Non-invasive stimulation of the human striatum disrupts reinforcement learning of motor skills

Reinforcement feedback can improve motor learning, but the underlying brain mechanisms remain underexplored. In particular, the causal contribution of specific patterns of oscillatory activity within the human striatum is unknown. To address this question, we exploited a recently developed non-invasive deep brain stimulation technique called transcranial temporal interference stimulation (tTIS) during reinforcement motor learning with concurrent neuroimaging, in a randomized, sham-controlled, double-blind study. Striatal tTIS applied at 80 Hz, but not at 20 Hz, abolished the benefits of reinforcement on motor learning. This effect was related to a selective modulation of neural activity within the striatum. Moreover, 80 Hz, but not 20 Hz, tTIS increased the neuromodulatory influence of the striatum on frontal areas involved in reinforcement motor learning. These results show that tTIS can non-invasively and selectively modulate a striatal mechanism involved in reinforcement learning, expanding our tools for the study of causal relationships between deep brain structures and human behaviour.

Conscious but not thinking-Mind-blanks during visuomotor tracking: An fMRI study of endogenous attention lapses

Attention lapses (ALs) are complete lapses of responsiveness in which performance is briefly but completely disrupted and during which, as opposed to microsleeps, the eyes remain open. Although the phenomenon of ALs has been investigated by behavioural and physiological means, the underlying cause of an AL has largely remained elusive. This study aimed to investigate the underlying physiological substrates of behaviourally identified endogenous ALs during a continuous visuomotor task, primarily to answer the question: Were the ALs during this task due to extreme mind-wandering or mind-blanks? The data from two studies were combined, resulting in data from 40 healthy non-sleep-deprived subjects (20M/20F; mean age 27.1 years, 20-45). Only 17 of the 40 subjects were used in the analysis due to a need for a minimum of two ALs per subject. Subjects performed a random 2-D continuous visuomotor tracking task for 50 and 20 min in Studies 1 and 2, respectively. Tracking performance, eye-video, and functional magnetic resonance imaging (fMRI) were recorded simultaneously. A human expert visually inspected the tracking performance and eye-video recordings to identify and categorise lapses of responsiveness as microsleeps or ALs. Changes in neural activity during 85 ALs (17 subjects) relative to responsive tracking were estimated by whole-brain voxel-wise fMRI and by haemodynamic response (HR) analysis in regions of interest (ROIs) from seven key networks to reveal the neural signature of ALs. Changes in functional connectivity (FC) within and between the key ROIs were also estimated. Networks explored were the default mode network, dorsal attention network, frontoparietal network, sensorimotor network, salience network, visual network, and working memory network. Voxel-wise analysis revealed a significant increase in blood-oxygen-level-dependent activity in the overlapping dorsal anterior cingulate cortex and supplementary motor area region but no significant decreases in activity; the increased activity is considered to represent a recovery-of-responsiveness process following an AL. This increased activity was also seen in the HR of the corresponding ROI. Importantly, HR analysis revealed no trend of increased activity in the posterior cingulate of the default mode network, which has been repeatedly demonstrated to be a strong biomarker of mind-wandering. FC analysis showed decoupling of external attention, which supports the involuntary nature of ALs, in addition to the neural recovery processes. Other findings were a decrease in HR in the frontoparietal network before the onset of ALs, and a decrease in FC between default mode network and working memory network. These findings converge to our conclusion that the ALs observed during our task were involuntary mind-blanks. This is further supported behaviourally by the short duration of the ALs (mean 1.7 s), which is considered too brief to be instances of extreme mind-wandering. This is the first study to demonstrate that at least the majority of complete losses of responsiveness on a continuous visuomotor task are, if not due to microsleeps, due to involuntary mind-blanks.

Eccentric cycling involves greater mental demand and cortical activation of the frontoparietal network

Eccentric, compared to concentric exercise, is proposed to involve different neuro-motor processing strategies and a higher level of mental demand. This study compared eccentric and concentric cycling at matched perceived effort and torque for the mental demand and related-cortical activation patterns. Nineteen men (30 ± 6 years) performed four different 5-min cycling conditions at 30 RPM on a semi-recumbent isokinetic cycle ergometer: (1) concentric at a moderate perceived effort (23 on the CR100® scale) without torque feedback; (2) concentric and (3) eccentric at the same average torque produced in the first condition; and (4) eccentric at the same moderate perceived effort than the first concentric condition. The conditions two to four were randomized. After each condition, mental demand was monitored using the NASA Task Load Index scale. Changes in oxy-(O2 Hb) and deoxy-(HHb) hemoglobin during exercise were measured over both prefrontal cortices and the right parietal lobe from a 15-probe layout using a continuous-wave NIRS system. Mental demand was significantly higher during eccentric compared to concentric cycling (+52%, p = 0.012) and when the exercise intensity was fixed by the torque rather than the perceived effort (+70%, p < 0.001). For both torque- or perceived effort-matched exercises, O2 Hb increased significantly (p < 0.001) in the left and right prefrontal cortices, and right parietal lobe, and HHb decreased in the left, and right, prefrontal cortices during eccentric compared to concentric cycling. This study supports that acute eccentric cycling, compared to concentric cycling, involves a higher mental demand, and frontoparietal network activation.

Connecting the dots: harnessing dual-site transcranial magnetic stimulation to quantify the causal influence of medial frontal areas on the motor cortex

Dual-site transcranial magnetic stimulation has been widely employed to investigate the influence of cortical structures on the primary motor cortex. Here, we leveraged this technique to probe the causal influence of two key areas of the medial frontal cortex, namely the supplementary motor area and the medial orbitofrontal cortex, on primary motor cortex. We show that supplementary motor area stimulation facilitates primary motor cortex activity across short (6 and 8 ms) and long (12 ms) inter-stimulation intervals, putatively recruiting cortico-cortical and cortico-subcortico-cortical circuits, respectively. Crucially, magnetic resonance imaging revealed that this facilitatory effect depended on a key morphometric feature of supplementary motor area: individuals with larger supplementary motor area volumes exhibited more facilitation from supplementary motor area to primary motor cortex for both short and long inter-stimulation intervals. Notably, we also provide evidence that the facilitatory effect of supplementary motor area stimulation at short intervals is unlikely to arise from spinal interactions of volleys descending simultaneously from supplementary motor area and primary motor cortex. On the other hand, medial orbitofrontal cortex stimulation moderately suppressed primary motor cortex activity at both short and long intervals, irrespective of medial orbitofrontal cortex volume. These results suggest that dual-site transcranial magnetic stimulation is a fruitful approach to investigate the differential influence of supplementary motor area and medial orbitofrontal cortex on primary motor cortex activity, paving the way for the multimodal assessment of these fronto-motor circuits in health and disease.

