Motor-commands decoding using peripheral nerve signals: a review

Non-invasive transcranial electrical brain stimulation guided by functional near-infrared spectroscopy for targeted neuromodulation: A review

One of the primary goals in cognitive neuroscience is to understand the neural mechanisms on which cognition is based. Researchers are trying to find how cognitive mechanisms are related to oscillations generated due to brain activity. The research focused on this topic has been considerably aided by developing non-invasive brain stimulation techniques. The dynamics of brain networks and the resultant behavior can be affected by non-invasive brain stimulation techniques, which make their use a focus of interest in many experiments and clinical fields. One essential non-invasive brain stimulation technique is transcranial electrical stimulation (tES), subdivided into transcranial direct and alternating current stimulation. tES has recently become more well-known because of the effective results achieved in treating chronic conditions. In addition, there has been exceptional progress in the interpretation and feasibility of tES techniques. Summarizing the beneficial effects of tES, this article provides an updated depiction of what has been accomplished to date, brief history, and the open questions that need to be addressed in the future. An essential issue in the field of tES is stimulation duration. This review briefly covers the stimulation durations that have been utilized in the field while monitoring the brain using functional-near infrared spectroscopy-based brain imaging.

A lightweight learning-based decoding algorithm for intraneural vagus nerve activity classification in pigs

OBJECTIVE

Bioelectronic medicine is an emerging field that aims at developing closed-loop neuromodulation protocols for the autonomic nervous system (ANS) to treat a wide range of disorders. When designing a closed-loop protocol for real time modulation of the ANS, the computational execution time and the memory and power demands of the decoding step are important factors to consider. In the context of cardiovascular and respiratory diseases, these requirements may partially explain why closed-loop clinical neuromodulation protocols that adapt stimulation parameters on patient's clinical characteristics are currently missing.

APPROACH

Here, we developed a lightweight learning-based decoder for the classification of cardiovascular and respiratory functional challenges from neural signals acquired through intraneural electrodes implanted in the cervical vagus nerve (VN) of 5 anaesthetized pigs. Our algorithm is based on signal temporal windowing, 9 handcrafted features, and Random Forest (RF) model for classification. Temporal windowing ranging from 50 ms to 1 sec, compatible in duration with cardio-respiratory dynamics, was applied to the data in order to mimic a pseudo real-time scenario.

MAIN RESULTS

We were able to achieve high balanced accuracy (BA) values over the whole range of temporal windowing duration. We identified 500 ms as the optimal temporal windowing duration for both BA values and computational execution time processing, achieving more than 86% for BA and a computational execution time of only ∼6.8 ms. Our algorithm outperformed in terms of balanced accuracy and computational execution time a state of the art decoding algorithm tested on the same dataset [1]. We found that RF outperformed other machine learning models such as Support Vector Machines, K-Nearest Neighbors, and Multi-Layer Perceptrons.

SIGNIFICANCE

Our approach could represent an important step towards the implementation of a closed-loop neuromodulation protocol relying on a single intraneural interface able to perform real-time decoding tasks and selective modulation of the VN.

Spatio-temporal feature extraction in sensory electroneurographic signals

The recording and analysis of peripheral neural signal can provide insight for various prosthetic and bioelectronics medicine applications. However, there are few studies that investigate how informative features can be extracted from population activity electroneurographic (ENG) signals. In this study, five feature extraction frameworks were implemented on sensory ENG datasets and their classification performance was compared. The datasets were collected in acute rat experiments where multi-channel nerve cuffs recorded from the sciatic nerve in response to proprioceptive stimulation of the hindlimb. A novel feature extraction framework, which incorporates spatio-temporal focus and dynamic time warping, achieved classification accuracies above 90% while keeping a low computational cost. This framework outperformed the remaining frameworks tested in this study and has improved the discrimination accuracy of the sensory signals. Thus, this study has extended the tools available to extract features from sensory population activity ENG signals. This article is part of the theme issue 'Advanced neurotechnologies: translating innovation for health and well-being'.

