Motion Cognitive Decoding of Cross-Subject Motor Imagery Guided on Different Visual Stimulus Materials

BACKGROUND

Motor imagery (MI) plays an important role in brain-computer interfaces, especially in evoking event-related desynchronization and synchronization (ERD/S) rhythms in electroencephalogram (EEG) signals. However, the procedure for performing a MI task for a single subject is subjective, making it difficult to determine the actual situation of an individual's MI task and resulting in significant individual EEG response variations during motion cognitive decoding.

METHODS

To explore this issue, we designed three visual stimuli (arrow, human, and robot), each of which was used to present three MI tasks (left arm, right arm, and feet), and evaluated differences in brain response in terms of ERD/S rhythms. To compare subject-specific variations of different visual stimuli, a novel cross-subject MI-EEG classification method was proposed for the three visual stimuli. The proposed method employed a covariance matrix centroid alignment for preprocessing of EEG samples, followed by a model agnostic meta-learning method for cross-subject MI-EEG classification.

RESULTS AND CONCLUSION

The experimental results showed that robot stimulus materials were better than arrow or human stimulus materials, with an optimal cross-subject motion cognitive decoding accuracy of 79.04%. Moreover, the proposed method produced robust classification of cross-subject MI-EEG signal decoding, showing superior results to conventional methods on collected EEG signals.

Pediatric stroke: We need to look for it

PURPOSE

This review provides a comprehensive overview of the characteristics and diagnosis of pediatric stroke, emphasizing the importance of early recognition and accurate assessment. Pediatric stroke is a complex condition with diverse etiologies, and its timely diagnosis is critical for initiating appropriate interventions and improving clinical outcomes.

RECENT FINDINGS

Recent advances in neuroimaging techniques, including magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), have significantly enhanced the diagnostic capabilities for pediatric stroke. Additionally, a better understanding of its underlying etiologies in specific cases, and of the importance of differential diagnosis have improved the outcome and prevention strategies in this vulnerable population. Despite these improvements, though, research still has a long way to go to optimize the management of this condition.

SUMMARY

Timely and accurate diagnosis of pediatric stroke remains a challenge due to its rarity and variability in clinical presentation, and to the presence of many mimic conditions. The integration of clinical evaluation, neuroimaging, and comorbidities analysis is crucial for achieving a precise diagnosis and guiding tailored treatment strategies for affected children.

Neurosurgical and BCI approaches to visual rehabilitation in occipital lobe tumor patients

This study investigates the effects of occipital lobe tumors on visual processing and the role of brain-computer interface (BCI) technologies in post-surgical visual rehabilitation. Through a combination of pre-surgical functional magnetic resonance imaging (fMRI) and Diffusion Tensor Imaging (DTI), intra-operative direct cortical stimulation (DCS) and Electrocorticography (ECoG), and post-surgical BCI interventions, we provide insight into the complex dynamics between occipital lobe tumors and visual function. Our results highlight a discrepancy between clinical assessments of visual field damage and the patient's reported visual experiences, suggesting a residual functional capacity within the damaged occipital regions. Additionally, the absence of expected visual phenomena during surgery and the promising outcomes from BCI-driven rehabilitation underscore the complexity of visual processing and the potential of technology-enhanced rehabilitation strategies. This work emphasizes the need for an interdisciplinary approach in developing effective treatments for visual impairments related to brain tumors, illustrating the significant implications for neurosurgical practices and the advancement of rehabilitation sciences.

A continuous pursuit dataset for online deep learning-based EEG brain-computer interface

This dataset is from an EEG brain-computer interface (BCI) study investigating the use of deep learning (DL) for online continuous pursuit (CP) BCI. In this task, subjects use Motor Imagery (MI) to control a cursor to follow a randomly moving target, instead of a single stationary target used in other traditional BCI tasks. DL methods have recently achieved promising performance in traditional BCI tasks, but most studies investigate offline data analysis using DL algorithms. This dataset consists of ~168 hours of EEG recordings from complex CP BCI experiments, collected from 28 unique human subjects over multiple sessions each, with an online DL-based decoder. The large amount of subject specific data from multiple sessions may be useful for developing new BCI decoders, especially DL methods that require large amounts of training data. By providing this dataset to the public, we hope to help facilitate the development of new or improved BCI decoding algorithms for the complex CP paradigm for continuous object control, bringing EEG-based BCIs closer to real-world applications.

EEG-based sensorimotor neurofeedback for motor neurorehabilitation in children and adults: A scoping review

OBJECTIVE

Therapeutic interventions for children and young people with dystonia and dystonic/dyskinetic cerebral palsy are limited. EEG-based neurofeedback is emerging as a neurorehabilitation tool. This scoping review maps research investigating EEG-based sensorimotor neurofeedback in adults and children with neurological motor impairments, including augmentative strategies.

METHODS

MEDLINE, CINAHL and Web of Science databases were searched up to 2023 for relevant studies. Study selection and data extraction were conducted independently by at least two reviewers.

RESULTS

Of 4380 identified studies, 133 were included, only three enrolling children. The most common diagnosis was adult-onset stroke (77%). Paradigms mostly involved upper limb motor imagery or motor attempt. Common neurofeedback modes included visual, haptic and/or electrical stimulation. EEG parameters varied widely and were often incompletely described. Two studies applied augmentative strategies. Outcome measures varied widely and included classification accuracy of the Brain-Computer Interface, degree of enhancement of mu rhythm modulation or other neurophysiological parameters, and clinical/motor outcome scores. Few studies investigated whether functional outcomes related specifically to the EEG-based neurofeedback.

CONCLUSIONS

There is limited evidence exploring EEG-based sensorimotor neurofeedback in individuals with movement disorders, especially in children. Further clarity of neurophysiological parameters is required to develop optimal paradigms for evaluating sensorimotor neurofeedback.

SIGNIFICANCE

The expanding field of sensorimotor neurofeedback offers exciting potential as a non-invasive therapy. However, this needs to be balanced by robust study design and detailed methodological reporting to ensure reproducibility and validation that clinical improvements relate to induced neurophysiological changes.

Study of the Brain Functional Connectivity Processes During Multi-Movement States of the Lower Limbs

Studies using source localization results have shown that cortical involvement increased in treadmill walking with brain-computer interface (BCI) control. However, the reorganization of cortical functional connectivity in treadmill walking with BCI control is largely unknown. To investigate this, a public dataset, a mobile brain-body imaging dataset recorded during treadmill walking with a brain-computer interface, was used. The electroencephalography (EEG)-coupling strength of the between-region and within-region during the continuous self-determinant movements of lower limbs were analyzed. The time-frequency cross-mutual information (TFCMI) method was used to calculate the coupling strength. The results showed the frontal-occipital connection increased in the gamma and delta bands (the threshold of the edge was >0.05) during walking with BCI, which may be related to the effective communication when subjects adjust their gaits to control the avatar. In walking with BCI control, the results showed theta oscillation within the left-frontal, which may be related to error processing and decision making. We also found that between-region connectivity was suppressed in walking with and without BCI control compared with in standing states. These findings suggest that walking with BCI may accelerate the rehabilitation process for lower limb stroke.

Nanorobot-Based Direct Implantation of Flexible Neural Electrode for BCI

Brain-Computer Interface (BCI) has gained remarkable prominence in biomedical community. While BCI holds vast potential across diverse domains, the implantation of neural electrodes poses multifaceted challenges to fully explore the power of BCI. Conventional rigid electrodes face the problem of foreign body reaction induced by mechanical mismatch to biological tissue, while flexible electrodes, though more preferential, lack controllability during implantation. Researchers have explored various strategies, from assistive shuttle to biodegradable coatings, to strike a balance between implantation rigidity and post-implantation flexibility. Yet, these approaches may introduce complications, including immune response, inflammations, and raising intracranial pressure. To this end, this paper proposes a novel nanorobot-based technique for direct implantation of flexible neural electrodes, leveraging the high controllability and repeatability of robotics to enhance the implantation quality. This approach features a dual-arm nanorobotic system equipped with stereo microscope, by which a flexible electrode is first visually aligned to the target neural tissue to establish contact and thereafter implanted into brain with well controlled insertion direction and depth. The key innovation is, through dual-arm coordination, the flexible electrode maintains straight along the implantation direction. With this approach, we implanted CNTf electrodes into cerebral cortex of mouse, and captured standard spiking neural signals.

