate to perceived quality of life improvements. Secondarily, we examined the effects of Tele-REINVENT, which uses EMG to quantify antagonistic muscle activity during movement attempt trials and transform individuated action into computer game control, on several different domains of stroke recovery.

Methods

For this pilot study, nine stroke survivors (age = 37-73 years) with chronic impairment (Fugl-Meyer = 14-40/66) completed 30 1-hour sessions of home-based training, consisting of six weeks of gaming that reinforced wrist extensor muscle activity while attenuating coactivation of flexor muscles. To assess motor control and performance, we measured changes in active wrist ranges of motion, the Fugl-Meyer Assessment, and Action Research Arm Test. We also collected an EMG-based test of muscle control to examine more subtle changes. To examine changes in perceived quality of life, we utilized the Stroke Impact Scale along with participant feedback.

Results

Results from our pilot data suggest that 30 sessions of remote training can induce modest changes on clinical and functional assessments, showing a statistically significant improvement of active wrist ranges of motion at the group level, changes that could allow some people with severe stroke to be eligible for other therapeutic approaches, such as RTP. Additionally, changes in motor control were correlated with the perceived impact of stroke on participation and impairment after training. We also report changes in corticomuscular coherence, which showed a laterality change from the ipsilesional motor cortex towards the contralesional hemisphere during wrist extension attempts. Finally, all participants showed high adherence to the protocol and reported enjoying using the system.

Conclusion

Overall, Tele-REINVENT represents a promising telerehabilitation intervention that might improve sensorimotor outcomes in severe chronic stroke, and that improving sensorimotor abilities even modestly may improve quality of life. We propose that Tele-REINVENT may be used as a precursor to help participants gain enough active movement to participate other occupational therapy interventions, such as RTP. Future work is needed to examine if home-based telerehabilitation to provide feedback of individuated muscle activity could increase meaningful rehabilitation accessibility and outcomes for underserved populations.

Influencing factors of corticomuscular coherence in stroke patients

Stroke, also known as cerebrovascular accident, is an acute cerebrovascular disease with a high incidence, disability rate, and mortality. It can disrupt the interaction between the cerebral cortex and external muscles. Corticomuscular coherence (CMC) is a common and useful method for studying how the cerebral cortex controls muscle activity. CMC can expose functional connections between the cortex and muscle, reflecting the information flow in the motor system. Afferent feedback related to CMC can reveal these functional connections. This paper aims to investigate the factors influencing CMC in stroke patients and provide a comprehensive summary and analysis of the current research in this area. This paper begins by discussing the impact of stroke and the significance of CMC in stroke patients. It then proceeds to elaborate on the mechanism of CMC and its defining formula. Next, the impacts of various factors on CMC in stroke patients were discussed individually. Lastly, this paper addresses current challenges and future prospects for CMC.

cTBS over primary motor cortex increased contralateral corticomuscular coupling and interhemispheric functional connection

Objective.Transcranial magnetic stimulation is a non-invasive brain stimulation technique that changes the activity of the cerebral cortex. Contralesional continuous theta burst stimulation (cTBS) has been proposed and verified beneficial to stroke motor recovery. However, the underlying mechanism is still unclear.Approach.20 healthy right-handed subjects were recruited in this study, receiving real-cTBS over their left primary motor cortex or sham-cTBS. We designed the finger tapping task (FTT) before and after stimulation and recorded the accuracy and reaction time (RT) of the task. The electroencephalogram and surface electromyogram signals were recorded during the left finger pinching task (FPT) before and after stimulation. We calculated cortico-muscular coherence (CMC) in the contralateral hemisphere and cortico-cortical coherence (CCC) in the bilateral hemisphere. The two-way repeated measures analysis of variance was used to analyze the effect of cTBS.Main results.In the FTT, there was a significant main effect of 'time' on RT (F(1, 38) = 24.739,p< 0.001). In the FPT, the results showed that there was a significant interaction effect on the CMC peak and area in the beta band (peak:F(1, 38) = 8.562,p= 0.006; area:F(1, 38) = 5.273,p= 0.027), on the CCC peak in the alpha band (F(1, 38) = 4.815,p= 0.034) and area in the beta band (F(1, 38) = 4.822,p= 0.034). The post hoc tests showed that the CMC peak (W= 20,p= 0.002), the CMC area (W= 13,p= 0.003) and the CCC peak (t= -2.696,p= 0.014) increased significantly after real-cTBS. However, there was no significant decrease or increase after sham-cTBS.Significance.Our study found that cTBS can improve CMC of contralateral hemisphere and CCC of bilateral hemisphere, indicating that cTBS can strengthen cortico-muscular and cortico-cortical coupling.

Multisensory Conflict Impairs Cortico-Muscular Network Connectivity and Postural Stability: Insights from Partial Directed Coherence Analysis

Sensory conflict impacts postural control, yet its effect on cortico-muscular interaction remains underexplored. We aimed to investigate sensory conflict's influence on the cortico-muscular network and postural stability. We used a rotating platform and virtual reality to present subjects with congruent and incongruent sensory input, recorded EEG (electroencephalogram) and EMG (electromyogram) data, and constructed a directed connectivity network. The results suggest that, compared to sensory congruence, during sensory conflict: (1) connectivity among the sensorimotor, visual, and posterior parietal cortex generally decreases, (2) cortical control over the muscles is weakened, (3) feedback from muscles to the cortex is strengthened, and (4) the range of body sway increases and its complexity decreases. These results underline the intricate effects of sensory conflict on cortico-muscular networks. During the sensory conflict, the brain adaptively decreases the integration of conflicting information. Without this integrated information, cortical control over muscles may be lessened, whereas the muscle feedback may be enhanced in compensation.

Effects of sling exercises on pain, function, and corticomuscular functional connectivity in individuals with chronic low back pain- preliminary study

BACKGROUND

Individuals with chronic low back pain (CLBP) exhibit altered brain function and trunk muscle activation.

AIM

This study examined the effects of sling exercises on pain, function, and corticomuscular coherence (CMC) in healthy adults and individuals with CLBP.

METHODS

Eight individuals with CLBP and 15 healthy adults received sling exercise training for 6 weeks. Before and after training, participants performed two motor tasks: rapid arm lifts and repeated trunk flexion-extension tasks, and electromyography of the trunk muscles and electroencephalography of the sensorimotor cortex were recorded. Chi-squared test and Mann-Whitney U tests were used for between group comparison, and Wilcoxon signed-rank tests were used for pre- and post-training comparison. Spearman's Rank Correlation Coefficient (Rs) was used to identify for the relationship between motor performance and Corticomuscular coherence.

RESULTS

Sling exercises significantly improved pain (median from 3 to 1, p = .01) and Oswestry Disability Index scores (median from 2.5 to 2, p = .03) in the CLBP group. During rapid arm lifts, individuals with CLBP showed lower beta CMC of the transverse abdominis and internal oblique (Tra/IO) (0.8 vs. 0.49, p = .01) and lumbar erector spinae (0.70 vs. 0.38, p = .04) than the control group at baseline. During trunk flexion-extension, the CLBP group showed higher gamma CMC of the left Tra/IO than the control group at baseline (0.28 vs. 0.16 , p = .001). After training, all CMC became statistically non-significant between groups. The training induced improvement in anticipatory activation of the Tra/IO was positively correlated with the beta CMC (rs = 0.7851, p = .02).

CONCLUSION

A 6-week sling exercises diminished pain and disability in patients with CLBP and improved the anticipatory activation and CMC in some trunk muscles. These improvements were associated with training induced changes in corticomuscular connectivity in individuals with CLBP.

Task-dependent alteration of beta-band intermuscular coherence is associated with ipsilateral corticospinal tract excitability

Beta-band (15-30 Hz) synchronization between the EMG signals of active limb muscles can serve as a non-invasive assay of corticospinal tract integrity. Tasks engaging a single limb often primarily utilize one corticospinal pathway, although bilateral neural circuits can participate in goal-directed actions involving multi-muscle coordination and utilization of feedback. Suboptimal utilization of such circuits after CNS injury can result in unintended mirror movements and activation of pathological synergies. Accordingly, it is important to understand how the actions of one limb (e.g., a less-affected limb after strokes) influence the opposite corticospinal pathway for the rehabilitation target. Certain unimanual actions decrease the excitability of the "unengaged" corticospinal tract, presumably to prevent mirror movement, but there is no direct way to predict the extent to which this will occur. In this study, we tested the hypothesis that task-dependent changes in beta-band drives to muscles of one hand will inversely correlate with changes in the opposite corticospinal tract excitability. Ten participants completed spring pinching tasks known to induce differential 15-30 Hz drive to muscles. During compressions, transcranial magnetic stimulation single pulses to the ipsilateral M1 were delivered to generate motor-evoked potentials in the unengaged hand. The task-induced changes in ipsilateral corticospinal excitability were inversely correlated with associated changes in EMG-EMG coherence of the task hand. These results demonstrate a novel connection between intermuscular coherence and the excitability of the "unengaged" corticospinal tract and provide a springboard for further mechanistic studies of unimanual tasks of varying difficulty and their effects on neural pathways relevant to rehabilitation.

