Enhancing sensorimotor BCI performance with assistive afferent activity: An online evaluation

Improved motor imagery skills after repetitive passive somatosensory stimulation: a parallel-group, pre-registered study

Introduction

Motor-imagery-based Brain-Machine Interface (MI-BMI) has been established as an effective treatment for post-stroke hemiplegia. However, the need for long-term intervention can represent a significant burden on patients. Here, we demonstrate that motor imagery (MI) instructions for BMI training, when supplemented with somatosensory stimulation in addition to conventional verbal instructions, can help enhance MI capabilities of healthy participants.

Methods

Sixteen participants performed MI during scalp EEG signal acquisition before and after somatosensory stimulation to assess MI-induced cortical excitability, as measured using the event-related desynchronization (ERD) of the sensorimotor rhythm (SMR). The non-dominant left hand was subjected to neuromuscular electrical stimulation above the sensory threshold but below the motor threshold (St-NMES), along with passive movement stimulation using an exoskeleton. Participants were randomly divided into an intervention group, which received somatosensory stimulation, and a control group, which remained at rest without stimulation.

Results

The intervention group exhibited a significant increase in SMR-ERD compared to the control group, indicating that somatosensory stimulation contributed to improving MI ability.

Discussion

This study demonstrates that somatosensory stimulation, combining electrical and mechanical stimuli, can improve MI capability and enhance the excitability of the sensorimotor cortex in healthy individuals.

Distinct and additive effects of visual and vibratory feedback for motor rehabilitation: an EEG study in healthy subjects

INTRODUCTION

The use of visual and proprioceptive feedback is a key property of motor rehabilitation techniques. This feedback can be used alone, for example, for vision in mirror or video therapy, for proprioception in focal tendon vibration therapy, or in combination, for example, in robot-assisted training. This Electroencephalographic (EEG) study in healthy subjects explored the distinct neurophysiological impact of adding visual (video therapy), proprioceptive (focal tendinous vibration), or combined feedback (video therapy and focal tendinous vibration) to a motor imagery task.

METHODS

Sixteen healthy volunteers performed 20 mental imagery (MI) tasks involving right wrist extension and flexion under four conditions: MI alone (IA), MI + video feedback observation (IO), MI + vibratory feedback (IV), and MI + observation + vibratory feedback (IOV). Brain activity was monitored with EEG, and time-frequency neurophysiological markers of movement were computed. The emotions of the patients were also measured during the task.

RESULTS

In the alpha band, we observed bilateral ERD in the visual feedback conditions (IO, IOV). In the beta band, the ERD was bilateral in the IA, IV and IOV but more lateralized in the IV and IOV. After movement, we observed strong ERS in the IO and IOV but not in the IA or IV. Embodiment was stronger in conditions with vibratory feedback (IOV > IV > IA and IO) CONCLUSION: Conditions with visual feedback (IO, IOV) recruit the mirror neurons system (alpha ERD) and provide more accurate feedback of the task than IA and IV, which triggers motor validation pathways (beta rebound analysis). Vibratory feedback enhances the recruitment of the left sensorimotor areas, with a synergistic effect in the IOV (beta ERD analysis), thus maximizing embodiment. Visual and vibratory feedback recruits the sensorimotor cortex during motor imagery in different ways and can be combined to maximize the benefits of both techniques TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT04449328 .

Challenges of neural interfaces for stroke motor rehabilitation

More than 85% of stroke survivors suffer from different degrees of disability for the rest of their lives. They will require support that can vary from occasional to full time assistance. These conditions are also associated to an enormous economic impact for their families and health care systems. Current rehabilitation treatments have limited efficacy and their long-term effect is controversial. Here we review different challenges related to the design and development of neural interfaces for rehabilitative purposes. We analyze current bibliographic evidence of the effect of neuro-feedback in functional motor rehabilitation of stroke patients. We highlight the potential of these systems to reconnect brain and muscles. We also describe all aspects that should be taken into account to restore motor control. Our aim with this work is to help researchers designing interfaces that demonstrate and validate neuromodulation strategies to enforce a contingent and functional neural linkage between the central and the peripheral nervous system. We thus give clues to design systems that can improve or/and re-activate neuroplastic mechanisms and open a new recovery window for stroke patients.