Flexible Electronics and Devices as Human-Machine Interfaces for Medical Robotics

Medical robots are invaluable players in non-pharmaceutical treatment of disabilities. Particularly, using prosthetic and rehabilitation devices with human-machine interfaces can greatly improve the quality of life for impaired patients. In recent years, flexible electronic interfaces and soft robotics have attracted tremendous attention in this field due to their high biocompatibility, functionality, conformability, and low-cost. Flexible human-machine interfaces on soft robotics will make a promising alternative to conventional rigid devices, which can potentially revolutionize the paradigm and future direction of medical robotics in terms of rehabilitation feedback and user experience. In this review, the fundamental components of the materials, structures, and mechanisms in flexible human-machine interfaces are summarized by recent and renowned applications in five primary areas: physical and chemical sensing, physiological recording, information processing and communication, soft robotic actuation, and feedback stimulation. This review further concludes by discussing the outlook and current challenges of these technologies as a human-machine interface in medical robotics.

Whole Brain Hemodynamic Response Based on Synchrony Analysis of Brain Signals for Effective Application of HD-tDCS in Stroke Patients: An fNIRS Study

In this study, the effective application of high-definition transcranial direct current stimulation (HD-tDCS) based on the whole brain hemodynamic response in stroke patients was investigated using functional near-infrared spectroscopy (fNIRS). The intrahemispheric and interhemispheric synchronization and cortical activity based on the time during 1 mA HD-tDCS were examined in 26 chronic cerebrovascular disease patients. At the beginning of HD-tDCS, the synchronization and brain activity in the whole brain increased rapidly and decreased after 5 min. In the middle of tDCS, the synchronization began to increase again, and strong synchronic connections were formed around the desired stimulation area. After tDCS, strong cortical activation was observed in the stimulation area, indicating that the baseline of the oxyhemoglobin (HbO) signal increased in the desired stimulation area. Therefore, the results of this study indicate that HD-tDCS can be applied efficiently to enhance the effect of tDCS. This stimulation method with tDCS can be explored clinically for more neurorehabilitation of patients with degenerative brain diseases.

The Use of the Velocity Selective Recording Technique to Reveal the Excitation Properties of the Ulnar Nerve in Pigs

Decoding information from the peripheral nervous system via implantable neural interfaces remains a significant challenge, considerably limiting the advancement of neuromodulation and neuroprosthetic devices. The velocity selective recording (VSR) technique has been proposed to improve the classification of neural traffic by combining temporal and spatial information through a multi-electrode cuff (MEC). Therefore, this study investigates the feasibility of using the VSR technique to characterise fibre type based on the electrically evoked compound action potentials (eCAP) propagating along the ulnar nerve of pigs in vivo. A range of electrical stimulation parameters (amplitudes of 50 μA-10 mA and pulse durations of 100 μs, 500 μs, 1000 μs, and 5000 μs) was applied on a cutaneous and a motor branch of the ulnar nerve in nine Danish landrace pigs. Recordings were made with a 14 ring MEC and a delay-and-add algorithm was used to convert the eCAPs into the velocity domain. The results revealed two fibre populations propagating along the cutaneous branch of the ulnar nerve, with mean velocities of 55 m/s and 21 m/s, while only one dominant fibre population was found for the motor branch, with a mean velocity of 63 m/s. Because of its simplicity to provide information on the fibre selectivity and direction of propagation of nerve fibres, VSR can be implemented to advance the performance of the bidirectional control of neural prostheses and bioelectronic medicine applications.

Multisite Simultaneous Neural Recording of Motor Pathway in Free-Moving Rats

Neural interfaces typically focus on one or two sites in the motoneuron system simultaneously due to the limitation of the recording technique, which restricts the scope of observation and discovery of this system. Herein, we built a system with various electrodes capable of recording a large spectrum of electrophysiological signals from the cortex, spinal cord, peripheral nerves, and muscles of freely moving animals. The system integrates adjustable microarrays, floating microarrays, and microwires to a commercial connector and cuff electrode on a wireless transmitter. To illustrate the versatility of the system, we investigated its performance for the behavior of rodents during tethered treadmill walking, untethered wheel running, and open field exploration. The results indicate that the system is stable and applicable for multiple behavior conditions and can provide data to support previously inaccessible research of neural injury, rehabilitation, brain-inspired computing, and fundamental neuroscience.

