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Jochumsen M, Poulsen KB, Sørensen SL, Sulkjær CS, Corydon FK, Strauss LS, Roos JB. Single-trial movement intention detection estimation in patients with Parkinson's disease: a movement-related cortical potential study. J Neural Eng 2024; 21:046036. [PMID: 38986452 DOI: 10.1088/1741-2552/ad6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/10/2024] [Indexed: 07/12/2024]
Abstract
Objectives. Parkinson patients often suffer from motor impairments such as tremor and freezing of movement that can be difficult to treat. To unfreeze movement, it has been suggested to provide sensory stimuli. To avoid constant stimulation, episodes with freezing of movement needs to be detected which is a challenge. This can potentially be obtained using a brain-computer interface (BCI) based on movement-related cortical potentials (MRCPs) that are observed in association with the intention to move. The objective in this study was to detect MRCPs from single-trial EEG.Approach. Nine Parkinson patients executed 100 wrist movements and 100 ankle movements while continuous EEG and EMG were recorded. The experiment was repeated in two sessions on separate days. Using temporal, spectral and template matching features, a random forest (RF), linear discriminant analysis, and k-nearest neighbours (kNN) classifier were constructed in offline analysis to discriminate between epochs containing movement-related or idle brain activity to provide an estimation of the performance of a BCI. Three classification scenarios were tested: 1) within-session (using training and testing data from the same session and participant), between-session (using data from the same participant from session one for training and session two for testing), and across-participant (using data from all participants except one for training and testing on the remaining participant).Main results. The within-session classification scenario was associated with the highest classification accuracies which were in the range of 88%-89% with a similar performance across sessions. The performance dropped to 69%-75% and 70%-75% for the between-session and across-participant classification scenario, respectively. The highest classification accuracies were obtained for the RF and kNN classifiers.Significance. The results indicate that it is possible to detect movement intentions in individuals with Parkinson's disease such that they can operate a BCI which may control the delivery of sensory stimuli to unfreeze movement.
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Affiliation(s)
- Mads Jochumsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Sascha Lan Sørensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Frida Krogh Corydon
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Julie Billingsø Roos
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Lee HS, Kim S, Kim H, Baik SM, Kim DH, Chang WH. No Additional Effects of Sequential Facilitatory Cerebral and Cerebellar rTMS in Subacute Stroke Patients. J Pers Med 2024; 14:687. [PMID: 39063941 PMCID: PMC11278256 DOI: 10.3390/jpm14070687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this study was to investigate the additional effects of cerebellar rTMS on the motor recovery of facilitatory rTMS over affected primary motor cortex (M1) in subacute stroke patients. Twenty-eight subacute stroke patients were recruited in this single-blind, randomized, controlled trial. The Cr-Cbll group received Cr-Cbll rTMS stimulation consisting of high-frequency rTMS over affected M1 (10 min), motor training (10 min), and high-frequency rTMS over contralesional Cbll (10 min). The Cr-sham group received sham rTMS instead of high-frequency rTMS over the cerebellum. Ten daily sessions were performed for 2 weeks. A Fugl-Meyer Assessment (FMA) was measured before (T0), immediately after (T1), and 2 months after the intervention (T2). A total of 20 participants (10 in the Cr-Cbll group and 10 in the Cr-sham group) completed the intervention. There was no significant difference in clinical characteristics between the two groups at T0. FMA was significantly improved after the intervention in both Cr-Cbll and Cr-sham groups (p < 0.05). However, there was no significant interaction in FMA between time and group. In conclusion, these results could not demonstrate that rTMS over the contralesional cerebellum has additional effects to facilitatory rTMS over the affected M1 for improving motor function in subacute stroke patients.
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Affiliation(s)
- Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sungwon Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Heegoo Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Seung-min Baik
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
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Sun J, Li C. Editorial: Advanced neurotechnology in stroke rehabilitation. Front Neurol 2024; 15:1440752. [PMID: 38966087 PMCID: PMC11222633 DOI: 10.3389/fneur.2024.1440752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Affiliation(s)
| | - Chong Li
- School of Clinical Medicine, Tsinghua University, Beijing, China
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Kelly AR, Glover DJ. Information Transmission through Biotic-Abiotic Interfaces to Restore or Enhance Human Function. ACS APPLIED BIO MATERIALS 2024; 7:3605-3628. [PMID: 38729914 DOI: 10.1021/acsabm.4c00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Advancements in reliable information transfer across biotic-abiotic interfaces have enabled the restoration of lost human function. For example, communication between neuronal cells and electrical devices restores the ability to walk to a tetraplegic patient and vision to patients blinded by retinal disease. These impactful medical achievements are aided by tailored biotic-abiotic interfaces that maximize information transfer fidelity by considering the physical properties of the underlying biological and synthetic components. This Review develops a modular framework to define and describe the engineering of biotic and abiotic components as well as the design of interfaces to facilitate biotic-abiotic information transfer using light or electricity. Delineating the properties of the biotic, interface, and abiotic components that enable communication can serve as a guide for future research in this highly interdisciplinary field. Application of synthetic biology to engineer light-sensitive proteins has facilitated the control of neural signaling and the restoration of rudimentary vision after retinal blindness. Electrophysiological methodologies that use brain-computer interfaces and stimulating implants to bypass spinal column injuries have led to the rehabilitation of limb movement and walking ability. Cellular interfacing methodologies and on-chip learning capability have been made possible by organic transistors that mimic the information processing capacity of neurons. The collaboration of molecular biologists, material scientists, and electrical engineers in the emerging field of biotic-abiotic interfacing will lead to the development of prosthetics capable of responding to thought and experiencing touch sensation via direct integration into the human nervous system. Further interdisciplinary research will improve electrical and optical interfacing technologies for the restoration of vision, offering greater visual acuity and potentially color vision in the near future.
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Affiliation(s)
- Alexander R Kelly
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Dominic J Glover
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
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Iwama S, Tsuchimoto S, Mizuguchi N, Ushiba J. EEG decoding with spatiotemporal convolutional neural network for visualization and closed-loop control of sensorimotor activities: A simultaneous EEG-fMRI study. Hum Brain Mapp 2024; 45:e26767. [PMID: 38923184 PMCID: PMC11199199 DOI: 10.1002/hbm.26767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Closed-loop neurofeedback training utilizes neural signals such as scalp electroencephalograms (EEG) to manipulate specific neural activities and the associated behavioral performance. A spatiotemporal filter for high-density whole-head scalp EEG using a convolutional neural network can overcome the ambiguity of the signaling source because each EEG signal includes information on the remote regions. We simultaneously acquired EEG and functional magnetic resonance images in humans during the brain-computer interface (BCI) based neurofeedback training and compared the reconstructed and modeled hemodynamic responses of the sensorimotor network. Filters constructed with a convolutional neural network captured activities in the targeted network with spatial precision and specificity superior to those of the EEG signals preprocessed with standard pipelines used in BCI-based neurofeedback paradigms. The middle layers of the trained model were examined to characterize the neuronal oscillatory features that contributed to the reconstruction. Analysis of the layers for spatial convolution revealed the contribution of distributed cortical circuitries to reconstruction, including the frontoparietal and sensorimotor areas, and those of temporal convolution layers that successfully reconstructed the hemodynamic response function. Employing a spatiotemporal filter and leveraging the electrophysiological signatures of the sensorimotor excitability identified in our middle layer analysis would contribute to the development of a further effective neurofeedback intervention.
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Affiliation(s)
- Seitaro Iwama
- Department of Biosciences and Informatics, Faculty of Science and TechnologyKeio UniversityYokohamaJapan
| | - Shohei Tsuchimoto
- School of Fundamental Science and TechnologyGraduate School of Keio UniversityYokohamaJapan
- Department of System NeuroscienceNational Institute for Physiological SciencesOkazakiJapan
| | - Nobuaki Mizuguchi
- Research Organization of Science and TechnologyRitsumeikan UniversityKusatsuJapan
- Institute of Advanced Research for Sport and Health ScienceRitsumeikan UniversityKusatsuJapan
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and TechnologyKeio UniversityYokohamaJapan
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Wang A, Tian X, Jiang D, Yang C, Xu Q, Zhang Y, Zhao S, Zhang X, Jing J, Wei N, Wu Y, Lv W, Yang B, Zang D, Wang Y, Zhang Y, Wang Y, Meng X. Rehabilitation with brain-computer interface and upper limb motor function in ischemic stroke: A randomized controlled trial. MED 2024; 5:559-569.e4. [PMID: 38642555 DOI: 10.1016/j.medj.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Upper limb motor dysfunction is a major problem in the rehabilitation of patients with stroke. Brain-computer interface (BCI) is a kind of communication system that converts the "ideas" in the brain into instructions and has been used in stroke rehabilitation. This study aimed to investigate the efficacy and safety of BCI in rehabilitation training on upper limb motor function among patients with ischemic stroke. METHODS This was an investigator-initiated, multicenter, randomized, open-label, blank-controlled clinical trial with blinded outcome assessment conducted at 17 centers in China. Patients were assigned in a 1:1 ratio to the BCI group or the control group based on traditional rehabilitation training. The primary efficacy outcome is the difference in improvement of the Fugl-Meyer Assessment upper extremity (FMA-UE) score between two groups at month 1 after randomization. The safety outcomes were any adverse events within 3 months. FINDINGS A total of 296 patients with ischemic stroke were enrolled and randomly allocated to the BCI group (n = 150) and the control group (n = 146). The primary efficacy outcomes of FMA-UE score change from baseline to 1 month were 13.17 (95% confidence interval [CI], 11.56-14.79) in the BCI group and 9.83 (95% CI, 8.19-11.47) in the control group (mean difference between groups was 3.35; 95% CI, 1.05-5.65; p = 0.0045). Adverse events occurred in 33 patients (22.00%) in the BCI group and in 31 patients (21.23%) in the control group. CONCLUSIONS BCI rehabilitation training can further improve upper limb motor function based on traditional rehabilitation training in patients with ischemic stroke. This study was registered at ClinicalTrials.gov: NCT04387474. FUNDING This work was supported by the National Key R&D Program of China (2018YFC1312903), the National Key Research and Development Program of China (2022YFC3600600), the Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University (CCMU2022ZKYXZ009), the Beijing Natural Science Foundation Haidian original innovation joint fund (L222123), the Fund for Young Talents of Beijing Medical Management Center (QML20230505), and the high-level public health talents (xuekegugan-02-47).
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Affiliation(s)
- Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xue Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Di Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chengyuan Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yifei Zhang
- Research and Development Center, Shandong Haitian Intelligent Engineering Co., Ltd., Shandong, China
| | - Shaoqing Zhao
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Wei
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuqian Wu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Lv
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Banghua Yang
- School of Mechatronic Engineering and Automation, Research Center of Brain Computer Engineering, Shanghai University, Shanghai, China
| | - Dawei Zang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yumei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Biswas P, Dodakian L, Wang PT, Johnson CA, See J, Chan V, Chou C, Lazouras W, McKenzie AL, Reinkensmeyer DJ, Nguyen DV, Cramer SC, Do AH, Nenadic Z. A single-center, assessor-blinded, randomized controlled clinical trial to test the safety and efficacy of a novel brain-computer interface controlled functional electrical stimulation (BCI-FES) intervention for gait rehabilitation in the chronic stroke population. BMC Neurol 2024; 24:200. [PMID: 38872109 PMCID: PMC11170800 DOI: 10.1186/s12883-024-03710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND In the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise in early feasibility studies. The current study describes the BCI-FES clinical trial, which examines the safety and efficacy of this system, compared to conventional physical therapy (PT), to improve gait velocity for those with chronic gait impairment post-stroke. The trial also aims to find other secondary factors that may impact or accompany these improvements and establish the potential of Hebbian-based rehabilitation therapies. METHODS This Phase II clinical trial is a two-arm, randomized, controlled, longitudinal study with 66 stroke participants in the chronic (> 6 months) stage of gait impairment. The participants undergo either BCI-FES paired with PT or dose-matched PT sessions (three times weekly for four weeks). The primary outcome is gait velocity (10-meter walk test), and secondary outcomes include gait endurance, range of motion, strength, sensation, quality of life, and neurophysiological biomarkers. These measures are acquired longitudinally. DISCUSSION BCI-FES holds promise for gait velocity improvements in stroke patients. This clinical trial will evaluate the safety and efficacy of BCI-FES therapy when compared to dose-matched conventional therapy. The success of this trial will inform the potential utility of a Phase III efficacy trial. TRIAL REGISTRATION The trial was registered as "BCI-FES Therapy for Stroke Rehabilitation" on February 19, 2020, at clinicaltrials.gov with the identifier NCT04279067.
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Grants
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
- 5R01HD095457 National Institutes of Health, United States
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Affiliation(s)
- Piyashi Biswas
- Department of Biomedical Engineering, University of California, Irvine, USA
| | - Lucy Dodakian
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
| | - Po T Wang
- Department of Biomedical Engineering, University of California, Irvine, USA
| | | | - Jill See
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
| | - Vicky Chan
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
| | - Cathy Chou
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
| | - Wendy Lazouras
- Department of Rehabilitation Services, University of California at Irvine Medical Center, Orange, USA
- Department of Epidemiology and Biostatistics, University of California, Irvine, USA
| | - Alison L McKenzie
- Department of Neurology, University of California, Irvine, USA
- Department of Physical Therapy, Chapman University, Orange, USA
| | - David J Reinkensmeyer
- Department of Anatomy and Neurobiology, University of California, Irvine, USA
- Department of Mechanical and Aerospace Engineering, University of California, Irvine, USA
| | - Danh V Nguyen
- Department of General Internal Medicine, University of California, Irvine, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles, USA
- California Rehabilitation Institute, Los Angeles, USA
| | - An H Do
- Department of Neurology, University of California, Irvine, USA.
| | - Zoran Nenadic
- Department of Biomedical Engineering, University of California, Irvine, USA.