Research on mental fatigue during long-term motor imagery: a pilot study

Mental fatigue during long-term motor imagery (MI) may affect intention recognition in MI applications. However, the current research lacks the monitoring of mental fatigue during MI and the definition of robust biomarkers. The present study aims to reveal the effects of mental fatigue on motor imagery recognition at the brain region level and explore biomarkers of mental fatigue. To achieve this, we recruited 10 healthy participants and asked them to complete a long-term motor imagery task involving both right- and left-handed movements. During the experiment, we recorded 32-channel EEG data and carried out a fatigue questionnaire for each participant. As a result, we found that mental fatigue significantly decreased the subjects' motor imagery recognition rate during MI. Additionally the theta power of frontal, central, parietal, and occipital clusters significantly increased after the presence of mental fatigue. Furthermore, the phase synchronization between the central cluster and the frontal and occipital lobes was significantly weakened. To summarize, the theta bands of frontal, central, and parieto-occipital clusters may serve as powerful biomarkers for monitoring mental fatigue during motor imagery. Additionally, changes in functional connectivity between the central cluster and the prefrontal and occipital lobes during motor imagery could be investigated as potential biomarkers.

Latent Prototype-Based Clustering: A Novel Exploratory Electroencephalography Analysis Approach

Electroencephalography (EEG)-based applications in brain-computer interfaces (BCIs), neurological disease diagnosis, rehabilitation, etc., rely on supervised approaches such as classification that requires given labels. However, with the ever-increasing amount of EEG data, incomplete or incorrectly labeled or unlabeled EEG data are increasing. It likely degrades the performance of supervised approaches. In this work, we put forward a novel unsupervised exploratory EEG analysis solution by clustering based on low-dimensional prototypes in latent space that are associated with the respective clusters. Having the prototype as a baseline of each cluster, a compositive similarity is defined to act as the critic function in clustering, which incorporates similarities on three levels. The approach is implemented with a Generative Adversarial Network (GAN), termed W-SLOGAN, by extending the Stein Latent Optimization for GANs (SLOGAN). The Gaussian Mixture Model (GMM) is utilized as the latent distribution to adapt to the diversity of EEG signal patterns. The W-SLOGAN ensures that images generated from each Gaussian component belong to the associated cluster. The adaptively learned Gaussian mixing coefficients make the model remain effective in dealing with an imbalanced dataset. By applying the proposed approach to two public EEG or intracranial EEG (iEEG) epilepsy datasets, our experiments demonstrate that the clustering results are close to the classification of the data. Moreover, we present several findings that were discovered by intra-class clustering and cross-analysis of clustering and classification. They show that the approach is attractive in practice in the diagnosis of the epileptic subtype, multiple labelling of EEG data, etc.

LGGNet: Learning From Local-Global-Graph Representations for Brain-Computer Interface

Neuropsychological studies suggest that co-operative activities among different brain functional areas drive high-level cognitive processes. To learn the brain activities within and among different functional areas of the brain, we propose local-global-graph network (LGGNet), a novel neurologically inspired graph neural network (GNN), to learn local-global-graph (LGG) representations of electroencephalography (EEG) for brain-computer interface (BCI). The input layer of LGGNet comprises a series of temporal convolutions with multiscale 1-D convolutional kernels and kernel-level attentive fusion. It captures temporal dynamics of EEG which then serves as input to the proposed local- and global-graph-filtering layers. Using a defined neurophysiologically meaningful set of local and global graphs, LGGNet models the complex relations within and among functional areas of the brain. Under the robust nested cross-validation settings, the proposed method is evaluated on three publicly available datasets for four types of cognitive classification tasks, namely the attention, fatigue, emotion, and preference classification tasks. LGGNet is compared with state-of-the-art (SOTA) methods, such as DeepConvNet, EEGNet, R2G-STNN, TSception, regularized graph neural network (RGNN), attention-based multiscale convolutional neural network-dynamical graph convolutional network (AMCNN-DGCN), hierarchical recurrent neural network (HRNN), and GraphNet. The results show that LGGNet outperforms these methods, and the improvements are statistically significant ( ) in most cases. The results show that bringing neuroscience prior knowledge into neural network design yields an improvement of classification performance. The source code can be found at https://github.com/yi-ding-cs/LGG.

Neurophysiologically Meaningful Motor Imagery EEG Simulation With Applications to Data Augmentation

Motor imagery-based Brain-Computer Interfaces (MI-BCIs) have gained a lot of attention due to their potential usability in neurorehabilitation and neuroprosthetics. However, the accurate recognition of MI patterns in electroencephalography signals (EEG) is hindered by several data-related limitations, which restrict the practical utilization of these systems. Moreover, leveraging deep learning (DL) models for MI decoding is challenged by the difficulty of accessing user-specific MI-EEG data on large scales. Simulated MI-EEG signals can be useful to address these issues, providing well-defined data for the validation of decoding models and serving as a data augmentation approach to improve the training of DL models. While substantial efforts have been dedicated to implementing effective data augmentation strategies and model-based EEG signal generation, the simulation of neurophysiologically plausible EEG-like signals has not yet been exploited in the context of data augmentation. Furthermore, none of the existing approaches have integrated user-specific neurophysiological information during the data generation process. Here, we present PySimMIBCI, a framework for generating realistic MI-EEG signals by integrating neurophysiologically meaningful activity into biophysical forward models. By means of PySimMIBCI, different user capabilities to control an MI-BCI can be simulated and fatigue effects can be included in the generated EEG. Results show that our simulated data closely resemble real data. Moreover, a proposed data augmentation strategy based on our simulated user-specific data significantly outperforms other state-of-the-art augmentation approaches, enhancing DL models performance by up to 15%.

Neural Correlate and Movement Decoding of Simultaneous-and-Sequential Bimanual Movements Using EEG Signals

Bimanual coordination is important for developing a natural motor brain-computer interface (BCI) from electroencephalogram (EEG) signals, covering the aspects of bilateral arm training for rehabilitation, bimanual coordination for daily-life assistance, and also improving the multidimensional control of BCIs. For the same task targets of both hands, simultaneous and sequential bimanual movements are two different bimanual coordination manners. Planning and performing motor sequences are the fundamental abilities of humans, and it is more natural to execute sequential movements compared to simultaneous movements in many complex tasks. However, to date, for these two different manners in which two hands coordinated to reach the same task targets, the differences in the neural correlate and also the feasibility of movement discrimination have not been explored. In this study, we aimed to investigate these two issues based on a bimanual reaching task for the first time. Finally, neural correlates in the view of the movement-related cortical potentials, event-related oscillations, and source imaging showed unique neural encoding patterns of sequential movements. Besides, for the same task targets of both hands, the simultaneous and sequential bimanual movements were successfully discriminated in both pre-movement and movement execution periods. This study revealed the neural encoding patterns of sequential bimanual movements and presented its values in developing a more natural and good-performance motor BCI.