The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements

Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided "silos," we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.

In-silico development and assessment of a Kalman filter motor decoder for prosthetic hand control

Up to 50% of amputees abandon their prostheses, partly due to rapid degradation of the control systems, which require frequent recalibration. The goal of this study was to develop a Kalman filter-based approach to decoding motoneuron activity to identify movement kinematics and thereby provide stable, long-term, accurate, real-time decoding. The Kalman filter-based decoder was examined via biologically varied datasets generated from a high-fidelity computational model of the spinal motoneuron pool. The estimated movement kinematics controlled a simulated MuJoCo prosthetic hand. This clear-box approach showed successful estimation of hand movements under eight varied physiological conditions with no retraining. The mean correlation coefficient of 0.98 and mean normalized root mean square error of 0.06 over these eight datasets provide proof of concept that this decoder would improve long-term integrity of performance while performing new, untrained movements. Additionally, the decoder operated in real-time (~0.3 ms). Further results include robust performance of the Kalman filter when re-trained to more severe post-amputation limitations in the type and number of motoneurons remaining. An additional analysis shows that the decoder achieves better accuracy when using the firing of individual motoneurons as input, compared to using aggregate pool firing. Moreover, the decoder demonstrated robustness to noise affecting both the trained decoder parameters and the decoded motoneuron activity. These results demonstrate the utility of a proof of concept Kalman filter decoder that can support prosthetics' control systems to maintain accurate and stable real-time movement performance.

Computational approaches to decode grasping force and velocity level in upper-limb amputee from intraneural peripheral signals

Objective. Recent results have shown the potentials of neural interfaces to provide sensory feedback to subjects with limb amputation increasing prosthesis usability. However, their advantages for decoding motor control signals over current methods based on electromyography (EMG) are still debated. In this study we compared a standard EMG-based method with approaches that use peripheral intraneural data to infer distinct levels of grasping force and velocity in a trans-radial amputee.Approach. Surface EMG (three channels) and intraneural signals (collected with transverse intrafascicular multichannel electrodes, TIMEs, 56 channels) were simultaneously recorded during the amputee's intended grasping movements. We sorted single unit activity (SUA) from each neural signal and then we identified the most informative units. EMG envelopes were extracted from the recorded EMG signals. A reference support vector machine (SVM) classifier was used to map EMG envelopes into desired force and velocity levels. Two decoding approaches using SUA were then tested and compared to the EMG-based reference classifier: (a) SVM classification of firing rates into desired force and velocity levels; (b) reconstruction of covariates (the grasp cue level or EMG envelopes) from neural data and use of covariates for classification into desired force and velocity levels.Main results.Using EMG envelopes as reconstructed covariates from SUA yielded significantly better results than the other approaches tested, with performance similar to that of the EMG-based reference classifier, and stable over three different recording days. Of the two reconstruction algorithms used in this approach, a linear Kalman filter and a nonlinear point process adaptive filter, the nonlinear filter gave better results.Significance.This study presented a new effective approach for decoding grasping force and velocity from peripheral intraneural signals in a trans-radial amputee, which relies on using SUA to reconstruct EMG envelopes. Being dependent on EMG recordings only for the training phase, this approach can fully exploit the advantages of implanted neural interfaces and potentially overcome, in the medium to long term, current state-of-the-art methods. (Clinical trial's registration number: NCT02848846).

Decoding hindlimb kinematics from descending and ascending neural signals during cat locomotion

OBJECTIVE

The main objective of this research is to record both sensory and motor information from the ascending and descending tracts within the spinal cord for decoding the hindlimb kinematics during walking on the treadmill.

APPROACH

Two different experimental paradigms (i.e., active and passive) were used in the current study. During active experiments, five cats were trained to walk bipedally while their hands kept on the front frame of the treadmill for balance or to walk quadrupedally. During passive experiments, the limb was passively moved by the experimenter. Local field potential (LFP) activity was recorded using a microwire array implanted in the dorsal column (DC) and lateral column (LC) of the L3-L4 spinal segments. The amplitude and frequency components of the LFP formed the feature set and the elastic net regularization was used to decode the hindlimb joint angles.