Inhalation boosts perceptual awareness and decision speed

The emergence of consciousness is one of biology's biggest mysteries. During the past two decades, a major effort has been made to identify the neural correlates of consciousness, but in comparison, little is known about the physiological mechanisms underlying first-person subjective experience. Attention is considered the gateway of information to consciousness. Recent work suggests that the breathing phase (i.e., inhalation vs. exhalation) modulates attention, in such a way that attention directed toward exteroceptive information would increase during inhalation. One key hypothesis emerging from this work is that inhalation would improve perceptual awareness and near-threshold decision-making. The present study directly tested this hypothesis. We recorded the breathing rhythms of 30 humans performing a near-threshold decision-making task, in which they had to decide whether a liminal Gabor was tilted to the right or the left (objective decision task) and then to rate their perceptual awareness of the Gabor orientation (subjective decision task). In line with our hypothesis, the data revealed that, relative to exhalation, inhalation improves perceptual awareness and speeds up objective decision-making, without impairing accuracy. Overall, the present study builds on timely questions regarding the physiological mechanisms underlying consciousness and shows that breathing shapes the emergence of subjective experience and decision-making.NEW & NOTEWORTHY Breathing is a ubiquitous biological rhythm in animal life. However, little is known about its effect on consciousness and decision-making. Here, we measured the respiratory rhythm of humans performing a near-threshold discrimination experiment. We show that inhalation, compared with exhalation, improves perceptual awareness and accelerates decision-making while leaving accuracy unaffected.

Management of post-traumatic stress disorder symptoms by yoga: an overview

BACKGROUND

Posttraumatic stress disorder (PTSD) can occur after trauma. While PTSD management strategies include first-line pharmacotherapy and psychotherapy, mind-body therapies, such as yoga, are applied in the PTSD population. This overview aimed to summarize the effectiveness of yoga interventions on PTSD symptoms in adults in a systematic review (SR) including randomized controlled trials (RCTs).

METHOD

We searched for SR with or without meta-analysis of RCTs involving adults with PTSD diagnosis or trauma history. The search was conducted until April 2022, through six databases (Cochrane Database, MEDLINE (Pubmed), Scopus, Embase, CINHAL and PEDro). The primary outcome was the evolution of PTSD symptoms throughout the intervention. Secondary outcomes included follow-up, safety, adherence, and cost of the intervention. Two authors independently performed the selection, data extraction and risk of bias assessment with the AMSTAR 2 tool and overlap calculation. This overview is a qualitative summary of the results obtained in the selected studies.

RESULTS

Eleven SRs were analyzed, of which 8 included meta-analyses. The overlap between studies was considered very high (corrected covered area of 21%). Fifty-nine RCTs involving 4434 participants were included. Yoga had a significant small-to-moderate effect-size on PTSD symptom decrease in 7 SRs and non-significant effects in 1 SR with meta-analysis. All SR without meta-analysis found beneficial effects of yoga on PTSD. Secondary outcomes were not sufficiently assessed to provide clear evidence. Results should be interpreted with caution as 1 SR was rated as at moderate risk of bias, 3 as low and 7 as critically low.

CONCLUSIONS

While yoga therapy seems promising for decreasing PTSD symptoms, future research should standardize yoga therapy duration/frequency/type and consider long-term efficacy to better delineate yoga therapy efficacy in PTSD patients.

Beyond mind wandering: Performance variability and neural activity during off-task thought and other attention lapses

To study the characteristics of attention lapses, a metronome response task and experience sampling were employed while recording fMRI data. Thought prompts queried several attention states (on-task, task-related interference, off-task, inattention). Off-task thoughts were probed on whether they arose in a spontaneous or constrained (i.e., directed) manner. Increased fMRI activation was observed in the default mode network during off-task thought and in subregions of the anterior cingulate cortex and inferior frontal gyrus during inattention. Activation also increased in the left hippocampus during constrained thoughts. Functional connectivity increased between the left superior temporal sulcus and right temporoparietal junction for constrained compared to spontaneous thoughts. Overall, behavioral results indicated a monotonic increase in performance variability from on-task to inattention. However, subtle but consistent differences were observed between self-reported attention state and performance. Results are discussed from perspectives of mind wandering frameworks, the function of brain networks, and the role of engagement in off-task thought.

Neural mechanisms underlying state mental fatigue: a systematic review and activation likelihood estimation meta-analysis

Sustained performance of cognitive tasks could lead to the development of state mental fatigue characterized by subjective sensation of mental weariness and decrease in cognitive performance. In addition to the occupational hazards associated with mental fatigue, it can also affect physical performance reducing endurance, balance, and sport-specific technical skills. Similarly, mental fatigue is a common symptom in certain chronic health conditions such as multiple sclerosis affecting quality of life of the patients. Despite its widely acknowledged negative impact, the neural mechanisms underlining this phenomenon are still not fully understood. We conducted a systematic review and activation likelihood estimation (ALE) meta-analysis of functional neuroimaging studies investigating the effect of mental fatigue due to time-on-task (TOT) on brain activity to elucidate the possible underlying mechanisms. Studies were included if they examined change in brain activity induced by experimental mental fatigue (TOT effect) or investigated the relationship between brain activity and subjective mental fatigue due to TOT. A total of 33 studies met the review's inclusion criteria, 13 of which were included in meta-analyses. Results of the meta-analyses revealed a decrease in activity with TOT in brain areas that constitute the cognitive control network. Additionally, an increased activity with TOT, as well as negative relationship with subjective mental fatigue was found in parts of the default mode network of the brain. The changes in cognitive control and the default mode networks of the brain due to state mental fatigue observed in this study were discussed in relation to the existing theories of mental fatigue.