Three-stage transfer learning for motor imagery EEG recognition

Motor imagery (MI) paradigms have been widely used in neural rehabilitation and drowsiness state assessment. The progress in brain-computer interface (BCI) technology has emphasized the importance of accurately and efficiently detecting motor imagery intentions from electroencephalogram (EEG). Despite the recent breakthroughs made in developing EEG-based algorithms for decoding MI, the accuracy and efficiency of these models remain limited by technical challenges posed by cross-subject heterogeneity in EEG data processing and the scarcity of EEG data for training. Inspired by the optimal transport theory, this study aims to develop a novel three-stage transfer learning (TSTL) method, which uses the existing labeled data from a source domain to improve classification performance on an unlabeled target domain. Notably, the proposed method comprises three components, namely, the Riemannian tangent space mapping (RTSM), source domain transformer (SDT), and optimal subspace mapping (OSM). The RTSM maps a symmetric positive definite matrix from the Riemannian space to the tangent space to minimize the marginal probability distribution drift. The SDT transforms the source domain to a target domain by finding the optimal transport mapping matrix to reduce the joint probability distribution differences. The OSM finally maps the transformed source domain and original target domain to the same subspace to further mitigate the distribution discrepancy. The performance of the proposed method was validated on two public BCI datasets, and the average accuracy of the algorithm on two datasets was 72.24% and 69.29%. Our results demonstrated the improved performance of EEG-based MI detection in comparison with state-of-the-art algorithms.

Cortico-muscular coherence of time-frequency and spatial characteristics under movement observation, movement execution, and movement imagery

Studies show that movement observation (MO), movement imagery (MI), or movement execution (ME) based brain-computer interface systems are promising in promoting the rehabilitation and reorganization of damaged motor function. This study was aimed to explore and compare the motor function rehabilitation mechanism among MO, MI, and ME. 64-channel electroencephalogram and 4-channel electromyogram data were collected from 39 healthy participants (25 males, 14 females; 18-23 years old) during MO, ME, and MI. We analyzed and compared the inter-cortical, inter-muscular, cortico-muscular, and spatial coherence under MO, ME, and MI. Under MO, ME, and MI, cortico-muscular coherence was strongest at the beta-lh band, which means the beta frequency band for cortical signals and the lh frequency band for muscular signals. 56.25-96.88% of the coherence coefficients were significantly larger than 0.5 (ps < 0.05) at the beta-lh band. MO and ME had a contralateral advantage in the spatial coherence between cortex and muscle, while MI had an ipsilateral advantage in the spatial coherence between cortex and muscle. Our results show that the cortico-muscular beta-lh band plays a critical role in the synchronous coupling between cortex and muscle. Also, our findings suggest that the primary motor cortex (M1), dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and premotor cortex (PMC) are the specific regions of MO, ME, and MI. However, their pathways of regulating muscles are different under MO, ME, and MI. This study is important for better understanding the motor function rehabilitation mechanism in MO, MI, and ME.

A two-stage transformer based network for motor imagery classification

Brain-computer interfaces (BCIs) are used to understand brain functioning and develop therapies for neurological and neurodegenerative disorders. Therefore, BCIs are crucial in rehabilitating motor dysfunction and advancing motor imagery applications. For motor imagery, electroencephalogram (EEG) signals are used to classify the subject's intention of moving a body part without actually moving it. This paper presents a two-stage transformer-based architecture that employs handcrafted features and deep learning techniques to enhance the classification performance on benchmarked EEG signals. Stage-1 is built on parallel convolution based EEGNet, multi-head attention, and separable temporal convolution networks for spatiotemporal feature extraction. Further, for enhanced classification, in stage-2, additional features and embeddings extracted from stage-1 are used to train TabNet. In addition, a novel channel cluster swapping data augmentation technique is also developed to handle the issue of limited samples for training deep learning architectures. The developed two-stage architecture offered an average classification accuracy of 88.5 % and 88.3 % on the BCI Competition IV-2a and IV-2b datasets, respectively, which is approximately 3.0 % superior over similar recent reported works.

Attention-based convolutional neural network with multi-modal temporal information fusion for motor imagery EEG decoding

Convolutional neural network (CNN) has been widely applied in motor imagery (MI)-based brain computer interface (BCI) to decode electroencephalography (EEG) signals. However, due to the limited perceptual field of convolutional kernel, CNN only extracts features from local region without considering long-term dependencies for EEG decoding. Apart from long-term dependencies, multi-modal temporal information is equally important for EEG decoding because it can offer a more comprehensive understanding of the temporal dynamics of neural processes. In this paper, we propose a novel deep learning network that combines CNN with self-attention mechanism to encapsulate multi-modal temporal information and global dependencies. The network first extracts multi-modal temporal information from two distinct perspectives: average and variance. A shared self-attention module is then designed to capture global dependencies along these two feature dimensions. We further design a convolutional encoder to explore the relationship between average-pooled and variance-pooled features and fuse them into more discriminative features. Moreover, a data augmentation method called signal segmentation and recombination is proposed to improve the generalization capability of the proposed network. The experimental results on the BCI Competition IV-2a (BCIC-IV-2a) and BCI Competition IV-2b (BCIC-IV-2b) datasets show that our proposed method outperforms the state-of-the-art methods and achieves 4-class average accuracy of 85.03% on the BCIC-IV-2a dataset. The proposed method implies the effectiveness of multi-modal temporal information fusion in attention-based deep learning networks and provides a new perspective for MI-EEG decoding. The code is available at https://github.com/Ma-Xinzhi/EEG-TransNet.

Continuous Tracking using Deep Learning-based Decoding for Non-invasive Brain-Computer Interface

Brain-computer interfaces (BCI) using electroencephalography (EEG) provide a non-invasive method for users to interact with external devices without the need for muscle activation. While noninvasive BCIs have the potential to improve the quality of lives of healthy and motor impaired individuals, they currently have limited applications due to inconsistent performance and low degrees of freedom. In this study, we use deep learning (DL)-based decoders for online Continuous Pursuit (CP), a complex BCI task requiring the user to track an object in two-dimensional space. We developed a labeling system to use CP data for supervised learning, trained DL-based decoders based on two architectures, including a newly proposed adaptation of the PointNet architecture, and evaluated the performance over several online sessions. We rigorously evaluated the DL-based decoders in a total of 28 human participants, and found that the DL-based models improved throughout the sessions as more training data became available and significantly outperformed a traditional BCI decoder by the last session. We also performed additional experiments to test an implementation of transfer learning by pre-training models on data from other subjects, and mid-session training to reduce inter-session variability. The results from these experiments showed that pre-training did not significantly improve performance, but updating the models mid-session may have some benefit. Overall, these findings support the use of DL-based decoders for improving BCI performance in complex tasks like CP, which can expand the potential applications of BCI devices and help improve the quality of lives of healthy and motor-impaired individuals.

Significance Statement

Brain-computer Interfaces (BCI) have the potential to replace or restore motor functions for patients and can benefit the general population by providing a direct link of the brain with robotics or other devices. In this work, we developed a paradigm using deep learning (DL)-based decoders for continuous control of a BCI system and demonstrated its capabilities through extensive online experiments. We also investigate how DL performance is affected by varying amounts of training data and collected more than 150 hours of BCI data that can be used to train new models. The results of this study provide valuable information for developing future DL-based BCI decoders which can improve performance and help bring BCIs closer to practical applications and wide-spread use.

Exploring new horizons: Emerging therapeutic strategies for pediatric stroke

Pediatric stroke presents unique challenges, and optimizing treatment strategies is essential for improving outcomes in this vulnerable population. This review aims to provide an overview of new, innovative, and potential treatments for pediatric stroke, with a primary objective to stimulate further research in this field. Our review highlights several promising approaches in the realm of pediatric stroke management, including but not limited to stem cell therapy and robotic rehabilitation. These innovative interventions offer new avenues for enhancing functional recovery, reducing long-term disability, and tailoring treatments to individual patient needs. The findings of this review underscore the importance of ongoing research and development of innovative treatments in pediatric stroke. These advancements hold significant clinical relevance, offering the potential to improve the lives of children affected by stroke by enhancing the precision, efficacy, and accessibility of therapeutic interventions. Embracing these innovations is essential in our pursuit of better outcomes and a brighter future for pediatric stroke care.