MAIN RESULTS

The results show that there is no significant difference between the information content of the signals recorded from the DC and LC regions during walking on the treadmill, but the information content of the DC is significantly higher than that of the LC during passively applied movement of the hindlimb in the anesthetized cats. Moreover, the decoding performance obtained using the recorded signals from the DC is comparable with that from the LC during locomotion. But, the decoding performance obtained using the recording channels in the DC is significantly better than that obtained using the signals recorded from the LC. The long-term analysis shows that robust decoding performance can be achieved over 2-3 months without a significant decrease in performance.

SIGNIFICANCE

This work presents a promising approach to developing a natural and robust motor neuroprosthesis device using descending neural signals to execute the movement and ascending neural signals as the feedback information for control of the movement.

Systematic analysis of wavelet denoising methods for neural signal processing

Objective.Among the different approaches for denoising neural signals, wavelet-based methods are widely used due to their ability to reduce in-band noise. All wavelet denoising algorithms have a common structure, but their effectiveness strongly depends on several implementation choices, including the mother wavelet, the decomposition level, the threshold definition, and the way it is applied (i.e. the thresholding). In this work, we investigated these factors to quantitatively assess their effects on neural signals in terms of noise reduction and morphology preservation, which are important when spike sorting is required downstream.Approach.Based on the spectral characteristics of the neural signal, according to the sampling rate of the signals, we considered two possible decomposition levels and identified the best-performing mother wavelet. Then, we compared different threshold estimation and thresholding methods and, for the best ones, we also evaluated their effect on clearing the approximation coefficients. The assessments were performed on synthetic signals that had been corrupted by different types of noise and on a murine peripheral nervous system dataset, both of which were sampled at about 16 kHz. The results were statistically analysed in terms of their Pearson's correlation coefficients, root-mean-square errors, and signal-to-noise ratios.Main results.As expected, the wavelet implementation choices greatly influenced the processing performance. Overall, the Haar wavelet with a five-level decomposition, hard thresholding method, and the threshold proposed by Hanet al(2007) achieved the best outcomes. Based on the adopted performance metrics, wavelet denoising with these parametrizations outperformed conventional 300-3000 Hz linear bandpass filtering.Significance.These results can be used to guide the reasoned and accurate selection of wavelet denoising implementation choices in the context of neural signal processing, particularly when spike-morphology preservation is required.

Detection of Mild Cognitive Impairment Using Convolutional Neural Network: Temporal-Feature Maps of Functional Near-Infrared Spectroscopy

Mild cognitive impairment (MCI) is the clinical precursor of Alzheimer's disease (AD), which is considered the most common neurodegenerative disease in the elderly. Some MCI patients tend to remain stable over time and do not evolve to AD. It is essential to diagnose MCI in its early stages and provide timely treatment to the patient. In this study, we propose a neuroimaging approach to identify MCI using a deep learning method and functional near-infrared spectroscopy (fNIRS). For this purpose, fifteen MCI subjects and nine healthy controls (HCs) were asked to perform three mental tasks: N-back, Stroop, and verbal fluency (VF) tasks. Besides examining the oxygenated hemoglobin changes (ΔHbO) in the region of interest, ΔHbO maps at 13 specific time points (i.e., 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, and 65 s) during the tasks and seven temporal feature maps (i.e., two types of mean, three types of slope, kurtosis, and skewness) in the prefrontal cortex were investigated. A four-layer convolutional neural network (CNN) was applied to identify the subjects into either MCI or HC, individually, after training the CNN model with ΔHbO maps and temporal feature maps above. Finally, we used the 5-fold cross-validation approach to evaluate the performance of the CNN. The results of temporal feature maps exhibited high classification accuracies: The average accuracies for the N-back task, Stroop task, and VFT, respectively, were 89.46, 87.80, and 90.37%. Notably, the highest accuracy of 98.61% was achieved from the ΔHbO slope map during 20-60 s interval of N-back tasks. Our results indicate that the fNIRS imaging approach based on temporal feature maps is a promising diagnostic method for early detection of MCI and can be used as a tool for clinical doctors to identify MCI from their patients.