Slowed reaction times in cognitive fatigue are not attributable to declines in motor preparation

Cognitive fatigue (CF) can result from sustained mental effort, is characterized by subjective feelings of exhaustion and cognitive performance deficits, and is associated with slowed simple reaction time (RT). This study determined whether declines in motor preparation underlie this RT effect. Motor preparation level was indexed using simple RT and the StartReact effect, wherein a prepared movement is involuntarily triggered at short latency by a startling acoustic stimulus (SAS). It was predicted that if decreased motor preparation underlies CF-associated RT increases, then an attenuated StartReact effect would be observed following cognitive task completion. Subjective fatigue assessment and a simple RT task were performed before and after a cognitively fatiguing task or non-fatiguing control intervention. On 25% of RT trials, a SAS replaced the go-signal to assess the StartReact effect. CF inducement was verified by significant declines in cognitive performance (p = 0.003), along with increases in subjective CF (p < 0.001) and control RT (p = 0.018) following the cognitive fatigue intervention, but not the control intervention. No significant pre-to-post-test changes in SAS RT were observed, indicating that RT increases resulting from CF are not substantially associated with declines in motor preparation, and instead may be attributable to other stages of processing during a simple RT task.

State-dependent effects of neural stimulation on brain function and cognition

Invasive and non-invasive brain stimulation methods are widely used in neuroscience to establish causal relationships between distinct brain regions and the sensory, cognitive and motor functions they subserve. When combined with concurrent brain imaging, such stimulation methods can reveal patterns of neuronal activity responsible for regulating simple and complex behaviours at the level of local circuits and across widespread networks. Understanding how fluctuations in physiological states and task demands might influence the effects of brain stimulation on neural activity and behaviour is at the heart of how we use these tools to understand cognition. Here we review the concept of such 'state-dependent' changes in brain activity in response to neural stimulation, and consider examples from research on altered states of consciousness (for example, sleep and anaesthesia) and from task-based manipulations of selective attention and working memory. We relate relevant findings from non-invasive methods used in humans to those obtained from direct electrical and optogenetic stimulation of neuronal ensembles in animal models. Given the widespread use of brain stimulation as a research tool in the laboratory and as a means of augmenting or restoring brain function, consideration of the influence of changing physiological and cognitive states is crucial for increasing the reliability of these interventions.

Hasty sensorimotor decisions rely on an overlap of broad and selective changes in motor activity

Humans and other animals are able to adjust their speed–accuracy trade-off (SAT) at will depending on the urge to act, favoring either cautious or hasty decision policies in different contexts. An emerging view is that SAT regulation relies on influences exerting broad changes on the motor system, tuning its activity up globally when hastiness is at premium. The present study aimed to test this hypothesis. A total of 50 participants performed a task involving choices between left and right index fingers, in which incorrect choices led either to a high or to a low penalty in 2 contexts, inciting them to emphasize either cautious or hasty policies. We applied transcranial magnetic stimulation (TMS) on multiple motor representations, eliciting motor-evoked potentials (MEPs) in 9 finger and leg muscles. MEP amplitudes allowed us to probe activity changes in the corresponding finger and leg representations, while participants were deliberating about which index to choose. Our data indicate that hastiness entails a broad amplification of motor activity, although this amplification was limited to the chosen side. On top of this effect, we identified a local suppression of motor activity, surrounding the chosen index representation. Hence, a decision policy favoring speed over accuracy appears to rely on overlapping processes producing a broad (but not global) amplification and a surround suppression of motor activity. The latter effect may help to increase the signal-to-noise ratio of the chosen representation, as supported by single-trial correlation analyses indicating a stronger differentiation of activity changes in finger representations in the hasty context.

Many have argued that the regulation of the speed-accuracy tradeoff relies on an urgency signal, which implements "collapsing decision thresholds" by tuning neural activity in a global manner in decision-related structures. This study indicates that the reality is more subtle, with several aspects of "urgency" being specifically targeted to particular corticospinal populations within the motor system.

Trading accuracy for speed over the course of a decision

Humans and other animals often need to balance the desire to gather sensory information (to make the best choice) with the urgency to act, facing a speed-accuracy tradeoff (SAT). Given the ubiquity of SAT across species, extensive research has been devoted to understanding the computational mechanisms allowing its regulation at different timescales, including from one context to another, and from one decision to another. However, animals must frequently change their SAT on even shorter timescales-that is, over the course of an ongoing decision-and little is known about the mechanisms that allow such rapid adaptations. The present study aimed at addressing this issue. Human subjects performed a decision task with changing evidence. In this task, subjects received rewards for correct answers but incurred penalties for mistakes. An increase or a decrease in penalty occurring halfway through the trial promoted rapid SAT shifts, favoring speeded decisions either in the early or in the late stage of the trial. Importantly, these shifts were associated with stage-specific adjustments in the accuracy criterion exploited for committing to a choice. Those subjects who decreased the most their accuracy criterion at a given decision stage exhibited the highest gain in speed, but also the highest cost in terms of performance accuracy at that time. Altogether, the current findings offer a unique extension of previous work, by suggesting that dynamic cha*nges in accuracy criterion allow the regulation of the SAT within the timescale of a single decision.NEW & NOTEWORTHY Extensive research has been devoted to understanding the mechanisms allowing the regulation of the speed-accuracy tradeoff (SAT) from one context to another and from one decision to another. Here, we show that humans can voluntarily change their SAT on even shorter timescales-that is, over the course of a decision. These rapid SAT shifts are associated with dynamic adjustments in the accuracy criterion exploited for committing to a choice.