Continuous tracking using deep learning-based decoding for noninvasive brain-computer interface

Brain-computer interfaces (BCI) using electroencephalography provide a noninvasive method for users to interact with external devices without the need for muscle activation. While noninvasive BCIs have the potential to improve the quality of lives of healthy and motor-impaired individuals, they currently have limited applications due to inconsistent performance and low degrees of freedom. In this study, we use deep learning (DL)-based decoders for online continuous pursuit (CP), a complex BCI task requiring the user to track an object in 2D space. We developed a labeling system to use CP data for supervised learning, trained DL-based decoders based on two architectures, including a newly proposed adaptation of the PointNet architecture, and evaluated the performance over several online sessions. We rigorously evaluated the DL-based decoders in a total of 28 human participants, and found that the DL-based models improved throughout the sessions as more training data became available and significantly outperformed a traditional BCI decoder by the last session. We also performed additional experiments to test an implementation of transfer learning by pretraining models on data from other subjects, and midsession training to reduce intersession variability. The results from these experiments showed that pretraining did not significantly improve performance, but updating the models' midsession may have some benefit. Overall, these findings support the use of DL-based decoders for improving BCI performance in complex tasks like CP, which can expand the potential applications of BCI devices and help to improve the quality of lives of healthy and motor-impaired individuals.

Performance of the Action Observation-Based Brain-Computer Interface in Stroke Patients and Gaze Metrics Analysis

Brain-computer interfaces (BCIs) are anticipated to improve the efficacy of rehabilitation for people with motor disabilities. However, applying BCI in clinical practice is still a challenge due to the great diversity of patients. In the current study, a novel action observation (AO) based BCI was proposed and tested on stroke patients. Ten non-hemineglect patients and ten hemineglect patients were recruited. Four AO stimuli were designed, each presenting a decomposed action to complete the reach-and-grasp task. EEG data and eye movement data were collected. Eye movement data was utilized to analyze the reasons for individual differences in BCI performance. Task discriminative component analysis was utilized to perform online target detection. The results showed that the designed AO-based BCI could simultaneously induce steady state motion visual evoked potential (SSMVEP) from the occipital region and sensory motor rhythm from the sensorimotor region in stroke patients. The average online detection accuracy among the four AO stimuli reached 67% within 3 s in the non-hemineglect group, while the accuracy only reached 35% in the hemineglect group. Gaze metrics showed that the average total duration of fixations during the stimulus phase in the hemineglect group was only 1.31 s ± 0.532 s which was significantly lower than that in the non-hemineglect group. The results indicated that hemineglect patients have difficulty gazing at the AO stimulus, resulting in poor detection performance and weak desynchronization in the sensorimotor region. Furthermore, the degree of neglect is inversely proportional to the target detection accuracy in hemineglect stroke patients. In addition, the gaze metrics associated with cognitive load were significantly correlated with the accuracy in non-hemineglect patients. It indicated the cognitive load may affect the AO-based BCI. The current study will expedite the clinical application of AO-based BCI.

Deep Learning: A Primer for Neurosurgeons

This chapter explores the transformative impact of deep learning (DL) on neurosurgery, elucidating its pivotal role in enhancing diagnostic performance, surgical planning, execution, and postoperative assessment. It delves into various deep learning architectures, including convolutional and recurrent neural networks, and their applications in analyzing neuroimaging data for brain tumors, spinal cord injuries, and other neurological conditions. The integration of DL in neurosurgical robotics and the potential for fully autonomous surgical procedures are discussed, highlighting advancements in surgical precision and patient outcomes. The chapter also examines the challenges of data privacy, quality, and interpretability that accompany the implementation of DL in neurosurgery. The potential for DL to revolutionize neurosurgical practices through improved diagnostics, patient-specific surgical planning, and the advent of intelligent surgical robots is underscored, promising a future where technology and healthcare converge to offer unprecedented solutions in neurosurgery.

TSPNet: a time-spatial parallel network for classification of EEG-based multiclass upper limb motor imagery BCI

The classification of electroencephalogram (EEG) motor imagery signals has emerged as a prominent research focus within the realm of brain-computer interfaces. Nevertheless, the conventional, limited categories (typically just two or four) offered by brain-computer interfaces fail to provide an extensive array of control modes. To address this challenge, we propose the Time-Spatial Parallel Network (TSPNet) for recognizing six distinct categories of upper limb motor imagery. Within TSPNet, temporal and spatial features are extracted separately, with the time dimension feature extractor and spatial dimension feature extractor performing their respective functions. Following this, the Time-Spatial Parallel Feature Extractor is employed to decouple the connection between temporal and spatial features, thus diminishing feature redundancy. The Time-Spatial Parallel Feature Extractor deploys a gating mechanism to optimize weight distribution and parallelize time-spatial features. Additionally, we introduce a feature visualization algorithm based on signal occlusion frequency to facilitate a qualitative analysis of TSPNet. In a six-category scenario, TSPNet achieved an accuracy of 49.1% ± 0.043 on our dataset and 49.7% ± 0.029 on a public dataset. Experimental results conclusively establish that TSPNet outperforms other deep learning methods in classifying data from these two datasets. Moreover, visualization results vividly illustrate that our proposed framework can generate distinctive classifier patterns for multiple categories of upper limb motor imagery, discerned through signals of varying frequencies. These findings underscore that, in comparison to other deep learning methods, TSPNet excels in intention recognition, which bears immense significance for non-invasive brain-computer interfaces.

A Novel Hybrid Brain-Computer Interface Combining the Illusion-Induced VEP and SSVEP

Traditional single-modality brain-computer interface (BCI) systems are limited by their reliance on a single characteristic of brain signals. To address this issue, incorporating multiple features from EEG signals can provide robust information to enhance BCI performance. In this study, we designed and implemented a novel hybrid paradigm that combined illusion-induced visual evoked potential (IVEP) and steady-state visual evoked potential (SSVEP) with the aim of leveraging their features simultaneously to improve system efficiency. The proposed paradigm was validated through two experimental studies, which encompassed feature analysis of IVEP with a static paradigm, and performance evaluation of hybrid paradigm in comparison with the conventional SSVEP paradigm. The characteristic analysis yielded significant differences in response waveforms among different motion illusions. The performance evaluation of the hybrid BCI demonstrates the advantage of integrating illusory stimuli into the SSVEP paradigm. This integration effectively enhanced the spatio-temporal features of EEG signals, resulting in higher classification accuracy and information transfer rate (ITR) within a short time window when compared to traditional SSVEP-BCI in four-command task. Furthermore, the questionnaire results of subjective estimation revealed that proposed hybrid BCI offers less eye fatigue, and potentially higher levels of concentration, physical condition, and mental condition for users. This work first introduced the IVEP signals in hybrid BCI system that could enhance performance efficiently, which is promising to fulfill the requirements for efficiency in practical BCI control systems.

Clinical applications of neurofeedback based on sensorimotor rhythm: a systematic review and meta-analysis

Background

Among the brain-machine interfaces, neurofeedback is a non-invasive technique that uses sensorimotor rhythm (SMR) as a clinical intervention protocol. This study aimed to investigate the clinical applications of SMR neurofeedback to understand its clinical effectiveness in different pathologies or symptoms.

Methods

A systematic review study with meta-analysis of the clinical applications of EEG-based SMR neurofeedback performed using pre-selected publication databases. A qualitative analysis of these studies was performed using the Consensus tool on the Reporting and Experimental Design of Neurofeedback studies (CRED-nf). The Meta-analysis of clinical efficacy was carried out using Review Manager software, version 5.4.1 (RevMan 5; Cochrane Collaboration, Oxford, UK).