Task-dependent Alteration in Delta Band Corticomuscular Coherence during Standing in Chronic Stroke Survivors

Balance control is an important indicator of mobility and independence in activities of daily living. How the changes in functional integrity of corticospinal tract due to stroke affects the maintenance of upright stance remains to be known. We investigated the changes in functional coupling between the cortex and lower limb muscles during a challenging balance task over multiple frequency bands in chronic stroke survivors. Eleven stroke patients and nine healthy controls performed a challenging balance task. They stood on a computerized platform with/without somatosensory input distortion created by sway-referencing the support surface, thereby varying the difficulty levels of the task. We computed corticomuscular coherence between Cz (electroencephalography) and leg muscles and assessed balance performance using Berg Balance scale (BBS), Timed-up and go (TUG) and center of pressure (COP) measures. We found lower delta frequency band coherence in stroke patients when compared with healthy controls under medium difficulty condition for distal but not proximal leg muscles. For both groups, we found similar coherence at other frequency bands. On BBS and TUG, stroke patients showed poor balance. However, similar group differences were not consistently observed across COP measures. The presence of distal versus proximal effect suggests differences in the (re)organization of the corticospinal connections across the two muscles groups for balance control. We argue that the observed group difference in the delta coherence might be due to altered mechanisms for the detection of somatosensory modulation resulting from sway-referencing of the support platform for balance control.

Corticomuscular and intermuscular coherence are correlated after stroke: a simplified motor control?

During movement, corticomuscular coherence is a measure of central-peripheral communication, while intermuscular coherence is a measure of the amount of common central drive to the muscles. Although these two measures are modified in stroke subjects, no author has explored a correlation between them, neither in stroke subjects nor in healthy subjects. Twenty-four chronic stroke subjects and 22 healthy control subjects were included in this cohort study, and they performed 20 active elbow extension movements. The electroencephalographic and electromyographic activity of the elbow flexors and extensors were recorded. Corticomuscular and intermuscular coherence were calculated in the time-frequency domain for each limb of stroke and control subjects. Partial rank correlations were performed to study the link between these two variables. Our results showed a positive correlation between corticomuscular and intermuscular coherence only for stroke subjects, for their paretic and non-paretic limbs (P < 0.022; Rho > 0.50). These results suggest, beyond the cortical and spinal hypotheses to explain them, that stroke subjects present a form of simplification of motor control. When central-peripheral communication increases, it is less modulated and more common to the muscles involved in the active movement. This motor control simplification suggests a new way of understanding the plasticity of the neuromuscular system after stroke.

A framework for quantifying the effects of transcranial magnetic stimulation on motor recovery from hemiparesis: Corticomuscular Network

OBJECTIVE

Transcranial magnetic stimulation (TMS) is an experimental therapy for promoting motor recovery from hemiparesis. At present, hemiparesis patients' responses to TMS are variable. To maximize its therapeutic potential, we need an approach that relates the electrophysiology of motor recovery and TMS. To this end, we propose Corticomuscular Network (CMN) representing the holistic motor system, including the cortico-cortical pathway, corticospinal tract, and muscle co-activation.

METHODS

CMN is made up of coherence between pairs of electrode signals and spatial locations of the electrodes. We associated coherence and graph features of CMN with Fugl-Meyer Assessment (FMA) for the upper extremity. Besides, we compared CMN between 8 patients with hemiparesis and 6 healthy controls and contrasted CMN of patients before and after a 1Hz TMS.

MAIN RESULTS

Corticomuscular coherence (CMC) correlated positively with FMA. The regression model between FMA and CMC between 5 pairs of channels had 0.99 adjusted R^2 and a p-value less than 0.01. Compared to healthy controls, CMN of patients tended to be a small-world network and was more interconnected with higher CMC. CMC between cortex and triceps brachii long head was higher in patients. 15-minute 1Hz TMS protocol induced coherence changes beyond the stimulation side and had a limited impact on CMN parameters that are related to motor recovery.

SIGNIFICANCE

CMN is a potential clinical approach to quantify rehabilitating progress. It also sheds light on the desirable electrophysiological effects of TMS based on which rehabilitating strategies can be optimized.

Measuring Spinal Cord Potentials and Cortico-Spinal Interactions After Wrist Movements Induced by Neuromuscular Electrical Stimulation

Electroencephalographic (EEG) correlates of movement have been studied extensively over many years. In the present work, we focus on investigating neural correlates that originate from the spine and study their connectivity to corresponding signals from the sensorimotor cortex using multivariate autoregressive (MVAR) models. To study cortico-spinal interactions, we simultaneously measured spinal cord potentials (SCPs) and somatosensory evoked potentials (SEPs) of wrist movements elicited by neuromuscular electrical stimulation. We identified directional connections between spine and cortex during both the extension and flexion of the wrist using only non-invasive recording techniques. Our connectivity estimation results are in alignment with various studies investigating correlates of movement, i.e., we found the contralateral side of the sensorimotor cortex to be the main sink of information as well as the spine to be the main source of it. Both types of movement could also be clearly identified in the time-domain signals.

The Control of Movements via Motor Gamma Oscillations

The ability to perform movements is vital for our daily life. Our actions are embedded in a complex environment where we need to deal efficiently in the face of unforeseen events. Neural oscillations play an important role in basic sensorimotor processes related to the execution and preparation of movements. In this review, I will describe the state of the art regarding the role of motor gamma oscillations in the control of movements. Experimental evidence from electrophysiological studies has shown that motor gamma oscillations accomplish a range of functions in motor control beyond merely signaling the execution of movements. However, these additional aspects associated with motor gamma oscillation remain to be fully clarified. Future work on different spatial, temporal and spectral scales is required to further understand the implications of gamma oscillations in motor control.

Individualized beta-band oscillatory transcranial direct current stimulation over the primary motor cortex enhances corticomuscular coherence and corticospinal excitability in healthy individuals

BACKGROUND

Simultaneously modulating individual neural oscillation and cortical excitability may be important for enhancing communication between the primary motor cortex and spinal motor neurons, which plays a key role in motor control. However, it is unknown whether individualized beta-band oscillatory transcranial direct current stimulation (otDCS) enhances corticospinal oscillation and excitability.

OBJECTIVE

This study investigated the effects of individualized beta-band otDCS on corticomuscular coherence (CMC) and corticospinal excitability in healthy individuals.

METHODS

In total, 29 healthy volunteers participated in separate experiments. They received the following stimuli for 10 min on different days: 1) 2-mA otDCS with individualized beta-band frequencies, 2) 2-mA transcranial alternating current stimulation (tACS) with individualized beta-band frequencies, and 3) 2-mA transcranial direct current stimulation (tDCS). The changes in CMC between the vertex and tibialis anterior (TA) muscle and TA muscle motor-evoked potentials (MEPs) were assessed before and after (immediately, 10 min, and 20 min after) stimulation on different days. Additionally, 20-Hz otDCS for 10 min was applied to investigate the effects of a fixed beta-band frequency on CMC.

RESULTS

otDCS significantly increased CMC and MEPs immediately after stimulation, whereas tACS and tDCS had no effects. There was a significant negative correlation between normalized CMC changes in response to 20-Hz otDCS and the numerical difference between the 20-Hz and individualized CMC peak frequency before the stimulation.

CONCLUSIONS

These findings suggest that simultaneous modulation of neural oscillation and cortical excitability is critical for enhancing corticospinal communication. Individualized otDCS holds potential as a useful method in the field of neurorehabilitation.

