1
|
Shen B, Xiao S, Yu C, Zhang C, Zhan J, Liu Y, Fu W. Cerebral hemodynamics underlying ankle force sense modulated by high-definition transcranial direct current stimulation. Cereb Cortex 2024; 34:bhae226. [PMID: 38850217 DOI: 10.1093/cercor/bhae226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 06/10/2024] Open
Abstract
This study aimed to investigate the effects of high-definition transcranial direct current stimulation on ankle force sense and underlying cerebral hemodynamics. Sixteen healthy adults (8 males and 8 females) were recruited in the study. Each participant received either real or sham high-definition transcranial direct current stimulation interventions in a randomly assigned order on 2 visits. An isokinetic dynamometer was used to assess the force sense of the dominant ankle; while the functional near-infrared spectroscopy was employed to monitor the hemodynamics of the sensorimotor cortex. Two-way analyses of variance with repeated measures and Pearson correlation analyses were performed. The results showed that the absolute error and root mean square error of ankle force sense dropped more after real stimulation than after sham stimulation (dropped by 23.4% vs. 14.9% for absolute error, and 20.0% vs. 10.2% for root mean square error). The supplementary motor area activation significantly increased after real high-definition transcranial direct current stimulation. The decrease in interhemispheric functional connectivity within the Brodmann's areas 6 was significantly correlated with ankle force sense improvement after real high-definition transcranial direct current stimulation. In conclusion, high-definition transcranial direct current stimulation can be used as a potential intervention for improving ankle force sense. Changes in cerebral hemodynamics could be one of the explanations for the energetic effect of high-definition transcranial direct current stimulation.
Collapse
Affiliation(s)
- Bin Shen
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Songlin Xiao
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Changxiao Yu
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Chuyi Zhang
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Jianglong Zhan
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Ying Liu
- School of Psychology, Shanghai University of Sport, 399 Changhai Road, Yangpu District, Shanghai 200438, China
| | - Weijie Fu
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| |
Collapse
|
2
|
Andersen AG, Riparbelli AC, Siebner HR, Konge L, Bjerrum F. Using neuroimaging to assess brain activity and areas associated with surgical skills: a systematic review. Surg Endosc 2024; 38:3004-3026. [PMID: 38653901 DOI: 10.1007/s00464-024-10830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Surgical skills acquisition is under continuous development due to the emergence of new technologies, and there is a need for assessment tools to develop along with these. A range of neuroimaging modalities has been used to map the functional activation of brain networks while surgeons acquire novel surgical skills. These have been proposed as a method to provide a deeper understanding of surgical expertise and offer new possibilities for the personalized training of future surgeons. With studies differing in modalities, outcomes, and surgical skills there is a need for a systematic review of the evidence. This systematic review aims to summarize the current knowledge on the topic and evaluate the potential use of neuroimaging in surgical education. METHODS We conducted a systematic review of neuroimaging studies that mapped functional brain activation while surgeons with different levels of expertise learned and performed technical and non-technical surgical tasks. We included all studies published before July 1st, 2023, in MEDLINE, EMBASE and WEB OF SCIENCE. RESULTS 38 task-based brain mapping studies were identified, consisting of randomized controlled trials, case-control studies, and observational cohort or cross-sectional studies. The studies employed a wide range of brain mapping modalities, including electroencephalography, functional magnetic resonance imaging, positron emission tomography, and functional near-infrared spectroscopy, activating brain areas involved in the execution and sensorimotor or cognitive control of surgical skills, especially the prefrontal cortex, supplementary motor area, and primary motor area, showing significant changes between novices and experts. CONCLUSION Functional neuroimaging can reveal how task-related brain activity reflects technical and non-technical surgical skills. The existing body of work highlights the potential of neuroimaging to link task-related brain activity patterns with the individual level of competency or improvement in performance after training surgical skills. More research is needed to establish its validity and usefulness as an assessment tool.
Collapse
Affiliation(s)
- Annarita Ghosh Andersen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark.