Exploring characteristic features of attention-deficit/hyperactivity disorder: findings from multi-modal MRI and candidate genetic data

The current study examined whether machine learning features best distinguishing attention-deficit/hyperactivity disorder (ADHD) from typically developing children (TDC) can explain clinical phenotypes using multi-modal neuroimaging and genetic data. Cortical morphology, diffusivity scalars, resting-state functional connectivity and polygenic risk score (PS) from norepinephrine, dopamine and glutamate genes were extracted from 47 ADHD and 47 matched TDC. Using random forests, classification accuracy was measured for each uni- and multi-modal model. The optimal model was used to explain symptom severity or task performance and its robustness was validated in the independent dataset including 18 ADHD and 18 TDC. The model consisting of cortical thickness and volume features achieved the best accuracy of 85.1%. Morphological changes across insula, sensory/motor, and inferior frontal cortex were also found as key predictors. Those explained 18.0% of ADHD rating scale, while dynamic regional homogeneity within default network explained 6.4% of the omission errors in continuous performance test. Ensemble of PS to optimal model showed minor effect on accuracy. Validation analysis achieved accuracy of 69.4%. Current findings suggest that structural deformities relevant to salience detection, sensory processing, and response inhibition may be robust classifiers and symptom predictors of ADHD. Altered local functional connectivity across default network predicted attentional lapse. However, further investigation is needed to clarify roles of genetic predisposition.

Role of the fronto-parietal cortex in prospective action judgments

Prospective judgments about one's capability to perform an action are assumed to involve mental simulation of the action. Previous studies of motor imagery suggest this simulation is supported by a large fronto-parietal network including the motor system. Experiment 1 used fMRI to assess the contribution of this fronto-parietal network to judgments about one's capacity to grasp objects of different sizes between index and thumb. The neural network underlying prospective graspability judgments overlapped the fronto-parietal network involved in explicit motor imagery of grasping. However, shared areas were located in the right hemisphere, outside the motor cortex, and were also activated during perceptual length judgments, suggesting a contribution to object size estimate rather than motor simulation. Experiment 2 used TMS over the motor cortex to probe transient excitability changes undetected with fMRI. Results show that graspability judgments elicited a selective increase of excitability in the thumb and index muscles, which was maximal before the object display and intermediate during the judgment. Together, these findings suggest that prospective action judgments do not rely on the motor system to simulate the action per se but to refresh the memory of one's maximal grip aperture and facilitate its comparison with object size in right fronto-parietal areas.

Motor training strengthens corticospinal suppression during movement preparation

Movement preparation involves a broad suppression in the excitability of the corticospinal pathway, a phenomenon called preparatory suppression. Here, we show that motor training strengthens preparatory suppression and that this strengthening is associated with faster reaction times. Our findings highlight a key role of preparatory suppression in training-driven behavioral improvements.

Mid-Task Physical Exercise Keeps Your Mind Vigilant: Evidences From Behavioral Performance and EEG Functional Connectivity

Accumulating efforts have been made to discover effective solutions for fatigue recovery with the ultimate aim of reducing adverse consequences of mental fatigue in real life. The previously-reported behavioral benefits of physical exercise on mental fatigue recovery prompted us to investigate the restorative effect and reveal the underlying neural mechanisms. Specifically, we introduced an empirical method to investigate the beneficial effect of physical exercise on the reorganization of EEG functional connectivity (FC) in a two-session experiment where one session including a successive 30-min psychomotor vigilance task (PVT) (No-intervention session) compared to an insertion of a mid-task 15-min cycling exercise (Intervention session). EEG FC was obtained from 21 participants and quantitatively assessed via graph theoretical analysis and a classification framework. The findings demonstrated the effectiveness of exercise intervention on behavioral performance as shown in improved reaction time and response accuracy. Although we found significantly altered network alterations towards the end of experiment in both sessions, no significant differences between the two sessions and no interaction between session and time were found in EEG network topology. Further interrogation of functional connectivity through classification analysis showed decreased FC in distributed brain areas, which may lead to the significant reduction of network efficiency in both sessions. Moreover, we showed distinct patterns of FC alterations between the two sessions, indicating different information processing strategies adopted in the intervention session. In sum, these results provide some of the first quantitative insights into the complex neural mechanism of exercise intervention for fatigue recovery and lead a new direction for further application research in real-world situations.

Tuning the Corticospinal System: How Distributed Brain Circuits Shape Human Actions

Interactive behaviors rely on the operation of several processes allowing the control of actions, including their selection, withholding, and cancellation. The corticospinal system provides a unique route through which multiple brain circuits can exert control over bodily motor acts. In humans, the influence of these modulatory circuits on the corticospinal system can be probed using various transcranial magnetic stimulation (TMS) protocols. Here, we review neural data from TMS studies at the basis of our current understanding of how diverse pathways—including intra-cortical, trans-cortical, and subcortico-cortical circuits—contribute to action control by tuning the activity of the corticospinal system. Critically, when doing so, we point out important caveats in the field that arise from the fact that these circuits, and their impact on the corticospinal system, have not been considered equivalently for action selection, withholding, and cancellation. This has led to the misleading view that some circuits or regions are specialized in specific control processes and that they produce particular modulatory changes in corticospinal excitability (e.g., generic vs. specific modulation of corticospinal excitability). Hence, we point to the need for more transversal research approaches in the field of action control.

Preparatory inhibition: Impact of choice in reaction time tasks

By applying transcranial magnetic stimulation (TMS) over primary motor cortex (M1) to elicit motor-evoked potentials (MEPs) in muscles of the contralateral hand during reaction time (RT) tasks, many studies have reported a strong global suppression of motor excitability during action preparation, a phenomenon called preparatory inhibition. Several hypotheses have been put forward regarding the role of this broad suppression, with the predominant view that it reflects inhibitory processes assisting action selection. However, this assumption is still a matter of debate. Here, we aimed at directly addressing this idea by comparing MEPs in a task that required subjects to select a finger response within a set of predefined options (choice RT task: left or right index finger abduction) or when subjects simply had to provide the same finger response on every trial, in the absence of choice (simple RT task). Moreover, we minimized any effect that could be associated with other forms of inhibition. In both versions of the task, TMS was applied on both M1 (double-coil protocol) at several time points between the go signal and the left or right index finger response, eliciting MEPs bilaterally in the prime mover (index finger agonist) and in an irrelevant muscle (pinky agonist). Overall, MEP suppression was moderate in this study compared to past research; it was only found for the irrelevant muscle. As such, MEPs in the index agonist were facilitated when elicited in a responding hand (e.g. left MEPs preceding left responses) and remained mostly unchanged in a non-responding hand (e.g. left MEPs preceding right responses). In contrast, MEPs were almost always suppressed in the pinky muscle when elicited in the non-responding hand. This finding contrasts with previous studies where preparatory inhibition usually concerns both relevant and irrelevant muscles. Yet importantly, the suppression was more consistent in the choice than in the simple RT task, supporting the view that preparatory inhibition may assist action selection.