Enhanced Descending Corticomuscular Coupling During Hand Grip With Static Force Compared With Enhancing Force

The interaction between cortex and muscles under hand motor with different force states has not been quantitatively investigated yet, which to some extent places the optimized movement tasks design for brain-computer interface (BCI) applications in hand motor rehabilitation under uncertainty. Converging evidence has suggested that both the descending corticospinal pathway and ascending sensory feedback pathway are involved in the generation of corticomuscular coupling. The present study aimed to explore the corticomuscular coupling during hand motor task with enhancing force and steady-state force. Twenty healthy subjects performed precision grip with enhancing and static force using the right hand with visual feedback of exerted force. Mutual information and Granger causal connectivity were assessed between electroencephalography (EEG) over primary motor cortex and electromyography (EMG) recordings, and statistically analyzed. The results showed that the mutual information value was significantly larger for static force in the beta and alpha frequency band than enhancing force state. Furthermore, compared with enhancing force, the Granger causal connectivity of descending pathways from cortex to muscle was significantly larger for static force in the beta and high alpha frequency band (10-20 Hz), indicating the connection between the primary motor cortex and muscle was strengthened for static force. In summary, the hand grip with static force resulted in an increasing corticomuscular coupling from EEG over the primary motor cortex to EMG compared with enhancing force, implying more attention was required in the static force state. These results have important implications toward motor rehabilitation therapy design for the recovery of impaired hand motor functions.

Disrupted cortico-peripheral interactions in motor disorders

Motor disorders may arise from neurological damage or diseases at different levels of the hierarchical motor control system and side-loops. Altered cortico-peripheral interactions might be essential characteristics indicating motor dysfunctions. By integrating cortical and peripheral responses, top-down and bottom-up cortico-peripheral coupling measures could provide new insights into the motor control and recovery process. This review first discusses the neural bases of cortico-peripheral interactions, and corticomuscular coupling and corticokinematic coupling measures are addressed. Subsequently, methodological efforts are summarized to enhance the modeling reliability of neural coupling measures, both linear and nonlinear approaches are introduced. The latest progress, limitations, and future directions are discussed. Finally, we emphasize clinical applications of cortico-peripheral interactions in different motor disorders, including stroke, neurodegenerative diseases, tremor, and other motor-related disorders. The modified interaction patterns and potential changes following rehabilitation interventions are illustrated. Altered coupling strength, modified coupling directionality, and reorganized cortico-peripheral activation patterns are pivotal attributes after motor dysfunction. More robust coupling estimation methodologies and combination with other neurophysiological modalities might more efficiently shed light on motor control and recovery mechanisms. Future studies with large sample sizes might be necessary to determine the reliabilities of cortico-peripheral interaction measures in clinical practice.

Electrical stimulation of the common peroneal nerve and its effects on the relationship between corticomuscular coherence and motor control in healthy adults

Background

Sensory input via neuromuscular electrical stimulation (NMES) may contribute to synchronization between motor cortex and spinal motor neurons and motor performance improvement in healthy adults and stroke patients. However, the optimal NMES parameters used to enhance physiological activity and motor performance remain unclear. In this study, we focused on sensory feedback induced by a beta-band frequency NMES (β-NMES) based on corticomuscular coherence (CMC) and investigated the effects of β-NMES on CMC and steady-state of isometric ankle dorsiflexion in healthy volunteers. Twenty-four participants received β-NMES at the peak beta-band CMC or fixed NMES (f-NMES) at 100 Hz on different days. NMES was applied to the right part of the common peroneal nerve for 20 min. The stimulation intensity was 95% of the motor threshold with a pulse width of 1 ms. The beta-band CMC and the coefficient of variation of force (Force CV) were assessed during isometric ankle dorsiflexion for 2 min. In the complementary experiment, we applied β-NMES to 14 participants and assessed beta-band CMC and motor evoked potentials (MEPs) with transcranial magnetic stimulation.

Results

No significant changes in the means of beta-band CMC, Force CV, and MEPs were observed before and after NMES conditions. Changes in beta-band CMC were correlated to (a) changes in Force CV immediately, at 10 min, and at 20 min after β-NMES (all cases, p < 0.05) and (b) changes in MEPs immediately after β-NMES (p = 0.01). No correlations were found after f-NMES.

Conclusions

Our results suggest that the sensory input via NMES was inadequate to change the beta-band CMC, corticospinal excitability, and voluntary motor output. Whereas, the β-NMES affects the relationship between changes in beta-band CMC, Force CV, and MEPs. These findings may provide the information to develop NMES parameters for neurorehabilitation in patients with motor dysfunction.

Delta Sleep-Inducing Peptide Recovers Motor Function in SD Rats after Focal Stroke

Background and Objectives: Mutual effect of the preliminary and therapeutic intranasal treatment of SD rats with DSIP (8 days) on the outcome of focal stroke, induced with intraluminal middle cerebral occlusion (MCAO), was investigated. Materials and Methods: The groups were the following: MCAO + vehicle, MCAO + DSIP, and SHAM-operated. DSIP or vehicle was applied nasally 60 (±15) minutes prior to the occlusion and for 7 days after reperfusion at dose 120 µg/kg. The battery of behavioral tests was performed on 1, 3, 7, 14, and 21 days after MCAO. Motor coordination and balance and bilateral asymmetry were tested. At the end of the study, animals were euthanized, and their brains were perfused, serial cryoslices were made, and infarction volume in them was calculated. Results: Although brain infarction in DSIP-treated animals was smaller than in vehicle-treated animals, the difference was not significant. However, motor performance in the rotarod test significantly recovered in DSIP-treated animals. Conclusions: Intranasal administration of DSIP in the course of 8 days leads to accelerated recovery of motor functions.

Stroke-induced alteration in multi-layer information transmission of cortico-motor system during elbow isometric contraction modulated by myoelectric-controlled interfaces

Objective. Human movement is a complex process requiring information transmission in inter-cortical, cortico-muscular and inter-muscular networks. Though motor deficits after stroke are associated with impaired networks in the cortico-motor system, the mechanisms underlying these networks are to date not fully understood. The purpose of this study is to investigate the changes in information transmission of the inter-cortical, cortico-muscular and inter-muscular networks after stroke and the effect of myoelectric-controlled interface (MCI) dimensionality on such information transmission in each network.Approach. Fifteen healthy control subjects and 11 post-stroke patients were recruited to perform elbow tracking tasks within different dimensional MCIs in this study. Their electromyography (EMG) and functional near-infrared spectroscopy (fNIRS) signals were recorded simultaneously. Transfer entropy was used to analyse the functional connection that represented the information transmission in each network based on the fNIRS and EMG signals.Main results.The results found that post-stroke patients showed the increased inter-cortical connection versus healthy control subjects, which might be attributed to cortical reorganisation to compensate for motor deficits. Compared to healthy control subjects, a lower strength cortico-muscular connection was found in post-stroke patients due to the reduction of information transmission following a stroke. Moreover, the increased MCI dimensionality strengthened inter-cortical, cortico-muscular and inter-muscular connections because of higher visual information processing demands.Significance. These findings not only provide a comprehensive overview to evaluate changes in the cortico-motor system due to stroke, but also suggest that increased MCI dimensionality may serve as a useful rehabilitation tool for boosting information transmission in the cortico-motor system of post-stroke patients.

Assessing the Usage of Indirect Motor Pathways Following a Hemiparetic Stroke

A hallmark impairment in a hemiparetic stroke is a loss of independent joint control resulting in abnormal co-activation of shoulder abductor and elbow flexor muscles in their paretic arm, clinically known as the flexion synergy. The flexion synergy appears while generating shoulder abduction (SABD) torques as lifting the paretic arm. This likely be caused by an increased reliance on contralesional indirect motor pathways following damage to direct corticospinal projections. The assessment of functional connectivity between brain and muscle signals, i.e., brain-muscle connectivity (BMC), may provide insight into such changes to the usage of motor pathways. Our previous model simulation shows that multi-synaptic connections along the indirect motor pathway can generate nonlinear connectivity. We hypothesize that increased usage of indirect motor pathways (as increasing SABD load) will lead to an increase of nonlinear BMC. To test this hypothesis, we measured brain activity, muscle activity from shoulder abductors when stroke participants generate 20% and 40% of maximum SABD torque with their paretic arm. We computed both linear and nonlinear BMC between EEG and EMG. We found dominant nonlinear BMC at contralesional/ipsilateral hemisphere for stroke, whose magnitude increased with the SABD load. These results supported our hypothesis and indicated that nonlinear BMC could provide a quantitative indicator for determining the usage of indirect motor pathways following a hemiparetic stroke.