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Agnes Cordelia Riparbelli
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Gastrounit, Surgical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| |
Collapse
|
3
|
Walia P, Fu Y, Norfleet J, Schwaitzberg SD, Intes X, De S, Cavuoto L, Dutta A. Brain-behavior analysis of transcranial direct current stimulation effects on a complex surgical motor task. FRONTIERS IN NEUROERGONOMICS 2024; 4:1135729. [PMID: 38234492 PMCID: PMC10790853 DOI: 10.3389/fnrgo.2023.1135729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
Transcranial Direct Current Stimulation (tDCS) has demonstrated its potential in enhancing surgical training and performance compared to sham tDCS. However, optimizing its efficacy requires the selection of appropriate brain targets informed by neuroimaging and mechanistic understanding. Previous studies have established the feasibility of using portable brain imaging, combining functional near-infrared spectroscopy (fNIRS) with tDCS during Fundamentals of Laparoscopic Surgery (FLS) tasks. This allows concurrent monitoring of cortical activations. Building on these foundations, our study aimed to explore the multi-modal imaging of the brain response using fNIRS and electroencephalogram (EEG) to tDCS targeting the right cerebellar (CER) and left ventrolateral prefrontal cortex (PFC) during a challenging FLS suturing with intracorporeal knot tying task. Involving twelve novices with a medical/premedical background (age: 22-28 years, two males, 10 females with one female with left-hand dominance), our investigation sought mechanistic insights into tDCS effects on brain areas related to error-based learning, a fundamental skill acquisition mechanism. The results revealed that right CER tDCS applied to the posterior lobe elicited a statistically significant (q < 0.05) brain response in bilateral prefrontal areas at the onset of the FLS task, surpassing the response seen with sham tDCS. Additionally, right CER tDCS led to a significant (p < 0.05) improvement in FLS scores compared to sham tDCS. Conversely, the left PFC tDCS did not yield a statistically significant brain response or improvement in FLS performance. In conclusion, right CER tDCS demonstrated the activation of bilateral prefrontal brain areas, providing valuable mechanistic insights into the effects of CER tDCS on FLS peformance. These insights motivate future investigations into the effects of CER tDCS on error-related perception-action coupling through directed functional connectivity studies.
Collapse
Affiliation(s)
- Pushpinder Walia
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Yaoyu Fu
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, United States
| | - Jack Norfleet
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, United States
| | - Steven D. Schwaitzberg
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Xavier Intes
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, United States
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Suvranu De
- Center for Modeling, Simulation, and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Lora Cavuoto
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, United States
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| |
Collapse
|
4
|
Anderson SJ, Warren AL, Abdullayeva N, Krigolson O, Hecker KG. Pathologists aren't pigeons: exploring the neural basis of visual recognition and perceptual expertise in pathology. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1579-1592. [PMID: 37184677 DOI: 10.1007/s10459-023-10232-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
Visual (perceptual) reasoning is a critical skill in many medical specialties, including pathology, diagnostic imaging, and dermatology. However, in an ever-compressed medical curriculum, learning and practicing this skill can be challenging. Previous studies (including work with pigeons) have suggested that using reward-feedback-based activities, novices can gain expert levels of visual diagnostic accuracy in shortened training times. But is this level of diagnostic accuracy a result of image recognition (categorization) or is it the acquisition of diagnostic expertise? To answer this, the authors measured electroencephalographic data (EEG) and two components of the human event-related brain potential (reward positivity and N170) to explore the nature of visual expertise in a novice-expert study in pathology visual diagnosis. It was found that the amplitude of the reward positivity decreased with learning in novices (suggesting a decrease in reliance on feedback, as in other studies). However, this signal remained significantly different from the experts whose reward positivity signal did not change over the course of the experiment. There were no changes in the amplitude of the N170 (a reported neural marker of visual expertise) in novices over time. Novice N170 signals remained statistically and significantly lower in amplitude compared to experts throughout task performance. These data suggest that, while novices gained the ability to recognize (categorize) pathologies through reinforcement learning as quantified by the change in reward positivity, increased accuracy, and decreased time for responses, there was little change in the neural marker associated with visual expertise (N170). This is consistent with the multi-dimensional and complex nature of visual expertise and provides insight into future training programs for novices to bridge the expertise gap.