Decoding of grasping tasks from intraneural recordings in trans-radial amputee

OBJECTIVE

A major challenge in neuroprosthetics is the restoration of sensory-motor hand functions in upper-limb amputees. Neuroprostheses based on the direct re-connection of the peripheral nerves may be an interesting approach for re-establishing the natural and effective bidirectional control of hand prostheses. Recent results have shown that transverse intrafascicular multi-channel electrodes (TIMEs) can restore natural and sophisticated sensory feedback. However, the potential of using TIME-recorded motor intraneural signals to decode grasping tasks has not as yet been explored.

APPROACH

In this study, we show that several hand-movement intentions can be decoded from intraneural signals recorded using four TIMEs implanted in the median and ulnar nerves of an upper limb amputee. Experimental sessions were performed over a week, from day 16 to day 23 after the surgical operation. Intraneural activity was recorded during several hand motor tasks imagined by the subject and processed offline.

MAIN RESULTS

We obtained a very high decoding accuracy considering 11 class states (up to 83%). These results confirm that neural signals recorded by multi-channel intraneural electrodes can be used to decode several movement intentions with high accuracy. Moreover, we were able to use same TIME channels for decoding over one week within the first month, even if the stability has to be confirmed during long-term experiments.

SIGNIFICANCE

Therefore, TIMEs could be used in the future to achieve a complete bidirectional approach exploiting neural pathways, to make a more natural and intuitive new generation of hand prostheses that have a closer resemblance to a healthy hand.

Neural signal recording and processing in somatic neuroprosthetic applications. A review

Neurointerfaces have acquired major relevance as both rehabilitative and therapeutic tools for patients with spinal cord injury, limb amputations and other neural disorders. Bidirectional neural interfaces are a key component for the functional control of neuroprosthetic devices. The two main neuroprosthetic applications of interfaces with the peripheral nervous system (PNS) are: the refined control of artificial prostheses with sensory neural feedback, and functional electrical stimulation (FES) systems attempting to generate motor or visceral responses in paralyzed organs. The results obtained in experimental and clinical studies with both, extraneural and intraneural electrodes are very promising in terms of the achieved functionality for the neural stimulation mode. However, the results of neural recordings with peripheral nerve interfaces are more limited. In this paper we review the different existing approaches for PNS signals recording, denoising, processing and classification, enabling their use for bidirectional interfaces. PNS recordings can provide three types of signals: i) population activity signals recorded by using extraneural electrodes placed on the outer surface of the nerve, which carry information about cumulative nerve activity; ii) spike activity signals recorded with intraneural electrodes placed inside the nerve, which carry information about the electrical activity of a set of individual nerve fibers; and iii) hybrid signals, which contain both spiking and cumulative signals. Finally, we also point out some of the main limitations, which are hampering clinical translation of neural decoding, and indicate possible solutions for improvement.

Reduction of Onset Delay in Functional Near-Infrared Spectroscopy: Prediction of HbO/HbR Signals

An intrinsic problem when using hemodynamic responses for the brain-machine interface is the slow nature of the physiological process. In this paper, a novel method that estimates the oxyhemoglobin changes caused by neuronal activations is proposed and validated. In monitoring the time responses of blood-oxygen-level-dependent signals with functional near-infrared spectroscopy (fNIRS), the early trajectories of both oxy- and deoxy-hemoglobins in their phase space are scrutinized. Furthermore, to reduce the detection time, a prediction method based upon a kernel-based recursive least squares (KRLS) algorithm is implemented. In validating the proposed approach, the fNIRS signals of finger tapping tasks measured from the left motor cortex are examined. The results show that the KRLS algorithm using the Gaussian kernel yields the best fitting for both ΔHbO (i.e., 87.5%) and ΔHbR (i.e., 85.2%) at q = 15 steps ahead (i.e., 1.63 s ahead at a sampling frequency of 9.19 Hz). This concludes that a neuronal activation can be concluded in about 0.1 s with fNIRS using prediction, which enables an almost real-time practice if combined with EEG.