Results

The qualitative analysis includes 44 studies, of which only 27 studies had some kind of control condition, five studies were double-blinded, and only three reported a blind follow-up throughout the intervention. The meta-analysis included a total sample of 203 individuals between stroke and fibromyalgia. Studies on multiple sclerosis, insomnia, quadriplegia, paraplegia, and mild cognitive impairment were excluded due to the absence of a control group or results based only on post-intervention scales. Statistical analysis indicated that stroke patients did not benefit from neurofeedback interventions when compared to other therapies (Std. mean. dif. 0.31, 95% CI 0.03-0.60, p = 0.03), and there was no significant heterogeneity among stroke studies, classified as moderate I2 = 46% p-value = 0.06. Patients diagnosed with fibromyalgia showed, by means of quantitative analysis, a better benefit for the group that used neurofeedback (Std. mean. dif. -0.73, 95% CI -1.22 to -0.24, p = 0.001). Thus, on performing the pooled analysis between conditions, no significant differences were observed between the neurofeedback intervention and standard therapy (0.05, CI 95%, -0.20 to -0.30, p = 0.69), with the presence of substantial heterogeneity I2 = 92.2%, p-value < 0.001.

Conclusion

We conclude that although neurofeedback based on electrophysiological patterns of SMR contemplates the interest of numerous researchers and the existence of research that presents promising results, it is currently not possible to point out the clinical benefits of the technique as a form of clinical intervention. Therefore, it is necessary to develop more robust studies with a greater sample of a more rigorous methodology to understand the benefits that the technique can provide to the population.

Fatigue factors and fatigue indices in SSVEP-based brain-computer interfaces: a systematic review and meta-analysis

Background

Fatigue is a serious challenge when applying a steady-state visual evoked potential (SSVEP)-based brain-computer interfaces (BCIs) in the real world. Many researchers have used quantitative indices to study the effect of visual stimuli on fatigue. According to a wide range of studies in fatigue analysis, there are contradictions and inconsistencies in the behavior of fatigue indicators.

New method

In this study, for the first time, a systematic review and meta-analysis were performed on fatigue indices and fatigue caused by stimulation paradigm. We queried three scientific search engines for studies published between 2000 and 2022. The inclusion criteria were papers investigating mental and visual fatigue from performing a visual task using electroencephalogram (EEG) signals.

Results

Attractiveness and variation are the most effective ways to reduce BCI fatigue. Therefore, zoom motion, Newton's ring motion, and cue patterns reduce fatigue. While the color of the cue could effectively reduce fatigue, its shape and background had no effect on fatigue. Additionally, the questionnaire and quantitative indicators such as frequency indices, signal-to-noise ratio (SNR), SSVEP amplitude, and multiscale entropy were utilized to assess fatigue. Meta-analysis indicated that when a person is fatigued, the spectrum amplitude of alpha, theta, and α + θ / β increase significantly, while SNR and SSVEP amplitude decrease significantly.

Conclusion

The outcomes of this study can be used to design more optimal stimulation protocols that cause less fatigue. Moreover, the level of fatigue can be quantitatively assessed with indicators without the participant's self-reports.

A Review on Motor Imagery with Transcranial Alternating Current Stimulation: Bridging Motor and Cognitive Welfare for Patient Rehabilitation

Research has shown the effectiveness of motor imagery in patient motor rehabilitation. Transcranial electrical stimulation has also demonstrated to improve patient motor and non-motor performance. However, mixed findings from motor imagery studies that involved transcranial electrical stimulation suggest that current experimental protocols can be further improved towards a unified design for consistent and effective results. This paper aims to review, with some clinical and neuroscientific findings from literature as support, studies of motor imagery coupled with different types of transcranial electrical stimulation and their experiments onhealthy and patient subjects. This review also includes the cognitive domains of working memory, attention, and fatigue, which are important for designing consistent and effective therapy protocols. Finally, we propose a theoretical all-inclusive framework that synergizes the three cognitive domains with motor imagery and transcranial electrical stimulation for patient rehabilitation, which holds promise of benefiting patients suffering from neuromuscular and cognitive disorders.

Electroencephalogram based brain-computer interface: Applications, challenges, and opportunities

Brain-Computer Interfaces (BCI) is an exciting and emerging research area for researchers and scientists. It is a suitable combination of software and hardware to operate any device mentally. This review emphasizes the significant stages in the BCI domain, current problems, and state-of-the-art findings. This article also covers how current results can contribute to new knowledge about BCI, an overview of BCI from its early developments to recent advancements, BCI applications, challenges, and future directions. The authors pointed to unresolved issues and expressed how BCI is valuable for analyzing the human brain. Humans' dependence on machines has led humankind into a new future where BCI can play an essential role in improving this modern world.

Effects of EMG-based robot for upper extremity rehabilitation on post-stroke patients: a systematic review and meta-analysis

Objective: A growing body of research shows the promise and efficacy of EMG-based robot interventions in improving the motor function in stroke survivors. However, it is still controversial whether the effect of EMG-based robot is more effective than conventional therapies. This study focused on the effects of EMG-based robot on upper limb motor control, spasticity and activity limitation in stroke survivors compared with conventional rehabilitation techniques. Methods: We searched electronic databases for relevant randomized controlled trials. Outcomes included Fugl-Meyer assessment scale (FMA), Modified Ashworth Scale (MAS), and activity level. Result: Thirteen studies with 330 subjects were included. The results showed that the outcomes post intervention was significantly improved in the EMG-based robot group. Results from subgroup analyses further revealed that the efficacy of the treatment was better in patients in the subacute stage, those who received a total treatment time of less than 1000 min, and those who received EMG-based robotic therapy combined with electrical stimulation (ES). Conclusion: The effect of EMG-based robot is superior to conventional therapies in terms of improving upper extremity motor control, spasticity and activity limitation. Further research should explore optimal parameters of EMG-based robot therapy and its long-term effects on upper limb function in post-stroke patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/; Identifier: 387070.

Development of Low-Contact-Impedance Dry Electrodes for Electroencephalogram Signal Acquisition

Dry electroencephalogram (EEG) systems have a short set-up time and require limited skin preparation. However, they tend to require strong electrode-to-skin contact. In this study, dry EEG electrodes with low contact impedance (<150 kΩ) were fabricated by partially embedding a polyimide flexible printed circuit board (FPCB) in polydimethylsiloxane and then casting them in a sensor mold with six symmetrical legs or bumps. Silver-silver chloride paste was used at the exposed tip of each leg or bump that must touch the skin. The use of an FPCB enabled the fabricated electrodes to maintain steady impedance. Two types of dry electrodes were fabricated: flat-disk electrodes for skin with limited hair and multilegged electrodes for common use and for areas with thick hair. Impedance testing was conducted with and without a custom head cap according to the standard 10-20 electrode arrangement. The experimental results indicated that the fabricated electrodes exhibited impedance values between 65 and 120 kΩ. The brain wave patterns acquired with these electrodes were comparable to those acquired using conventional wet electrodes. The fabricated EEG electrodes passed the primary skin irritation tests based on the ISO 10993-10:2010 protocol and the cytotoxicity tests based on the ISO 10993-5:2009 protocol.

Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia: a randomized controlled trial

BACKGROUND

Seeking positive and comprehensive rehabilitation methods after stroke is an urgent problem to be solved, which is very important to improve the dysfunction of stroke. The aim of this study was to investigate the effects of motor imagery-based brain-computer interface training (MI-BCI) on upper limb function and attention in stroke patients with hemiplegia.