Collapse
Affiliation(s)
- Sarah J Anderson
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amy L Warren
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Nia Abdullayeva
- Department of Biological Sciences, Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Olav Krigolson
- Neuroscience Graduate Program, University of Victoria, Victoria, BC, Canada
| | - Kent G Hecker
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
5
|
Kamat A, Eastmond C, Gao Y, Nemani A, Yanik E, Cavuoto L, Hackett M, Norfleet J, Schwaitzberg S, De S, Intes X. Assessment of Surgical Tasks Using Neuroimaging Dataset (ASTaUND). Sci Data 2023; 10:699. [PMID: 37838752 PMCID: PMC10576768 DOI: 10.1038/s41597-023-02603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023] Open
Abstract
Functional near-infrared spectroscopy (fNIRS) is a neuroimaging tool for studying brain activity in mobile subjects. Open-access fNIRS datasets are limited to simple and/or motion-restricted tasks. Here, we report a fNIRS dataset acquired on mobile subjects performing Fundamentals of Laparoscopic Surgery (FLS) tasks in a laboratory environment. Demonstrating competency in the FLS tasks is a prerequisite for board certification in general surgery in the United States. The ASTaUND data set was acquired over four different studies. We provide the relevant information about the hardware, FLS task execution protocols, and subject demographics to facilitate the use of this open-access data set. We also provide the concurrent FLS scores, a quantitative metric for surgical skill assessment developed by the FLS committee. This data set is expected to support the growing field of assessing surgical skills via neuroimaging data and provide an example of data processing pipeline for use in realistic, non-restrictive environments.
Collapse
Affiliation(s)
- Anil Kamat
- Center for Modeling, Simulation, and Imaging for Medicine, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA.
| | - Condell Eastmond
- Center for Modeling, Simulation, and Imaging for Medicine, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA.
| | - Yuanyuan Gao
- Boston University Neurophotonics Center, Boston, Massachusetts, 02215, USA
| | - Arun Nemani
- Center for Modeling, Simulation, and Imaging for Medicine, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA
| | - Erim Yanik
- Florida A&M University-Florida State University College of Engineering, Tallahassee, FL, 32310, USA
| | - Lora Cavuoto
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, 14260, USA
| | - Matthew Hackett
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 14260, USA
| | - Jack Norfleet
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 14260, USA
| | - Steven Schwaitzberg
- U.S. Army Combat Capabilities Development Command - Soldier Center (CCDC SC), Orlando, FL, USA
| | - Suvranu De
- Florida A&M University-Florida State University College of Engineering, Tallahassee, FL, 32310, USA
| | - Xavier Intes
- Center for Modeling, Simulation, and Imaging for Medicine, Rensselaer Polytechnic Institute, Troy, New York, 12180, USA
| |
Collapse
|
6
|
Galvin D, Toth AJ, O'Reilly B, O'Sullivan R, Campbell MJ. M1 transcranial direct current stimulation augments laparoscopic surgical skill acquisition. Sci Rep 2023; 13:13731. [PMID: 37612337 PMCID: PMC10447451 DOI: 10.1038/s41598-023-40440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
The acquisition of basic surgical skills is a key component of medical education and trainees in laparoscopic surgery typically begin developing their skills using simulation box trainers. However, despite the advantages of simulation surgical training, access can be difficult for many trainees. One technique that has shown promise to enhance the deliberate practice of motor skills is transcranial electric stimulation (tES). The purpose of this study was to assess the impact of transcranial direct current stimulation (tDCS) on training induced improvements and retention of traditional time and kinematic based laparoscopic surgical skill metrics. Forty-nine medical students were randomly allocated to a neurostimulation or sham group and completed 5 training sessions of a bead transfer and threading laparoscopic task. Participants in both the sham and stimulation groups significantly improved their time and kinematic performance on both tasks following training. Although we did find that participants who received M1 tDCS saw greater performance benefits in response to training on a bead transfer task compared to those receiving sham stimulation no effect of neurostimulation was found for the threading task. This finding raises new questions regarding the effect that motor task complexity has on the efficacy of neurostimulation to augment training induced improvement and contributes to a growing body of research investigating the effects of neurostimulation on the sensory-motor performance of laparoscopic surgical skill.
Collapse
Affiliation(s)
- Daniel Galvin
- ASSERT Centre, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Adam J Toth
- Lero, The Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland.