Effect of Immersive Virtual Reality-Based Bilateral Arm Training in Patients with Chronic Stroke

Virtual reality (VR)-based therapies are widely used in stroke rehabilitation. Although various studies have used VR techniques for bilateral upper limb training, most have been only semi-immersive and have only been performed in an artificial environment. This study developed VR content and protocols based on activities of daily living to provide immersive VR-based bilateral arm training (VRBAT) for upper limb rehabilitation in stroke patients. Twelve patients with chronic stroke were randomized to a VRBAT group or a normal bilateral arm training (NBAT) group and attended 30-min training sessions five times a week for four weeks. At the end of the training, there was a significant difference in upper limb function in both groups (p < 0.05) and in the upper limb function sensory test for proprioception in the NBAT group (p < 0.05). There was no significant between-group difference in upper limb muscle activity after training. The relative alpha and beta power values for electroencephalographic measurements were significantly improved in both groups. These findings indicate that both VRBAT and NBAT are effective interventions for improving upper limb function and electroencephalographic activity in patients with chronic stroke.

Temporal Dynamics of Corticomuscular Coherence Reflects Alteration of the Central Mechanisms of Neural Motor Control in Post-Stroke Patients

The neural control of muscular activity during a voluntary movement implies a continuous updating of a mix of afferent and efferent information. Corticomuscular coherence (CMC) is a powerful tool to explore the interactions between the motor cortex and the muscles involved in movement realization. The comparison of the temporal dynamics of CMC between healthy subjects and post-stroke patients could provide new insights into the question of how agonist and antagonist muscles are controlled related to motor performance during active voluntary movements. We recorded scalp electroencephalography activity, electromyography signals from agonist and antagonist muscles, and upper limb kinematics in eight healthy subjects and seventeen chronic post-stroke patients during twenty repeated voluntary elbow extensions and explored whether the modulation of the temporal dynamics of CMC could contribute to motor function impairment. Concomitantly with the alteration of elbow extension kinematics in post-stroke patients, dynamic CMC analysis showed a continuous CMC in both agonist and antagonist muscles during movement and highlighted that instantaneous CMC in antagonist muscles was higher for post-stroke patients compared to controls during the acceleration phase of elbow extension movement. In relation to motor control theories, our findings suggest that CMC could be involved in the online control of voluntary movement through the continuous integration of sensorimotor information. Moreover, specific alterations of CMC in antagonist muscles could reflect central command alterations of the selectivity in post-stroke patients.

Identifying bidirectional total and non-linear information flow in functional corticomuscular coupling during a dorsiflexion task: a pilot study

Background

The key challenge to constructing functional corticomuscular coupling (FCMC) is to accurately identify the direction and strength of the information flow between scalp electroencephalography (EEG) and surface electromyography (SEMG). Traditional TE and TDMI methods have difficulty in identifying the information interaction for short time series as they tend to rely on long and stable data, so we propose a time-delayed maximal information coefficient (TDMIC) method. With this method, we aim to investigate the directional specificity of bidirectional total and nonlinear information flow on FCMC, and to explore the neural mechanisms underlying motor dysfunction in stroke patients.

Methods

We introduced a time-delayed parameter in the maximal information coefficient to capture the direction of information interaction between two time series. We employed the linear and non-linear system model based on short data to verify the validity of our algorithm. We then used the TDMIC method to study the characteristics of total and nonlinear information flow in FCMC during a dorsiflexion task for healthy controls and stroke patients.

Results

The simulation results showed that the TDMIC method can better detect the direction of information interaction compared with TE and TDMI methods. For healthy controls, the beta band (14–30 Hz) had higher information flow in FCMC than the gamma band (31–45 Hz). Furthermore, the beta-band total and nonlinear information flow in the descending direction (EEG to EMG) was significantly higher than that in the ascending direction (EMG to EEG), whereas in the gamma band the ascending direction had significantly higher information flow than the descending direction. Additionally, we found that the strong bidirectional information flow mainly acted on Cz, C3, CP3, P3 and CPz. Compared to controls, both the beta-and gamma-band bidirectional total and nonlinear information flows of the stroke group were significantly weaker. There is no significant difference in the direction of beta- and gamma-band information flow in stroke group.

Conclusions

The proposed method could effectively identify the information interaction between short time series. According to our experiment, the beta band mainly passes downward motor control information while the gamma band features upward sensory feedback information delivery. Our observation demonstrate that the center and contralateral sensorimotor cortex play a major role in lower limb motor control. The study further demonstrates that brain damage caused by stroke disrupts the bidirectional information interaction between cortex and effector muscles in the sensorimotor system, leading to motor dysfunction.

Antagonistic muscle prefatigue weakens the functional corticomuscular coupling during isometric elbow extension contraction

OBJECTIVE

During muscle fatigue, acute changes in the interaction between the sensorimotor cortex and peripheral neurons have been widely studied. However, it is still unclear about the effect of antagonist muscle prefatigue on corticomuscular coupling and central modulation. The purpose of this study was to investigate the changes in the magnitude of electroencephalogram-electromyography (EEG-EMG) coherence and phase synchronization index (PSI) induced by antagonistic muscle prefatigue.

METHODS

Twelve young male volunteers conducted a 30-s long, nonfatiguing isometric elbow extension with a target force level of 20% maximum voluntary contraction (MVC) before and after a fatiguing sustained elbow flexion contraction at 20% MVC until task failure. Coherence and PSI between the EEG recorded over the sensorimotor cortex and the surface EMG of the triceps brachii (TB) muscle were quantified for the pre- and post-fatigue elbow extension contractions.

RESULTS

Coherence and PSI in the gamma frequency band (35-60 Hz) were found significantly decreased in the postfatigue elbow extension contraction than the prefatigue contraction. The power of the EEG in the beta and gamma band were significantly increased, while the EMG power showed no significant changes when the antagonistic muscle was prefatigued. PSI in the gamma frequency band between the EMG of the TB muscle and the EEG were found significantly decreased during postfatigue elbow extension contraction compared with prefatigue contraction.

CONCLUSION

Antagonistic muscle prefatigue led to significantly lower gamma band corticomuscular coherence and phase coupling during an isometric elbow extension position task. The lower corticomuscular coupling may indicate a central modulation mechanism of antagonist muscle prefatigue that related to decreased descending common drive or joint instability compensation modulation mechanism.

CMC is more than a measure of corticospinal tract integrity in acute stroke patients

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CMC is weaker and occurs at lower frequencies in acute stroke patients.

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Both afferent and efferent input signals contribute to CMC.

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CMC should not be used as a direct measure of corticospinal tract integrity.

In healthy subjects, motor cortex activity and electromyographic (EMG) signals from contracting contralateral muscle show coherence in the beta (15–30 Hz) range. Corticomuscular coherence (CMC) is considered a sign of functional coupling between muscle and brain. Based on prior studies, CMC is altered in stroke, but functional significance of this finding has remained unclear. Here, we examined CMC in acute stroke patients and correlated the results with clinical outcome measures and corticospinal tract (CST) integrity estimated with diffusion tensor imaging (DTI). During isometric contraction of the extensor carpi radialis muscle, EMG and magnetoencephalographic oscillatory signals were recorded from 29 patients with paresis of the upper extremity due to ischemic stroke and 22 control subjects. CMC amplitudes and peak frequencies at 13–30 Hz were compared between the two groups. In the patients, the peak frequency in both the affected and the unaffected hemisphere was significantly (p < 0.01) lower and the strength of CMC was significantly (p < 0.05) weaker in the affected hemisphere compared to the control subjects. The strength of CMC in the patients correlated with the level of tactile sensitivity and clinical test results of hand function. In contrast, no correlation between measures of CST integrity and CMC was found. The results confirm the earlier findings that CMC is altered in acute stroke and demonstrate that CMC is bidirectional and not solely a measure of integrity of the efferent corticospinal tract.