- Department of Electrical Engineering and Computer Science, University of California, Irvine, USA.
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Pan H, Ding P, Wang F, Li T, Zhao L, Nan W, Fu Y, Gong A. Comprehensive evaluation methods for translating BCI into practical applications: usability, user satisfaction and usage of online BCI systems. Front Hum Neurosci 2024; 18:1429130. [PMID: 38903409 PMCID: PMC11188342 DOI: 10.3389/fnhum.2024.1429130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Although brain-computer interface (BCI) is considered a revolutionary advancement in human-computer interaction and has achieved significant progress, a considerable gap remains between the current technological capabilities and their practical applications. To promote the translation of BCI into practical applications, the gold standard for online evaluation for classification algorithms of BCI has been proposed in some studies. However, few studies have proposed a more comprehensive evaluation method for the entire online BCI system, and it has not yet received sufficient attention from the BCI research and development community. Therefore, the qualitative leap from analyzing and modeling for offline BCI data to the construction of online BCI systems and optimizing their performance is elaborated, and then user-centred is emphasized, and then the comprehensive evaluation methods for translating BCI into practical applications are detailed and reviewed in the article, including the evaluation of the usability (including effectiveness and efficiency of systems), the evaluation of the user satisfaction (including BCI-related aspects, etc.), and the evaluation of the usage (including the match between the system and user, etc.) of online BCI systems. Finally, the challenges faced in the evaluation of the usability and user satisfaction of online BCI systems, the efficacy of online BCI systems, and the integration of BCI and artificial intelligence (AI) and/or virtual reality (VR) and other technologies to enhance the intelligence and user experience of the system are discussed. It is expected that the evaluation methods for online BCI systems elaborated in this review will promote the translation of BCI into practical applications.
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Affiliation(s)
- He Pan
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, China
- Brain Cognition and Brain-Computer Intelligence Integration Group, Kunming University of Science and Technology, Kunming, China
| | - Peng Ding
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, China
- Brain Cognition and Brain-Computer Intelligence Integration Group, Kunming University of Science and Technology, Kunming, China
| | - Fan Wang
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, China
- Brain Cognition and Brain-Computer Intelligence Integration Group, Kunming University of Science and Technology, Kunming, China
| | - Tianwen Li
- Brain Cognition and Brain-Computer Intelligence Integration Group, Kunming University of Science and Technology, Kunming, China
- Faculty of Science, Kunming University of Science and Technology, Kunming, China
| | - Lei Zhao
- Brain Cognition and Brain-Computer Intelligence Integration Group, Kunming University of Science and Technology, Kunming, China
- Faculty of Science, Kunming University of Science and Technology, Kunming, China
| | - Wenya Nan
- Department of Psychology, School of Education, Shanghai Normal University, Shanghai, China
| | - Yunfa Fu
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming, China
- Brain Cognition and Brain-Computer Intelligence Integration Group, Kunming University of Science and Technology, Kunming, China
| | - Anmin Gong
- School of Information Engineering, Chinese People's Armed Police Force Engineering University, Xi’an, China
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Ma ZZ, Wu JJ, Cao Z, Hua XY, Zheng MX, Xing XX, Ma J, Xu JG. Motor imagery-based brain-computer interface rehabilitation programs enhance upper extremity performance and cortical activation in stroke patients. J Neuroeng Rehabil 2024; 21:91. [PMID: 38812014 PMCID: PMC11134735 DOI: 10.1186/s12984-024-01387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/18/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The most challenging aspect of rehabilitation is the repurposing of residual functional plasticity in stroke patients. To achieve this, numerous plasticity-based clinical rehabilitation programs have been developed. This study aimed to investigate the effects of motor imagery (MI)-based brain-computer interface (BCI) rehabilitation programs on upper extremity hand function in patients with chronic hemiplegia. DESIGN A 2010 Consolidated Standards for Test Reports (CONSORT)-compliant randomized controlled trial. METHODS Forty-six eligible stroke patients with upper limb motor dysfunction participated in the study, six of whom dropped out. The patients were randomly divided into a BCI group and a control group. The BCI group received BCI therapy and conventional rehabilitation therapy, while the control group received conventional rehabilitation only. The Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) score was used as the primary outcome to evaluate upper extremity motor function. Additionally, functional magnetic resonance imaging (fMRI) scans were performed on all patients before and after treatment, in both the resting and task states. We measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), z conversion of ALFF (zALFF), and z conversion of ReHo (ReHo) in the resting state. The task state was divided into four tasks: left-hand grasping, right-hand grasping, imagining left-hand grasping, and imagining right-hand grasping. Finally, meaningful differences were assessed using correlation analysis of the clinical assessments and functional measures. RESULTS A total of 40 patients completed the study, 20 in the BCI group and 20 in the control group. Task-related blood-oxygen-level-dependent (BOLD) analysis showed that when performing the motor grasping task with the affected hand, the BCI group exhibited significant activation in the ipsilateral middle cingulate gyrus, precuneus, inferior parietal gyrus, postcentral gyrus, middle frontal gyrus, superior temporal gyrus, and contralateral middle cingulate gyrus. When imagining a grasping task with the affected hand, the BCI group exhibited greater activation in the ipsilateral superior frontal gyrus (medial) and middle frontal gyrus after treatment. However, the activation of the contralateral superior frontal gyrus decreased in the BCI group relative to the control group. Resting-state fMRI revealed increased zALFF in multiple cerebral regions, including the contralateral precentral gyrus and calcarine and the ipsilateral middle occipital gyrus and cuneus, and decreased zALFF in the ipsilateral superior temporal gyrus in the BCI group relative to the control group. Increased zReHo in the ipsilateral cuneus and contralateral calcarine and decreased zReHo in the contralateral middle temporal gyrus, temporal pole, and superior temporal gyrus were observed post-intervention. According to the subsequent correlation analysis, the increase in the FMA-UE score showed a positive correlation with the mean zALFF of the contralateral precentral gyrus (r = 0.425, P < 0.05), the mean zReHo of the right cuneus (r = 0.399, P < 0.05). CONCLUSION In conclusion, BCI therapy is effective and safe for arm rehabilitation after severe poststroke hemiparesis. The correlation of the zALFF of the contralateral precentral gyrus and the zReHo of the ipsilateral cuneus with motor improvements suggested that these values can be used as prognostic measures for BCI-based stroke rehabilitation. We found that motor function was related to visual and spatial processing, suggesting potential avenues for refining treatment strategies for stroke patients. TRIAL REGISTRATION The trial is registered in the Chinese Clinical Trial Registry (number ChiCTR2000034848, registered July 21, 2020).
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Affiliation(s)
- Zhen-Zhen Ma
- Department of Rehabilitation Medicine, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Zhi Cao
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Department of Trauma and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Mou-Xiong Zheng
- Department of Trauma and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Jian-Guang Xu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China.
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10
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Awuah WA, Ahluwalia A, Darko K, Sanker V, Tan JK, Tenkorang PO, Ben-Jaafar A, Ranganathan S, Aderinto N, Mehta A, Shah MH, Lee Boon Chun K, Abdul-Rahman T, Atallah O. Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications. World Neurosurg 2024; 189:138-153. [PMID: 38789029 DOI: 10.1016/j.wneu.2024.05.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
Brain-computer interfaces (BCIs), a remarkable technological advancement in neurology and neurosurgery, mark a significant leap since the inception of electroencephalography in 1924. These interfaces effectively convert central nervous system signals into commands for external devices, offering revolutionary benefits to patients with severe communication and motor impairments due to a myriad of neurological conditions like stroke, spinal cord injuries, and neurodegenerative disorders. BCIs enable these individuals to communicate and interact with their environment, using their brain signals to operate interfaces for communication and environmental control. This technology is especially crucial for those completely locked in, providing a communication lifeline where other methods fall short. The advantages of BCIs are profound, offering autonomy and an improved quality of life for patients with severe disabilities. They allow for direct interaction with various devices and prostheses, bypassing damaged or nonfunctional neural pathways. However, challenges persist, including the complexity of accurately interpreting brain signals, the need for individual calibration, and ensuring reliable, long-term use. Additionally, ethical considerations arise regarding autonomy, consent, and the potential for dependence on technology. Despite these challenges, BCIs represent a transformative development in neurotechnology, promising enhanced patient outcomes and a deeper understanding of brain-machine interfaces.
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Affiliation(s)
| | - Arjun Ahluwalia
- School of Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Kwadwo Darko
- Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, India
| | - Joecelyn Kirani Tan
- Faculty of Medicine, University of St Andrews, St. Andrews, Scotland, United Kingdom.
| | | | - Adam Ben-Jaafar
- University College Dublin, School of Medicine, Belfield, Dublin, Ireland
| | - Sruthi Ranganathan
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
| | - Aashna Mehta
- University of Debrecen-Faculty of Medicine, Debrecen, Hungary
| | | | | | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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11
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Barmpas K, Panagakis Y, Zoumpourlis G, Adamos DA, Laskaris N, Zafeiriou S. A causal perspective on brainwave modeling for brain-computer interfaces. J Neural Eng 2024; 21:036001. [PMID: 38621380 DOI: 10.1088/1741-2552/ad3eb5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/15/2024] [Indexed: 04/17/2024]
Abstract
Objective. Machine learning (ML) models have opened up enormous opportunities in the field of brain-computer Interfaces (BCIs). Despite their great success, they usually face severe limitations when they are employed in real-life applications outside a controlled laboratory setting.Approach. Mixing causal reasoning, identifying causal relationships between variables of interest, with brainwave modeling can change one's viewpoint on some of these major challenges which can be found in various stages in the ML pipeline, ranging from data collection and data pre-processing to training methods and techniques.Main results. In this work, we employ causal reasoning and present a framework aiming to breakdown and analyze important challenges of brainwave modeling for BCIs.Significance. Furthermore, we present how general ML practices as well as brainwave-specific techniques can be utilized and solve some of these identified challenges. And finally, we discuss appropriate evaluation schemes in order to measure these techniques' performance and efficiently compare them with other methods that will be developed in the future.
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Affiliation(s)
- Konstantinos Barmpas
- Department of Computing, Imperial College London, London SW7 2RH, United Kingdom
- Cogitat Ltd, London, United Kingdom
| | - Yannis Panagakis
- Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens 15784, Greece
- Archimedes Research Unit, Research Center Athena, Athens 15125, Greece
- Cogitat Ltd, London, United Kingdom
| | | | - Dimitrios A Adamos
- Department of Computing, Imperial College London, London SW7 2RH, United Kingdom
- Cogitat Ltd, London, United Kingdom
| | - Nikolaos Laskaris
- School of Informatics, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
- Cogitat Ltd, London, United Kingdom
| | - Stefanos Zafeiriou
- Department of Computing, Imperial College London, London SW7 2RH, United Kingdom
- Cogitat Ltd, London, United Kingdom
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12
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Gangadharan SK, Ramakrishnan S, Paek A, Ravindran A, Prasad VA, Vidal JLC. Characterization of Event Related Desynchronization in Chronic Stroke Using Motor Imagery Based Brain Computer Interface for Upper Limb Rehabilitation. Ann Indian Acad Neurol 2024; 27:297-306. [PMID: 38835164 PMCID: PMC11232817 DOI: 10.4103/aian.aian_1056_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/02/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE Motor imagery-based brain-computer interface (MI-BCI) is a promising novel mode of stroke rehabilitation. The current study aims to investigate the feasibility of MI-BCI in upper limb rehabilitation of chronic stroke survivors and also to study the early event-related desynchronization after MI-BCI intervention. METHODS Changes in the characteristics of sensorimotor rhythm modulations in response to a short brain-computer interface (BCI) intervention for upper limb rehabilitation of stroke-disabled hand and normal hand were examined. The participants were trained to modulate their brain rhythms through motor imagery or execution during calibration, and they played a virtual marble game during the feedback session, where the movement of the marble was controlled by their sensorimotor rhythm. RESULTS Ipsilesional and contralesional activities were observed in the brain during the upper limb rehabilitation using BCI intervention. All the participants were able to successfully control the position of the virtual marble using their sensorimotor rhythm. CONCLUSIONS The preliminary results support the feasibility of BCI in upper limb rehabilitation and unveil the capability of MI-BCI as a promising medical intervention. This study provides a strong platform for clinicians to build upon new strategies for stroke rehabilitation by integrating MI-BCI with various therapeutic options to induce neural plasticity and recovery.