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
| | - Barry O'Reilly
- ASSERT Centre, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Ray O'Sullivan
- ASSERT Centre, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Mark J Campbell
- Lero, The Science Foundation Ireland Research Centre for Software, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| |
Collapse
|
7
|
Goble M, Caddick V, Patel R, Modi H, Darzi A, Orihuela-Espina F, Leff DR. Optical neuroimaging and neurostimulation in surgical training and assessment: A state-of-the-art review. FRONTIERS IN NEUROERGONOMICS 2023; 4:1142182. [PMID: 38234498 PMCID: PMC10790870 DOI: 10.3389/fnrgo.2023.1142182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/03/2023] [Indexed: 01/19/2024]
Abstract
Introduction Functional near-infrared spectroscopy (fNIRS) is a non-invasive optical neuroimaging technique used to assess surgeons' brain function. The aim of this narrative review is to outline the effect of expertise, stress, surgical technology, and neurostimulation on surgeons' neural activation patterns, and highlight key progress areas required in surgical neuroergonomics to modulate training and performance. Methods A literature search of PubMed and Embase was conducted to identify neuroimaging studies using fNIRS and neurostimulation in surgeons performing simulated tasks. Results Novice surgeons exhibit greater haemodynamic responses across the pre-frontal cortex than experts during simple surgical tasks, whilst expert surgical performance is characterized by relative prefrontal attenuation and upregulation of activation foci across other regions such as the supplementary motor area. The association between PFC activation and mental workload follows an inverted-U shaped curve, activation increasing then attenuating past a critical inflection point at which demands outstrip cognitive capacity Neuroimages are sensitive to the impact of laparoscopic and robotic tools on cognitive workload, helping inform the development of training programs which target neural learning curves. FNIRS differs in comparison to current tools to assess proficiency by depicting a cognitive state during surgery, enabling the development of cognitive benchmarks of expertise. Finally, neurostimulation using transcranial direct-current-stimulation may accelerate skill acquisition and enhance technical performance. Conclusion FNIRS can inform the development of surgical training programs which modulate stress responses, cognitive learning curves, and motor skill performance. Improved data processing with machine learning offers the possibility of live feedback regarding surgeons' cognitive states during operative procedures.
Collapse
Affiliation(s)
- Mary Goble
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
8
|
Guimarães AN, Porto AB, Marcori AJ, Lage GM, Altimari LR, Alves Okazaki VH. Motor learning and tDCS: A systematic review on the dependency of the stimulation effect on motor task characteristics or tDCS assembly specifications. Neuropsychologia 2023; 179:108463. [PMID: 36567006 DOI: 10.1016/j.neuropsychologia.2022.108463] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
TDCS is one of the most commonly used methods among studies with transcranial electrical stimulation and motor skills learning. Differences between study results suggest that the effect of tDCS on motor learning is dependent on the motor task performed or on the tDCS assembly specification used in the learning process. This systematic review aimed to analyze the tDCS effect on motor learning and verify whether this effect is dependent on the task or tDCS assembly specifications. Searches were performed in PubMed, SciELO, LILACS, Web of Science, CINAHL, Scopus, SPORTDiscus, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and PsycINFO. Articles were included that analyzed the effect of tDCS on motor learning through pre-practice, post-practice, retention, and/or transfer tests (period ≥24 h). The tDCS was most frequently applied to the primary motor cortex (M1) or the cerebellar cortex (CC) and the majority of studies found significant stimulation effects. Studies that analyzed identical or similar motor tasks show divergent results for the tDCS effect, even when the assembly specifications are the same. The tDCS effect is not dependent on motor task characteristics or tDCS assembly specifications alone but is dependent on the interaction between these factors. This interaction occurs between uni and bimanual tasks with anodal uni and bihemispheric (bilateral) stimulations at M1 or with anodal unihemispheric stimulations (unilateral and centrally) at CC, and between tasks of greater or lesser difficulty with single or multiple tDCS sessions. Movement time seems to be more sensitive than errors to indicate the effects of tDCS on motor learning, and a sufficient amount of motor practice to reach the "learning plateau" also seems to determine the effect of tDCS on motor learning.