Time-Frequency Maximal Information Coefficient Method and its Application to Functional Corticomuscular Coupling

An important challenge in the study of functional corticomuscular coupling (FCMC) is an accurate capture of the coupling relationship between the cerebral cortex and the effector muscle. The coherence method is a linear analysis method, which has certain limitations in further revealing the nonlinear coupling between neural signals. Although mutual information (MI) and transfer entropy (TE) based on information theory can capture both linear and nonlinear correlations, the equitability of these algorithms is ignored and the nonlinear components of the correlation cannot be separated. The maximal information coefficient (MIC) is a suitable method to measure the coupling between neurophysiological signals. This study extends the MIC to the time-frequency domain, named time-frequency maximal information coefficient (TFMIC), to explore the FCMC in a specific frequency band. The effectiveness, equitability, and robustness of the algorithm on the simulation data was verified and compared with coherence, TE- and MI- based methods. Simulation results showed that the TFMIC could accurately detect the coupling for different functional relationships at low noise levels. The dorsiflexion experimental results revealed that the beta-band (14-30 Hz) significant coupling was observed at channels Cz, C4, FC4, and FCz. Additionally, the results showed that the coupling was higher in the alpha-band (8-13 Hz) and beta-band (14-30 Hz) than in the gamma-band (31-45 Hz). This might be related to a transition between sensorimotor states. Specifically, the nonlinear component of FCMC was also observed at channels Cz, C4, FC4, and FCz. This study expanded the research on nonlinear coupling components in FCMC.

Cross-frequency and iso-frequency estimation of functional corticomuscular coupling after stroke

Functional corticomuscular coupling (FCMC) between the brain and muscles has been used for motor function assessment after stroke. Two types, iso-frequency coupling (IFC) and cross-frequency coupling (CFC), are existed in sensory-motor system for healthy people. However, in stroke, only a few studies focused on IFC between electroencephalogram (EEG) and electromyogram (EMG) signals, and no CFC studies have been found. Considering the intrinsic complexity and rhythmicity of the biological system, we first used the wavelet package transformation (WPT) to decompose the EEG and EMG signals into several subsignals with different frequency bands, and then applied transfer entropy (TE) to analyze the IFC and CFC relationship between each pair-wise subsignal. In this study, eight stroke patients and eight healthy people were enrolled. Results showed that both IFC and CFC still existed in stroke patients (EEG → EMG: 1:1, 3:2, 2:1; EMG → EEG: 1:1, 2:1, 2:3, 3:1). Compared with the stroke-unaffected side and healthy controls, the stroke-affected side yielded lower alpha, beta and gamma synchronization (IFC: beta; CFC: alpha, beta and gamma). Further analysis indicated that stroke patients yielded no significant difference of the FCMC between EEG → EMG and EMG → EEG directions. Our study indicated that alpha and beta bands were essential to concentrating and maintaining the motor capacities, and provided a new insight in understanding the propagation and function in the sensory-motor system.

A Virtual Reality Muscle-Computer Interface for Neurorehabilitation in Chronic Stroke: A Pilot Study

Severe impairment of limb movement after stroke can be challenging to address in the chronic stage of stroke (e.g., greater than 6 months post stroke). Recent evidence suggests that physical therapy can still promote meaningful recovery after this stage, but the required high amount of therapy is difficult to deliver within the scope of standard clinical practice. Digital gaming technologies are now being combined with brain–computer interfaces to motivate engaging and frequent exercise and promote neural recovery. However, the complexity and expense of acquiring brain signals has held back widespread utilization of these rehabilitation systems. Furthermore, for people that have residual muscle activity, electromyography (EMG) might be a simpler and equally effective alternative. In this pilot study, we evaluate the feasibility and efficacy of an EMG-based variant of our REINVENT virtual reality (VR) neurofeedback rehabilitation system to increase volitional muscle activity while reducing unintended co-contractions. We recruited four participants in the chronic stage of stroke recovery, all with severely restricted active wrist movement. They completed seven 1-hour training sessions during which our head-mounted VR system reinforced activation of the wrist extensor muscles without flexor activation. Before and after training, participants underwent a battery of clinical and neuromuscular assessments. We found that training improved scores on standardized clinical assessments, equivalent to those previously reported for brain–computer interfaces. Additionally, training may have induced changes in corticospinal communication, as indexed by an increase in 12–30 Hz corticomuscular coherence and by an improved ability to maintain a constant level of wrist muscle activity. Our data support the feasibility of using muscle–computer interfaces in severe chronic stroke, as well as their potential to promote functional recovery and trigger neural plasticity.

Altered Corticomuscular Coherence (CMCoh) Pattern in the Upper Limb During Finger Movements After Stroke

Background: Proximal compensation to the distal movements is commonly observed in the affected upper extremity (UE) of patients with chronic stroke. However, the cortical origin of this compensation has not been well-understood. In this study, corticomuscular coherence (CMCoh) and electromyography (EMG) analysis were adopted to investigate the corticomuscular coordinating pattern of proximal UE compensatory activities when conducting distal UE movements in chronic stroke.

Method: Fourteen chronic stroke subjects and 10 age-matched unimpaired controls conducted isometric finger extensions and flexions at 20 and 40% of maximal voluntary contractions. Electroencephalogram (EEG) data were recorded from the sensorimotor area and EMG signals were captured from extensor digitorum (ED), flexor digitorum (FD), triceps brachii (TRI), and biceps brachii (BIC) to investigate the CMCoh peak values in the Beta band. EMG parameters, i.e., the EMG activation level and co-contraction index (CI), were analyzed to evaluate the compensatory muscular patterns in the upper limb.

Result: The peak CMCoh with statistical significance (P < 0.05) was found shifted from the ipsilesional side to the contralesional side in the proximal UE muscles, while to the central regions in the distal UE muscle in chronic strokes. Significant differences (P < 0.05) were observed in both peak ED and FD CMCohs during finger extensions between the two groups. The unimpaired controls exhibited significant intragroup differences between 20 and 40% levels in extensions for peak ED and FD CMCohs (P < 0.05). The stroke subjects showed significant differences in peak TRI and BIC CMCohs (P < 0.01). No significant inter- or intra-group difference was observed in peak CMCoh during finger flexions. EMG parameters showed higher EMG activation levels in TRI and BIC muscles (P < 0.05), and higher CI values in the muscle pairs involving TRI and BIC during all the extension and flexion tasks in the stroke group than those in the control group (P < 0.05).

Conclusion: The post-stroke proximal muscular compensations from the elbow to the finger movements were cortically originated, with the center mainly located in the contralesional hemisphere.

Intra- and Inter-Rater Reliability of Manual Feature Extraction Methods in Movement Related Cortical Potential Analysis

Event related potentials (ERPs) provide insight into the neural activity generated in response to motor, sensory and cognitive processes. Despite the increasing use of ERP data in clinical research little is known about the reliability of human manual ERP labelling methods. Intra-rater and inter-rater reliability were evaluated in five electroencephalography (EEG) experts who labelled the peak negativity of averaged movement related cortical potentials (MRCPs) derived from thirty datasets. Each dataset contained 50 MRCP epochs from healthy people performing cued voluntary or imagined movement, or people with stroke performing cued voluntary movement. Reliability was assessed using the intraclass correlation coefficient and standard error of measurement. Excellent intra- and inter-rater reliability was demonstrated in the voluntary movement conditions in healthy people and people with stroke. In comparison reliability in the imagined condition was low to moderate. Post-hoc secondary epoch analysis revealed that the morphology of the signal contributed to the consistency of epoch inclusion; potentially explaining the differences in reliability seen across conditions. Findings from this study may inform future research focused on developing automated labelling methods for ERP feature extraction and call to the wider community of researchers interested in utilizing ERPs as a measure of neurophysiological change or in the delivery of EEG-driven interventions.

Corticospinal Control of Human Locomotion as a New Determinant of Age-Related Sarcopenia: An Exploratory Study

Sarcopenia is a muscle disease listed within the ICD-10 classification. Several operational definitions have been created for sarcopenia screening; however, an international consensus is lacking. The Centers for Disease Control and Prevention have recently recognized that sarcopenia detection requires improved diagnosis and screening measures. Mounting evidence hints towards changes in the corticospinal communication system where corticomuscular coherence (CMC) reflects an effective mechanism of corticospinal interaction. CMC can be assessed during locomotion by means of simultaneously measuring Electroencephalography (EEG) and Electromyography (EMG). The aim of this study was to perform sarcopenia screening in community-dwelling older adults and explore the possibility of using CMC assessed during gait to discriminate between sarcopenic and non-sarcopenic older adults. Receiver Operating Characteristic (ROC) curves showed high sensitivity, precision and accuracy of CMC assessed from EEG Cz sensor and EMG sensors located over Musculus Vastus Medialis [Cz-VM; AUC (95.0%CI): 0.98 (0.92-1.04), sensitivity: 1.00, 1-specificity: 0.89, p < 0.001] and with Musculus Biceps Femoris [Cz-BF; AUC (95.0%CI): 0.86 (0.68-1.03), sensitivity: 1.00, 1-specificity: 0.70, p < 0.001]. These muscles showed significant differences with large magnitude of effect between sarcopenic and non-sarcopenic older adults [Hedge's g (95.0%CI): 2.2 (1.3-3.1), p = 0.005 and Hedge's g (95.0%CI): 1.5 (0.7-2.2), p = 0.010; respectively]. The novelty of this exploratory investigation is the hint toward a novel possible determinant of age-related sarcopenia, derived from corticospinal control of locomotion and shown by the observed large differences in CMC when sarcopenic and non-sarcopenic older adults are compared. This, in turn, might represent in future a potential treatment target to counteract sarcopenia as well as a parameter to monitor the progression of the disease and/or the potential recovery following other treatment interventions.