Novel multivariate methods to track frequency shifts of neural oscillations in EEG/MEG recordings

Instantaneous and peak frequency changes in neural oscillations have been linked to many perceptual, motor, and cognitive processes. Yet, the majority of such studies have been performed in sensor space and only occasionally in source space. Furthermore, both terms have been used interchangeably in the literature, although they do not reflect the same aspect of neural oscillations. In this paper, we discuss the relation between instantaneous frequency, peak frequency, and local frequency, the latter also known as spectral centroid. Furthermore, we propose and validate three different methods to extract source signals from multichannel data whose (instantaneous, local, or peak) frequency estimate is maximally correlated to an experimental variable of interest. Results show that the local frequency might be a better estimate of frequency variability than instantaneous frequency under conditions with low signal-to-noise ratio. Additionally, the source separation methods based on local and peak frequency estimates, called LFD and PFD respectively, provide more stable estimates than the decomposition based on instantaneous frequency. In particular, LFD and PFD are able to recover the sources of interest in simulations performed with a realistic head model, providing higher correlations with an experimental variable than multiple linear regression. Finally, we also tested all decomposition methods on real EEG data from a steady-state visual evoked potential paradigm and show that the recovered sources are located in areas similar to those previously reported in other studies, thus providing further validation of the proposed methods.

Enhancing Visual-Guided Motor Imagery Performance via Sensory Threshold Somatosensory Electrical Stimulation Training

OBJECTIVE

Motor imagery (MI) based brain- computer interface (BCI) has been widely studied as an effective way to enhance motor learning and promote motor recovery. However, the accuracy of MI-BCI heavily depends on whether subjects can perform MI tasks correctly, which largely limits the general application of MI-BCI. To overcome this limitation, a training strategy based on the combination of MI and sensory threshold somatosensory electrical stimulation (MI+st-SES) is proposed in this study.

METHODS

Thirty healthy subjects were recruited and randomly divided into SES group and control group. Both groups performed left-hand and right-hand MI tasks in three consecutive blocks. The main difference between two groups lies in the second block, where subjects in SES group received the st-SES during MI tasks whereas the control group performed MI tasks only.

RESULTS

The results showed that the SES group had a significant improvement in event-related desynchronization (ERD) of alpha rhythm after the training session of MI+st-SES (left-hand: F(2,27) = 9.98, p<0.01; right-hand: F(2, 27) = 10.43, p<0.01). The classification accuracy between left- and right-hand MI in the SES group was also significantly improved following MI+st-SES training (F(2,27) = 6.46, p<0.01). In contrary, there was no significant difference between the first and third blocks in the control group (F(2,27) = 0.18, p = 0.84). The functional connectivity based on weighted pairwise phase consistency (wPPC) over the sensorimotor area also showed an increase after the MI+st-SES training.

CONCLUSION AND SIGNIFICANCE

Our findings indicate that training based on MI+st-SES is a promising way to foster MI performance and assist subjects in achieving efficient BCI control.

A Review of Online Classification Performance in Motor Imagery-Based Brain–Computer Interfaces for Stroke Neurorehabilitation

Motor imagery (MI)-based brain–computer interfaces (BCI) have shown increased potential for the rehabilitation of stroke patients; nonetheless, their implementation in clinical practice has been restricted due to their low accuracy performance. To date, although a lot of research has been carried out in benchmarking and highlighting the most valuable classification algorithms in BCI configurations, most of them use offline data and are not from real BCI performance during the closed-loop (or online) sessions. Since rehabilitation training relies on the availability of an accurate feedback system, we surveyed articles of current and past EEG-based BCI frameworks who report the online classification of the movement of two upper limbs in both healthy volunteers and stroke patients. We found that the recently developed deep-learning methods do not outperform the traditional machine-learning algorithms. In addition, patients and healthy subjects exhibit similar classification accuracy in current BCI configurations. Lastly, in terms of neurofeedback modality, functional electrical stimulation (FES) yielded the best performance compared to non-FES systems.

Cortical processing during robot and functional electrical stimulation

Introduction

Like alpha rhythm, the somatosensory mu rhythm is suppressed in the presence of somatosensory inputs by implying cortical excitation. Sensorimotor rhythm (SMR) can be classified into two oscillatory frequency components: mu rhythm (8-13 Hz) and beta rhythm (14-25 Hz). The suppressed/enhanced SMR is a neural correlate of cortical activation related to efferent and afferent movement information. Therefore, it would be necessary to understand cortical information processing in diverse movement situations for clinical applications.

