Cardiac Computed Tomography Angiography in Infants and Young Children Without Sedation.

Cardiac computed tomography (CT) imaging plays a pivotal role in the diagnosis and management of infants and young children with congenital heart disease (CHD). While the benefits of CT imaging are well-established, the challenge lies in adapting these procedures to the unique requirements of infants and young children. Traditionally, sedation has been a common practice to ensure cooperation and motion control during imaging. However, using sedation introduces its challenges including potential risks, limitations, and cost implications. In this study, authors explore the feasibility, safety, and diagnostic accuracy of unsedated cardiac CT examinations in infants and young children. This study proves cardiac CT can be performed in India without sedation using simple restraining techniques. This approach aligns with the cultural and familial dynamics prevalent in the country and holds the potential to address economic and infrastructure challenges.

Invariant neural dynamics drive commands to control different movements.

It has been proposed that the nervous system has the capacity to generate a wide variety of movements because it reuses some invariant code. Previous work has identified that dynamics of neural population activity are similar during different movements, where dynamics refer to how the instantaneous spatial pattern of population activity changes in time. Here, we test whether invariant dynamics of neural populations are actually used to issue the commands that direct movement. Using a brain-machine interface (BMI) that transforms rhesus macaques' motor-cortex activity into commands for a neuroprosthetic cursor, we discovered that the same command is issued with different neural-activity patterns in different movements. However, these different patterns were predictable, as we found that the transitions between activity patterns are governed by the same dynamics across movements. These invariant dynamics are low dimensional, and critically, they align with the BMI, so that they predict the specific component of neural activity that actually issues the next command. We introduce a model of optimal feedback control (OFC) that shows that invariant dynamics can help transform movement feedback into commands, reducing the input that the neural population needs to control movement. Altogether our results demonstrate that invariant dynamics drive commands to control a variety of movements and show how feedback can be integrated with invariant dynamics to issue generalizable commands.

Leigh's disease, a fatal finding in the common world: A case report.

Leigh syndrome is a neurodegenerative mitochondrial disorder of childhood characterized by symmetrical spongiform lesions in the brain. The clinical presentation of Leigh's syndrome can vary significantly. However, in the majority of cases, it usually presents as a progressive neurological disease involving motor and cognitive development. It is common to see signs and symptoms of the midbrain and brainstem involvement. Limited data are present on the brain processes occurring in Leigh's syndrome which can be attributed to fatal respiratory failure. Raised lactate levels in the blood and/or cerebrospinal fluid are noted. Magnetic resonance imaging (MRI) findings such as necrotic, symmetrical lesions in the BG/brain stem are helpful in arriving at the diagnosis of Leigh's syndrome. It's of utmost importance to determine whether fatal respiratory failure can be predicted based on clinical characteristics and findings on MRI. In our report, we presented 3 cases from rural India, including a 2-year-old male child presenting with UMN lesion signs, a 3-month-old female infant with delayed developmental milestones with lab results suggestive of Leigh's disease, and a 12-year-old female child with epistaxis and generalized weakness. As discussed above, all 3 cases presented differently with a variety of signs and symptoms and would have gone undiagnosed without the use of brain imaging. The study concluded with the impression that while MRI is essential to the initial diagnosis of Leigh's disease, MRI alone cannot be used to predict fatal respiratory failure in patients with Leigh's disease. In any dilemma regarding diagnosis even with MRI, molecular studies remain the gold standard.

Rapid control and feedback rates enhance neuroprosthetic control.

Brain-machine interfaces (BMI) create novel sensorimotor pathways for action. Much as the sensorimotor apparatus shapes natural motor control, the BMI pathway characteristics may also influence neuroprosthetic control. Here, we explore the influence of control and feedback rates, where control rate indicates how often motor commands are sent from the brain to the prosthetic, and feedback rate indicates how often visual feedback of the prosthetic is provided to the subject. We developed a new BMI that allows arbitrarily fast control and feedback rates, and used it to dissociate the effects of each rate in two monkeys. Increasing the control rate significantly improved control even when feedback rate was unchanged. Increasing the feedback rate further facilitated control. We also show that our high-rate BMI significantly outperformed state-of-the-art methods due to higher control and feedback rates, combined with a different point process mathematical encoding model. Our BMI paradigm can dissect the contribution of different elements in the sensorimotor pathway, providing a unique tool for studying neuroprosthetic control mechanisms.

Control of Redundant Kinematic Degrees of Freedom in a Closed-Loop Brain-Machine Interface.