A Between-Subject fNIRS-BCI Study on Detecting Self-Regulated Intention During Walking

OBJECTIVE

Most BCI (brain-computer interface) studies have focused on detecting motion intention from a resting state. However, the dynamic regulation of two motion states, which usually happens in real life, is rarely studied. Besides, popular within-subject methods also require an extensive and time-consuming learning stage when testing on a new subject. This paper proposed a method to discriminate dynamic gait- adjustment intention with strong adaptability for different subjects.

METHODS

Cerebral hemoglobin signals obtained from 30 subjects were studied to decode gait-adjustment intention. Cerebral hemoglobin information was recorded by using fNIRS (functional near infrared spectroscopy) technology. Mathematical morphology filtering was applied to remove zero drift and EWM (Entropy Weight Method) was used to calculate the average hemoglobin values over Regions of Interest (ROIs). The gradient boosting decision tree (GBDT) was utilized to detect the onset of self-regulated intention. A 2-layer-GA-SVM (Genetic Algorithm-Support Vector Machine) model based on stacking algorithm was further proposed to identify the four types of self-regulated intention (speed increase, speed reduction, step increase, and step reduction).

RESULTS

It was found that GBDT had a good performance to detect the onset intention with an average AUC (Area Under Curve) of 0.894. The 2-layer-GA-SVM model boosted the average ACC (accuracy) of four types of intention from 70.6% to 84.4% ( p = 0.005 ) from the single GA-SVM model. Furthermore, the proposed method passed pseudo-online test with the average results as following: AUC = 0.883, TPR (True Positive Rate) = 97.5%, FPR (False Positive Rate) = 0.11%, and LAY (Detection Latency) = -0.52 ± 2.57 seconds for the recognition of gait-adjustment intention; ACC = 80% for the recognition of adjusted gait.

CONCLUSION

The results indicate that it is feasible to decode dynamic gait-adjustment intentions from a motion state for different subjects based on fNIRS technology. It has a potential to realize the practical application of fNIRS-based brain-computer interface technology in controlling walking-assistive devices.

A rat model for assessing the long-term safety and performance of peripheral nerve electrode arrays

BACKGROUND

High-resolution peripheral nerve interfaces (PNIs) can provide amputees with intuitive motor control and sensory feedback. Current PNIs are limited by early device failure and suboptimal long-term stability. The present study aims to incorporate functional assessment into an in vivo test platform to assess the long-term safety and performance of PNIs for recording and stimulation.

NEW METHODS

Utah electrode arrays (EA) were implanted in the rat sciatic nerve along with electromyography wires in the gastrocnemius and tibialis anterior. Cranial EEG screws were implanted in the somatosensory cortex for 12 weeks. Spontaneous neural activity was recorded using the implanted EA and stimulation-induced activity was monitored throughout the experiment. The impedance of each electrode was measured, and nerve function tests were conducted throughout the EA lifetime. Post-hoc safety assessments included scanning electron microscopy (SEM) of the EA and nerve histomorphometric analysis.

RESULTS

EA recordings were stable, and stimulation with EA elicited somatosensory evoked potentials and muscle contractions. Motor and sensory function tests indicated minimal deficits. Histomorphometric analysis indicated changes in nerve microstructure. SEM indicated EA-tip fracture, while lead wire breakage primarily caused device failure.

COMPARISON WITH EXISTING METHODS

We improved our prior platform with the addition of functional assessments of sensory pathways, a robust EMG array design to increase device longevity, and quantitative analysis of nerve microstructure.

CONCLUSION

We present a test platform for long-term assessment of peripheral nerve interfaces for stimulation and recording. Using this platform, we demonstrate recording and stimulation with minimal impact on nerve function, while EA lead wire breakage and tip fracture could limit long-term device use.