Use of a Portable Functional Near-Infrared Spectroscopy (fNIRS) System to Examine Team Experience During Crisis Event Management in Clinical Simulations

Objective: The aim of this study was to investigate the utilization of a portable functional near-infrared spectroscopy (fNIRS) system, the fNIRS Pioneer^TM, to examine team experience in high-fidelity simulation-based crisis event management (CEM) training for anesthesiologists in operating rooms.

Background: Effective evaluation of team performance and experience in CEM simulations is essential for healthcare training and research. Neurophysiological measures with wearable devices can provide useful indicators of team experience to compliment traditional self-report, observer ratings, and behavioral performance measures. fNIRS measured brain blood oxygenation levels and neural synchrony can be used as indicators of workload and team engagement, which is vital for optimal team performance.

Methods: Thirty-three anesthesiologists, who were attending CEM training in two-person teams, participated in this study. The participants varied in their expertise level and the simulation scenarios varied in difficulty level. The oxygenated and de-oxygenated hemoglobin (HbO and HbR) levels in the participants’ prefrontal cortex were derived from data recorded by a portable one-channel fNIRS system worn by all participants throughout CEM training. Team neural synchrony was measured by HbO/HbR wavelet transformation coherence (WTC). Observer-rated workload and self-reported workload and mood were also collected.

Results: At the individual level, the pattern of HbR level corresponded to changes of workload for the individuals in different roles during different phases of a scenario; but this was not the case for HbO level. Thus, HbR level may be a better indicator for individual workload in the studied setting. However, HbR level was insensitive to differences in scenario difficulty and did not correlate with observer-rated or self-reported workload. At the team level, high levels of HbO and HbR WTC were observed during active teamwork. Furthermore, HbO WTC was sensitive to levels of scenario difficulty.

Conclusion: This study showed that it was feasible to use a portable fNIRS system to study workload and team engagement in high-fidelity clinical simulations. However, more work is needed to establish the sensitivity, reliability, and validity of fNIRS measures as indicators of team experience.

A Systematic Review of Integrated Functional Near-Infrared Spectroscopy (fNIRS) and Transcranial Magnetic Stimulation (TMS) Studies

Background: The capacity for TMS to elicit neural activity and manipulate cortical excitability has created significant expectation regarding its use in both cognitive and clinical neuroscience. However, the absence of an ability to quantify stimulation effects, particularly outside of the motor cortex, has led clinicians and researchers to pair noninvasive brain stimulation with noninvasive neuroimaging techniques. fNIRS, as an optical and wearable neuroimaging technique, is an ideal candidate for integrated use with TMS. Together, TMS+fNIRS may offer a hybrid alternative to "blind" stimulation to assess NIBS in therapy and research. Objective: In this systematic review, the current body of research into the transient and prolonged effects of TMS on fNIRS-based cortical hemodynamic measures while at rest and during tasks are discussed. Additionally, studies investigating the relation of fNIRS to measures of cortical excitability as produced by TMS-evoked Motor-Evoked-Potential (MEP) are evaluated. The aim of this review is to outline the integrated use of TMS+fNIRS and consolidate findings related to use of fNIRS to monitor changes attributed to TMS and the relationship of fNIRS to cortical excitability itself. Methods: Key terms were searched in PubMed and Web-of-Science to identify studies investigating the use of both fNIRS and TMS. Works from Google-Scholar and referenced works in identified papers were also assessed for relevance. All published experimental studies using both fNIRS and TMS techniques in the study methodology were included. Results: A combined literature search of neuroimaging and neurostimulation studies identified 53 papers detailing the joint use of fNIRS and TMS. 22/53 investigated the immediate effects of TMS at rest in the DLPFC and M1 as measured by fNIRS. 21/22 studies reported a significant effect in [HbO] for 40/54 stimulation conditions with 14 resulting an increase and 26 in a decrease. While 15/22 studies also reported [HbR], only 5/37 conditions were significant. Task effects of fNIRS+TMS were detailed in 16 studies, including 10 with clinical populations. Most studies only reported significant changes in [HbO] related measures. Studies comparing fNIRS to changes in MEP-measured cortical excitability suggest that fNIRS measures may be spatially more diffuse but share similar traits. Conclusion: This review summarizes the progress in the development of this emerging hybrid neuroimaging & neurostimulation methodology and its applications. Despite encouraging progress and novel applications, a lack of replicated works, along with highly disparate methodological approaches, highlight the need for further controlled studies. Interpretation of current research directions, technical challenges of TMS+fNIRS, and recommendations regarding future works are discussed.

Investigating the effect of anticipating a startling acoustic stimulus on preparatory inhibition

OBJECTIVES

Motor-evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) show a profound suppression when elicited during the instructed-delay of reaction time (RT) tasks. One predominant hypothesis is that this phenomenon, called "preparatory inhibition", reflects the operation of processes that suppress motor activity to withhold prepared (but delayed) responses, a form of impulse control. In addition, a startling acoustic stimulus (SAS) - a loud and narrow sound - can trigger the release of prepared responses in RT tasks. We predicted that, if such premature release is clearly forbidden, then anticipating a SAS during delay periods may be associated with increased preparatory inhibition for greater impulse control.