METHODS

Sixty stroke patients with impairment of upper extremity function and decreased attention were randomly assigned to the control group (CR group) or the experimental group (BCI group) in a 1:1 ratio. Patients in the CR group received conventional rehabilitation. Patients in the BCI group received 20 min of MI-BCI training five times a week for 3 weeks (15 sessions) in addition to conventional rehabilitation. The primary outcome measures were the changes in Fugl-Meyer Motor Function Assessment of Upper Extremities (FMA-UE) and Attention Network Test (ANT) from baseline to 3 weeks.

RESULTS

About 93% of the patients completed the allocated training. Compared with the CR group, among those in the BCI group, FMA-UE was increased by 8.0 points (95%CI, 5.0 to 10.0; P < 0.001). Alert network response time (32.4ms; 95%CI, 58.4 to 85.6; P < 0.001), orienting network response (5.6ms; 95%CI, 29.8 to 55.8; P = 0.010), and corrects number (8.0; 95%CI, 17.0 to 28.0; P < 0.001) also increased in the BCI group compared with the CR group. Additionally, the executive control network response time (- 105.9ms; 95%CI, - 68.3 to - 23.6; P = 0.002), the total average response time (- 244.8ms; 95%CI, - 155.8 to - 66.2; P = 0.002), and total time (- 122.0ms; 95%CI, - 80.0 to - 35.0; P = 0.001) were reduced in the BCI group compared with the CR group.

CONCLUSION

MI-BCI combined with conventional rehabilitation training could better enhance upper limb motor function and attention in stroke patients. This training method may be feasible and suitable for individuals with stroke.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry with Portal Number ChiCTR2100050430(27/08/2021).

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION AND SIGNIFICANCE

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

Design of Fatigue Driving Behavior Detection Based on Circle Hough Transform

Chronic fatigue symptoms of jobs are risk factors that may cause errors and lead to occupational accidents. For instance, occupational injuries and traffic accidents stem from overlooking long-term fatigue. According to statistics for fatigue driving, it was found that fatigue driving is one of the main causes of traffic accidents. The resulting decrease in the quality of traffic, as well as impaired traffic flow efficiency and functioning, contributes markedly to the societal costs of fatigue. This article proposes a noninvasive physical method for fatigue detection using a machine vision image algorithm. The main technology was implemented using a software framework based on optimized skin color segmentation and edge detection, as well as eye contour extraction. By integrating machine vision and an optimized Hove transform algorithm, our method mainly identifies fatigue based on the detected target's face, head gestures, mouth aspect ratio (MAR), and eye condition, and then triggers an alarm through an intelligent auxiliary device. Our evaluation results of facial image data analysis showed that with an ideal eye threshold of 0.3, PERCLOS-80 standard, MAR, and head gesture-nod frequency, the method can be used to detect fatigue data accurately and systematically, thereby fulfilling the purpose of alerting a group of high-risk drivers and preventing them from engaging in high-risk activities in an involuntary state.

A transfer learning-based feedback training motivates the performance of SMR-BCI

Objective. Feedback training is a practical approach to brain-computer interface (BCI) end-users learning to modulate their sensorimotor rhythms (SMRs). BCI self-regulation learning has been shown to be influenced by subjective psychological factors, such as motivation. However, few studies have taken into account the users' self-motivation as additional guidance for the cognitive process involved in BCI learning. In this study we tested a transfer learning (TL) feedback method designed to increase self-motivation by providing information about past performance.Approach. Electroencephalography (EEG) signals from the previous runs were affine transformed and displayed as points on the screen, along with the newly recorded EEG signals in the current run, giving the subjects a context for self-motivation. Subjects were asked to separate the feedback points for the current run under the display of the separability of prior training. We conducted a between-subject feedback training experiment, in which 24 healthy SMR-BCI naive subjects were trained to imagine left- and right-hand movements. The participants were provided with either TL feedback or typical cursor-bar (CB) feedback (control condition), for three sessions on separate days.Main results. The behavioral results showed an increased challenge and stable mastery confidence, suggesting that subjects' motivation grew as the feedback training went on. The EEG results showed favorable overall training effects with TL feedback in terms of the class distinctiveness and EEG discriminancy. Performance was 28.5% higher in the third session than in the first. About 41.7% of the subjects were 'learners' including not only low-performance subjects, but also good-performance subjects who might be affected by the ceiling effect. Subjects were able to control BCI with TL feedback with a higher performance of 60.5% during the last session compared to CB feedback.Significance. The present study demonstrated that the proposed TL feedback method boosted psychological engagement through the self-motivated context, and further allowed subjects to modulate SMR effectively. The proposed TL feedback method also provided an alternative to typical CB feedback.

Non-invasive brain stimulation for fatigue in post-acute sequelae of SARS-CoV-2 (PASC)

BACKGROUND

and purpose: Fatigue is among the most common persistent symptoms following post-acute sequelae of Sars-COV-2 infection (PASC). The current study investigated the potential therapeutic effects of High-Definition transcranial Direct Current Stimulation (HD-tDCS) associated with rehabilitation program for the management of PASC-related fatigue.

METHODS

Seventy patients with PASC-related fatigue were randomized to receive 3 mA or sham HD-tDCS targeting the left primary motor cortex (M1) for 30 min paired with a rehabilitation program. Each patient underwent 10 sessions (2 sessions/week) over five weeks. Fatigue was measured as the primary outcome before and after the intervention using the Modified Fatigue Impact Scale (MFIS). Pain level, anxiety severity and quality of life were secondary outcomes assessed, respectively, through the McGill Questionnaire, Hamilton Anxiety Rating Scale (HAM-A) and WHOQOL.

RESULTS

Active HD-tDCS resulted in significantly greater reduction in fatigue compared to sham HD-tDCS (mean group MFIS reduction of 22.11 points vs 10.34 points). Distinct effects of HD-tDCS were observed in fatigue domains with greater effect on cognitive (mean group difference 8.29 points; effect size 1.1; 95% CI 3.56-13.01; P < .0001) and psychosocial domains (mean group difference 2.37 points; effect size 1.2; 95% CI 1.34-3.40; P < .0001), with no significant difference between the groups in the physical subscale (mean group difference 0.71 points; effect size 0.1; 95% CI 4.47-5.90; P = .09). Compared to sham, the active HD-tDCS group also had a significant reduction in anxiety (mean group difference 4.88; effect size 0.9; 95% CI 1.93-7.84; P < .0001) and improvement in quality of life (mean group difference 14.80; effect size 0.7; 95% CI 7.87-21.73; P < .0001). There was no significant difference in pain (mean group difference -0.74; no effect size; 95% CI 3.66-5.14; P = .09).

CONCLUSION

An intervention with M1 targeted HD-tDCS paired with a rehabilitation program was effective in reducing fatigue and anxiety, while improving quality of life in people with PASC.

Exploring the ability of stroke survivors in using the contralesional hemisphere to control a brain-computer interface

Brain-computer interfaces (BCIs) have recently been shown to be clinically effective as a novel method of stroke rehabilitation. In many BCI-based studies, the activation of the ipsilesional hemisphere was considered a key factor required for motor recovery after stroke. However, emerging evidence suggests that the contralesional hemisphere also plays a role in motor function rehabilitation. The objective of this study is to investigate the effectiveness of the BCI in detecting motor imagery of the affected hand from contralesional hemisphere. We analyzed a large EEG dataset from 136 stroke patients who performed motor imagery of their stroke-impaired hand. BCI features were extracted from channels covering either the ipsilesional, contralesional or bilateral hemisphere, and the offline BCI accuracy was computed using 10 [Formula: see text] 10-fold cross-validations. Our results showed that most stroke patients can operate the BCI using either their contralesional or ipsilesional hemisphere. Those with the ipsilesional BCI accuracy of less than 60% had significantly higher motor impairments than those with the ipsilesional BCI accuracy above 80%. Interestingly, those with the ipsilesional BCI accuracy of less than 60% achieved a significantly higher contralesional BCI accuracy, whereas those with the ipsilesional BCI accuracy more than 80% had significantly poorer contralesional BCI accuracy. This study suggests that contralesional BCI may be a useful approach for those with a high motor impairment who cannot accurately generate signals from ipsilesional hemisphere to effectively operate BCI.