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Affiliation(s)
- Sagila K Gangadharan
- Department of Electrical Engineering, Indian Institute of Technology Palakkad, Palakkad, Kerala, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India
| | - Andrew Paek
- Department of Electrical and Computer Engineering, Noninvasive Brain Machine Interface Systems Lab, University of Houston, Houston, USA
| | - Akshay Ravindran
- Department of Electrical and Computer Engineering, Noninvasive Brain Machine Interface Systems Lab, University of Houston, Houston, USA
| | - Vinod A Prasad
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore
| | - Jose L Contreras Vidal
- Department of Electrical and Computer Engineering, Noninvasive Brain Machine Interface Systems Lab, University of Houston, Houston, USA
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13
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Xu S, Li C, Wei C, Kang X, Shu S, Liu G, Xu Z, Han M, Luo J, Tang W. Closed-Loop Wearable Device Network of Intrinsically-Controlled, Bilateral Coordinated Functional Electrical Stimulation for Stroke. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2304763. [PMID: 38429890 PMCID: PMC11077660 DOI: 10.1002/advs.202304763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/28/2024] [Indexed: 03/03/2024]
Abstract
Innovative functional electrical stimulation has demonstrated effectiveness in enhancing daily walking and rehabilitating stroke patients with foot drop. However, its lack of precision in stimulating timing, individual adaptivity, and bilateral symmetry, resulted in diminished clinical efficacy. Therefore, a closed-loop wearable device network of intrinsically controlled functional electrical stimulation (CI-FES) system is proposed, which utilizes the personal surface myoelectricity, derived from the intrinsic neuro signal, as the switch to activate/deactivate the stimulation on the affected side. Simultaneously, it decodes the myoelectricity signal of the patient's healthy side to adjust the stimulation intensity, forming an intrinsically controlled loop with the inertial measurement units. With CI-FES assistance, patients' walking ability significantly improved, evidenced by the shift in ankle joint angle mean and variance from 105.53° and 28.84 to 102.81° and 17.71, and the oxyhemoglobin concentration tested by the functional near-infrared spectroscopy. In long-term CI-FES-assisted clinical testing, the discriminability in machine learning classification between patients and healthy individuals gradually decreased from 100% to 92.5%, suggesting a remarkable recovery tendency, further substantiated by performance on the functional movement scales. The developed CI-FES system is crucial for contralateral-hemiplegic stroke recovery, paving the way for future closed-loop stimulation systems in stroke rehabilitation is anticipated.
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Affiliation(s)
- Shuxing Xu
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- Center on Nanoenergy ResearchSchool of Physical Science & TechnologyGuangxi UniversityNanning530004China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
| | - Chengyu Li
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
| | - Conghui Wei
- Rehabilitation Medicine DepartmentThe Second Affiliated Hospital of Nanchang UniversityNanchang City330006P. R. China
| | - Xinfang Kang
- Rehabilitation Medicine DepartmentThe Second Affiliated Hospital of Nanchang UniversityNanchang City330006P. R. China
| | - Sheng Shu
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
| | - Guanlin Liu
- Center on Nanoenergy ResearchSchool of Physical Science & TechnologyGuangxi UniversityNanning530004China
| | - Zijie Xu
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
| | - Mengdi Han
- Department of Biomedical EngineeringCollege of Future TechnologyPeking UniversityBeijing100871China
| | - Jun Luo
- Rehabilitation Medicine DepartmentThe Second Affiliated Hospital of Nanchang UniversityNanchang City330006P. R. China
| | - Wei Tang
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijing101400China
- School of Nanoscience and TechnologyUniversity of Chinese Academy of SciencesBeijing100049China
- Institute of Applied NanotechnologyJiaxingZhejiang314031China
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14
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Dawson J, Abdul-Rahim AH, Kimberley TJ. Neurostimulation for treatment of post-stroke impairments. Nat Rev Neurol 2024; 20:259-268. [PMID: 38570705 DOI: 10.1038/s41582-024-00953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
Neurostimulation, the use of electrical stimulation to modulate the activity of the nervous system, is now commonly used for the treatment of chronic pain, movement disorders and epilepsy. Many neurostimulation techniques have now shown promise for the treatment of physical impairments in people with stroke. In 2021, vagus nerve stimulation was approved by the FDA as an adjunct to intensive rehabilitation therapy for the treatment of chronic upper extremity deficits after ischaemic stroke. In 2024, pharyngeal electrical stimulation was conditionally approved by the UK National Institute for Health and Care Excellence for neurogenic dysphagia in people with stroke who have a tracheostomy. Many other approaches have also been tested in pivotal device trials and a number of approaches are in early-phase study. Typically, neurostimulation techniques aim to increase neuroplasticity in response to training and rehabilitation, although the putative mechanisms of action differ and are not fully understood. Neurostimulation techniques offer a number of practical advantages for use after stroke, such as precise dosing and timing, but can be invasive and costly to implement. This Review focuses on neurostimulation techniques that are now in clinical use or that have reached the stage of pivotal trials and show considerable promise for the treatment of post-stroke impairments.
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Affiliation(s)
- Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Azmil H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Teresa J Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Institute of Health Professions, Massachusetts General Hospital, Boston, MA, USA
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Lo YT, Lim MJR, Kok CY, Wang S, Blok SZ, Ang TY, Ng VYP, Rao JP, Chua KSG. Neural Interface-Based Motor Neuroprosthesis in Poststroke Upper Limb Neurorehabilitation: An Individual Patient Data Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00910-9. [PMID: 38579958 DOI: 10.1016/j.apmr.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To determine the efficacy of neural interface-based neurorehabilitation, including brain-computer interface, through conventional and individual patient data (IPD) meta-analysis and to assess clinical parameters associated with positive response to neural interface-based neurorehabilitation. DATA SOURCES PubMed, EMBASE, and Cochrane Library databases up to February 2022 were reviewed. STUDY SELECTION Studies using neural interface-controlled physical effectors (functional electrical stimulation and/or powered exoskeletons) and reported Fugl-Meyer Assessment-upper-extremity (FMA-UE) scores were identified. This meta-analysis was prospectively registered on PROSPERO (#CRD42022312428). PRISMA guidelines were followed. DATA EXTRACTION Changes in FMA-UE scores were pooled to estimate the mean effect size. Subgroup analyses were performed on clinical parameters and neural interface parameters with both study-level variables and IPD. DATA SYNTHESIS Forty-six studies containing 617 patients were included. Twenty-nine studies involving 214 patients reported IPD. FMA-UE scores increased by a mean of 5.23 (95% confidence interval [CI]: 3.85-6.61). Systems that used motor attempt resulted in greater FMA-UE gain than motor imagery, as did training lasting >4 vs ≤4 weeks. On IPD analysis, the mean time-to-improvement above minimal clinically important difference (MCID) was 12 weeks (95% CI: 7 to not reached). At 6 months, 58% improved above MCID (95% CI: 41%-70%). Patients with severe impairment (P=.042) and age >50 years (P=.0022) correlated with the failure to improve above the MCID on univariate log-rank tests. However, these factors were only borderline significant on multivariate Cox analysis (hazard ratio [HR] 0.15, P=.08 and HR 0.47, P=.06, respectively). CONCLUSION Neural interface-based motor rehabilitation resulted in significant, although modest, reductions in poststroke impairment and should be considered for wider applications in stroke neurorehabilitation.
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Affiliation(s)
- Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute; Duke-NUS Medical School.
| | - Mervyn Jun Rui Lim
- Department of Neurosurgery, National University Hospital; National University of Singapore, Yong Loo Lin School of Medicine
| | - Chun Yen Kok
- Department of Neurosurgery, National Neuroscience Institute
| | - Shilin Wang
- Department of Neurosurgery, National Neuroscience Institute
| | | | - Ting Yao Ang
- Department of Neurosurgery, National Neuroscience Institute
| | | | - Jai Prashanth Rao
- Department of Neurosurgery, National Neuroscience Institute; Duke-NUS Medical School
| | - Karen Sui Geok Chua
- National University of Singapore, Yong Loo Lin School of Medicine; Institute of Rehabilitation Excellence, Tan Tock Seng Hospital Rehabilitation Centre; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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16
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Behboodi A, Kline J, Gravunder A, Phillips C, Parker SM, Damiano DL. Development and evaluation of a BCI-neurofeedback system with real-time EEG detection and electrical stimulation assistance during motor attempt for neurorehabilitation of children with cerebral palsy. Front Hum Neurosci 2024; 18:1346050. [PMID: 38633751 PMCID: PMC11021665 DOI: 10.3389/fnhum.2024.1346050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
In the realm of motor rehabilitation, Brain-Computer Interface Neurofeedback Training (BCI-NFT) emerges as a promising strategy. This aims to utilize an individual's brain activity to stimulate or assist movement, thereby strengthening sensorimotor pathways and promoting motor recovery. Employing various methodologies, BCI-NFT has been shown to be effective for enhancing motor function primarily of the upper limb in stroke, with very few studies reported in cerebral palsy (CP). Our main objective was to develop an electroencephalography (EEG)-based BCI-NFT system, employing an associative learning paradigm, to improve selective control of ankle dorsiflexion in CP and potentially other neurological populations. First, in a cohort of eight healthy volunteers, we successfully implemented a BCI-NFT system based on detection of slow movement-related cortical potentials (MRCP) from EEG generated by attempted dorsiflexion to simultaneously activate Neuromuscular Electrical Stimulation which assisted movement and served to enhance sensory feedback to the sensorimotor cortex. Participants also viewed a computer display that provided real-time visual feedback of ankle range of motion with an individualized target region displayed to encourage maximal effort. After evaluating several potential strategies, we employed a Long short-term memory (LSTM) neural network, a deep learning algorithm, to detect the motor intent prior to movement onset. We then evaluated the system in a 10-session ankle dorsiflexion training protocol on a child with CP. By employing transfer learning across sessions, we could significantly reduce the number of calibration trials from 50 to 20 without compromising detection accuracy, which was 80.8% on average. The participant was able to complete the required calibration trials and the 100 training trials per session for all 10 sessions and post-training demonstrated increased ankle dorsiflexion velocity, walking speed and step length. Based on exceptional system performance, feasibility and preliminary effectiveness in a child with CP, we are now pursuing a clinical trial in a larger cohort of children with CP.
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Affiliation(s)
- Ahad Behboodi
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
- Neurorehabilitation and Biomechanics Research Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Julia Kline
- Neurorehabilitation and Biomechanics Research Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Andrew Gravunder
- Neurorehabilitation and Biomechanics Research Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Connor Phillips
- Neurorehabilitation and Biomechanics Research Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Sheridan M. Parker
- Neurorehabilitation and Biomechanics Research Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Diane L. Damiano
- Neurorehabilitation and Biomechanics Research Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
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17
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Li X, Li H, Liu Y, Liang W, Zhang L, Zhou F, Zhang Z, Yuan X. The effect of electromyographic feedback functional electrical stimulation on the plantar pressure in stroke patients with foot drop. Front Neurosci 2024; 18:1377702. [PMID: 38629052 PMCID: PMC11018889 DOI: 10.3389/fnins.2024.1377702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose The purpose of this study was to observe, using Footscan analysis, the effect of electromyographic feedback functional electrical stimulation (FES) on the changes in the plantar pressure of drop foot patients. Methods This case-control study enrolled 34 stroke patients with foot drop. There were 17 cases received FES for 20 min per day, 5 days per week for 4 weeks (the FES group) and the other 17 cases only received basic rehabilitations (the control group). Before and after 4 weeks, the walking speed, spatiotemporal parameters and plantar pressure were measured. Results After 4 weeks treatments, Both the FES and control groups had increased walking speed and single stance phase percentage, decreased step length symmetry index (SI), double stance phase percentage and start time of the heel after 4 weeks (p < 0.05). The increase in walking speed and decrease in step length SI in the FES group were more significant than the control group after 4 weeks (p < 0.05). The FES group had an increased initial contact phase, decreased SI of the maximal force (Max F) and impulse in the medial heel after 4 weeks (p < 0.05). Conclusion The advantages of FES were: the improvement of gait speed, step length SI, and the enhancement of propulsion force were more significant. The initial contact phase was closer to the normal range, which implies that the control of ankle dorsiflexion was improved. The plantar dynamic parameters between the two sides of the foot were more balanced than the control group. FES is more effective than basic rehabilitations for stroke patients with foot drop based on current spatiotemporal parameters and plantar pressure results.
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Affiliation(s)
| | | | | | | | | | | | - Zhiqiang Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiangnan Yuan
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
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18
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Buccilli B. Exploring new horizons: Emerging therapeutic strategies for pediatric stroke. Exp Neurol 2024; 374:114701. [PMID: 38278205 DOI: 10.1016/j.expneurol.2024.114701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
Pediatric stroke presents unique challenges, and optimizing treatment strategies is essential for improving outcomes in this vulnerable population. This review aims to provide an overview of new, innovative, and potential treatments for pediatric stroke, with a primary objective to stimulate further research in this field. Our review highlights several promising approaches in the realm of pediatric stroke management, including but not limited to stem cell therapy and robotic rehabilitation. These innovative interventions offer new avenues for enhancing functional recovery, reducing long-term disability, and tailoring treatments to individual patient needs. The findings of this review underscore the importance of ongoing research and development of innovative treatments in pediatric stroke. These advancements hold significant clinical relevance, offering the potential to improve the lives of children affected by stroke by enhancing the precision, efficacy, and accessibility of therapeutic interventions. Embracing these innovations is essential in our pursuit of better outcomes and a brighter future for pediatric stroke care.