Evaluation of Neural Degeneration Biomarkers in the Prefrontal Cortex for Early Identification of Patients With Mild Cognitive Impairment: An fNIRS Study

Mild cognitive impairment (MCI), a condition characterizing poor cognition, is associated with aging and depicts early symptoms of severe cognitive impairment, known as Alzheimer's disease (AD). Meanwhile, early detection of MCI can prevent progression to AD. A great deal of research has been performed in the past decade on MCI detection. However, availability of biomarkers for MCI detection requires greater attention. In our study, we evaluated putative and reliable biomarkers for diagnosing MCI by performing different mental tasks (i.e., N-back task, Stroop task, and verbal fluency task) using functional near-infrared spectroscopy (fNIRS) signals on a group of 15 MCI patients and 9 healthy control (HC). The 15 digital biomarkers (i.e., five means, seven slopes, peak, skewness, and kurtosis) and two image biomarkers (t-map, correlation map) in the prefrontal cortex (PFC) (i.e., left PFC, middle PFC, and right PFC) between the MCI and HC groups were investigated by the statistical analysis, linear discriminant analysis (LDA), and convolutional neural network (CNN) individually. The results reveal that the statistical analysis using digital biomarkers (with a p-value < 0.05) could not distinguish the MCI patients from the HC over 60% accuracy. Therefore, the current statistical analysis needs to be improved to be used for diagnosing the MCI patients. The best accuracy with LDA was 76.67% with the N-back and Stroop tasks. However, the CNN classification results trained by image biomarkers showed a high accuracy. In particular, the CNN results trained via t-maps revealed the best accuracy (90.62%) with the N-back task, whereas the CNN result trained by the correlation maps was 85.58% with the N-back task. Also, the results illustrated that investigating the sub-regions (i.e., right, middle, left) of the PFC for detecting MCI would be better than examining the whole PFC. The t-map (or/and the correlation map) is conclusively recommended as an image biomarker for early detection of AD. The combination of CNN and image biomarkers can provide a reliable clinical tool for diagnosing MCI patients.

Effects of Acupuncture Therapy on MCI Patients Using Functional Near-Infrared Spectroscopy

Acupuncture therapy (AT) is a non-pharmacological method of treatment that has been applied to various neurological diseases. However, studies on its longitudinal effect on the neural mechanisms of patients with mild cognitive impairment (MCI) for treatment purposes are still lacking in the literature. In this clinical study, we assess the longitudinal effects of ATs on MCI patients using two methods: (i) Montreal Cognitive Assessment test (MoCA-K, Korean version), and (ii) the hemodynamic response (HR) analyses using functional near-infrared spectroscopy (fNIRS). fNIRS signals of a working memory (WM) task were acquired from the prefrontal cortex. Twelve elderly MCI patients and 12 healthy people were recruited as target and healthy control (HC) groups, respectively. Each group went through an fNIRS scanning procedure three times: The initial data were obtained without any ATs, and subsequently a total of 24 AT sessions were conducted for MCI patients (i.e., MCI-0: the data prior to ATs, MCI-1: after 12 sessions of ATs for 6 weeks, MCI-2: another 12 sessions of ATs for 6 weeks). The mean HR responses of all MCI-0–2 cases were lower than those of HCs. To compare the effects of AT on MCI patients, MoCA-K results, temporal HR data, and spatial activation patterns (i.e., t-maps) were examined. In addition, analyses of functional connectivity (FC) and graph theory upon WM tasks were conducted. With ATs, (i) the averaged MoCA-K test scores were improved (MCI-1, p = 0.002; MCI-2, p = 2.9e^–4); (ii) the mean HR response of WM tasks was increased (p < 0.001); and (iii) the t-maps of MCI-1 and MCI-2 were enhanced. Furthermore, an increased FC in the prefrontal cortex in both MCI-1/MCI-2 cases in comparison to MCI-0 was obtained (p < 0.01), and an increasing trend in the graph theory parameters was observed. All these findings reveal that ATs have a positive impact on improving the cognitive function of MCI patients. In conclusion, ATs can be used as a therapeutic tool for MCI patients as a non-pharmacological method (Clinical trial registration number: KCT 0002451 https://cris.nih.go.kr/cris/en/).