METHODS

Subjects performed a behavioural (n=16) and TMS (n=11) experiment. Both used a choice RT task that required subjects to choose a response based on a preparatory cue but to only release it after an imperative signal. SAS and TMS pulses were elicited at the end of the delay period and subjects were asked to do their best to only release their response after the imperative signal, even in the presence of SAS. SAS could be either rare or frequent, in separate blocks.

RESULTS

Consistent with the literature, SAS shortened RTs, especially when they occurred frequently. Moreover, MEPs were suppressed when subjects delayed prepared responses but this preparatory inhibition did not depend on whether SAS were frequent or rare.

DISCUSSION

The stronger RT shortening with frequent rather than rare SAS may be due to increased attention and/or reduced reactive inhibition to SAS, leaving preparatory inhibition unaffected.

Visuomotor Correlates of Conflict Expectation in the Context of Motor Decisions

Many behaviors require choosing between conflicting options competing against each other in visuomotor areas. Such choices can benefit from top-down control processes engaging frontal areas in advance of conflict when it is anticipated. Yet, very little is known about how this proactive control system shapes the visuomotor competition. Here, we used electroencephalography in human subjects (male and female) to identify the visual and motor correlates of conflict expectation in a version of the Eriksen Flanker task that required left or right responses according to the direction of a central target arrow surrounded by congruent or incongruent (conflicting) flankers. Visual conflict was either highly expected (it occurred in 80% of trials; mostly incongruent blocks) or very unlikely (20% of trials; mostly congruent blocks). We evaluated selective attention in the visual cortex by recording target- and flanker-related steady-state visual-evoked potentials (SSVEPs) and probed action selection by measuring response-locked potentials (RLPs) in the motor cortex. Conflict expectation enhanced accuracy in incongruent trials, but this improvement occurred at the cost of speed in congruent trials. Intriguingly, this behavioral adjustment occurred while visuomotor activity was less finely tuned: target-related SSVEPs were smaller while flanker-related SSVEPs were higher in mostly incongruent blocks than in mostly congruent blocks, and incongruent trials were associated with larger RLPs in the ipsilateral (nonselected) motor cortex. Hence, our data suggest that conflict expectation recruits control processes that augment the tolerance for inappropriate visuomotor activations (rather than processes that downregulate their amplitude), allowing for overflow activity to occur without having it turn into the selection of an incorrect response.SIGNIFICANCE STATEMENT Motor choices made in front of discordant visual information are more accurate when conflict can be anticipated, probably due to the engagement of top-down control from frontal areas. How this control system modulates activity within visual and motor areas is unknown. Here, we show that, when control processes are recruited in anticipation of conflict, as evidenced by higher midfrontal theta activity, visuomotor activity is less finely tuned: visual processing of the goal-relevant location was reduced and the motor cortex displayed more inappropriate activations, compared with when conflict was unlikely. We argue that conflict expectation is associated with an expansion of the distance-to-selection threshold, improving accuracy while the need for online control of visuomotor activity is reduced.

On the role of the prefrontal cortex in fatigue effects on cognitive flexibility - a system neurophysiological approach

Demanding tasks like cognitive flexibility show time-related deterioration of performance (i.e. fatigability effects). Fatigability has been associated with structural and functional properties of the prefrontal cortex. However, the electrophysiological underpinnings of these processes are not well understood. We examined n = 34 healthy participants with a task switching paradigm in which switches were either signaled by cues or needed to be maintained by working memory processes. We analyzed event-related potentials (ERPs) and performed residue iteration decomposition (RIDE) to account for effects of fatigue on intra-individual variability of neurophysiological data. This was combined with source localization methods. We show that task switching is affected by time on task (TOT) effects mostly when working memory processes are needed. On a neurophysiological level, this effect could not be observed in standard ERPs, but only after accounting for intra-individual variability using RIDE. The RIDE data suggests that during task switching, fatigability specifically affects response recoding processes that are associated with functions of the middle frontal gyrus (MFG; BA10). The results underline propositions of the ‘opportunity cost model’, which states that fatigability effects of executive functions depend on the degree to which tasks engage similar prefrontal regions - in this case working memory and task switching mechanisms.

Using a Double-Coil TMS Protocol to Assess Preparatory Inhibition Bilaterally

Transcranial magnetic stimulation (TMS) applied over the primary motor cortex (M1), elicits motor-evoked potentials (MEPs) in contralateral limb muscles which are valuable indicators of corticospinal excitability (CSE) at the time of stimulation. So far, most studies have used single-coil TMS over one M1, yielding MEPs in muscles of a single limb-usually the hand. However, tracking CSE in the two hands simultaneously would be useful in many contexts. We recently showed that, in the resting state, double-coil stimulation of the two M1 with a 1 ms inter-pulse interval (double-coil_{1 ms} TMS) elicits MEPs in both hands that are comparable to MEPs obtained using single-coil TMS. To further evaluate this new technique, we considered the MEPs elicited by double-coil_{1 ms} TMS in an instructed-delay choice reaction time task where a prepared response has to be withheld until an imperative signal is displayed. Single-coil TMS studies have repetitively shown that in this type of task, the motor system is transiently inhibited during the delay period, as evident from the broad suppression of MEP amplitudes. Here, we aimed at investigating whether a comparable inhibitory effect can be observed with MEPs elicited using double-coil_{1 ms} TMS. To do so, we compared the amplitude as well as the coefficient of variation (CV) of MEPs produced by double-coil_{1 ms} or single-coil TMS during action preparation. We observed that MEPs were suppressed (smaller amplitude) and often less variable (smaller CV) during the delay period compared to baseline. Importantly, these effects were equivalent whether single-coil or double-coil_{1 ms} TMS was used. This suggests that double-coil_{1 ms} TMS is a reliable tool to assess CSE, not only when subjects are at rest, but also when they are involved in a task, opening new research horizons for scientists interested in the corticospinal correlates of human behavior.