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Affiliation(s)
- Barbara Buccilli
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
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19
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Chen D, Zhao Z, Zhang S, Chen S, Wu X, Shi J, Liu N, Pan C, Tang Y, Meng C, Zhao X, Tao B, Liu W, Chen D, Ding H, Zhang P, Tang Z. Evolving Therapeutic Landscape of Intracerebral Hemorrhage: Emerging Cutting-Edge Advancements in Surgical Robots, Regenerative Medicine, and Neurorehabilitation Techniques. Transl Stroke Res 2024:10.1007/s12975-024-01244-x. [PMID: 38558011 DOI: 10.1007/s12975-024-01244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
Intracerebral hemorrhage (ICH) is the most serious form of stroke and has limited available therapeutic options. As knowledge on ICH rapidly develops, cutting-edge techniques in the fields of surgical robots, regenerative medicine, and neurorehabilitation may revolutionize ICH treatment. However, these new advances still must be translated into clinical practice. In this review, we examined several emerging therapeutic strategies and their major challenges in managing ICH, with a particular focus on innovative therapies involving robot-assisted minimally invasive surgery, stem cell transplantation, in situ neuronal reprogramming, and brain-computer interfaces. Despite the limited expansion of the drug armamentarium for ICH over the past few decades, the judicious selection of more efficacious therapeutic modalities and the exploration of multimodal combination therapies represent opportunities to improve patient prognoses after ICH.
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Affiliation(s)
- Danyang Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhixian Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shenglun Zhang
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuan Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian Shi
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Na Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yingxin Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cai Meng
- School of Astronautics, Beihang University, Beijing, China
| | - Xingwei Zhao
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Tao
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenjie Liu
- Beijing WanTeFu Medical Instrument Co., Ltd., Beijing, China
| | - Diansheng Chen
- Institute of Robotics, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Han Ding
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Jeong CH, Lim H, Lee J, Lee HS, Ku J, Kang YJ. Attentional state-synchronous peripheral electrical stimulation during action observation induced distinct modulation of corticospinal plasticity after stroke. Front Neurosci 2024; 18:1373589. [PMID: 38606309 PMCID: PMC11007104 DOI: 10.3389/fnins.2024.1373589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Brain computer interface-based action observation (BCI-AO) is a promising technique in detecting the user's cortical state of visual attention and providing feedback to assist rehabilitation. Peripheral nerve electrical stimulation (PES) is a conventional method used to enhance outcomes in upper extremity function by increasing activation in the motor cortex. In this study, we examined the effects of different pairings of peripheral nerve electrical stimulation (PES) during BCI-AO tasks and their impact on corticospinal plasticity. Materials and methods Our innovative BCI-AO interventions decoded user's attentive watching during task completion. This process involved providing rewarding visual cues while simultaneously activating afferent pathways through PES. Fifteen stroke patients were included in the analysis. All patients underwent a 15 min BCI-AO program under four different experimental conditions: BCI-AO without PES, BCI-AO with continuous PES, BCI-AO with triggered PES, and BCI-AO with reverse PES application. PES was applied at the ulnar nerve of the wrist at an intensity equivalent to 120% of the sensory threshold and a frequency of 50 Hz. The experiment was conducted randomly at least 3 days apart. To assess corticospinal and peripheral nerve excitability, we compared pre and post-task (post 0, post 20 min) parameters of motor evoked potential and F waves under the four conditions in the muscle of the affected hand. Results The findings indicated that corticospinal excitability in the affected hemisphere was higher when PES was synchronously applied with AO training, using BCI during a state of attentive watching. In contrast, there was no effect on corticospinal activation when PES was applied continuously or in the reverse manner. This paradigm promoted corticospinal plasticity for up to 20 min after task completion. Importantly, the effect was more evident in patients over 65 years of age. Conclusion The results showed that task-driven corticospinal plasticity was higher when PES was applied synchronously with a highly attentive brain state during the action observation task, compared to continuous or asynchronous application. This study provides insight into how optimized BCI technologies dependent on brain state used in conjunction with other rehabilitation training could enhance treatment-induced neural plasticity.
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Affiliation(s)
- Chang Hyeon Jeong
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Hyunmi Lim
- Department of Biomedical Engineering, Keimyung University, Daegu, Republic of Korea
| | - Jiye Lee
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, Keimyung University, Daegu, Republic of Korea
| | - Youn Joo Kang
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
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Losanno E, Badi M, Roussinova E, Bogaard A, Delacombaz M, Shokur S, Micera S. An Investigation of Manifold-Based Direct Control for a Brain-to-Body Neural Bypass. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2024; 5:271-280. [PMID: 38766541 PMCID: PMC11100864 DOI: 10.1109/ojemb.2024.3381475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 05/22/2024] Open
Abstract
Objective: Brain-body interfaces (BBIs) have emerged as a very promising solution for restoring voluntary hand control in people with upper-limb paralysis. The BBI module decoding motor commands from brain signals should provide the user with intuitive, accurate, and stable control. Here, we present a preliminary investigation in a monkey of a brain decoding strategy based on the direct coupling between the activity of intrinsic neural ensembles and output variables, aiming at achieving ease of learning and long-term robustness. Results: We identified an intrinsic low-dimensional space (called manifold) capturing the co-variation patterns of the monkey's neural activity associated to reach-to-grasp movements. We then tested the animal's ability to directly control a computer cursor using cortical activation along the manifold axes. By daily recalibrating only scaling factors, we achieved rapid learning and stable high performance in simple, incremental 2D tasks over more than 12 weeks of experiments. Finally, we showed that this brain decoding strategy can be effectively coupled to peripheral nerve stimulation to trigger voluntary hand movements. Conclusions: These results represent a proof of concept of manifold-based direct control for BBI applications.
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Affiliation(s)
- E. Losanno
- The Biorobotics Institute and Department of Excellence in Robotics and AIScuola Superiore Sant'Anna56025PisaItaly
- Modular Implantable Neuroprostheses (MINE) LaboratoryUniversità Vita-Salute San Raffaele and Scuola Superiore Sant'AnnaMilanItaly
| | - M. Badi
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of BioengineeringÉcole Polytechnique Fédérale de Lausanne (EPFL)1015LausanneSwitzerland
| | - E. Roussinova
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of BioengineeringÉcole Polytechnique Fédérale de Lausanne (EPFL)1015LausanneSwitzerland
| | - A. Bogaard
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and MedicineUniversity of Fribourg1700FribourgSwitzerland
| | - M. Delacombaz
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and MedicineUniversity of Fribourg1700FribourgSwitzerland
| | - S. Shokur
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of BioengineeringÉcole Polytechnique Fédérale de Lausanne (EPFL)1015LausanneSwitzerland
| | - S. Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AIScuola Superiore Sant'Anna56025PisaItaly
- Modular Implantable Neuroprostheses (MINE) LaboratoryUniversità Vita-Salute San Raffaele and Scuola Superiore Sant'AnnaMilanItaly
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of BioengineeringÉcole Polytechnique Fédérale de Lausanne (EPFL)1015LausanneSwitzerland
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22
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Sieghartsleitner S, Sebastián-Romagosa M, Cho W, Grünwald J, Ortner R, Scharinger J, Kamada K, Guger C. Upper extremity training followed by lower extremity training with a brain-computer interface rehabilitation system. Front Neurosci 2024; 18:1346607. [PMID: 38500488 PMCID: PMC10944934 DOI: 10.3389/fnins.2024.1346607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Brain-computer interfaces (BCIs) based on functional electrical stimulation have been used for upper extremity motor rehabilitation after stroke. However, little is known about their efficacy for multiple BCI treatments. In this study, 19 stroke patients participated in 25 upper extremity followed by 25 lower extremity BCI training sessions. Methods Patients' functional state was assessed using two sets of clinical scales for the two BCI treatments. The Upper Extremity Fugl-Meyer Assessment (FMA-UE) and the 10-Meter Walk Test (10MWT) were the primary outcome measures for the upper and lower extremity BCI treatments, respectively. Results Patients' motor function as assessed by the FMA-UE improved by an average of 4.2 points (p < 0.001) following upper extremity BCI treatment. In addition, improvements in activities of daily living and clinically relevant improvements in hand and finger spasticity were observed. Patients showed further improvements after the lower extremity BCI treatment, with walking speed as measured by the 10MWT increasing by 0.15 m/s (p = 0.001), reflecting a substantial meaningful change. Furthermore, a clinically relevant improvement in ankle spasticity and balance and mobility were observed. Discussion The results of the current study provide evidence that both upper and lower extremity BCI treatments, as well as their combination, are effective in facilitating functional improvements after stroke. In addition, and most importantly improvements did not stop after the first 25 upper extremity BCI sessions.
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Affiliation(s)
- Sebastian Sieghartsleitner
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | | | - Woosang Cho
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
| | - Johannes Grünwald
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | - Rupert Ortner
- g.tec Medical Engineering Spain S.L., Barcelona, Spain
| | - Josef Scharinger
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | | | - Christoph Guger
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- g.tec Medical Engineering Spain S.L., Barcelona, Spain
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Reichert C, Sweeney-Reed CM, Hinrichs H, Dürschmid S. A toolbox for decoding BCI commands based on event-related potentials. Front Hum Neurosci 2024; 18:1358809. [PMID: 38505100 PMCID: PMC10949531 DOI: 10.3389/fnhum.2024.1358809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024] Open
Abstract
Commands in brain-computer interface (BCI) applications often rely on the decoding of event-related potentials (ERP). For instance, the P300 potential is frequently used as a marker of attention to an oddball event. Error-related potentials and the N2pc signal are further examples of ERPs used for BCI control. One challenge in decoding brain activity from the electroencephalogram (EEG) is the selection of the most suitable channels and appropriate features for a particular classification approach. Here we introduce a toolbox that enables ERP-based decoding using the full set of channels, while automatically extracting informative components from relevant channels. The strength of our approach is that it handles sequences of stimuli that encode multiple items using binary classification, such as target vs. nontarget events typically used in ERP-based spellers. We demonstrate examples of application scenarios and evaluate the performance of four openly available datasets: a P300-based matrix speller, a P300-based rapid serial visual presentation (RSVP) speller, a binary BCI based on the N2pc, and a dataset capturing error potentials. We show that our approach achieves performances comparable to those in the original papers, with the advantage that only conventional preprocessing is required by the user, while channel weighting and decoding algorithms are internally performed. Thus, we provide a tool to reliably decode ERPs for BCI use with minimal programming requirements.
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Affiliation(s)
- Christoph Reichert
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Catherine M. Sweeney-Reed
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto von Guericke University, Magdeburg, Germany
| | - Hermann Hinrichs
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto von Guericke University, Magdeburg, Germany
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | - Stefan Dürschmid
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto von Guericke University, Magdeburg, Germany
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Cellular Neuroscience, Leibniz Institute for Neurobiology, Magdeburg, Germany
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24
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Kumari R, Dybus A, Purcell M, Vučković A. Motor priming to enhance the effect of physical therapy in people with spinal cord injury. J Spinal Cord Med 2024:1-15. [PMID: 38391261 DOI: 10.1080/10790268.2024.2317011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
CONTEXT Brain-Computer Interface (BCI) is an emerging neurorehabilitation therapy for people with spinal cord injury (SCI). OBJECTIVE The study aimed to test whether priming the sensorimotor system using BCI-controlled functional electrical stimulation (FES) before physical practice is more beneficial than physical practice alone. METHODS Ten people with subacute SCI participated in a randomized control trial where the experimental (N = 5) group underwent BCI-FES priming (∼15 min) before physical practice (30 min), while the control (N = 5) group performed physical practice (40 min) of the dominant hand. The primary outcome measures were BCI accuracy, adherence, and perceived workload. The secondary outcome measures were manual muscle test, grip strength, the range of motion, and Electroencephalography (EEG) measured brain activity. RESULTS The average BCI accuracy was 85%. The experimental group found BCI-FES priming mentally demanding but not frustrating. Two participants in the experimental group did not complete all sessions due to early discharge. There were no significant differences in physical outcomes between the groups. The ratio between eyes closed to eyes opened EEG activity increased more in the experimental group (theta Pθ = 0.008, low beta Plβ = 0.009, and high beta Phβ = 1.48e-04) indicating better neurological outcomes. There were no measurable immediate effects of BCI-FES priming. CONCLUSION Priming the brain before physical therapy is feasible but may require more than 15 min. This warrants further investigation with an increased sample size.
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Affiliation(s)
- Radha Kumari
- Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK
| | - Aleksandra Dybus
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mariel Purcell
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Aleksandra Vučković
- Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK
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Barra B, Kumar R, Gopinath C, Mirzakhalili E, Lempka SF, Gaunt RA, Fisher LE. High-frequency amplitude-modulated sinusoidal stimulation induces desynchronized yet controllable neural firing. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.14.580219. [PMID: 38405798 PMCID: PMC10888888 DOI: 10.1101/2024.02.14.580219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Regaining sensory feedback is pivotal for people living with limb amputation. Electrical stimulation of sensory fibers in peripheral nerves has been shown to restore focal percepts in the missing limb. However, conventional rectangular current pulses induce sensations often described as unnatural. This is likely due to the synchronous and periodic nature of activity evoked by these pulses. Here we introduce a fast-oscillating amplitude-modulated sinusoidal (FAMS) stimulation waveform that desynchronizes evoked neural activity. We used a computational model to show that sinusoidal waveforms evoke asynchronous and irregular firing and that firing patterns are frequency dependent. We designed the FAMS waveform to leverage both low- and high-frequency effects and found that membrane non-linearities enhance neuron-specific differences when exposed to FAMS. We implemented this waveform in a feline model of peripheral nerve stimulation and demonstrated that FAMS-evoked activity is more asynchronous than activity evoked by rectangular pulses, while being easily controllable with simple stimulation parameters. These results represent an important step towards biomimetic stimulation strategies useful for clinical applications to restore sensory feedback.