Brain-machine interface (BMI) systems use signals acquired from the brain to directly control the movement of an actuator, such as a computer cursor or a robotic arm, with the goal of restoring motor function lost due to injury or disease of the nervous system. In BMIs with kinematically redundant actuators, the combination of the task goals and the system under neural control can allow for many equally optimal task solutions. The extent to which kinematically redundant degrees of freedom (DOFs) in a BMI system may be under direct neural control is unknown. To address this question, a Kalman filter was used to decode single- and multi-unit cortical neural activity of two macaque monkeys into the joint velocities of a virtual four-link kinematic chain. Subjects completed movements of the chain's endpoint to instructed target locations within a two-dimensional plane. This system was kinematically redundant for an endpoint movement task, as four DOFs were used to manipulate the 2-D endpoint position. Both subjects successfully performed the task and improved with practice by producing faster endpoint velocity control signals. Kinematic redundancy allowed null movements whereby the individual links of the chain could move in a way that cancels out and does not result in endpoint movement. As the subjects became more proficient at controlling the chain, the amount of null movement also increased. Task performance suffered when the links of the kinematic chain were hidden and only the endpoint was visible. Furthermore, all four DOFs of the joint-velocity control space exhibited task-relevant modulation. The relative usage of each DOF depended on the configuration of the chain, and trials in which the less-prominent DOFs were utilized also had better task performance. Overall, these results indicate that the subjects incorporated the redundant components of the control space into their control strategy. Future BMI systems with kinematic redundancy, such as exoskeletal systems or anthropomorphic robotic arms, may benefit from allowing neural control over redundant configuration dimensions as well as the end-effector.

Modeling distinct sources of neural variability driving neuroprosthetic control.

Many closed-loop, continuous-control brain-machine interface (BMI) architectures rely on decoding via a linear readout of noisy population neural activity. However, recent work has found that decomposing neural population activity into correlated and uncorrelated variability reveals that improvements in cursor control coincide with the emergence of correlated neural variability. In order to address how correlated and uncorrelated neural variability arises and contributes to BMI cursor control, we simulate a neural population receiving combinations of shared inputs affecting all cells and private inputs affecting only individual cells. When simulating BMI cursor-control with different populations, we find that correlated activity generates faster, straighter cursor trajectories, yet sometimes at the cost of inaccuracies. We also find that correlated variability can be generated from either shared inputs or quickly updated private inputs. Overall, our results suggest a role for both correlated and uncorrelated neural activity in cursor control, and potential mechanisms by which correlated activity may emerge.

Accelerating Submovement Decomposition With Search-Space Reduction Heuristics.

OBJECTIVE: Movements made by healthy individuals can be characterized as superpositions of smooth bell-shaped velocity curves. Decomposing complex movements into these simpler "submovement" building blocks is useful for studying the neural control of movement as well as measuring motor impairment due to neurological injury. APPROACH: One prevalent strategy to submovement decomposition is to formulate it as an optimization problem. This optimization problem is nonconvex and finding an exact solution is computationally burdensome. We build on previous literature that generated approximate solutions to the submovement optimization problem. RESULTS: First, we demonstrate broad conditions on the submovement building block functions that enable the optimization variables to be partitioned into disjoint subsets, allowing for a faster alternating minimization solution. Specifically, the amplitude parameters of a submovement can typically be fit independently of its shape parameters. Second, we develop a method to concentrate the search in regions of high error to make more efficient use of optimization routine iterations. CONCLUSION: Both innovations result in substantial reductions in computation time across multiple nonhuman primate subjects and diverse task conditions. SIGNIFICANCE: These innovations may accelerate analysis of submovements for basic neuroscience and enable real-time applications of submovement decomposition.

Continuous closed-loop decoder adaptation with a recursive maximum likelihood algorithm allows for rapid performance acquisition in brain-machine interfaces.

Closed-loop decoder adaptation (CLDA) is an emerging paradigm for both improving and maintaining online performance in brain-machine interfaces (BMIs). The time required for initial decoder training and any subsequent decoder recalibrations could be potentially reduced by performing continuous adaptation, in which decoder parameters are updated at every time step during these procedures, rather than waiting to update the decoder at periodic intervals in a more batch-based process. Here, we present recursive maximum likelihood (RML), a CLDA algorithm that performs continuous adaptation of a Kalman filter decoder's parameters. We demonstrate that RML possesses a variety of useful properties and practical algorithmic advantages. First, we show how RML leverages the accuracy of updates based on a batch of data while still adapting parameters on every time step. Second, we illustrate how the RML algorithm is parameterized by a single, intuitive half-life parameter that can be used to adjust the rate of adaptation in real time. Third, we show how even when the number of neural features is very large, RML's memory-efficient recursive update rules can be reformulated to also be computationally fast so that continuous adaptation is still feasible. To test the algorithm in closed-loop experiments, we trained three macaque monkeys to perform a center-out reaching task by using either spiking activity or local field potentials to control a 2D computer cursor. RML achieved higher levels of performance more rapidly in comparison to a previous CLDA algorithm that adapts parameters on a more intermediate timescale. Overall, our results indicate that RML is an effective CLDA algorithm for achieving rapid performance acquisition using continuous adaptation.