Gamma frequency band shift of contralateral corticomuscular synchronous oscillations with force strength for hand movement tasks

Bilateral voluntary contractions involve functional changes in both primary motor cortices. However how the unilateral voluntary contraction of hand muscles influences the contralateral corticomuscular synchronous oscillations mechanisms remains unclear. In the bimanual tasks, nine healthy subjects were instructed to generate force by abducting their left-hand index finger against a force sensor and simultaneously the right-hand precise pinch task with visual feedback. They were divided into four conditions according to the two contraction force levels of the left-hand muscles 5% and 50% maximal isometric voluntary contraction (MVC) and with/without visual feedback for the right hand. Corticomuscular synchronization of the right hand in the beta band was revealed when the subjects performed the bimanual exercise with 5% MVC of left-hand muscles, which is consistent with previous studies. As the contraction strength of the left-hand muscle increased to 50% MVC, the corticomuscular coherence (CMC) frequency of the right hand shifted to gamma band, and the CMC in beta band decreased significantly (P < 0.05) in the electroencephalography→electromyography direction. This phenomenon suggests that the corticomuscular synchronous oscillation will shift from beta band to higher frequencies (principally gamma) as the contraction force of the contralateral hand increases, which may be due to the changes in the subject's attention and more frequent synchronization of neuromuscular motor neurons oscillations. These findings will be helpful to explore the hand motion control and feedback mechanisms, and further provide a basis for the application of neuromuscular coupling in clinical rehabilitation evaluation.Video abstract: http://links.lww.com/WNR/A571.

Distribution of pesticides in agricultural and urban soils of Brazil: a critical review

The extensive use of pesticides leads to soil contamination and is harmful to environmental health. Brazil is considered the world's largest consumer of pesticides; however, there is no published review of the distribution and concentration of pesticides in the Brazilian soils. Thus, the objective of this study was to analyze the occurrence of pesticide residues in Brazilian soils through a systematic review of the data obtained from the official records of government agencies and scientific literature. Further, this review aims to estimate the risk quotient using the data extracted from these studies and compare it with the values from current legislation. The studies on pesticides were selected and screened, out of which 21 scientific articles were included in this review. The studies highlighted that 55 pesticides were detected in the soils in Brazil. Of these, 58% belonged to the chemical class of organochlorines and their concentration ranged from 0.0002-1243.68 mg kg-1. DDT (0.00002-1243.68 mg kg-1), HCH (0.00007-962.00 mg kg-1) and diuron (0.0031-4.16 mg kg-1) contributed to highest pesticide concentrations in soil. Residential soils had higher pesticide concentrations and greater risk factors than the agricultural soils. Moreover, 20% of the studies detected mixtures containing more than 10 types of pesticides. This study concluded that the specific scenarios evaluated by the reviewed studies do not reflect the current pesticide use and contamination in Brazil and there is a need for more information related to pesticide contamination in soils.

Time-Frequency-Domain Copula-Based Granger Causality and Application to Corticomuscular Coupling in Stroke

The corticomuscular coupling (CMC) characterization between the motor cortex and muscles during motion control is a valid biomarker of motor system function after stroke, which can improve clinical decision-making. However, traditional CMC analysis is mainly based on the coherence method that can’t determine the coupling direction, whereas Granger Causality (GC) is limited in identifying linear cause–effect relationship. In this paper, a time-frequency domain copula-based GC (copula-GC) method is proposed to assess CMC characteristic. The 32-channel electroencephalogram (EEG) signals over brain scalp and electromyography (EMG) signals from upper limb were recorded during controlling and maintaining steady-state force output for five stroke patients and five healthy controls. Then, the time-frequency copula-GC analysis was applied to evaluate the CMC strength in both directions. Experimental results show that the CMC strength of descending direction is greater than that of ascending direction in the time domain for healthy controls. With the increase of grip strength, the bi-directional CMC strength has an increasing trend. Meanwhile, the bi-directional CMC strength of right hand is larger than that of left hand. In addition, the bi-directional CMC strength of stroke patients is lower than that of healthy controls. In the frequency domain, the strongest CMC is observed at the beta frequency band. Additionally, the CMC strength of descending direction is slightly larger than that of ascending direction in healthy controls, while the CMC strength of descending direction is lower than that of ascending direction in stroke patients. We suggest that the proposed time-frequency domain analysis approach based on copula-GC can effectively detect complex functional coupling between cortical oscillations and muscle activities, and provide a potential quantitative analysis measure for motion control and rehabilitation evaluation.

Functional Corticomuscular Signal Coupling Is Weakened during Voluntary Motor Action in Cancer-Related Fatigue

Background and Purpose

Cancer-related fatigue (CRF) is widely recognized as one of the most common symptoms and side effects of cancer and/or its treatment. However, neuropathological mechanisms contributing to CRF are largely unknown, and the lack of knowledge makes CRF difficult to treat. Recent research has shown dissociation between changes in the brain and muscle signals during voluntary motor performance in cancer survivors with CRF, and this dissociation may be caused by an interruption in functional coupling (FC) of the two signals. The goal of this study was to assess the FC between EEG (cortical signal) and EMG (muscular signal) in individuals with CRF and compare the FC with that of healthy controls during a motor task that led to progressive muscle fatigue.

Method

Eight cancer survivors with CRF and nine healthy participants sustained an isometric elbow flexion contraction (at 30% maximal level) until self-perceived exhaustion. The entire duration of the EEG and EMG recordings was divided into the first-half (less-fatigue stage) and second-half (more-fatigue stage) artifact-free epochs without overlapping. The EEG-EMG coupling (measured by coherence of the two signals) in each group and stage was computed. Coherence values at different frequencies were statistically analyzed using a repeated-measure general linear model.

Results

The results demonstrated that compared to healthy controls, CRF participants sustained the contraction for a significantly shorter time and exhibited robust and significantly lower EEG-EMG coherence at the alpha (8~14 Hz) and beta (15~35 Hz) frequency bands. Both the CRF and healthy control groups exhibited significantly decreased EEG-EMG coherence from the less-fatigue to more-fatigue stages at the alpha and beta frequency bands, indicating fatigue-induced weakening of functional corticomuscular coupling.

Conclusion

Impaired functional coupling between the brain and muscle signals could be a consequence of cancer and/or its treatment, and it may be one of the contributing factors to the abnormal feeling of fatigue that caused the early failure of sustaining a prolonged motor task.

Corticomuscular Coherence and Its Applications: A Review

Corticomuscular coherence (CMC) is an index utilized to indicate coherence between brain motor cortex and associated body muscles, conventionally. As an index of functional connections between the cortex and muscles, CMC research is the focus of neurophysiology in recent years. Although CMC has been extensively studied in healthy subjects and sports disorders, the purpose of its applications is still ambiguous, and the magnitude of CMC varies among individuals. Here, we aim to investigate factors that modulate the variation of CMC amplitude and compare significant CMC between these factors to find a well-developed research prospect. In the present review, we discuss the mechanism of CMC and propose a general definition of CMC. Factors affecting CMC are also summarized as follows: experimental design, band frequencies and force levels, age correlation, and difference between healthy controls and patients. In addition, we provide a detailed overview of the current CMC applications for various motor disorders. Further recognition of the factors affecting CMC amplitude can clarify the physiological mechanism and is beneficial to the implementation of CMC clinical methods.