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Affiliation(s)
- Beatrice Barra
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Neuroscience Institute, New York University Langone Health, New York, USA
| | - Ritesh Kumar
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| | - Chaitanya Gopinath
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ehsan Mirzakhalili
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Scott F. Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Robert A. Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, USA
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, USA
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26
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Naddaf M. Mind-reading devices are revealing the brain's secrets. Nature 2024; 626:706-708. [PMID: 38378830 DOI: 10.1038/d41586-024-00481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
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Kumar S, Alawieh H, Racz FS, Fakhreddine R, Millán JDR. Transfer learning promotes acquisition of individual BCI skills. PNAS NEXUS 2024; 3:pgae076. [PMID: 38426121 PMCID: PMC10903645 DOI: 10.1093/pnasnexus/pgae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
Subject training is crucial for acquiring brain-computer interface (BCI) control. Typically, this requires collecting user-specific calibration data due to high inter-subject neural variability that limits the usability of generic decoders. However, calibration is cumbersome and may produce inadequate data for building decoders, especially with naïve subjects. Here, we show that a decoder trained on the data of a single expert is readily transferrable to inexperienced users via domain adaptation techniques allowing calibration-free BCI training. We introduce two real-time frameworks, (i) Generic Recentering (GR) through unsupervised adaptation and (ii) Personally Assisted Recentering (PAR) that extends GR by employing supervised recalibration of the decoder parameters. We evaluated our frameworks on 18 healthy naïve subjects over five online sessions, who operated a customary synchronous bar task with continuous feedback and a more challenging car racing game with asynchronous control and discrete feedback. We show that along with improved task-oriented BCI performance in both tasks, our frameworks promoted subjects' ability to acquire individual BCI skills, as the initial neurophysiological control features of an expert subject evolved and became subject specific. Furthermore, those features were task-specific and were learned in parallel as participants practiced the two tasks in every session. Contrary to previous findings implying that supervised methods lead to improved online BCI control, we observed that longitudinal training coupled with unsupervised domain matching (GR) achieved similar performance to supervised recalibration (PAR). Therefore, our presented frameworks facilitate calibration-free BCIs and have immediate implications for broader populations-such as patients with neurological pathologies-who might struggle to provide suitable initial calibration data.
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Affiliation(s)
- Satyam Kumar
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Hussein Alawieh
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Frigyes Samuel Racz
- Department of Neurology, The University of Texas at Austin, Austin, TX 78712, USA
- Mulva Clinic for the Neurosciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Rawan Fakhreddine
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - José del R Millán
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Neurology, The University of Texas at Austin, Austin, TX 78712, USA
- Mulva Clinic for the Neurosciences, The University of Texas at Austin, Austin, TX 78712, USA
- Departement of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
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Brunner I, Lundquist CB, Pedersen AR, Spaich EG, Dosen S, Savic A. Brain computer interface training with motor imagery and functional electrical stimulation for patients with severe upper limb paresis after stroke: a randomized controlled pilot trial. J Neuroeng Rehabil 2024; 21:10. [PMID: 38245782 PMCID: PMC10799379 DOI: 10.1186/s12984-024-01304-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Restorative Brain-Computer Interfaces (BCI) that combine motor imagery with visual feedback and functional electrical stimulation (FES) may offer much-needed treatment alternatives for patients with severely impaired upper limb (UL) function after a stroke. OBJECTIVES This study aimed to examine if BCI-based training, combining motor imagery with FES targeting finger/wrist extensors, is more effective in improving severely impaired UL motor function than conventional therapy in the subacute phase after stroke, and if patients with preserved cortical-spinal tract (CST) integrity benefit more from BCI training. METHODS Forty patients with severe UL paresis (< 13 on Action Research Arm Test (ARAT) were randomized to either a 12-session BCI training as part of their rehabilitation or conventional UL rehabilitation. BCI sessions were conducted 3-4 times weekly for 3-4 weeks. At baseline, Transcranial Magnetic Stimulation (TMS) was performed to examine CST integrity. The main endpoint was the ARAT at 3 months post-stroke. A binominal logistic regression was conducted to examine the effect of treatment group and CST integrity on achieving meaningful improvement. In the BCI group, electroencephalographic (EEG) data were analyzed to investigate changes in event-related desynchronization (ERD) during the course of therapy. RESULTS Data from 35 patients (15 in the BCI group and 20 in the control group) were analyzed at 3-month follow-up. Few patients (10/35) improved above the minimally clinically important difference of 6 points on ARAT, 5/15 in the BCI group, 5/20 in control. An independent-samples Mann-Whitney U test revealed no differences between the two groups, p = 0.382. In the logistic regression only CST integrity was a significant predictor for improving UL motor function, p = 0.007. The EEG analysis showed significant changes in ERD of the affected hemisphere and its lateralization only during unaffected UL motor imagery at the end of the therapy. CONCLUSION This is the first RCT examining BCI training in the subacute phase where only patients with severe UL paresis were included. Though more patients in the BCI group improved relative to the group size, the difference between the groups was not significant. In the present study, preserved CTS integrity was much more vital for UL improvement than which type of intervention the patients received. Larger studies including only patients with some preserved CST integrity should be attempted.
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Affiliation(s)
- Iris Brunner
- Department of Clinical Medicine, Hammel Neurocenter and University Hospital, Aarhus University, Voldbyvej 12, 8450, Hammel, Denmark.
| | | | - Asger Roer Pedersen
- University Research Clinic for Innovative Patient Pathways, Diagnostic Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark
| | - Erika G Spaich
- Department of Health Science and Technology, Aalborg University, 9220, Aalborg, Denmark
| | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, 9220, Aalborg, Denmark
| | - Andrej Savic
- Science and Research Centre, University of Belgrade-School of Electrical Engineering, Belgrade, 11000, Serbia
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Capogrosso M, Balaguer JM, Prat-Ortega G, Verma N, Yadav P, Sorensen E, de Freitas R, Ensel S, Borda L, Donadio S, Liang L, Ho J, Damiani A, Grigsby E, Fields D, Gonzalez-Martinez J, Gerszten P, Weber D, Pirondini E. Supraspinal control of motoneurons after paralysis enabled by spinal cord stimulation. RESEARCH SQUARE 2024:rs.3.rs-3650257. [PMID: 38260333 PMCID: PMC10802737 DOI: 10.21203/rs.3.rs-3650257/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.
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Affiliation(s)
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
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Zhang M, Zhu F, Jia F, Wu Y, Wang B, Gao L, Chu F, Tang W. Efficacy of brain-computer interfaces on upper extremity motor function rehabilitation after stroke: A systematic review and meta-analysis. NeuroRehabilitation 2024; 54:199-212. [PMID: 38143387 DOI: 10.3233/nre-230215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND The recovery of upper limb function is crucial to the daily life activities of stroke patients. Brain-computer interface technology may have potential benefits in treating upper limb dysfunction. OBJECTIVE To systematically evaluate the efficacy of brain-computer interfaces (BCI) in the rehabilitation of upper limb motor function in stroke patients. METHODS Six databases up to July 2023 were reviewed according to the PRSIMA guidelines. Randomized controlled trials of BCI-based upper limb functional rehabilitation for stroke patients were selected for meta-analysis by pooling standardized mean difference (SMD) to summarize the evidence. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. RESULTS Twenty-five studies were included. The studies showed that BCI had a small effect on the improvement of upper limb function after the intervention. In terms of total duration of training, < 12 hours of training may result in better rehabilitation, but training duration greater than 12 hours suggests a non significant therapeutic effect of BCI training. CONCLUSION This meta-analysis suggests that BCI has a slight efficacy in improving upper limb function and has favorable long-term outcomes. In terms of total duration of training, < 12 hours of training may lead to better rehabilitation.
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Affiliation(s)
- Ming Zhang
- Department of Mechatronic Engineering, China University of Mining and Technology, Jiangsu, China
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Medical University, Jiangsu, China
| | - Feilong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Fan Jia
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Medical University, Jiangsu, China
| | - Yu Wu
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Bin Wang
- Departments of Rehabilitation Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ling Gao
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Medical University, Jiangsu, China
| | - Fengming Chu
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Medical University, Jiangsu, China
| | - Wei Tang
- Department of Mechatronic Engineering, China University of Mining and Technology, Jiangsu, China
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31
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Awaji A, Fuchigami T, Ogata R, Morioka S. Effects of Vibration-Based Generation of Timing of Tactile Perception on Upper Limb Function After Stroke: A Case Study. Cureus 2023; 15:e50855. [PMID: 38249200 PMCID: PMC10798842 DOI: 10.7759/cureus.50855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Sensorimotor dysfunction of the fingers and hands hinders the recovery of motor function post-stroke. Generally, hemiplegic patients are unable to properly control the dynamic friction generated between their fingers and objects during hand/finger muscle activity. In addition to sensory information, a sense of agency generated by the temporal synchronization of sensory prediction and sensory feedback is required to control this dynamic friction. In the present study, we utilized a novel rehabilitation device that transmits real-time fingertip contact information to a transducer in a case of stroke hemiplegia with sensorimotor deficits and stagnated hand/finger motor performance. Post-intervention, the patient's upper extremity motor function score (FMA-UE), which had previously been in a state of arrested recovery, improved from 51/66 to 61/66, especially in the wrist joints. Excessive grip force during object grasping and frequency of falling objects was notably decreased post-intervention. We believe that rehabilitation tasks using perceptual generation via transducer will be a new tool for the rehabilitation of post-stroke hand/finger sensorimotor deficits.
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Affiliation(s)
- Ayaka Awaji
- Department of Physical Therapy, Faculty of Health Sciences, Kio University, Nara, JPN
| | - Takeshi Fuchigami
- Neurorehabilitation Research Center, Kio University, Nara, JPN
- Department of Rehabilitation, Kishiwada Rehabilitation Hospital, Osaka, JPN
- Stroke Rehabilitation Research Laboratory, Kishiwada Rehabilitation Hospital, Osaka, JPN
| | - Rento Ogata
- Department of Rehabilitation, Kishiwada Rehabilitation Hospital, Osaka, JPN
- Stroke Rehabilitation Research Laboratory, Kishiwada Rehabilitation Hospital, Osaka, JPN
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, JPN
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, JPN
- Stroke Rehabilitation Research Laboratory, Kishiwada Rehabilitation Hospital, Osaka, JPN
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Suzuki Y, Jovanovic LI, Fadli RA, Yamanouchi Y, Marquez-Chin C, Popovic MR, Nomura T, Milosevic M. Evidence That Brain-Controlled Functional Electrical Stimulation Could Elicit Targeted Corticospinal Facilitation of Hand Muscles in Healthy Young Adults. Neuromodulation 2023; 26:1612-1621. [PMID: 35088740 DOI: 10.1016/j.neurom.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Brain-computer interface (BCI)-controlled functional electrical stimulation (FES) has been used in rehabilitation for improving hand motor function. However, mechanisms of improvements are still not well understood. The objective of this study was to investigate how BCI-controlled FES affects hand muscle corticospinal excitability. MATERIALS AND METHODS A total of 12 healthy young adults were recruited in the study. During BCI calibration, a single electroencephalography channel from the motor cortex and a frequency band were chosen to detect event-related desynchronization (ERD) of cortical oscillatory activity during kinesthetic wrist motor imagery (MI). The MI-based BCI system was used to detect active states on the basis of ERD activity in real time and produce contralateral wrist extension movements through FES of the extensor carpi radialis (ECR) muscle. As a control condition, FES was used to generate wrist extension at random intervals. The two interventions were performed on separate days and lasted 25 minutes. Motor evoked potentials (MEPs) in ECR (intervention target) and flexor carpi radialis (FCR) muscles were elicited through single-pulse transcranial magnetic stimulation of the motor cortex to compare corticospinal excitability before (pre), immediately after (post0), and 30 minutes after (post30) the interventions. RESULTS After the BCI-FES intervention, ECR muscle MEPs were significantly facilitated at post0 and post30 time points compared with before the intervention (pre), whereas there were no changes in the FCR muscle corticospinal excitability. Conversely, after the random FES intervention, both ECR and FCR muscle MEPs were unaffected compared with before the intervention (pre). CONCLUSIONS Our results demonstrated evidence that BCI-FES intervention could elicit muscle-specific short-term corticospinal excitability facilitation of the intervention targeted (ECR) muscle only, whereas randomly applied FES was ineffective in eliciting any changes. Notably, these findings suggest that associative cortical and peripheral activations during BCI-FES can effectively elicit targeted muscle corticospinal excitability facilitation, implying possible rehabilitation mechanisms.
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Affiliation(s)
- Yoshiyuki Suzuki
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan
| | - Lazar I Jovanovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Rizaldi A Fadli
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan
| | - Yuki Yamanouchi
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan.