Methods

In this work, the EEG of 10 healthy volunteers was recorded while fingers were moved passively under different kinetic and kinematic conditions for proprioceptive stimulation. For the kinetics aspect, afferent brain activity (no simultaneous volition) was compared under two conditions of finger extension: (1) generated by an orthosis and (2) generated by the orthosis simultaneously combined and assisted with functional electrical stimulation (FES) applied at the forearm muscles related to finger extension. For the kinematic aspect, the finger extension was divided into two phases: (1) dynamic extension and (2) static extension (holding the extended position).

Results

In the kinematic aspect, both mu and beta rhythms were more suppressed during a dynamic than a static condition. However, only the mu rhythm showed a significant difference between kinetic conditions (with and without FES) affected by attention to proprioception after transitioning from dynamic to static state, but the beta rhythm was not.

Discussion

Our results indicate that mu rhythm was influenced considerably by muscle kinetics during finger movement produced by external devices, which has relevant implications for the design of neuromodulation and neurorehabilitation interventions.

Identification of spatial patterns with maximum association between power of resting state neural oscillations and trait anxiety

Anxiety affects approximately 5-10% of the adult population worldwide, placing a large burden on the health systems. Despite its omnipresence and impact on mental and physical health, most of the individuals affected by anxiety do not receive appropriate treatment. Current research in the field of psychiatry emphasizes the need to identify and validate biological markers relevant to this condition. Neurophysiological preclinical studies are a prominent approach to determine brain rhythms that can be reliable markers of key features of anxiety. However, while neuroimaging research consistently implicated prefrontal cortex and subcortical structures, such as amygdala and hippocampus, in anxiety, there is still a lack of consensus on the underlying neurophysiological processes contributing to this condition. Methods allowing non-invasive recording and assessment of cortical processing may provide an opportunity to help identify anxiety signatures that could be used as intervention targets. In this study, we apply Source-Power Comodulation (SPoC) to electroencephalography (EEG) recordings in a sample of participants with different levels of trait anxiety. SPoC was developed to find spatial filters and patterns whose power comodulates with an external variable in individual participants. The obtained patterns can be interpreted neurophysiologically. Here, we extend the use of SPoC to a multi-subject setting and test its validity using simulated data with a realistic head model. Next, we apply our SPoC framework to resting state EEG of 43 human participants for whom trait anxiety scores were available. SPoC inter-subject analysis of narrow frequency band data reveals neurophysiologically meaningful spatial patterns in the theta band (4-7 Hz) that are negatively correlated with anxiety. The outcome is specific to the theta band and not observed in the alpha (8-12 Hz) or beta (13-30 Hz) frequency range. The theta-band spatial pattern is primarily localised to the superior frontal gyrus. We discuss the relevance of our spatial pattern results for the search of biomarkers for anxiety and their application in neurofeedback studies.

The Effects of Sensory Threshold Somatosensory Electrical Stimulation on Users With Different MI-BCI Performance

Motor imagery-based brain-computer interface (MI-BCI) has been largely studied to improve motor learning and promote motor recovery. However, the difficulty in performing MI limits the widespread application of MI-BCI. It has been suggested that the usage of sensory threshold somatosensory electrical stimulation (st-SES) is a promising way to guide participants on MI tasks, but it is still unclear whether st-SES is effective for all users. In the present study, we aimed to examine the effects of st-SES on the MI-BCI performance in two BCI groups (High Performers and Low Performers). Twenty healthy participants were recruited to perform MI and resting tasks with EEG recordings. These tasks were modulated with or without st-SES. We demonstrated that st-SES improved the performance of MI-BCI in the Low Performers, but led to a decrease in the accuracy of MI-BCI in the High Performers. Furthermore, for the Low Performers, the combination of st-SES and MI resulted in significantly greater event-related desynchronization (ERD) and sample entropy of sensorimotor rhythm than MI alone. However, the ERD and sample entropy values of MI did not change significantly during the st-SES intervention in the High Performers. Moreover, we found that st-SES had an effect on the functional connectivity of the fronto-parietal network in the alpha band of Low Performers and the beta band of High Performers, respectively. Our results demonstrated that somatosensory input based on st-SES was only beneficial for sensorimotor cortical activation and MI-BCI performance in the Low Performers, but not in the High Performers. These findings help to optimize guidance strategies to adapt to different categories of users in the practical application of MI-BCI.