EEG-Based Person Identification during Escalating Cognitive Load

With the development of human society, there is an increasing importance for reliable person identification and authentication to protect a person's material and intellectual property. Person identification based on brain signals has captured substantial attention in recent years. These signals are characterized by original patterns for a specific person and are capable of providing security and privacy of an individual in biometric identification. This study presents a biometric identification method based on a novel paradigm with accrual cognitive brain load from relaxing with eyes closed to the end of a serious game, which includes three levels with increasing difficulty. The used database contains EEG data from 21 different subjects. Specific patterns of EEG signals are recognized in the time domain and classified using a 1D Convolutional Neural Network proposed in the MATLAB environment. The ability of person identification based on individual tasks corresponding to a given degree of load and their fusion are examined by 5-fold cross-validation. Final accuracies of more than 99% and 98% were achieved for individual tasks and task fusion, respectively. The reduction of EEG channels is also investigated. The results imply that this approach is suitable to real applications.

Application of a Brain-Computer Interface System with Visual and Motor Feedback in Limb and Brain Functional Rehabilitation after Stroke: Case Report

(1) Objective: To investigate the feasibility, safety, and effectiveness of a brain-computer interface (BCI) system with visual and motor feedback in limb and brain function rehabilitation after stroke. (2) Methods: First, we recruited three hemiplegic stroke patients to perform rehabilitation training using a BCI system with visual and motor feedback for two consecutive days (four sessions) to verify the feasibility and safety of the system. Then, we recruited five other hemiplegic stroke patients for rehabilitation training (6 days a week, lasting for 12-14 days) using the same BCI system to verify the effectiveness. The mean and Cohen's w were used to compare the changes in limb motor and brain functions before and after training. (3) Results: In the feasibility verification, the continuous motor state switching time (CMSST) of the three patients was 17.8 ± 21.0s, and the motor state percentages (MSPs) in the upper and lower limb training were 52.6 ± 25.7% and 72.4 ± 24.0%, respectively. The effective training revolutions (ETRs) per minute were 25.8 ± 13.0 for upper limb and 24.8 ± 6.4 for lower limb. There were no adverse events during the training process. Compared with the baseline, the motor function indices of the five patients were improved, including sitting balance ability, upper limb Fugel-Meyer assessment (FMA), lower limb FMA, 6 min walking distance, modified Barthel index, and root mean square (RMS) value of triceps surae, which increased by 0.4, 8.0, 5.4, 11.4, 7.0, and 0.9, respectively, and all had large effect sizes (Cohen's w ≥ 0.5). The brain function indices of the five patients, including the amplitudes of the motor evoked potentials (MEP) on the non-lesion side and lesion side, increased by 3.6 and 3.7, respectively; the latency of MEP on the non-lesion side was shortened by 2.6 ms, and all had large effect sizes (Cohen's w ≥ 0.5). (4) Conclusions: The BCI system with visual and motor feedback is applicable in active rehabilitation training of stroke patients with hemiplegia, and the pilot results show potential multidimensional benefits after a short course of treatment.

Motor Imagery Analysis from Extensive EEG Data Representations Using Convolutional Neural Networks

Motor imagery is a complex mental task that represents muscular movement without the execution of muscular action, involving cognitive processes of motor planning and sensorimotor proprioception of the body. Since the mental task has similar behavior to that of the motor execution process, it can be used to create rehabilitation routines for patients with some motor skill impairment. However, due to the nature of this mental task, its execution is complicated. Hence, the classification of these signals in scenarios such as brain-computer interface systems tends to have a poor performance. In this work, we study in depth different forms of data representation of motor imagery EEG signals for distinct CNN-based models as well as novel EEG data representations including spectrograms and multidimensional raw data. With the aid of transfer learning, we achieve results up to 93% accuracy, exceeding the current state of the art. However, although these results are strong, they entail the use of high computational resources to generate the samples, since they are based on spectrograms. Thus, we searched further for alternative forms of EEG representations, based on 1D, 2D, and 3D variations of the raw data, leading to promising results for motor imagery classification that still exceed the state of the art. Hence, in this work, we focus on exploring alternative methods to process and improve the classification of motor imagery features with few preprocessing techniques.

Enhancement of lower limb motor imagery ability via dual-level multimodal stimulation and sparse spatial pattern decoding method

Recently, motor imagery brain-computer interfaces (MI-BCIs) with stimulation systems have been developed in the field of motor function assistance and rehabilitation engineering. An efficient stimulation paradigm and Electroencephalogram (EEG) decoding method have been designed to enhance the performance of MI-BCI systems. Therefore, in this study, a multimodal dual-level stimulation paradigm is designed for lower-limb rehabilitation training, whereby visual and auditory stimulations act on the sensory organ while proprioceptive and functional electrical stimulations are provided to the lower limb. In addition, upper triangle filter bank sparse spatial pattern (UTFB-SSP) is proposed to automatically select the optimal frequency sub-bands related to desynchronization rhythm during enhanced imaginary movement to improve the decoding performance. The effectiveness of the proposed MI-BCI system is demonstrated on an the in-house experimental dataset and the BCI competition IV IIa dataset. The experimental results show that the proposed system can effectively enhance the MI performance by inducing the α, β and γ rhythms in lower-limb movement imagery tasks.

Predicting individual muscle fatigue tolerance by resting-state EEG brain network

OBJECTIVE

Exercise-induced muscle fatigue is a complex physiological phenomenon involving the central and peripheral nervous systems, and fatigue tolerance varies across individuals. Various studies have emphasized the close relationships between muscle fatigue and the brain. However, the relationships between the resting-state electroencephalogram (rsEEG) brain network and individual muscle fatigue tolerance remain unexplored.

APPROACH

Eighteen elite water polo athletes took part in our experiment. Five-minute before- and after-fatigue-exercise rsEEG and fatiguing task (i.e., elbow flexion and extension) electromyography (EMG) data were recorded. Based on the graph theory, we constructed the before- and after-task rsEEG coherence network and compared the network differences between them. Then, the correlation between the before-fatigue rsEEG network properties and the EMG fatigue indexes when a subject cannot keep on exercising anymore was profiled. Finally, a prediction model based on the before-fatigue rsEEG network properties was established to predict fatigue tolerance.

MAIN RESULTS

Results of this study revealed the significant differences between the before- and after-exercise rsEEG brain network and found significant high correlations between before-exercise rsEEG network properties in the beta band and individual muscle fatigue tolerance. Finally, an efficient support vector regression (SVR) model based on the before-exercise rsEEG network properties in the beta band was constructed and achieved the accurate prediction of individual fatigue tolerance. Similar results were also revealed on another thirty-subject swimmer data set further demonstrating the reliability of predicting fatigue tolerance based on the rsEEG network.

SIGNIFICANCE

Our study investigates the relationship between the rsEEG brain network and individual muscle fatigue tolerance and provides a potential objective physiological biomarker for tolerance prediction and the regulation of muscle fatigue.

fNIRS-based adaptive visuomotor task improves sensorimotor cortical activation

OBJECTIVE

Investigating how to promote the functional activation of the central sensorimotor system is an important goal in the neurorehabilitation research domain. We aim to validate the effectiveness of facilitating cortical excitability using a closed-loop visuomotor task, in which the task difficulty is adaptively adjusted based on an individual's sensorimotor cortical activation.