Designing dynamical properties of brain-machine interfaces to optimize task-specific performance.

Brain-machine interfaces (BMIs) are dynamical systems whose properties ultimately influence performance. For instance, a 2-D BMI in which cursor position is controlled using a Kalman filter will, by default, create an attractor point that "pulls" the cursor to particular points in the workspace. If created unintentionally, such effects may not be beneficial for BMI performance. However, there have been few empirical studies exploring how various dynamical effects of closed-loop BMIs ultimately influence performance. In this work, we utilize experimental data from two macaque monkeys operating a closed-loop BMI to reach to 2-D targets and show that certain dynamical properties correlate with performance loss. We also show that other dynamical properties represent tradeoffs between naturally competing objectives, such as speed versus accuracy. These findings highlight the importance of fine-tuning the dynamical properties of closed-loop BMIs to optimize task-specific performance.

High-performance brain-machine interface enabled by an adaptive optimal feedback-controlled point process decoder.

Brain-machine interface (BMI) performance has been improved using Kalman filters (KF) combined with closed-loop decoder adaptation (CLDA). CLDA fits the decoder parameters during closed-loop BMI operation based on the neural activity and inferred user velocity intention. These advances have resulted in the recent ReFIT-KF and SmoothBatch-KF decoders. Here we demonstrate high-performance and robust BMI control using a novel closed-loop BMI architecture termed adaptive optimal feedback-controlled (OFC) point process filter (PPF). Adaptive OFC-PPF allows subjects to issue neural commands and receive feedback with every spike event and hence at a faster rate than the KF. Moreover, it adapts the decoder parameters with every spike event in contrast to current CLDA techniques that do so on the time-scale of minutes. Finally, unlike current methods that rotate the decoded velocity vector, adaptive OFC-PPF constructs an infinite-horizon OFC model of the brain to infer velocity intention during adaptation. Preliminary data collected in a monkey suggests that adaptive OFC-PPF improves BMI control. OFC-PPF outperformed SmoothBatch-KF in a self-paced center-out movement task with 8 targets. This improvement was due to both the PPF's increased rate of control and feedback compared with the KF, and to the OFC model suggesting that the OFC better approximates the user's strategy. Also, the spike-by-spike adaptation resulted in faster performance convergence compared to current techniques. Thus adaptive OFC-PPF enabled proficient BMI control in this monkey.

Likelihood Gradient Ascent (LGA): a closed-loop decoder adaptation algorithm for brain-machine interfaces.

Closed-loop decoder adaptation (CLDA) is an emerging paradigm for improving or maintaining the online performance of brain-machine interfaces (BMIs). Here, we present Likelihood Gradient Ascent (LGA), a novel CLDA algorithm for a Kalman filter (KF) decoder that uses stochastic, gradient-based corrections to update KF parameters during closed-loop BMI operation. LGA's gradient-based paradigm presents a variety of potential advantages over other "batch" CLDA methods, including the ability to update decoder parameters on any time-scale, even on every decoder iteration. Using a closed-loop BMI simulator, we compare the LGA algorithm to the Adaptive Kalman Filter (AKF), a partially gradient-based CLDA algorithm that has been previously tested in non-human primate experiments. In contrast to the AKF's separate mean-squared error objective functions, LGA's update rules are derived directly from a single log likelihood objective, making it one step towards a potentially optimal continuously adaptive CLDA algorithm for BMIs.

Parameter estimation for maximizing controllability of linear brain-machine interfaces.

Brain-machine interfaces (BMIs) must be carefully designed for closed-loop control to ensure the best possible performance. The Kalman filter (KF) is a recursive linear BMI algorithm which has been shown to smooth cursor kinematics and improve control over non-recursive linear methods. However, recursive estimators are not without their drawbacks. Here we show that recursive decoders can decrease BMI controllability by coupling kinematic variables that the subject might expect to be unrelated. For instance, a 2D neural cursor where velocity is controlled using a KF can increase the difficulty of straight reaches by linking horizontal and vertical velocity estimates. These effects resemble force fields in arm control. Analysis of experimental data from one non-human primate controlling a position/velocity KF cursor in closed-loop shows that the presence of these force-field effects correlated with decreased performance. We designed a modified KF parameter estimation algorithm to eliminate these effects. Cursor controllability improved significantly when our modifications were used in a closed-loop BMI simulator. Thus, designing highly controllable BMIs requires parameter estimation techniques that carefully craft relationships between decoded variables.