Brain activation associated with eccentric movement: A narrative review of the literature

The movement occurring when a muscle exerts tension while lengthening is known as eccentric muscle action. Literature contains limited evidence on how our brain controls eccentric movement. However, how the cortical regions in the motor network are activated during eccentric muscle actions may be critical for understanding the underlying control mechanism of eccentric movements encountered in daily tasks. This is a novel topic that has only recently begun to be investigated through advancements in neuroimaging methods (electroencephalography, EEG; functional magnetic resonance imaging, fMRI). This review summarizes a selection of seven studies indicating mainly: longer time and higher cortical signal amplitude (EEG) for eccentric movement preparation and execution, greater magnitude of cortical signals with wider activated brain area (EEG, fMRI), and weaker brain functional connectivity (fMRI) between primary motor cortex (M1) and other cortical areas involved in the motor network during eccentric muscle actions. Only some differences among studies due to the forms of movement with overload were observed in the contralateral (to the active hand) M1 activity during eccentric movement. Altogether, the findings indicate an important challenge to the brain for controlling the eccentric movement. However, our understanding remains limited regarding the acute effects of eccentric exercise on cortical regions and their cooperation as functional networks that support motor functions. Further analysis and standardized protocols will provide deeper insights into how different cortical regions of the underlying motor network interplay with each other in increasingly demanding muscle exertions in eccentric mode.

Towards assessing corticospinal excitability bilaterally: Validation of a double-coil TMS method

BACKGROUND

For several decades, Transcranial magnetic stimulation (TMS) has been used to monitor corticospinal excitability (CSE) changes in various contexts. Habitually, single-coil TMS is applied over one primary motor cortex (M1), eliciting motor-evoked potentials (MEPs) in a contralateral limb muscle, usually a hand effector. However, in many situations, it would be useful to obtain MEPs in both hands simultaneously, to track CSE bilaterally. Such an approach requires stimulating both M1 concurrently while avoiding interference between the two descending stimuli.

NEW METHOD

We examined MEPs obtained at rest using a double-coil TMS approach where the two M1 are stimulated with a 1ms inter-pulse interval (double-coil_1ms). MEPs were acquired using double-coil_1ms (MEP_double) or single-coil (MEP_single) TMS, at five different intensities of stimulation (100, 115, 130, 145 or 160% of the resting motor threshold, rMT). Given the 1ms inter-pulse interval in double-coil_1ms trials, MEP_double were either evoked by a 1st (MEP_double-1) or a 2nd (MEP_double-2) TMS pulse.

RESULTS

All MEP_TYPE (MEP_TYPE=MEP_single, MEP_double-1 and MEP_double-2) were equivalent, regardless of the hand within which they were elicited, the intensity of stimulation or the pulse order.

COMPARISON WITH EXISTING METHOD

This method allows one to observe state-related CSE changes for the two hands simultaneously on a trial-by-trial basis.

CONCLUSION

These results infer the absence of any neural interactions between the two cortico-spinal volleys with double-coil_1ms TMS. Hence, this technique can be reliably used to assess CSE bilaterally, opening new research perspectives for scientists interested in physiological markers of activity in the motor output system.

Learning stage-dependent effect of M1 disruption on value-based motor decisions

The present study aimed at characterizing the impact of M1 disruption on the implementation of implicit value information in motor decisions, at both early stages (during reinforcement learning) and late stages (after consolidation) of action value encoding. Fifty subjects performed, over three consecutive days, a task that required them to select between two finger responses according to the color (instruction) and to the shape (implicit, undisclosed rule) of an imperative signal: considering the implicit rule in addition to the instruction allowed subjects to earn more money. We investigated the functional contribution of M1 to the implementation of the implicit rule in subjects' motor decisions. Continuous theta burst stimulation (cTBS) was applied over M1 either on Day 1 or on Day 3, producing a temporary lesion either during reinforcement learning (cTBS_Learning group) or after consolidation of the implicit rule, during decision-making (cTBS_Decision group), respectively. Interestingly, disrupting M1 activity on Day 1 improved the reliance on the implicit rule, plausibly because M1 cTBS increased dopamine release in the putamen in an indirect way. This finding corroborates the view that cTBS may affect activity in unstimulated areas, such as the basal ganglia. Notably, this effect was short-lasting; it did not persist overnight, suggesting that the functional integrity of M1 during learning is a prerequisite for the consolidation of implicit value information to occur. Besides, cTBS over M1 did not impact the use of the implicit rule when applied on Day 3, although it did so when applied on Day 2 in a recent study where the reliance on the implicit rule declined following cTBS (Derosiere et al., 2017). Overall, these findings indicate that the human M1 is functionally involved in the consolidation and implementation of implicit value information underlying motor decisions. However, M1 contribution seems to vanish as subjects become more experienced in using the implicit value information to make their motor decisions.

The effects of a mid-task break on the brain connectome in healthy participants: A resting-state functional MRI study

Although rest breaks are commonly administered as a countermeasure to reduce mental fatigue and boost cognitive performance, the effects of taking a break on behavior are not consistent. Moreover, our understanding of the underlying neural mechanisms of rest breaks and how they modulate mental fatigue is still rudimentary. In this study, we investigated the effects of receiving a rest break on the topological properties of brain connectivity networks via a two-session experimental paradigm, in which one session comprised four successive blocks of a mentally demanding visual selective attention task (No-rest session), whereas the other contained a rest break between the second and third task blocks (Rest session). Functional brain networks were constructed using resting-state functional MRI data recorded from 20 healthy adults before and after the performance of the task blocks. Behaviorally, subjects displayed robust time-on-task (TOT) declines, as reflected by increasingly slower reaction time as the test progressed and lower post-task self-reported ratings of engagement. However, we did not find a significant effect on task performance due to administering a mid-task break. Compared to pre-task measurements, post-task functional brain networks demonstrated an overall decrease of optimal small-world properties together with lower global efficiency. Specifically, we found TOT-related reduced nodal efficiency in brain regions that mainly resided in the subcortical areas. More interestingly, a significant block-by-session interaction was revealed in local efficiency, attributing to a significant post-task decline in No-rest session and a preserved local efficiency when a mid-task break opportunity was introduced in the Rest session. Taken together, these findings augment our understanding of how the resting brain reorganizes following the accumulation of prolonged task, suggest dissociable processes between the neural mechanisms of fatigue and recovery, and provide some of the first quantitative insights into the cognitive neuroscience of work and rest.