Cortico-Muscular Coherence Is Reduced Acutely Post-stroke and Increases Bilaterally During Motor Recovery: A Pilot Study

Motor recovery following stroke is believed to necessitate alteration in functional connectivity between cortex and muscle. Cortico-muscular coherence has been proposed as a potential biomarker for post-stroke motor deficits, enabling a quantification of recovery, as well as potentially indicating the regions of cortex involved in recovery of function. We recorded simultaneous EEG and EMG during wrist extension from healthy participants and patients following ischaemic stroke, evaluating function at three time points post-stroke. EEG–EMG coherence increased over time, as wrist mobility recovered clinically, and by the final evaluation, coherence was higher in the patient group than in the healthy controls. Moreover, the cortical distribution differed between the groups, with coherence involving larger and more bilaterally scattered areas of cortex in the patients than in the healthy participants. The findings suggest that EEG–EMG coherence has the potential to serve as a biomarker for motor recovery and to provide information about the cortical regions that should be targeted in rehabilitation therapies based on real-time EEG.

Low Gamma Band Cortico-muscular Coherence Inter-Hemisphere Difference following Chronic Stroke

Brain oscillation and motor control process would change due to chronic stroke. Inter-hemisphere brain activation patterns may relate to motor related recovery. This study employed cortico-muscular coherence to explore cortical motor control process during wrist isometric contraction experiments of both affected and unaffected hands from chronic stroke subjects. Eleven chronic stroke subjects with moderate hand function involved in the experiments and each subject took three visits. Multitaper coherence estimation with bias-correction was performed to acquire cortico-muscular coherence, neuronal coherence source Localization was conducted to determine typical scalp motivation area during isometric contraction. Non-parametric permutation based multiple frequency bin statistics was utilized to compare the difference between two sides. The results demonstrated significant typical low gamma band inter-hemisphere disparity in cortico-muscular coherence between two sides after chronic stroke. The spatial topographical pattern and source Localization outcomes also supported these findings.

Muscle Extremely Low Frequency Magnetic Stimulation Eliminates the Effect of Fatigue on EEG-EMG Coherence during the Lateral Raise Task: A Pilot Quantitative Investigation

The aim of this study was to quantitatively investigate the effects of force load, muscle fatigue, and extremely low frequency (ELF) magnetic stimulation on electroencephalography- (EEG-) electromyography (EMG) coherence during right arm lateral raise task. Eighteen healthy male subjects were recruited. EEG and EMG signals were simultaneously recorded from each subject while three different loads (0, 1, and 3kg) were added on the forearm. ELF magnetic stimulation was applied to the subject's deltoid muscle between tasks during the resting period. Univariate ANOVA showed that all EEG-EMG coherence areas of C3, C4, CP5, and CP6 were not significantly affected by the force load (all p>0.05) and that muscle fatigue led to statistically significant reductions on the coherence area of gamma band in C3 (p=0.014) and CP5 (p=0.019). More interestingly, these statistically significant reductions disappeared with the application of muscle ELF magnetic stimulation, indicating its potential application to eliminate the effect of fatigue.

Predicting Gains With Visuospatial Training After Stroke Using an EEG Measure of Frontoparietal Circuit Function

The heterogeneity of stroke prompts the need for predictors of individual treatment response to rehabilitation therapies. We previously studied healthy subjects with EEG and identified a frontoparietal circuit in which activity predicted training-related gains in visuomotor tracking. Here we asked whether activity in this same frontoparietal circuit also predicts training-related gains in visuomotor tracking in patients with chronic hemiparetic stroke. Subjects (n = 12) underwent dense-array EEG recording at rest, then received 8 sessions of visuomotor tracking training delivered via home-based telehealth methods. Subjects showed significant training-related gains in the primary behavioral endpoint, Success Rate score on a standardized test of visuomotor tracking, increasing an average of 24.2 ± 21.9% (p = 0.003). Activity in the circuit of interest, measured as coherence (20–30 Hz) between leads overlying ipsilesional frontal (motor cortex) and parietal lobe, significantly predicted training-related gains in visuomotor tracking change, measured as change in Success Rate score (r = 0.61, p = 0.037), supporting the main study hypothesis. Results were specific to the hypothesized ipsilesional motor-parietal circuit, as coherence within other circuits did not predict training-related gains. Analyses were repeated after removing the four subjects with injury to motor or parietal areas; this increased the strength of the association between activity in the circuit of interest and training-related gains. The current study found that (1) Eight sessions of training can significantly improve performance on a visuomotor task in patients with chronic stroke, (2) this improvement can be realized using home-based telehealth methods, (3) an EEG-based measure of frontoparietal circuit function predicts training-related behavioral gains arising from that circuit, as hypothesized and with specificity, and (4) incorporating measures of both neural function and neural injury improves prediction of stroke rehabilitation therapy effects.

Multiscale Information Transfer in Functional Corticomuscular Coupling Estimation Following Stroke: A Pilot Study

Recently, functional corticomuscular coupling (FCMC) between the cortex and the contralateral muscle has been used to evaluate motor function after stroke. As we know, the motor-control system is a closed-loop system that is regulated by complex self-regulating and interactive mechanisms which operate in multiple spatial and temporal scales. Multiscale analysis can represent the inherent complexity. However, previous studies in FCMC for stroke patients mainly focused on the coupling strength in single-time scale, without considering the changes of the inherently directional and multiscale properties in sensorimotor systems. In this paper, a multiscale-causal model, named multiscale transfer entropy, was used to quantify the functional connection between electroencephalogram over the scalp and electromyogram from the flexor digitorum superficialis (FDS) recorded simultaneously during steady-state grip task in eight stroke patients and eight healthy controls. Our results showed that healthy controls exhibited higher coupling when the scale reached up to about 12, and the FCMC in descending direction was stronger at certain scales (1, 7, 12, and 14) than that in ascending direction. Further analysis showed these multi-time scale characteristics mainly focused on the beta1 band at scale 11 and beta2 band at scale 9, 11, 13, and 15. Compared to controls, the multiscale properties of the FCMC for stroke were changed, the strengths in both directions were reduced, and the gaps between the descending and ascending directions were disappeared over all scales. Further analysis in specific bands showed that the reduced FCMC mainly focused on the alpha2 at higher scale, beta1 and beta2 across almost the entire scales. This study about multi-scale confirms that the FCMC between the brain and muscles is capable of complex and directional characteristics, and these characteristics in functional connection for stroke are destroyed by the structural lesion in the brain that might disrupt coordination, feedback, and information transmission in efferent control and afferent feedback. The study demonstrates for the first time the multiscale and directional characteristics of the FCMC for stroke patients, and provides a preliminary observation for application in clinical assessment following stroke.

Abnormal functional corticomuscular coupling after stroke

Motor dysfunction is a major consequence after stroke and it is generally believed that the loss of motor ability is caused by the impairments in neural network that controls movement. To explore the abnormal mechanisms how the brain controls shoulder abduction and elbow flexion in "flexion synergy" following stroke, we used the functional corticomuscular coupling (FCMC) between the brain and the muscles as a tool to identify the temporal evolution of corticomuscular interaction between the synkinetic and separate phases. 59-channel electroencephalogram (EEG) over brain scalp and 2-channel electromyogram (EMG) from biceps brachii (BB)/deltoid (DT) were recorded in sixteen stroke patients with motor dysfunction and eight healthy controls during a task of uplifting the arm (stage 1) and maintaining up to the chest (stage 2). As a result, compared to healthy controls, stroke patients had abnormally reduced coherence in EEG-BB combination and increased coherence in EEG-DT combination. Compared to synkinetic stroke patients, separate ones exhibited higher coupling at gamma-band during stage 1 and higher at beta-band during stage 2 in EEG-BB combination, but lower at beta-band during stage 2 in EEG-DT combination. Therefore, we infer that the disorders of efferent control and afferent proprioception in sensorimotor system for stroke patients effect on the oscillation at beta and gamma bands. Patients need integrate more information for shoulder abduction to compensate for the functional loss of elbow flexion in the recovery process, so that partial cortical cortex controlling on the elbow flexion may work on the shoulder abduction during "flexion synergy". Such researches could provide new perspective on the temporal evolution of corticomuscular interaction after stroke and add to our understanding of possible pathomechanisms how the brain abnormally controls shoulder abduction and elbow flexion in "flexion synergy".

Using Corticomuscular Coherence to Reflect Function Recovery of Paretic Upper Limb after Stroke: A Case Study

Purpose

Motor deficits after stroke are supposed to arise from the reduced neural drive from the brain to muscles. This study aimed to demonstrate the feasibility of reflecting the motor function improvement after stroke with the measurement of corticomuscular coherence (CMC) in an individual subject.