Functional connectivity ensemble method to enhance BCI performance (FUCONE)

OBJECTIVE

Relying on the idea that functional connectivity provides important insights on the underlying dynamic of neuronal interactions, we propose a novel framework that combines functional connectivity estimators and covariance-based pipelines to improve the classification of mental states, such as motor imagery.

METHODS

A Riemannian classifier is trained for each estimator and an ensemble classifier combines the decisions in each feature space. A thorough assessment of the functional connectivity estimators is provided and the best performing pipeline among those tested, called FUCONE, is evaluated on different conditions and datasets.

RESULTS

Using a meta-analysis to aggregate results across datasets, FUCONE performed significantly better than all state-of-the-art methods.

CONCLUSION

The performance gain is mostly imputable to the improved diversity of the feature spaces, increasing the robustness of the ensemble classifier with respect to the inter- and intra-subject variability.

SIGNIFICANCE

Our results offer new insights into the need to consider functional connectivity-based methods to improve the BCI performance.

Effects of brain-computer interface with functional electrical stimulation for gait rehabilitation in multiple sclerosis patients: preliminary findings in gait speed and event-related desynchronization onset latency

Objective.Brain-computer Interfaces (BCI) with functional electrical stimulation (FES) as a feedback device might promote neuroplasticity and hence improve motor function. Novel findings suggested that neuroplasticity could be possible in people with multiple sclerosis (pwMS). This preliminary study explores the effects of using a BCI-FES in therapeutic intervention, as an emerging methodology for gait rehabilitation in pwMS.Approach.People with relapsing-remitting, primary progressive or secondary progressive MS were evaluated with the inclusion criteria to enroll the nine participants required by the statistically computed sample size. Each patient trained with a BCI-FES during 24 sessions distributed in eight weeks. The effects were evaluated on gait speed (Timed 25 Foot Walk), walking ability (12-item Multiple Sclerosis Walking Scale), quality of life measures, the true positive rate as the BCI-FES performance metric and the event-related desynchronization (ERD) onset latency of the sensorimotor rhythms.Main results.Seven patients completed the therapeutic intervention. A statistically and clinically significant post-treatment improvement was observed in gait speed, as a result of a reduction in the time to walk 25 feet (-1.99 s,p= 0.018), and walking ability (-31.25 score points,p= 0.028). The true positive rate showed a statistically significant improvement (+15.87 score points,p= 0.018). An earlier ERD onset latency (-180 ms) after treatment was found.Significance.This is the first study that explored gait rehabilitation using BCI-FES in pwMS. The results showed improvement in gait which might have been promoted by changes in functional brain connections involved in sensorimotor rhythm modulation. Although more studies with a larger sample size and control group are required to validate the efficacy of this approach, these results suggest that BCI-FES technology could have a positive effect on MS gait rehabilitation.

Functional Connectivity Analysis in Motor-Imagery Brain Computer Interfaces

Motor Imagery BCI systems have a high rate of users that are not capable of modulating their brain activity accurately enough to communicate with the system. Several studies have identified psychological, cognitive, and neurophysiological measures that might explain this MI-BCI inefficiency. Traditional research had focused on mu suppression in the sensorimotor area in order to classify imagery, but this does not reflect the true dynamics that underlie motor imagery. Functional connectivity reflects the interaction between brain regions during the MI task and resting-state network and is a promising tool in improving MI-BCI classification. In this study, 54 novice MI-BCI users were split into two groups based on their accuracy and their functional connectivity was compared in three network scales (Global, Large and Local scale) during the resting-state, left vs. right-hand motor imagery task, and the transition between the two phases. Our comparison of High and Low BCI performers showed that in the alpha band, functional connectivity in the right hemisphere was increased in High compared to Low aptitude MI-BCI users during motor imagery. These findings contribute to the existing literature that indeed connectivity might be a valuable feature in MI-BCI classification and in solving the MI-BCI inefficiency problem.