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Balaguer JM, Prat-Ortega G, Verma N, Yadav P, Sorensen E, de Freitas R, Ensel S, Borda L, Donadio S, Liang L, Ho J, Damiani A, Grigsby E, Fields DP, Gonzalez-Martinez JA, Gerszten PC, Fisher LE, Weber DJ, Pirondini E, Capogrosso M. SUPRASPINAL CONTROL OF MOTONEURONS AFTER PARALYSIS ENABLED BY SPINAL CORD STIMULATION. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.29.23298779. [PMID: 38076797 PMCID: PMC10705627 DOI: 10.1101/2023.11.29.23298779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.
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Affiliation(s)
- Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Genis Prat-Ortega
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Nikhil Verma
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Prakarsh Yadav
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Erynn Sorensen
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Roberto de Freitas
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Scott Ensel
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Luigi Borda
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Serena Donadio
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
| | - Lucy Liang
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Jonathan Ho
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- School of Medicine, University of Pittsburgh, Pittsburgh, US
| | - Arianna Damiani
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Erinn Grigsby
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
| | - Daryl P. Fields
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | | | - Peter C. Gerszten
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Lee E. Fisher
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
- Dept. of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Douglas J. Weber
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, US
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
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Miao M, Yang Z, Zeng H, Zhang W, Xu B, Hu W. Explainable cross-task adaptive transfer learning for motor imagery EEG classification. J Neural Eng 2023; 20:066021. [PMID: 37963394 DOI: 10.1088/1741-2552/ad0c61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/14/2023] [Indexed: 11/16/2023]
Abstract
Objective. In the field of motor imagery (MI) electroencephalography (EEG)-based brain-computer interfaces, deep transfer learning (TL) has proven to be an effective tool for solving the problem of limited availability in subject-specific data for the training of robust deep learning (DL) models. Although considerable progress has been made in the cross-subject/session and cross-device scenarios, the more challenging problem of cross-task deep TL remains largely unexplored.Approach. We propose a novel explainable cross-task adaptive TL method for MI EEG decoding. Firstly, similarity analysis and data alignment are performed for EEG data of motor execution (ME) and MI tasks. Afterwards, the MI EEG decoding model is obtained via pre-training with extensive ME EEG data and fine-tuning with partial MI EEG data. Finally, expected gradient-based post-hoc explainability analysis is conducted for the visualization of important temporal-spatial features.Main results. Extensive experiments are conducted on one large ME EEG High-Gamma dataset and two large MI EEG datasets (openBMI and GIST). The best average classification accuracy of our method reaches 80.00% and 72.73% for OpenBMI and GIST respectively, which outperforms several state-of-the-art algorithms. In addition, the results of the explainability analysis further validate the correlation between ME and MI EEG data and the effectiveness of ME/MI cross-task adaptation.Significance. This paper confirms that the decoding of MI EEG can be well facilitated by pre-existing ME EEG data, which largely relaxes the constraint of training samples for MI EEG decoding and is important in a practical sense.
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Affiliation(s)
- Minmin Miao
- School of Information Engineering, Huzhou University, Huzhou, People's Republic of China
- Zhejiang Province Key Laboratory of Smart Management & Application of Modern Agricultural Resources, Huzhou University, Huzhou, People's Republic of China
| | - Zhong Yang
- School of Information Engineering, Huzhou University, Huzhou, People's Republic of China
| | - Hong Zeng
- School of Instrument Science and Engineering, Southeast University, Nanjing, People's Republic of China
| | - Wenbin Zhang
- College of Computer and Information, Hohai University, Nanjing, People's Republic of China
| | - Baoguo Xu
- School of Instrument Science and Engineering, Southeast University, Nanjing, People's Republic of China
| | - Wenjun Hu
- School of Information Engineering, Huzhou University, Huzhou, People's Republic of China
- Zhejiang Province Key Laboratory of Smart Management & Application of Modern Agricultural Resources, Huzhou University, Huzhou, People's Republic of China
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Pan L, Wang K, Xu L, Sun X, Yi W, Xu M, Ming D. Riemannian geometric and ensemble learning for decoding cross-session motor imagery electroencephalography signals. J Neural Eng 2023; 20:066011. [PMID: 37931299 DOI: 10.1088/1741-2552/ad0a01] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/06/2023] [Indexed: 11/08/2023]
Abstract
Objective.Brain-computer interfaces (BCIs) enable a direct communication pathway between the human brain and external devices, without relying on the traditional peripheral nervous and musculoskeletal systems. Motor imagery (MI)-based BCIs have attracted significant interest for their potential in motor rehabilitation. However, current algorithms fail to account for the cross-session variability of electroencephalography signals, limiting their practical application.Approach.We proposed a Riemannian geometry-based adaptive boosting and voting ensemble (RAVE) algorithm to address this issue. Our approach segmented the MI period into multiple sub-datasets using a sliding window approach and extracted features from each sub-dataset using Riemannian geometry. We then trained adaptive boosting (AdaBoost) ensemble learning classifiers for each sub-dataset, with the final BCI output determined by majority voting of all classifiers. We tested our proposed RAVE algorithm and eight other competing algorithms on four datasets (Pan2023, BNCI001-2014, BNCI001-2015, BNCI004-2015).Main results.Our results showed that, in the cross-session scenario, the RAVE algorithm outperformed the eight other competing algorithms significantly under different within-session training sample sizes. Compared to traditional algorithms that involved a large number of training samples, the RAVE algorithm achieved similar or even better classification performance on the datasets (Pan2023, BNCI001-2014, BNCI001-2015), even when it did not use or only used a small number of within-session training samples.Significance.These findings indicate that our cross-session decoding strategy could enable MI-BCI applications that require no or minimal training process.
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Affiliation(s)
- Lincong Pan
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, People's Republic of China
| | - Kun Wang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
- Haihe Laboratory of Brain-computer Interaction and Human-machine Integration, Tianjin 300392, People's Republic of China
| | - Lichao Xu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Xinwei Sun
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, People's Republic of China
| | - Weibo Yi
- Beijing Machine and Equipment Institute, Beijing 100192, People's Republic of China
| | - Minpeng Xu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, People's Republic of China
- Haihe Laboratory of Brain-computer Interaction and Human-machine Integration, Tianjin 300392, People's Republic of China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, People's Republic of China
- Haihe Laboratory of Brain-computer Interaction and Human-machine Integration, Tianjin 300392, People's Republic of China
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Canny E, Vansteensel MJ, van der Salm SMA, Müller-Putz GR, Berezutskaya J. Boosting brain-computer interfaces with functional electrical stimulation: potential applications in people with locked-in syndrome. J Neuroeng Rehabil 2023; 20:157. [PMID: 37980536 PMCID: PMC10656959 DOI: 10.1186/s12984-023-01272-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023] Open
Abstract
Individuals with a locked-in state live with severe whole-body paralysis that limits their ability to communicate with family and loved ones. Recent advances in brain-computer interface (BCI) technology have presented a potential alternative for these people to communicate by detecting neural activity associated with attempted hand or speech movements and translating the decoded intended movements to a control signal for a computer. A technique that could potentially enrich the communication capacity of BCIs is functional electrical stimulation (FES) of paralyzed limbs and face to restore body and facial movements of paralyzed individuals, allowing to add body language and facial expression to communication BCI utterances. Here, we review the current state of the art of existing BCI and FES work in people with paralysis of body and face and propose that a combined BCI-FES approach, which has already proved successful in several applications in stroke and spinal cord injury, can provide a novel promising mode of communication for locked-in individuals.
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Affiliation(s)
- Evan Canny
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariska J Vansteensel
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra M A van der Salm
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gernot R Müller-Putz
- Institute of Neural Engineering, Laboratory of Brain-Computer Interfaces, Graz University of Technology, Graz, Austria
| | - Julia Berezutskaya
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
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37
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Hao Z, Zhai X, Peng B, Cheng D, Zhang Y, Pan Y, Dou W. CAMBA framework: Unveiling the brain asymmetry alterations and longitudinal changes after stroke using resting-state EEG. Neuroimage 2023; 282:120405. [PMID: 37820859 DOI: 10.1016/j.neuroimage.2023.120405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/19/2023] [Accepted: 10/08/2023] [Indexed: 10/13/2023] Open
Abstract
Hemispheric asymmetry or lateralization is a fundamental principle of brain organization. However, it is poorly understood to what extent the brain asymmetries across different levels of functional organizations are evident in health or altered in brain diseases. Here, we propose a framework that integrates three degrees of brain interactions (isolated nodes, node-node, and edge-edge) into a unified analysis pipeline to capture the sliding window-based asymmetry dynamics at both the node and hemisphere levels. We apply this framework to resting-state EEG in healthy and stroke populations and investigate the stroke-induced abnormal alterations in brain asymmetries and longitudinal asymmetry changes during poststroke rehabilitation. We observe that the mean asymmetry in patients was abnormally enhanced across different frequency bands and levels of brain interactions, with these abnormal patterns strongly associated with the side of the stroke lesion. Compared to healthy controls, patients displayed significant alterations in asymmetry fluctuations, disrupting and reconfiguring the balance of inter-hemispheric integration and segregation. Additionally, analyses reveal that specific abnormal asymmetry metrics in patients tend to move towards those observed in healthy controls after short-term brain-computer interface rehabilitation. Furthermore, preliminary evidence suggests that baseline clinical and asymmetry features can predict poststroke improvements in the Fugl-Meyer assessment of the lower extremity (mean absolute error of about 2). Overall, these findings advance our understanding of hemispheric asymmetry. Our framework offers new insights into the mechanisms underlying brain alterations and recovery after a brain lesion, may help identify prognostic biomarkers, and can be easily extended to different functional modalities.
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Affiliation(s)
- Zexuan Hao
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Xiaoxue Zhai
- Department of Rehabilitation Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
| | - Bo Peng
- Department of Rehabilitation Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
| | - Dandan Cheng
- Department of Rehabilitation Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
| | - Yanlin Zhang
- Department of Rehabilitation Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
| | - Yu Pan
- Department of Rehabilitation Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China.
| | - Weibei Dou
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China.
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Li W, Li C, Liu A, Lin PJ, Mo L, Zhao H, Xu Q, Meng X, Ji L. Lesion-specific cortical activation following sensory stimulation in patients with subacute stroke. J Neuroeng Rehabil 2023; 20:155. [PMID: 37957755 PMCID: PMC10644526 DOI: 10.1186/s12984-023-01276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Sensory stimulation can play a fundamental role in the activation of the primary sensorimotor cortex (S1-M1), which can promote motor learning and M1 plasticity in stroke patients. However, studies have focused mainly on investigating the influence of brain lesion profiles on the activation patterns of S1-M1 during motor tasks instead of sensory tasks. Therefore, the objective of this study is to explore the lesion-specific activation patterns due to different brain lesion profiles and types during focal vibration (FV). METHODS In total 52 subacute stroke patients were recruited in this clinical experiment, including patients with basal ganglia hemorrhage/ischemia, brainstem ischemia, other subcortical ischemia, cortical ischemia, and mixed cortical-subcortical ischemia. Electroencephalograms (EEG) were recorded following a resting state lasting for 4 min and three sessions of FV. FV was applied over the muscle belly of the affected limb's biceps for 3 min each session. Beta motor-related EEG power desynchronization overlying S1-M1 was used to indicate the activation of S1-M1, while the laterality coefficient (LC) of the activation of S1-M1 was used to assess the interhemispheric asymmetry of brain activation. RESULTS (1) Regarding brain lesion profiles, FV could lead to the significant activation of bilateral S1-M1 in patients with basal ganglia ischemia and other subcortical ischemia. The activation of ipsilesional S1-M1 in patients with brainstem ischemia was higher than that in patients with cortical ischemia. No activation of S1-M1 was observed in patients with lesions involving cortical regions. (2) Regarding brain lesion types, FV could induce the activation of bilateral S1-M1 in patients with basal ganglia hemorrhage, which was significantly higher than that in patients with basal ganglia ischemia. Additionally, LC showed no significant correlation with the modified Barthel index (MBI) in all patients, but a positive correlation with MBI in patients with basal ganglia lesions. CONCLUSIONS These results reveal that sensory stimulation can induce lesion-specific activation patterns of S1-M1. This indicates FV could be applied in a personalized manner based on the lesion-specific activation of S1-M1 in stroke patients with different lesion profiles and types. Our study may contribute to a better understanding of the underlying mechanisms of cortical reorganization.
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Affiliation(s)
- Wei Li
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Chong Li
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
- School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
- Medical Research Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Aixian Liu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ping-Ju Lin
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Linhong Mo
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hongliang Zhao
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Quan Xu
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Xiangzun Meng
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Linhong Ji
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
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Mang J, Xu Z, Qi Y, Zhang T. Favoring the cognitive-motor process in the closed-loop of BCI mediated post stroke motor function recovery: challenges and approaches. Front Neurorobot 2023; 17:1271967. [PMID: 37881517 PMCID: PMC10595019 DOI: 10.3389/fnbot.2023.1271967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
The brain-computer interface (BCI)-mediated rehabilitation is emerging as a solution to restore motor skills in paretic patients after stroke. In the human brain, cortical motor neurons not only fire when actions are carried out but are also activated in a wired manner through many cognitive processes related to movement such as imagining, perceiving, and observing the actions. Moreover, the recruitment of motor cortexes can usually be regulated by environmental conditions, forming a closed-loop through neurofeedback. However, this cognitive-motor control loop is often interrupted by the impairment of stroke. The requirement to bridge the stroke-induced gap in the motor control loop is promoting the evolution of the BCI-based motor rehabilitation system and, notably posing many challenges regarding the disease-specific process of post stroke motor function recovery. This review aimed to map the current literature surrounding the new progress in BCI-mediated post stroke motor function recovery involved with cognitive aspect, particularly in how it refired and rewired the neural circuit of motor control through motor learning along with the BCI-centric closed-loop.