EMG- Versus EEG-Triggered Electrical Stimulation for Inducing Corticospinal Plasticity

Brain-computer interfaces have been proposed for stroke rehabilitation. Motor cortical activity derived from the electroencephalography (EEG) can trigger external devices that provide congruent sensory feedback. However, many stroke patients regain residual muscle (EMG: electromyography) control due to spontaneous recovery and rehabilitation; therefore, EEG may not be necessary as a control signal. In this paper, a direct comparison was made between the induction of corticospinal plasticity using either EEG- or EMG-controlled electrical nerve stimulation. Twenty healthy participants participated in two intervention sessions consisting of EEG- and EMG-controlled electrical stimulation. The sessions consisted of 50 pairings between foot dorsiflexion movements (decoded through either EEG or EMG) and electrical stimulation of the common peroneal nerve. Before, immediately after and 30 minutes after the intervention, 15 motor evoked potentials (MEPs) were elicited in tibialis anterior through transcranial magnetic stimulation. Increased MEPs were observed immediately after (62 ± 26%, 73 ± 27% for EEG- and EMG-triggered electrical stimulation, respectively) and 30 minutes after each of the two interventions (79 ± 26% and 72 ± 27%) compared to the pre-intervention measurement. There was no difference between the interventions. Both EEG- and EMG-controlled electrical stimulation can induce corticospinal plasticity which suggests that stroke patients with residual EMG can use that modality instead of EEG to trigger stimulation.

Early Detection of Hemodynamic Responses Using EEG: A Hybrid EEG-fNIRS Study

Enhanced classification accuracy and a sufficient number of commands are highly demanding in brain computer interfaces (BCIs). For a successful BCI, early detection of brain commands in time is essential. In this paper, we propose a novel classifier using a modified vector phase diagram and the power of electroencephalography (EEG) signal for early prediction of hemodynamic responses. EEG and functional near-infrared spectroscopy (fNIRS) signals for a motor task (thumb tapping) were obtained concurrently. Upon the resting state threshold circle in the vector phase diagram that uses the maximum values of oxy- and deoxy-hemoglobin (ΔHbO and ΔHbR) during the resting state, we introduce a secondary (inner) threshold circle using the ΔHbO and ΔHbR magnitudes during the time window of 1 s where an EEG activity is noticeable. If the trajectory of ΔHbO and ΔHbR touches the resting state threshold circle after passing through the inner circle, this indicates that ΔHbO was increasing and ΔHbR was decreasing (i.e., the start of a hemodynamic response). It takes about 0.5 s for an fNIRS signal to cross the resting state threshold circle after crossing the EEG-based circle. Thus, an fNIRS-based BCI command can be generated in 1.5 s. We achieved an improved accuracy of 86.0% using the proposed method in comparison with the 63.8% accuracy obtained using linear discriminant analysis in a window of 0~1.5 s. Moreover, the active brain locations (identified using the proposed scheme) were spatially specific when a t-map was made after 10 s of stimulation. These results demonstrate the possibility of enhancing the classification accuracy for a brain-computer interface with a time window of 1.5 s using the proposed method.

Existence of Initial Dip for BCI: An Illusion or Reality

A tight coupling between the neuronal activity and the cerebral blood flow (CBF) is the motivation of many hemodynamic response (HR)-based neuroimaging modalities. The increase in neuronal activity causes the increase in CBF that is indirectly measured by HR modalities. Upon functional stimulation, the HR is mainly categorized in three durations: (i) initial dip, (ii) conventional HR (i.e., positive increase in HR caused by an increase in the CBF), and (iii) undershoot. The initial dip is a change in oxygenation prior to any subsequent increase in CBF and spatially more specific to the site of neuronal activity. Despite additional evidence from various HR modalities on the presence of initial dip in human and animal species (i.e., cat, rat, and monkey); the existence/occurrence of an initial dip in HR is still under debate. This article reviews the existence and elusive nature of the initial dip duration of HR in intrinsic signal optical imaging (ISOI), functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). The advent of initial dip and its elusiveness factors in ISOI and fMRI studies are briefly discussed. Furthermore, the detection of initial dip and its role in brain-computer interface using fNIRS is examined in detail. The best possible application for the initial dip utilization and its future implications using fNIRS are provided.