Does feedback based on FES-evoked nociceptive withdrawal reflex condition event-related desynchronization? An exploratory study with brain-computer interfaces

Introduction.Event-related desynchronization (ERD) is used in brain-computer interfaces (BCI) to detect the user's motor intention (MI) and convert it into a command for an actuator to provide sensory feedback or mobility, for example by means of functional electrical stimulation (FES). Recent studies have proposed to evoke the nociceptive withdrawal reflex (NWR) using FES, in order to evoke synergistic movements of the lower limb and to facilitate the gait rehabilitation of stroke patients. The use of NWR to provide sensorimotor feedback in ERD-based BCI is novel; thererfore, the conditioning effect that nociceptive stimuli might have on MI is still unknown.Objetive.To assess the ERD produced during the MI after FES-evoked NWR, in order to evaluate if nociceptive stimuli condition subsequent ERDs.Methods. Data from 528 electroencephalography trials of 8 healthy volunteers were recorded and analyzed. Volunteers used an ERD-based BCI, which provided two types of feedback: intrisic by the FES-evoked NWR and extrinsic by virtual reality. The electromyogram of the tibialis anterior muscle was also recorded. The main outcome variables were the normalized root mean square of the evoked electromyogram (RMS_norm), the average electroencephalogram amplitude at the ERD frequency during MI (A¯MI) and the percentage decrease ofA¯MIrelative to rest (ERD%) at the first MI subsequent to the activation of the BCI.Results.No evidence of changes of theRMS_normon both theA¯MI(p = 0.663) and theERD%(p = 0.252) of the subsequent MI was detected. A main effect of the type of feedback was found in the subsequentA¯MI(p < 0.001), with intrinsic feedback resulting in a largerA¯MI.Conclusions.No evidence of ERD conditioning was observed using BCI feedback based on FES-evoked NWR .Significance.FES-evoked NWR could constitute a potential feedback modality in an ERD-based BCI to facilitate motor recovery of stroke people.

Improving motor imagery classification during induced motor perturbations

Objective.Motor imagery is the mental simulation of movements. It is a common paradigm to design brain-computer interfaces (BCIs) that elicits the modulation of brain oscillatory activity similar to real, passive and induced movements. In this study, we used peripheral stimulation to provoke movements of one limb during the performance of motor imagery tasks. Unlike other works, in which induced movements are used to support the BCI operation, our goal was to test and improve the robustness of motor imagery based BCI systems to perturbations caused by artificially generated movements.Approach.We performed a BCI session with ten participants who carried out motor imagery of three limbs. In some of the trials, one of the arms was moved by neuromuscular stimulation. We analysed 2-class motor imagery classifications with and without movement perturbations. We investigated the performance decrease produced by these disturbances and designed different computational strategies to attenuate the observed classification accuracy drop.Main results.When the movement was induced in a limb not coincident with the motor imagery classes, extracting oscillatory sources of the movement imagination tasks resulted in BCI performance being similar to the control (undisturbed) condition; when the movement was induced in a limb also involved in the motor imagery tasks, the performance drop was significantly alleviated by spatially filtering out the neural noise caused by the stimulation. We also show that the loss of BCI accuracy was accompanied by weaker power of the sensorimotor rhythm. Importantly, this residual power could be used to predict whether a BCI user will perform with sufficient accuracy under the movement disturbances.Significance.We provide methods to ameliorate and even eliminate motor related afferent disturbances during the performance of motor imagery tasks. This can help improving the reliability of current motor imagery based BCI systems.

Towards a mechanistic approach for the development of non-invasive brain-computer interfaces for motor rehabilitation

Brain-computer interfaces (BCIs) designed for motor rehabilitation use brain signals associated with motor-processing states to guide neuroplastic changes in a state-dependent manner. These technologies are uniquely positioned to induce targeted and functionally relevant plastic changes in the human motor nervous system. However, while several studies have shown that BCI-based neuromodulation interventions may improve motor function in patients with lesions in the central nervous system, the neurophysiological structures and processes targeted with the BCI interventions have not been identified. In this review, we first summarize current knowledge of the changes in the central nervous system associated with learning new motor skills. Then, we propose a classification of current BCI paradigms for plasticity induction and motor rehabilitation based on the expected neural plastic changes promoted. This classification proposes four paradigms based on two criteria: the plasticity induction methods and the brain states targeted. The existing evidence regarding the brain circuits and processes targeted with these different BCIs is discussed in detail. The proposed classification aims to serve as a starting point for future studies trying to elucidate the underlying plastic changes following BCI interventions.