Collapse
Affiliation(s)
- Anderson Nascimento Guimarães
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Alessandra Beggiato Porto
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Alexandre Jehan Marcori
- University of São Paulo, Av. Professor Mello Moraes 65, CEP 05508-030, Vila Universitaria, São Paulo, SP, Brazil.
| | - Guilherme Menezes Lage
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, CEP 31270-901, Belo Horizonte, MG, Brazil.
| | - Leandro Ricardo Altimari
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| | - Victor Hugo Alves Okazaki
- State University of Londrina, Londrina. Rodovia Celso Garcia Cid - Pr 445, Km 380, Cx. Postal 10.011, CEP 86057-970, Campus Universitário, Londrina, PR, Brazil.
| |
Collapse
|
9
|
Walia P, Fu Y, Norfleet J, Schwaitzberg SD, Intes X, De S, Cavuoto L, Dutta A. Error-related brain state analysis using electroencephalography in conjunction with functional near-infrared spectroscopy during a complex surgical motor task. Brain Inform 2022; 9:29. [PMID: 36484977 PMCID: PMC9733771 DOI: 10.1186/s40708-022-00179-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Error-based learning is one of the basic skill acquisition mechanisms that can be modeled as a perception-action system and investigated based on brain-behavior analysis during skill training. Here, the error-related chain of mental processes is postulated to depend on the skill level leading to a difference in the contextual switching of the brain states on error commission. Therefore, the objective of this paper was to compare error-related brain states, measured with multi-modal portable brain imaging, between experts and novices during the Fundamentals of Laparoscopic Surgery (FLS) "suturing and intracorporeal knot-tying" task (FLS complex task)-the most difficult among the five psychomotor FLS tasks. The multi-modal portable brain imaging combined functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) for brain-behavior analysis in thirteen right-handed novice medical students and nine expert surgeons. The brain state changes were defined by quasi-stable EEG scalp topography (called microstates) changes using 32-channel EEG data acquired at 250 Hz. Six microstate prototypes were identified from the combined EEG data from experts and novices during the FLS complex task that explained 77.14% of the global variance. Analysis of variance (ANOVA) found that the proportion of the total time spent in different microstates during the 10-s error epoch was significantly affected by the skill level (p < 0.01), the microstate type (p < 0.01), and the interaction between the skill level and the microstate type (p < 0.01). Brain activation based on the slower oxyhemoglobin (HbO) changes corresponding to the EEG band power (1-40 Hz) changes were found using the regularized temporally embedded Canonical Correlation Analysis of the simultaneously acquired fNIRS-EEG signals. The HbO signal from the overlying the left inferior frontal gyrus-opercular part, left superior frontal gyrus-medial orbital, left postcentral gyrus, left superior temporal gyrus, right superior frontal gyrus-medial orbital cortical areas showed significant (p < 0.05) difference between experts and novices in the 10-s error epoch. We conclude that the difference in the error-related chain of mental processes was the activation of cognitive top-down attention-related brain areas, including left dorsolateral prefrontal/frontal eye field and left frontopolar brain regions, along with a 'focusing' effect of global suppression of hemodynamic activation in the experts, while the novices had a widespread stimulus(error)-driven hemodynamic activation without the 'focusing' effect.
Collapse
Affiliation(s)
- Pushpinder Walia
- grid.273335.30000 0004 1936 9887Neuroengineering and Informatics for Rehabilitation Laboratory, Department of Biomedical Engineering, University at Buffalo, Buffalo, USA
| | - Yaoyu Fu
- grid.273335.30000 0004 1936 9887Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, USA
| | - Jack Norfleet
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, USA
| | - Steven D. Schwaitzberg
- grid.273335.30000 0004 1936 9887University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Xavier Intes
- grid.33647.350000 0001 2160 9198Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY USA ,grid.33647.350000 0001 2160 9198Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, USA
| | - Suvranu De
- grid.33647.350000 0001 2160 9198Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY USA ,grid.33647.350000 0001 2160 9198Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, USA
| | - Lora Cavuoto
- grid.273335.30000 0004 1936 9887Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, USA
| | - Anirban Dutta
- grid.36511.300000 0004 0420 4262Neuroengineering and Informatics for Rehabilitation and Simulation-Based Learning, University of Lincoln, Lincoln, UK
| |
Collapse
|
10
|
Gao Y, Chao H, Cavuoto L, Yan P, Kruger U, Norfleet JE, Makled BA, Schwaitzberg S, De S, Intes X. Deep learning-based motion artifact removal in functional near-infrared spectroscopy. NEUROPHOTONICS 2022; 9:041406. [PMID: 35475257 PMCID: PMC9034734 DOI: 10.1117/1.nph.9.4.041406] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/10/2022] [Indexed: 06/01/2023]
Abstract
Significance: Functional near-infrared spectroscopy (fNIRS), a well-established neuroimaging technique, enables monitoring cortical activation while subjects are unconstrained. However, motion artifact is a common type of noise that can hamper the interpretation of fNIRS data. Current methods that have been proposed to mitigate motion artifacts in fNIRS data are still dependent on expert-based knowledge and the post hoc tuning of parameters. Aim: Here, we report a deep learning method that aims at motion artifact removal from fNIRS data while being assumption free. To the best of our knowledge, this is the first investigation to report on the use of a denoising autoencoder (DAE) architecture for motion artifact removal. Approach: To facilitate the training of this deep learning architecture, we (i) designed a specific loss function and (ii) generated data to mimic the properties of recorded fNIRS sequences. Results: The DAE model outperformed conventional methods in lowering residual motion artifacts, decreasing mean squared error, and increasing computational efficiency. Conclusion: Overall, this work demonstrates the potential of deep learning models for accurate and fast motion artifact removal in fNIRS data.