APPROACH

We developed a novel visuomotor task, in which subjects moved a handle of a haptic device along a specific path while exerting a constant force against a virtual surface under visual feedback. The difficulty levels of the task were adapted with the aim of increasing the activation of sensorimotor areas, measured non-invasively by functional near-infrared spectroscopy. The changes in brain activation of the bilateral prefrontal cortex, sensorimotor cortex, and the occipital cortex obtained during the adaptive visuomotor task (adaptive group), were compared to the brain activation pattern elicited by the same duration of task with random difficulties in a control group.

MAIN RESULTS

During one intervention session, the adaptive group showed significantly increased activation in the bilateral sensorimotor cortex, also enhanced effective connectivity between the prefrontal and sensorimotor areas compared to the control group.

SIGNIFICANCE

Our findings demonstrated that the fNIRS-based adaptive visuomotor task with high ecological validity can facilitate the neural activity in sensorimotor areas and thus has the potential to improve hand motor functions.

Toward an Adapted Neurofeedback for Post-stroke Motor Rehabilitation: State of the Art and Perspectives

Stroke is a severe health issue, and motor recovery after stroke remains an important challenge in the rehabilitation field. Neurofeedback (NFB), as part of a brain–computer interface, is a technique for modulating brain activity using on-line feedback that has proved to be useful in motor rehabilitation for the chronic stroke population in addition to traditional therapies. Nevertheless, its use and applications in the field still leave unresolved questions. The brain pathophysiological mechanisms after stroke remain partly unknown, and the possibilities for intervention on these mechanisms to promote cerebral plasticity are limited in clinical practice. In NFB motor rehabilitation, the aim is to adapt the therapy to the patient’s clinical context using brain imaging, considering the time after stroke, the localization of brain lesions, and their clinical impact, while taking into account currently used biomarkers and technical limitations. These modern techniques also allow a better understanding of the physiopathology and neuroplasticity of the brain after stroke. We conducted a narrative literature review of studies using NFB for post-stroke motor rehabilitation. The main goal was to decompose all the elements that can be modified in NFB therapies, which can lead to their adaptation according to the patient’s context and according to the current technological limits. Adaptation and individualization of care could derive from this analysis to better meet the patients’ needs. We focused on and highlighted the various clinical and technological components considering the most recent experiments. The second goal was to propose general recommendations and enhance the limits and perspectives to improve our general knowledge in the field and allow clinical applications. We highlighted the multidisciplinary approach of this work by combining engineering abilities and medical experience. Engineering development is essential for the available technological tools and aims to increase neuroscience knowledge in the NFB topic. This technological development was born out of the real clinical need to provide complementary therapeutic solutions to a public health problem, considering the actual clinical context of the post-stroke patient and the practical limits resulting from it.

Design of hydrogel-based wearable EEG electrodes for medical applications

The electroencephalogram (EEG) is considered to be a promising method for studying brain disorders. Because of its non-invasive nature, subjects take a lower risk compared to some other invasive methods, while the systems record the brain signal. With the technological advancement of neural and material engineering, we are in the process of achieving continuous monitoring of neural activity through wearable EEG. In this article, we first give a brief introduction to EEG bands, circuits, wired/wireless EEG systems, and analysis algorithms. Then, we review the most recent advances in the interfaces used for EEG recordings, focusing on hydrogel-based EEG electrodes. Specifically, the advances for important figures of merit for EEG electrodes are reviewed. Finally, we summarize the potential medical application of wearable EEG systems.

A Transfer Learning Algorithm to Reduce Brain-Computer Interface Calibration Time for Long-Term Users

Current motor imagery-based brain-computer interface (BCI) systems require a long calibration time at the beginning of each session before they can be used with adequate levels of classification accuracy. In particular, this issue can be a significant burden for long term BCI users. This article proposes a novel transfer learning algorithm, called r-KLwDSA, to reduce the BCI calibration time for long-term users. The proposed r-KLwDSA algorithm aligns the user's EEG data collected in previous sessions to the few EEG trials collected in the current session, using a novel linear alignment method. Thereafter, the aligned EEG trials from the previous sessions and the few EEG trials from the current sessions are fused through a weighting mechanism before they are used for calibrating the BCI model. To validate the proposed algorithm, a large dataset containing the EEG data from 11 stroke patients, each performing 18 BCI sessions, was used. The proposed framework demonstrated a significant improvement in the classification accuracy, of over 4% compared to the session-specific algorithm, when there were as few as two trials per class available from the current session. The proposed algorithm was particularly successful in improving the BCI accuracy of the sessions that had initial session-specific accuracy below 60%, with an average improvement of around 10% in the accuracy, leading to more stroke patients having meaningful BCI rehabilitation.

Sensorimotor Rhythm-Brain Computer Interface With Audio-Cue, Motor Observation and Multisensory Feedback for Upper-Limb Stroke Rehabilitation: A Controlled Study

Several studies have shown the positive clinical effect of brain computer interface (BCI) training for stroke rehabilitation. This study investigated the efficacy of the sensorimotor rhythm (SMR)-based BCI with audio-cue, motor observation and multisensory feedback for post-stroke rehabilitation. Furthermore, we discussed the interaction between training intensity and training duration in BCI training. Twenty-four stroke patients with severe upper limb (UL) motor deficits were randomly assigned to two groups: 2-week SMR-BCI training combined with conventional treatment (BCI Group, BG, n = 12) and 2-week conventional treatment without SMR-BCI intervention (Control Group, CG, n = 12). Motor function was measured using clinical measurement scales, including Fugl-Meyer Assessment-Upper Extremities (FMA-UE; primary outcome measure), Wolf Motor Functional Test (WMFT), and Modified Barthel Index (MBI), at baseline (Week 0), post-intervention (Week 2), and follow-up week (Week 4). EEG data from patients allocated to the BG was recorded at Week 0 and Week 2 and quantified by mu suppression means event-related desynchronization (ERD) in mu rhythm (8–12 Hz). All functional assessment scores (FMA-UE, WMFT, and MBI) significantly improved at Week 2 for both groups (p < 0.05). The BG had significantly higher FMA-UE and WMFT improvement at Week 4 compared to the CG. The mu suppression of bilateral hemisphere both had a positive trend with the motor function scores at Week 2. This study proposes a new effective SMR-BCI system and demonstrates that the SMR-BCI training with audio-cue, motor observation and multisensory feedback, together with conventional therapy may promote long-lasting UL motor improvement.

Clinical Trial Registration: [http://www.chictr.org.cn], identifier [ChiCTR2000041119].

Investigating the dose-response relationship between motor imagery and motor recovery of upper-limb impairment and function in chronic stroke: A scoping review

The recovery of upper-limb impairment and dysfunction post-stroke is often incomplete owing to the limited time in therapy focused on upper-limb recovery and the severity of the impairment. In these cases, motor imagery (MI) may be used as a precursor to physical therapies to initiate rehabilitation early on when it would be otherwise impossible to engage in therapy, as well as to increase the dose of therapy when MI is used in adjunct to physical therapy. While previous reviews have shown MI to be effective as a therapeutic option, disparity in findings exists, with some studies suggesting MI is not an effective treatment for post-stroke impairment and dysfunction. One factor contributing to these findings is inconsistency in the dose of MI applied. To explore the relationship between MI dose and recovery, a scoping review of MI literature as a treatment for adult survivors of stroke with chronic upper-limb motor deficit was performed. Embase, Medline and CINHAL databases were searched for articles related to MI and stroke. Following a two-phase review process, 21 papers were included, and data related to treatment dose and measures of impairment and function were extracted. Effect sizes were calculated to investigate the effect of dosage on motor recovery. Findings showed a high degree of variability in dosage regimens across studies, with no clear pattern for the effect of dose on outcome. The present review highlights the gaps in MI literature, including variables that contribute to the dose-response relationship, that future studies should consider when implementing MI.