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Affiliation(s)
- Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuo Xu
- Department of Rehabilitation, China-Japan Union Hospital of Jilin University, Changchun, China
| | - YingBin Qi
- Department of Neurology, Jilin Province People's Hospital, Changchun, China
| | - Ting Zhang
- Rehabilitation Therapeutics, School of Nursing, Jilin University, Changchun, China
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Wang P, Liu J, Wang L, Ma H, Mei X, Zhang A. Effects of brain-Computer interface combined with mindfulness therapy on rehabilitation of hemiplegic patients with stroke: a randomized controlled trial. Front Psychol 2023; 14:1241081. [PMID: 37876845 PMCID: PMC10590922 DOI: 10.3389/fpsyg.2023.1241081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Aim To explore the effects of brain-computer interface training combined with mindfulness therapy on Hemiplegic Patients with Stroke. Background The prevention and treatment of stroke still faces great challenges. Maximizing the improvement of patients' ability to perform activities of daily living, limb motor function, and reducing anxiety, depression, and other social and psychological problems to improve patients' overall quality of life is the focus and difficulty of clinical rehabilitation work. Methods Patients were recruited from December 2021 to November 2022, and assigned to either the intervention or control group following a simple randomization procedure (computer-generated random numbers). Both groups received conventional rehabilitation treatment, while patients in the intervention group additionally received brain-computer interface training and mindfulness therapy. The continuous treatment duration was 5 days per week for 8 weeks. Limb motor function, activities of daily living, mindfulness attention awareness level, sleep quality, and quality of life of the patients were measured (in T0, T1, and T2). Generalized estimated equation (GEE) were used to evaluate the effects. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2300070382). Results A total of 128 participants were randomized and 64 each were assigned to the intervention and control groups (of these, eight patients were lost to follow-up). At 6 months, compared with the control group, intervention group showed statistically significant improvements in limb motor function, mindful attention awareness, activities of daily living, sleep quality, and quality of life. Conclusion Brain-computer interface combined with mindfulness therapy training can improve limb motor function, activities of daily living, mindful attention awareness, sleep quality, and quality of life in hemiplegic patients with stroke. Impact This study provides valuable insights into post-stroke care. It may help improve the effect of rehabilitation nursing to improve the comprehensive ability and quality of life of patients after stroke. Clinical review registration https://www.chictr.org.cn/, identifier ChiCTR2300070382.
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Affiliation(s)
- Pei Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji’nan, Shandong, China
| | - Jinyu Liu
- School of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Lili Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji’nan, Shandong, China
| | - Huifang Ma
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji’nan, Shandong, China
| | - Xingyan Mei
- Linyi People’s Hospital, Linyi, Shandong, China
| | - Aihua Zhang
- School of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, Shandong, China
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Yu C, Ying X, Shahbazi MA, Yang L, Ma Z, Ye L, Yang W, Sun R, Gu T, Tang R, Fan S, Yao S. A nano-conductive osteogenic hydrogel to locally promote calcium influx for electro-inspired bone defect regeneration. Biomaterials 2023; 301:122266. [PMID: 37597298 DOI: 10.1016/j.biomaterials.2023.122266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Abstract
Conductive nano-materials and electrical stimulation (ES) have been recognized as a synergetic therapy for ordinary excitable tissue repair. It is worth noting that hard tissues, such as bone tissue, possess bioelectrical properties as well. However, insufficient attention is paid to the synergetic therapy for bone defect regeneration via conductive biomaterials with ES. Here, a novel nano-conductive hydrogel comprising calcium phosphate-PEDOT:PSS-magnesium titanate-methacrylated alginate (CPM@MA) was synthesized for electro-inspired bone tissue regeneration. The nano-conductive CPM@MA hydrogel has demonstrated excellent electroactivity, biocompatibility, and osteoinductivity. Additionally, it has the potential to enhance cellular functionality by increasing endogenous transforming growth factor-beta1 (TGF-β1) and activating TGF-β/Smad2 signaling pathway. The synergetic therapy could facilitate intracellular calcium enrichment, resulting in a 5.8-fold increase in calcium concentration compared to the control group in the CPM@MA ES + group. The nano-conductive CPM@MA hydrogel with ES could significantly promote electro-inspired bone defect regeneration in vivo, uniquely allowing a full repair of rat femoral defect within 4 weeks histologically and mechanically. These results demonstrate that our synergistic strategy effectively promotes bone restoration, thereby offering potential advancements in the field of electro-inspired hard tissue regeneration using novel nano-materials with ES.
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Affiliation(s)
- Congcong Yu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China
| | - Xiaozhang Ying
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China; Department of Orthopaedics, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou, 310003, Zhejiang, China
| | - Mohammad-Ali Shahbazi
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands; W.J. Kolff Institute for Biomedical Engineering and Materials Science, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, the Netherlands
| | - Linjun Yang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China
| | - Zaiqiang Ma
- Center for Biomaterials and Biopathways, Department of Chemistry, Zhejiang University, Hangzhou, Zhejiang, 310027, China
| | - Lin Ye
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China
| | - Wentao Yang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China
| | - Rongtai Sun
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China
| | - Tianyuan Gu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China
| | - Ruikang Tang
- Center for Biomaterials and Biopathways, Department of Chemistry, Zhejiang University, Hangzhou, Zhejiang, 310027, China.
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China.
| | - Shasha Yao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration, Translational Research of Zhejiang Province Hangzhou, Zhejiang, 310016, China.
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Hofmeijer J, Ham F, Kwakkel G. Evidence of rTMS for Motor or Cognitive Stroke Recovery: Hype or Hope? Stroke 2023; 54:2500-2511. [PMID: 37747964 DOI: 10.1161/strokeaha.123.043159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Evidence of efficacy of repetitive transcranial magnetic stimulation (rTMS) for stroke recovery is hampered by an unexplained variability of reported effect sizes and an insufficient understanding of mechanisms of action. We aimed to (1) briefly summarize evidence of efficacy, (2) identify critical factors to explain the reported variation in effects, and (3) provide mechanism-based recommendations for future trials. METHODS We performed a systematic review of the literature according to Cochrane and PRISMA Protocols. We included trials with ≥10 patients per treatment group. We classified outcome measures according to the International Classification of Functioning, Disability, and Health. Meta-analysis was done when at least 3 trials were reported on the same construct. In case of significant summary effect sizes with significant heterogeneity, we used sensitivity analyses to test for correlations and differences between found individual effect sizes and possible effect modifiers such as patient-, repetitive transcranial magnetic stimulation-, and trial characteristics. RESULTS We included 57 articles (N=2595). Funnel plots showed no publication bias. We found significant effect sizes at the level of body function (upper limb synergies, muscle strength, language functioning, global cognitive functioning, visual/spatial inattention) with repetitive transcranial magnetic stimulation within or beyond 3 months after stroke. We also found significant effect sizes at the level of activities. We found no subgroup differences or significant correlations between individual summary effect sizes and any tested possible effect modifier. CONCLUSIONS Repetitive transcranial magnetic stimulation holds the potential to benefit a range of motor and cognitive outcomes after stroke, but the evidence of efficacy is challenged by unexplained heterogeneity across many small sampled trials. We propose large trials with the collection of individual patient data on baseline severity and brain network integrity with sufficiently powered subgroup analyses, as well as protocolized time-locked training of the target behavior. Additional neurophysiological and biomechanical data may help in understanding mechanisms and identifying biomarkers of treatment efficacy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: CRD42022300330.
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Affiliation(s)
- Jeannette Hofmeijer
- Department of Clinical Neurophysiology, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands (J.H.)
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands (J.H.)
| | - Florien Ham
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands (J.H.)
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, the Netherlands (G.K.)
- Department of Acquired Brain Injuries, Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, the Netherlands (G.K.)
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.)
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Zhang X, Nan J, Xu M, Chen L, Ni G, Ming D. PSIs of EEG With Refined Frequency Decomposition Could Prognose Motor Recovery Before Rehabilitation Intervention. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3760-3771. [PMID: 37721877 DOI: 10.1109/tnsre.2023.3316210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Stroke often leads to permanent impairment in motor function. Accurate and quantitative prognosis of potential motor recovery before rehabilitation intervention can help healthcare centers improve resources organization and enable individualized intervention. The context of this paper investigated the potential of using electroencephalography (EEG) functional connectivity (FC) measures as biomarkers for assessing and prognosing improvement of Fugl-Meyer Assessment in upper extremity motor function ( ∆FMU) among participants with chronic stroke. EEG data from resting and motor imagery task were recorded from 13 participants with chronic stroke. Three functional connectivity methods, which were Pearson correlation measure (PCM), weighted Phase Lag Index (wPLI) and phase synchronization index (PSI), were investigated, under three regions of interest (inter-hemispheric, intra-hemispheric, and whole-brain), in two statues (resting and motor imagery), with 15 refined center frequencies. We applied correlation analysis to identify the optimal center frequencies and pairs of synchronized channels that were consistently associated with ∆FMU . Predictive models were generated using regression analysis algorithms based on optimized center frequencies and channel pairs identified from the proposed analysis method, with leave-one-out cross-validation. We found that PSI in the Alpha band (with center frequency of 9Hz) was the most sensitive FC measures for prognosing motor recovery. Strong and significant correlations were identified between the predictions and actual ∆FMU scores both in the resting state ( [Formula: see text], [Formula: see text], N=13) and motor imagery ( [Formula: see text], [Formula: see text], N=13). Our results suggested that EEG connectivity measured with PSI in resting state could be a promising biomarker for quantifying motor recovery before motor rehabilitation intervention.
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Nunes JD, Vourvopoulos A, Blanco-Mora DA, Jorge C, Fernandes JC, Bermudez i Badia S, Figueiredo P. Brain activation by a VR-based motor imagery and observation task: An fMRI study. PLoS One 2023; 18:e0291528. [PMID: 37756271 PMCID: PMC10529559 DOI: 10.1371/journal.pone.0291528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023] Open
Abstract
Training motor imagery (MI) and motor observation (MO) tasks is being intensively exploited to promote brain plasticity in the context of post-stroke rehabilitation strategies. This may benefit from the use of closed-loop neurofeedback, embedded in brain-computer interfaces (BCI's) to provide an alternative non-muscular channel, which may be further augmented through embodied feedback delivered through virtual reality (VR). Here, we used functional magnetic resonance imaging (fMRI) in a group of healthy adults to map brain activation elicited by an ecologically-valid task based on a VR-BCI paradigm called NeuRow, whereby participants perform MI of rowing with the left or right arm (i.e., MI), while observing the corresponding movement of the virtual arm of an avatar (i.e., MO), on the same side, in a first-person perspective. We found that this MI-MO task elicited stronger brain activation when compared with a conventional MI-only task based on the Graz BCI paradigm, as well as to an overt motor execution task. It recruited large portions of the parietal and occipital cortices in addition to the somatomotor and premotor cortices, including the mirror neuron system (MNS), associated with action observation, as well as visual areas related with visual attention and motion processing. Overall, our findings suggest that the virtual representation of the arms in an ecologically-valid MI-MO task engage the brain beyond conventional MI tasks, which we propose could be explored for more effective neurorehabilitation protocols.
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Affiliation(s)
- João D. Nunes
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, and Faculty of Engineering, University of Porto, Porto, Portugal
| | - Athanasios Vourvopoulos
- Institute for Systems and Robotics - Lisboa, and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Diego Andrés Blanco-Mora
- Faculdade de Ciências Exatas e da Engenharia, N-LINCS Madeira — ARDITI, Universidade da Madeira, Funchal, Portugal
| | - Carolina Jorge
- Faculdade de Ciências Exatas e da Engenharia, N-LINCS Madeira — ARDITI, Universidade da Madeira, Funchal, Portugal
| | - Jean-Claude Fernandes
- Central Hospital of Funchal, Physical Medicine and Rehabilitation Service, Funchal, Portugal
| | - Sergi Bermudez i Badia
- Faculdade de Ciências Exatas e da Engenharia, N-LINCS Madeira — ARDITI, Universidade da Madeira, Funchal, Portugal
| | - Patrícia Figueiredo
- Institute for Systems and Robotics - Lisboa, and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Fadli RA, Yamanouchi Y, Jovanovic LI, Popovic MR, Marquez-Chin C, Nomura T, Milosevic M. Effectiveness of motor and prefrontal cortical areas for brain-controlled functional electrical stimulation neuromodulation. J Neural Eng 2023; 20:056022. [PMID: 37714143 DOI: 10.1088/1741-2552/acfa22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/15/2023] [Indexed: 09/17/2023]
Abstract
Objective. Brain-computer interface (BCI)-controlled functional electrical stimulation (FES) could excite the central nervous system to enhance upper limb motor recovery. Our current study assessed the effectiveness of motor and prefrontal cortical activity-based BCI-FES to help elucidate the underlying neuromodulation mechanisms of this neurorehabilitation approach.Approach. The primary motor cortex (M1) and prefrontal cortex (PFC) BCI-FES interventions were performed for 25 min on separate days with twelve non-disabled participants. During the interventions, a single electrode from the contralateral M1 or PFC was used to detect event-related desynchronization (ERD) in the calibrated frequency range. If the BCI system detected ERD within 15 s of motor imagery, FES activated wrist extensor muscles. Otherwise, if the BCI system did not detect ERD within 15 s, a subsequent trial was initiated without FES. To evaluate neuromodulation effects, corticospinal excitability was assessed using single-pulse transcranial magnetic stimulation, and cortical excitability was assessed by motor imagery ERD and resting-state functional connectivity before, immediately, 30 min, and 60 min after each intervention.Main results. M1 and PFC BCI-FES interventions had similar success rates of approximately 80%, while the M1 intervention was faster in detecting ERD activity. Consequently, only the M1 intervention effectively elicited corticospinal excitability changes for at least 60 min around the targeted cortical area in the M1, suggesting a degree of spatial localization. However, cortical excitability measures did not indicate changes after either M1 or PFC BCI-FES.Significance. Neural mechanisms underlying the effectiveness of BCI-FES neuromodulation may be attributed to the M1 direct corticospinal projections and/or the closer timing between ERD detection and FES, which likely enhanced Hebbian-like plasticity by synchronizing cortical activation detected by the BCI system with the sensory nerve activation and movement related reafference elicited by FES.