A Comprehensive Review on Critical Issues and Possible Solutions of Motor Imagery Based Electroencephalography Brain-Computer Interface

Motor imagery (MI) based brain–computer interface (BCI) aims to provide a means of communication through the utilization of neural activity generated due to kinesthetic imagination of limbs. Every year, a significant number of publications that are related to new improvements, challenges, and breakthrough in MI-BCI are made. This paper provides a comprehensive review of the electroencephalogram (EEG) based MI-BCI system. It describes the current state of the art in different stages of the MI-BCI (data acquisition, MI training, preprocessing, feature extraction, channel and feature selection, and classification) pipeline. Although MI-BCI research has been going for many years, this technology is mostly confined to controlled lab environments. We discuss recent developments and critical algorithmic issues in MI-based BCI for commercial deployment.

Intensity and Dose of Neuromuscular Electrical Stimulation Influence Sensorimotor Cortical Excitability

Neuromuscular electrical stimulation (NMES) of the nervous system has been extensively used in neurorehabilitation due to its capacity to engage the muscle fibers, improving muscle tone, and the neural pathways, sending afferent volleys toward the brain. Although different neuroimaging tools suggested the capability of NMES to regulate the excitability of sensorimotor cortex and corticospinal circuits, how the intensity and dose of NMES can neuromodulate the brain oscillatory activity measured with electroencephalography (EEG) is still unknown to date. We quantified the effect of NMES parameters on brain oscillatory activity of 12 healthy participants who underwent stimulation of wrist extensors during rest. Three different NMES intensities were included, two below and one above the individual motor threshold, fixing the stimulation frequency to 35 Hz and the pulse width to 300 μs. Firstly, we efficiently removed stimulation artifacts from the EEG recordings. Secondly, we analyzed the effect of amplitude and dose on the sensorimotor oscillatory activity. On the one hand, we observed a significant NMES intensity-dependent modulation of brain activity, demonstrating the direct effect of afferent receptor recruitment. On the other hand, we described a significant NMES intensity-dependent dose-effect on sensorimotor activity modulation over time, with below-motor-threshold intensities causing cortical inhibition and above-motor-threshold intensities causing cortical facilitation. Our results highlight the relevance of intensity and dose of NMES, and show that these parameters can influence the recruitment of the sensorimotor pathways from the muscle to the brain, which should be carefully considered for the design of novel neuromodulation interventions based on NMES.

Sensorimotor Functional Connectivity: A Neurophysiological Factor Related to BCI Performance

Brain-Computer Interfaces (BCIs) are systems that allow users to control devices using brain activity alone. However, the ability of participants to command BCIs varies from subject to subject. About 20% of potential users of sensorimotor BCIs do not gain reliable control of the system. The inefficiency to decode user's intentions requires the identification of neurophysiological factors determining “good” and “poor” BCI performers. One of the important neurophysiological aspects in BCI research is that the neuronal oscillations, used to control these systems, show a rich repertoire of spatial sensorimotor interactions. Considering this, we hypothesized that neuronal connectivity in sensorimotor areas would define BCI performance. Analyses for this study were performed on a large dataset of 80 inexperienced participants. They took part in a calibration and an online feedback session recorded on the same day. Undirected functional connectivity was computed over sensorimotor areas by means of the imaginary part of coherency. The results show that post- as well as pre-stimulus connectivity in the calibration recording is significantly correlated to online feedback performance in μ and feedback frequency bands. Importantly, the significance of the correlation between connectivity and BCI feedback accuracy was not due to the signal-to-noise ratio of the oscillations in the corresponding post and pre-stimulus intervals. Thus, this study demonstrates that BCI performance is not only dependent on the amplitude of sensorimotor oscillations as shown previously, but that it also relates to sensorimotor connectivity measured during the preceding training session. The presence of such connectivity between motor and somatosensory systems is likely to facilitate motor imagery, which in turn is associated with the generation of a more pronounced modulation of sensorimotor oscillations (manifested in ERD/ERS) required for the adequate BCI performance. We also discuss strategies for the up-regulation of such connectivity in order to enhance BCI performance.