Primary motor cortex contributes to the implementation of implicit value-based rules during motor decisions

In the present study, we investigated the functional contribution of the human primary motor cortex (M1) to motor decisions. Continuous theta burst stimulation (cTBS) was used to alter M1 activity while participants performed a decision-making task in which the reward associated with the subjects' responses (right hand finger movements) depended on explicit and implicit value-based rules. Subjects performed the task over two consecutive days and cTBS occurred in the middle of Day 2, once the subjects were just about to implement implicit rules, in addition to the explicit instructions, to choose their responses, as evident in the control group (cTBS over the right somatosensory cortex). Interestingly, cTBS over the left M1 prevented subjects from implementing the implicit value-based rule while its implementation was enhanced in the group receiving cTBS over the right M1. Hence, cTBS had opposite effects depending on whether it was applied on the contralateral or ipsilateral M1. The use of the explicit value-based rule was unaffected by cTBS in the three groups of subject. Overall, the present study provides evidence for a functional contribution of M1 to the implementation of freshly acquired implicit rules, possibly through its involvement in a cortico-subcortical network controlling value-based motor decisions.

Comparison of Motor Inhibition in Variants of the Instructed-Delay Choice Reaction Time Task

Using instructed-delay choice reaction time (RT) paradigms, many previous studies have shown that the motor system is transiently inhibited during response preparation: motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) over the primary motor cortex are typically suppressed during the delay period. This effect has been observed in both selected and non-selected effectors, although MEP changes in selected effectors have been more inconsistent across task versions. Here, we compared changes in MEP amplitudes in three different variants of an instructed-delay choice RT task. All variants required participants to choose between left and right index finger movements but the responses were either provided “in the air” (Variant 1), on a regular keyboard (Variant 2), or on a response device designed to control from premature responses (Variant 3). The task variants also differed according to the visual layout (more concrete in Variant 3) and depending on whether participants received a feedback of their performance (absent in Variant 1). Behavior was globally comparable between the three variants of the task although the propensity to respond prematurely was highest in Variant 2 and lowest in Variant 3. MEPs elicited in a non-selected hand were similarly suppressed in the three variants of the task. However, significant differences emerged when considering MEPs elicited in the selected hand: these MEPs were suppressed in Variants 1 and 3 whereas they were often facilitated in Variant 2, especially in the right dominant hand. In conclusion, MEPs elicited in selected muscles seem to be more sensitive to small variations to the task design than those recorded in non-selected effectors, probably because they reflect a complex combination of inhibitory and facilitatory influences on the motor output system. Finally, the use of a standard keyboard seems to be particularly inappropriate because it encourages participants to respond promptly with no means to control for premature responses, probably increasing the relative amount of facilitatory influences at the time motor inhibition is probed.

Cognitive functions and cerebral oxygenation changes during acute and prolonged hypoxic exposure

The present study aimed to assess specific cognitive processes (cognitive control and time perception) and hemodynamic correlates using functional near-infrared spectroscopy (fNIRS) during acute and prolonged high-altitude exposure. Eleven male subjects were transported via helicopter and dropped at 14 272 ft (4 350 meters) of altitude where they stayed for 4 days. Cognitive tasks, involving a conflict task and temporal bisection task, were performed at sea level the week before ascending to high altitude, the day of arrival (D0), the second (D2) and fourth (D4) day at high altitude. Cortical hemodynamic changes in the prefrontal cortex (PFC) area were monitored with fNIRS at rest and during the conflict task. Results showed that high altitude impacts information processing in terms of speed and accuracy. In the early hours of exposure (D0), participants displayed slower reaction times (RT) and decision errors were twice as high. While error rate for simple spontaneous responses remained twice that at sea level, the slow-down of RT was not detectable after 2 days at high-altitude. The larger fNIRS responses from D0 to D2 suggest that higher prefrontal activity partially counteracted cognitive performance decrements. Cognitive control, assessed through the build-up of a top-down response suppression mechanism, the early automatic response activation and the post-error adjustment were not impacted by hypoxia. However, during prolonged hypoxic exposure the temporal judgments were underestimated suggesting a slowdown of the internal clock. A decrease in cortical arousal level induced by hypoxia could consistently explain both the slowdown of the internal clock and the persistence of a higher number of errors after several days of exposure.

Towards a near infrared spectroscopy-based estimation of operator attentional state

Given the critical risks to public health and safety that can involve lapses in attention (e.g., through implication in workplace accidents), researchers have sought to develop cognitive-state tracking technologies, capable of alerting individuals engaged in cognitively demanding tasks of potentially dangerous decrements in their levels of attention. The purpose of the present study was to address this issue through an investigation of the reliability of optical measures of cortical correlates of attention in conjunction with machine learning techniques to distinguish between states of full attention and states characterized by reduced attention capacity during a sustained attention task. Seven subjects engaged in a 30 minutes duration sustained attention reaction time task with near infrared spectroscopy (NIRS) monitoring over the prefrontal and the right parietal areas. NIRS signals from the first 10 minutes of the task were considered as characterizing the ‘full attention’ class, while the NIRS signals from the last 10 minutes of the task were considered as characterizing the ‘attention decrement’ class. A two-class support vector machine algorithm was exploited to distinguish between the two levels of attention using appropriate NIRS-derived signal features. Attention decrement occurred during the task as revealed by the significant increase in reaction time in the last 10 compared to the first 10 minutes of the task (p<.05). The results demonstrate relatively good classification accuracy, ranging from 65 to 90%. The highest classification accuracy results were obtained when exploiting the oxyhemoglobin signals (i.e., from 77 to 89%, depending on the cortical area considered) rather than the deoxyhemoglobin signals (i.e., from 65 to 66%). Moreover, the classification accuracy increased to 90% when using signals from the right parietal area rather than from the prefrontal cortex. The results support the feasibility of developing cognitive tracking technologies using NIRS and machine learning techniques.