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Affiliation(s)
- Rizaldi A Fadli
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama, Toyonaka 560-8531, Japan
- Department of Biomedical Engineering, University of Miami College of Engineering, 1251 Memorial Drive, Coral Gables, FL 33146, United States of America
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL 33136, United States of America
| | - Yuki Yamanouchi
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama, Toyonaka 560-8531, Japan
| | - Lazar I Jovanovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto. 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto. 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama, Toyonaka 560-8531, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama, Toyonaka 560-8531, Japan
- Department of Biomedical Engineering, University of Miami College of Engineering, 1251 Memorial Drive, Coral Gables, FL 33146, United States of America
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL 33136, United States of America
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Vidaurre C, Irastorza-Landa N, Sarasola-Sanz A, Insausti-Delgado A, Ray AM, Bibián C, Helmhold F, Mahmoud WJ, Ortego-Isasa I, López-Larraz E, Lozano Peiteado H, Ramos-Murguialday A. Challenges of neural interfaces for stroke motor rehabilitation. Front Hum Neurosci 2023; 17:1070404. [PMID: 37789905 PMCID: PMC10543821 DOI: 10.3389/fnhum.2023.1070404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
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.
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Affiliation(s)
- Carmen Vidaurre
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
- Ikerbasque Science Foundation, Bilbao, Spain
| | | | | | | | - Andreas M. Ray
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Carlos Bibián
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Florian Helmhold
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Wala J. Mahmoud
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Iñaki Ortego-Isasa
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Eduardo López-Larraz
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain, Zaragoza, Spain
| | | | - Ander Ramos-Murguialday
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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Jovanovic LI, Jervis Rademeyer H, Pakosh M, Musselman KE, Popovic MR, Marquez-Chin C. Scoping Review on Brain-Computer Interface-Controlled Electrical Stimulation Interventions for Upper Limb Rehabilitation in Adults: A Look at Participants, Interventions, and Technology. Physiother Can 2023; 75:276-290. [PMID: 37736411 PMCID: PMC10510539 DOI: 10.3138/ptc-2021-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/07/2021] [Accepted: 12/07/2021] [Indexed: 09/23/2023]
Abstract
Purpose While current rehabilitation practice for improving arm and hand function relies on physical/occupational therapy, a growing body of research evaluates the effects of technology-enhanced rehabilitation. We review interventions that combine a brain-computer interface (BCI) with electrical stimulation (ES) for upper limb movement rehabilitation to summarize the evidence on (1) populations of study participants, (2) BCI-ES interventions, and (3) the BCI-ES systems. Method After searching seven databases, two reviewers identified 23 eligible studies. We consolidated information on the study participants, interventions, and approaches used to develop integrated BCI-ES systems. The included studies investigated the use of BCI-ES interventions with stroke and spinal cord injury (SCI) populations. All studies used electroencephalography to collect brain signals for the BCI, and functional electrical stimulation was the most common type of ES. The BCI-ES interventions were typically conducted without a therapist, with sessions varying in both frequency and duration. Results Of the 23 eligible studies, only 3 studies involved the SCI population, compared to 20 involving individuals with stroke. Conclusions Future BCI-ES interventional studies could address this gap. Additionally, standardization of device and rehabilitation modalities, and study-appropriate involvement with therapists, can be considered to advance this intervention towards clinical implementation.
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Affiliation(s)
- Lazar I. Jovanovic
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
| | - Hope Jervis Rademeyer
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| | - Kristin E. Musselman
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Milos R. Popovic
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
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Li F, Zhang D, Chen J, Tang K, Li X, Hou Z. Research hotspots and trends of brain-computer interface technology in stroke: a bibliometric study and visualization analysis. Front Neurosci 2023; 17:1243151. [PMID: 37732305 PMCID: PMC10507647 DOI: 10.3389/fnins.2023.1243151] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Background The incidence and mortality rates of stroke are escalating due to the growing aging population, which presents a significant hazard to human health. In the realm of stroke, brain-computer interface (BCI) technology has gained considerable attention as a means to enhance treatment efficacy and improve quality of life. Consequently, a bibliometric visualization analysis was performed to investigate the research hotspots and trends of BCI technology in stroke, with the objective of furnishing reference and guidance for future research. Methods This study utilized the Science Citation Index Expanded (SCI-Expanded) within the Web of Science Core Collection (WoSCC) database as the data source, selecting relevant literature published between 2013 and 2022 as research sample. Through the application of VOSviewer 1.6.19 and CiteSpace 6.2.R2 visualization analysis software, as well as the bibliometric online analysis platform, the scientific knowledge maps were constructed and subjected to visualization display, and statistical analysis. Results This study encompasses a total of 693 relevant literature, which were published by 2,556 scholars from 975 institutions across 53 countries/regions and have been collected by 185 journals. In the past decade, BCI technology in stroke research has exhibited an upward trend in both annual publications and citations. China and the United States are high productivity countries, while the University of Tubingen stands out as the most contributing institution. Birbaumer N and Pfurtscheller G are the authors with the highest publication and citation frequency in this field, respectively. Frontiers in Neuroscience has published the most literature, while Journal of Neural Engineering has the highest citation frequency. The research hotspots in this field cover keywords such as stroke, BCI, rehabilitation, motor imagery (MI), motor recovery, electroencephalogram (EEG), neurorehabilitation, neural plasticity, task analysis, functional electrical stimulation (FES), motor impairment, feature extraction, and induced movement therapy, which to a certain extent reflect the development trend and frontier research direction of this field. Conclusion This study comprehensively and visually presents the extensive and in-depth literature resources of BCI technology in stroke research in the form of knowledge maps, which facilitates scholars to gain a more convenient understanding of the development and prospects in this field, thereby promoting further research work.
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Affiliation(s)
- Fangcun Li
- Department of Rehabilitation Medicine, Guilin Municipal Hospital of Traditional Chinese Medicine, Guilin, China
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Ding Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Jie Chen
- Department of Pharmacy, Guilin Municipal Hospital of Traditional Chinese Medicine, Guilin, China
| | - Ke Tang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaomei Li
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Zhaomeng Hou
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Department of Orthopedics and Traumatology, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, China
- Department of Orthopedics and Traumatology, Yancheng TCM Hospital, Yancheng, China
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49
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Ramirez-Nava AG, Mercado-Gutierrez JA, Quinzaños-Fresnedo J, Toledo-Peral C, Vega-Martinez G, Gutierrez MI, Pacheco-Gallegos MDR, Hernández-Arenas C, Gutiérrez-Martínez J. Functional electrical stimulation therapy controlled by a P300-based brain-computer interface, as a therapeutic alternative for upper limb motor function recovery in chronic post-stroke patients. A non-randomized pilot study. Front Neurol 2023; 14:1221160. [PMID: 37669261 PMCID: PMC10470638 DOI: 10.3389/fneur.2023.1221160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/03/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Up to 80% of post-stroke patients present upper-limb motor impairment (ULMI), causing functional limitations in daily activities and loss of independence. UMLI is seldom fully recovered after stroke when using conventional therapeutic approaches. Functional Electrical Stimulation Therapy (FEST) controlled by Brain-Computer Interface (BCI) is an alternative that may induce neuroplastic changes, even in chronic post-stroke patients. The purpose of this work was to evaluate the effects of a P300-based BCI-controlled FEST intervention, for ULMI recovery of chronic post-stroke patients. Methods A non-randomized pilot study was conducted, including 14 patients divided into 2 groups: BCI-FEST, and Conventional Therapy. Assessments of Upper limb functionality with Action Research Arm Test (ARAT), performance impairment with Fugl-Meyer assessment (FMA), Functional Independence Measure (FIM) and spasticity through Modified Ashworth Scale (MAS) were performed at baseline and after carrying out 20 therapy sessions, and the obtained scores compared using Chi square and Mann-Whitney U statistical tests (𝛼 = 0.05). Results After training, we found statistically significant differences between groups for FMA (p = 0.012), ARAT (p < 0.001), and FIM (p = 0.025) scales. Discussion It has been shown that FEST controlled by a P300-based BCI, may be more effective than conventional therapy to improve ULMI after stroke, regardless of chronicity. Conclusion The results of the proposed BCI-FEST intervention are promising, even for the most chronic post-stroke patients often relegated from novel interventions, whose expected recovery with conventional therapy is very low. It is necessary to carry out a randomized controlled trial in the future with a larger sample of patients.
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Affiliation(s)
- Ana G. Ramirez-Nava
- Neurological Rehabilitation Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Jorge A. Mercado-Gutierrez
- Medical Engineering Research Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Jimena Quinzaños-Fresnedo
- Neurological Rehabilitation Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Cinthya Toledo-Peral
- Medical Engineering Research Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Gabriel Vega-Martinez
- Medical Engineering Research Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Mario Ibrahin Gutierrez
- Consejo Nacional de Humanidades, Ciencias y Tecnologías - Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | | | - Claudia Hernández-Arenas
- Neurological Rehabilitation Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Josefina Gutiérrez-Martínez
- Medical Engineering Research Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
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50
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Schroeder ML, Sherafati A, Ulbrich RL, Wheelock MD, Svoboda AM, Klein ED, George TG, Tripathy K, Culver JP, Eggebrecht AT. Mapping cortical activations underlying covert and overt language production using high-density diffuse optical tomography. Neuroimage 2023; 276:120190. [PMID: 37245559 PMCID: PMC10760405 DOI: 10.1016/j.neuroimage.2023.120190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023] Open
Abstract
Gold standard neuroimaging modalities such as functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and more recently electrocorticography (ECoG) have provided profound insights regarding the neural mechanisms underlying the processing of language, but they are limited in applications involving naturalistic language production especially in developing brains, during face-to-face dialogues, or as a brain-computer interface. High-density diffuse optical tomography (HD-DOT) provides high-fidelity mapping of human brain function with comparable spatial resolution to that of fMRI but in a silent and open scanning environment similar to real-life social scenarios. Therefore, HD-DOT has potential to be used in naturalistic settings where other neuroimaging modalities are limited. While HD-DOT has been previously validated against fMRI for mapping the neural correlates underlying language comprehension and covert (i.e., "silent") language production, HD-DOT has not yet been established for mapping the cortical responses to overt (i.e., "out loud") language production. In this study, we assessed the brain regions supporting a simple hierarchy of language tasks: silent reading of single words, covert production of verbs, and overt production of verbs in normal hearing right-handed native English speakers (n = 33). First, we found that HD-DOT brain mapping is resilient to movement associated with overt speaking. Second, we observed that HD-DOT is sensitive to key activations and deactivations in brain function underlying the perception and naturalistic production of language. Specifically, statistically significant results were observed that show recruitment of regions in occipital, temporal, motor, and prefrontal cortices across all three tasks after performing stringent cluster-extent based thresholding. Our findings lay the foundation for future HD-DOT studies of imaging naturalistic language comprehension and production during real-life social interactions and for broader applications such as presurgical language assessment and brain-machine interfaces.
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Affiliation(s)
- Mariel L Schroeder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA; Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, USA
| | - Arefeh Sherafati
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel L Ulbrich
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA; University of Missouri School of Medicine, Columbia, MO, USA
| | - Muriah D Wheelock
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Alexandra M Svoboda
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA; University of Cincinnati Medical Center, Cincinnati, Oh, USA
| | - Emma D Klein
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tessa G George
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Kalyan Tripathy
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA; Washington University School of Medicine, St Louis, MO, USA
| | - Joseph P Culver
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA; Division of Biology & Biomedical Sciences, Washington University School of Medicine, St Louis, MO, USA; Department of Physics, Washington University in St. Louis, St Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St Louis, MO, USA
| | - Adam T Eggebrecht
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA; Division of Biology & Biomedical Sciences, Washington University School of Medicine, St Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St Louis, MO, USA.
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