Collapse
Affiliation(s)
- Yuanyuan Gao
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation and Imaging in Medicine, Troy, New York, United States
| | - Hanqing Chao
- Rensselaer Polytechnic Institute, Department of Biomedical Engineering, Troy, New York, United States
| | - Lora Cavuoto
- University at Buffalo, Department of Industrial and Systems Engineering, Buffalo, New York, United States
| | - Pingkun Yan
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation and Imaging in Medicine, Troy, New York, United States
- Rensselaer Polytechnic Institute, Department of Biomedical Engineering, Troy, New York, United States
| | - Uwe Kruger
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation and Imaging in Medicine, Troy, New York, United States
- Rensselaer Polytechnic Institute, Department of Biomedical Engineering, Troy, New York, United States
| | - Jack E. Norfleet
- U.S. Army Combat Capabilities Development Command–Soldier Center, Orlando, Florida, United States
- SFC Paul Ray Smith Simulation and Training Technology Center, Orlando, Florida, United States
- Medical Simulation Research Branch, Orlando, Florida, United States
| | - Basiel A. Makled
- U.S. Army Combat Capabilities Development Command–Soldier Center, Orlando, Florida, United States
- SFC Paul Ray Smith Simulation and Training Technology Center, Orlando, Florida, United States
- Medical Simulation Research Branch, Orlando, Florida, United States
| | - Steven Schwaitzberg
- University at Buffalo, Department of Surgery, Buffalo, New York, United States
| | - Suvranu De
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation and Imaging in Medicine, Troy, New York, United States
- Rensselaer Polytechnic Institute, Department of Biomedical Engineering, Troy, New York, United States
| | - Xavier Intes
- Rensselaer Polytechnic Institute, Center for Modeling, Simulation and Imaging in Medicine, Troy, New York, United States
- Rensselaer Polytechnic Institute, Department of Biomedical Engineering, Troy, New York, United States
| |
Collapse
|
11
|
Kamat A, Makled B, Norfleet J, Schwaitzberg SD, Intes X, De S, Dutta A. Directed information flow during laparoscopic surgical skill acquisition dissociated skill level and medical simulation technology. NPJ SCIENCE OF LEARNING 2022; 7:19. [PMID: 36008451 PMCID: PMC9411170 DOI: 10.1038/s41539-022-00138-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/04/2022] [Indexed: 05/11/2023]
Abstract
Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain-behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R2 = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η2 = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R2 = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.
Collapse
Affiliation(s)
- Anil Kamat
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Basiel Makled
- US Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, USA
| | - Jack Norfleet
- US Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, USA
| | | | - Xavier Intes
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Anirban Dutta
- Neuroengineering and Informatics for Rehabilitation Laboratory, Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA.
| |
Collapse
|
12
|
Hong KS, Khan MNA, Ghafoor U. Non-invasive transcranial electrical brain stimulation guided by functional near-infrared spectroscopy for targeted neuromodulation: A review. J Neural Eng 2022; 19. [PMID: 35905708 DOI: 10.1088/1741-2552/ac857d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/29/2022] [Indexed: 11/12/2022]
Abstract
One of the primary goals in cognitive neuroscience is to understand the neural mechanisms on which cognition is based. Researchers are trying to find how cognitive mechanisms are related to oscillations generated due to brain activity. The research focused on this topic has been considerably aided by developing non-invasive brain stimulation techniques. The dynamics of brain networks and the resultant behavior can be affected by non-invasive brain stimulation techniques, which make their use a focus of interest in many experiments and clinical fields. One essential non-invasive brain stimulation technique is transcranial electrical stimulation (tES), subdivided into transcranial direct and alternating current stimulation. tES has recently become more well-known because of the effective results achieved in treating chronic conditions. In addition, there has been exceptional progress in the interpretation and feasibility of tES techniques. Summarizing the beneficial effects of tES, this article provides an updated depiction of what has been accomplished to date, brief history, and the open questions that need to be addressed in the future. An essential issue in the field of tES is stimulation duration. This review briefly covers the stimulation durations that have been utilized in the field while monitoring the brain using functional-near infrared spectroscopy-based brain imaging.