Method

A stroke patient was recruited to participate in an experiment before and after the function recovery of his paretic upper limb, respectively. An elbow flexion task with a constant muscle contraction level was involved in the experiment. Electromyography and electroencephalography signals were recorded simultaneously to estimate the CMC. The non-parameter statistical analysis was used to test the significance of CMC differences between the first and second times of experiments.

Result

The strongest corticomuscular coupling emerged at the motor cortex contralateral to the contracting muscles for both the affected and unaffected limbs. The strength of the corticomuscular coupling between activities from the paretic limb muscles and the contralateral motor cortex for the second time of experiment increased significantly compared with that for the first time. However, the CMC of the unaffected limb had no significant changes between two times of experiments.

Conclusion

The results demonstrated that the increased corticomuscular coupling strength resulted from the motor function restoration of the paretic limb. The measure of CMC can reflect the recovery of motor function after stroke by quantifying interactions between activities from the motor cortex and controlled muscles.

Corticomuscular coherence in the acute and subacute phase after stroke

OBJECTIVE

Stroke is one of the leading causes of physical disability due to damage of the motor cortex or the corticospinal tract. In the present study we set out to investigate the role of adaptations in the corticospinal pathway for motor recovery during the subacute phase after stroke.

METHODS

We examined 19 patients with clinically diagnosed stroke and 18 controls. The patients had unilateral mild to moderate weakness of the hand. Each patient attended two sessions at approximately 3days (acute) and 38days post stroke (subacute). Task-related changes in the communication between motor cortex and muscles were evaluated from coupling in the frequency domain between EEG and EMG during movement of the paretic hand.

RESULTS

Corticomuscular coherence (CMC) and intermuscular coherence (IMC) were reduced in patients as compared to controls. Paretic hand motor performance improved within 4-6weeks after stroke, but no change was observed in CMC or IMC.

CONCLUSIONS

CMC and IMC were reduced in patients in the early phase after stroke. However, changes in coherence do not appear to be an efficient marker for early recovery of hand function following stroke.

SIGNIFICANCE

This is the first study to demonstrate sustained reduced coherence in acute and subacute stroke.

Ipsilateral EEG mu rhythm reflects the excitability of uncrossed pathways projecting to shoulder muscles

BACKGROUND

Motor planning, imagery or execution is associated with event-related desynchronization (ERD) of mu rhythm oscillations (8-13 Hz) recordable over sensorimotor areas using electroencephalography (EEG). It was shown that motor imagery involving distal muscles, e.g. finger movements, results in contralateral ERD correlating with increased excitability of the contralateral corticospinal tract (c-CST). Following the rationale that purposefully increasing c-CST excitability might facilitate motor recovery after stroke, ERD recently became an attractive target for brain-computer interface (BCI)-based neurorehabilitation training. It was unclear, however, whether ERD would also reflect excitability of the ipsilateral corticospinal tract (i-CST) that mainly innervates proximal muscles involved in e.g. shoulder movements. Such knowledge would be important to optimize and extend ERD-based BCI neurorehabilitation protocols, e.g. to restore shoulder movements after stroke. Here we used single-pulse transcranial magnetic stimulation (TMS) targeting the ipsilateral primary motor cortex to elicit motor evoked potentials (MEPs) of the trapezius muscle. To assess whether ERD reflects excitability of the i-CST, a correlation analysis between between MEP amplitudes and ipsilateral ERD was performed.

METHODS

Experiment 1 consisted of a motor execution task during which 10 healthy volunteers performed elevations of the shoulder girdle or finger pinching while a 128-channel EEG was recorded. Experiment 2 consisted of a motor imagery task during which 16 healthy volunteers imagined shoulder girdle elevations or finger pinching while an EEG was recorded; the participants simultaneously received randomly timed, single-pulse TMS to the ipsilateral primary motor cortex. The spatial pattern and amplitude of ERD and the amplitude of the agonist muscle's TMS-induced MEPs were analyzed.

RESULTS

ERDs occurred bilaterally during both execution and imagery of shoulder girdle elevations, but were lateralized to the contralateral hemisphere during finger pinching. We found that trapezius MEPs increased during motor imagery of shoulder elevations and correlated with ipsilateral ERD amplitudes.

CONCLUSIONS

Ipsilateral ERD during execution and imagery of shoulder girdle elevations appears to reflect the excitability of uncrossed pathways projecting to the shoulder muscles. As such, ipsilateral ERD could be used for neurofeedback training of shoulder movement, aiming at reanimation of the i-CST.

Topographical measures of functional connectivity as biomarkers for post-stroke motor recovery

BACKGROUND

Biomarkers derived from neural activity of the brain present a vital tool for the prediction and evaluation of post-stroke motor recovery, as well as for real-time biofeedback opportunities.

METHODS

In order to encapsulate recovery-related reorganization of brain networks into such biomarkers, we have utilized the generalized measure of association (GMA) and graph analyses, which include global and local efficiency, as well as hemispheric interdensity and intradensity. These methods were applied to electroencephalogram (EEG) data recorded during a study of 30 stroke survivors (21 male, mean age 57.9 years, mean stroke duration 22.4 months) undergoing 12 weeks of intensive therapeutic intervention.

RESULTS

We observed that decreases of the intradensity of the unaffected hemisphere are correlated (r s =-0.46;p<0.05) with functional recovery, as measured by the upper-extremity portion of the Fugl-Meyer Assessment (FMUE). In addition, high initial values of local efficiency predict greater improvement in FMUE (R 2=0.16;p<0.05). In a subset of 17 subjects possessing lesions of the cerebral cortex, reductions of global and local efficiency, as well as the intradensity of the unaffected hemisphere are found to be associated with functional improvement (r s =-0.60,-0.66,-0.75;p<0.05). Within the same subgroup, high initial values of global and local efficiency, are predictive of improved recovery (R 2=0.24,0.25;p<0.05). All significant findings were specific to the 12.5-25 Hz band.

CONCLUSIONS

These topological measures show promise for prognosis and evaluation of therapeutic outcomes, as well as potential application to BCI-enabled biofeedback.

A critical period of corticomuscular and EMG-EMG coherence detection in healthy infants aged 9-25 weeks

KEY POINTS

The early postnatal development of functional corticospinal connections in human infants is not fully clarified. Corticospinal drive to upper and lower limb muscle shows developmental changes with an increased functional coupling in infants between 9 and 25 weeks in the beta frequency band. The changes in functional coupling coincide with the developmental period where fidgety movements are present in healthy infants. Data support a possible sensitive period where functional connections between corticospinal tract fibres and spinal motoneurones undergo activity-dependent reorganization.

ABSTRACT

The early postnatal development of functional corticospinal connections in human infants is not fully clarified. We used EEG and EMG to investigate the development of corticomuscular and intramuscular coherence as indicators of functional corticospinal connectivity in healthy infants aged 1-66 weeks. EEG was recorded over leg and hand area of motor cortex. EMG recordings were made from right ankle dorsiflexor and right wrist extensor muscles. Quantification of the amount of corticomuscular coherence in the 20-40 Hz frequency band showed a significantly larger coherence for infants aged 9-25 weeks compared to younger and older infants. Coherence between paired EMG recordings from tibialis anterior muscle in the 20-40 Hz frequency band was also significantly larger for the 9-25 week age group. A low-amplitude, broad-duration (40-50 ms) central peak of EMG-EMG synchronization was observed for infants younger than 9 weeks, whereas a short-lasting (10-20 ms) central peak was observed for EMG-EMG synchronization in older infants. This peak was largest for infants aged 9-25 weeks. These data suggest that the corticospinal drive to lower and upper limb muscles shows significant developmental changes with an increase in functional coupling in infants aged 9-25 weeks, a period which coincides partly with the developmental period of normal fidgety movements. We propose that these neurophysiological findings may reflect the existence of a sensitive period where the functional connections between corticospinal tract fibres and spinal motoneurones undergo activity-dependent reorganization. This may be relevant for the timing of early therapy interventions in infants with pre- and perinatal brain injury.

Therapeutic Applications of BCI Technologies

Brain-computer interface (BCI) technology can restore communication and control to people who are severely paralyzed. There has been speculation that this technology might also be useful for a variety of diverse therapeutic applications. This survey considers possible ways that BCI technology can be applied to motor rehabilitation following stroke, Parkinson's disease, and psychiatric disorders. We consider potential neural signals as well as the design and goals of BCI-based therapeutic applications. These diverse applications all share a reliance on neuroimaging and signal processing technologies. At the same time, each of these potential applications presents a series of unique challenges.