Collapse
Affiliation(s)
- Keum-Shik Hong
- Department of Cogno-mechatronics Engineering, Pusan National University, 2 Busandaehak-ro, Geumgeong-gu, Busan, Busan, 609735, Korea (the Republic of)
| | - M N Afzal Khan
- Pusan National University, Department of Mechanical Engineering, Busan, 46241, Korea (the Republic of)
| | - Usman Ghafoor
- School of Mechanical Engineering, Pusan National University College of Engineering, room 204, Busan, 46241, Korea (the Republic of)
| |
Collapse
|
13
|
Videira AS, Canadas D, De O Pires L, Andrade A, Ferreira HA, Miranda PC, Fernandes SR. How the Number and Distance of Electrodes Change the Induced Electric Field in the Cortex during Multichannel tDCS. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2357-2360. [PMID: 36086582 DOI: 10.1109/embc48229.2022.9871114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Multichannel transcranial direct current stimulation (tDCS) is a promising approach to target neuromodulation of neural networks by making use of variable number of electrodes and distances to facilitate/inhibit specific connectivity patterns. Optimization of the electric field (EF) spatial distribution through computational models can provide a more accurate definition of the stimulation settings that are more effective. In this study, we investigate the effect of increasing the number of cathodes around a central anode placed over the target. We demonstrate that anode-cathode distance has the largest influence in the EF and using more than 3 cathodes did not result in considerable changes in the EF magnitude and direction. This could be relevant for simultaneous tDCS-electroencephalography (EEG) applications, by saving electrode positions for EEG acquisition. Clinical Relevance- This study demonstrates that distance between electrodes is more relevant than electrode number in determining the electric field distribution, and that a highly-focused stimulation can be equally effective with fewer electrodes.
Collapse
|
14
|
Walia P, Kumar KN, Dutta A. Neuroimaging Guided Transcranial Electrical Stimulation in Enhancing Surgical Skill Acquisition. Comment on Hung et al. The Efficacy of Transcranial Direct Current Stimulation in Enhancing Surgical Skill Acquisition: A Preliminary Meta-Analysis of Randomized Controlled Trials. Brain Sci. 2021, 11, 707. Brain Sci 2021; 11:1078. [PMID: 34439698 PMCID: PMC8395024 DOI: 10.3390/brainsci11081078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 01/02/2023] Open
Abstract
Surgical skill acquisition may be facilitated with a safe application of transcranial direct current stimulation (tDCS). A preliminary meta-analysis of randomized control trials showed that tDCS was associated with significantly better improvement in surgical performance than the sham control; however, meta-analysis does not address the mechanistic understanding. It is known from skill learning studies that the hierarchy of cognitive control shows a rostrocaudal axis in the frontal lobe where a shift from posterior to anterior is postulated to mediate progressively abstract, higher-order control. Therefore, optimizing the transcranial electrical stimulation to target surgical task-related brain activation at different stages of motor learning may provide the causal link to the learning behavior. This comment paper presents the computational approach for neuroimaging guided tDCS based on open-source software pipelines and an open-data of functional near-infrared spectroscopy (fNIRS) for complex motor tasks. We performed an fNIRS-based cortical activation analysis using AtlasViewer software that was used as the target for tDCS of the motor complexity-related brain regions using ROAST software. For future studies on surgical skill training, it is postulated that the higher complexity laparoscopic suturing with intracorporeal knot tying task may result in more robust activation of the motor complexity-related brain areas when compared to the lower complexity laparoscopic tasks.
Collapse
Affiliation(s)
- Pushpinder Walia
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14260, USA;
| | - Kavya Narendra Kumar
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260, USA;
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260, USA;
| |
Collapse
|