Low Frequency Brain Oscillations during the execution and imagination of simple hand movements for Brain-Computer Interface applications.

Low Frequency Brain Oscillations (LFOs) are brief periods of oscillatory activity in delta and lower theta band that appear at motor cortical areas before and around movement onset. It has been shown that LFO power decreases in post-stroke patients and re-emerges with motor functional recovery. To date, LFOs have not yet been explored during the motor execution (ME) and imagination (MI) of simple hand movements, often used in BCI-supported motor rehabilitation protocols post-stroke. This study aims at analyzing the LFOs during the ME and MI of the finger extension task in a sample of 10 healthy subjects and 2 stroke patients in subacute phase. The results showed that LFO power peaks occur in the preparatory phase of both ME and MI tasks on the sensorimotor channels in healthy subjects and their alterations in stroke patients. Clinical Relevance- Results suggest that LFOs could be explored as biomarker of the motor function recovery in rehabilitative protocols based on the movement imagination.

Cortico-Muscular Coupling Allows to Discriminate Different Types of Hand Movements.

Cortico-muscular coupling (CMC) could be used as potential input of a novel hybrid Brain-Computer Interface (hBCI) for motor re-learning after stroke. Here, we aim of addressing the design of a hBCI able to classify different movement tasks taking into account the interplay between the cerebral and residual or recovered muscular activity involved in a given movement. Hence, we compared the performances of four classification methods based on CMC features to evaluate their ability in discriminating finger extension from grasping movements executed by 17 healthy subjects. We also explored how the variation in the dimensionality of the feature domain would influence the different classifier performances. Results showed that, regardless of the model, few CMC features (up to 10) allow for a successful classification of two different movements type. Moreover, support vector machine classifier with linear kernel showed the best trade-off between performances and system usability (few electrodes). Thus, these results suggest that a hBCI based on brain-muscular interplay holds the potential to enable more informed neural plasticity and functional motor recovery after stroke. Furthermore, this CMC-based BCI could also allow for a more "natural control" (l.e., that resembling physiological control) of prosthetic devices.

Distinctive physiological muscle synergy patterns define the Box and Block Task execution as revealed by electromyographic features.

Stroke survivors experience muscular pattern alterations of the upper limb that decrease their ability to perform daily-living activities. The Box and Block test (BBT) is widely used to assess the unilateral manual dexterity. Although BBT provides insights into functional performance, it returns limited information about the mechanisms contributing to the impaired movement. This study aims at exploring the BBT by means of muscle synergies analysis during the execution of BBT in a sample of 12 healthy participants with their dominant and non-dominant upper limb. Results revealed that: (i) the BBT can be described by 1 or 2 synergies; the number of synergies (ii) does not differ between dominant and non-dominant sides and (iii) varies considering each phase of the task; (iv) the transfer phase requires more synergies. Clinical Relevance- This preliminary study characterizes muscular synergies during the BBT task in order to establish normative patterns that could assist in understanding the neuromuscular demands and support future evaluations of stroke deficits.

Adaptive learning in the detection of Movement Related Cortical Potentials improves usability of associative Brain-Computer Interfaces.

Brain-computer interfaces have increasingly found applications in motor function recovery in stroke patients. In this context, it has been demonstrated that associative-BCI protocols, implemented by means the movement related cortical potentials (MRCPs), induce significant cortical plasticity. To date, no methods have been proposed to deal with brain signal (i.e. MRCP feature) non-stationarity. This study introduces adaptive learning methods in MRCP detection and aims at comparing a no-adaptive approach based on the Locality Sensitive Discriminant Analysis (LSDA) with three LSDA-based adaptive approaches. As a proof of concept, EEG and force data were collected from six healthy subjects while performing isometric ankle dorsiflexion. Results revealed that adaptive algorithms increase the number of true detections and decrease the number of false positives per minute. Moreover, the markedly reduction of BCI system calibration time suggests that these methods have the potential to improve the usability of associative-BCI in post-stroke motor recovery.

Community detection: Comparison among clustering algorithms and application to EEG-based brain networks.

Community structure is a feature of complex networks that can be crucial for the understanding of their internal organization. This is particularly true for brain networks, as the brain functioning is thought to be based on a modular organization. In the last decades, many clustering algorithms were developed with the aim to identify communities in networks of different nature. However, there is still no agreement about which one is the most reliable, and to test and compare these algorithms under a variety of conditions would be beneficial to potential users. In this study, we performed a comparative analysis between six different clustering algorithms, analyzing their performances on a ground-truth consisting of simulated networks with properties spanning a wide range of conditions. Results show the effect of factors like the noise level, the number of clusters, the network dimension and density on the performances of the algorithms and provide some guidelines about the use of the more appropriate algorithm according to the different conditions. The best performances under a wide range of conditions were obtained by Louvain and Leicht & Newman algorithms, while Ronhovde and Infomap proved to be more appropriate in very noisy conditions. Finally, as a proof of concept, we applied the algorithms under exam to brain functional connectivity networks obtained from EEG signals recorded during a sustained movement of the right hand, obtaining a clustering of scalp electrodes which agrees with the results of the simulation study conducted.

Transcranial cerebellar direct current stimulation: Effects on brain resting state oscillatory and network activity.

Transcranial cerebellar direct current stimulation (tcDCS) can offer new insights into the cerebellar function and disorders, by modulating noninvasively the activity of cerebellar networks. Taking into account the functional interplay between the cerebellum and the cerebral cortex, we addressed the effects of unilateral tcDCS (active electrode positioned over the right cerebellar hemisphere) on the electroencephalographic (EEG) oscillatory activity and on the cortical network organization at resting state. Effects on spectral (de)synchronizations and functional connectivity after anodal and cathodal stimulation were assessed with respect to a sham condition. A lateralized synchronization over the sensorimotor area in gamma band, as well as an increase of the network segregation in sensory-motor rhythms and a higher communication between hemispheres in gamma band, were detected after anodal stimulation. The same measures after cathodal tcDCS returned responses similar to the sham condition.

Interfacing brain with computer to improve communication and rehabilitation after brain damage.

Communication and control of the external environment can be provided via brain-computer interfaces (BCIs) to replace a lost function in persons with severe diseases and little or no chance of recovery of motor abilities (ie, amyotrophic lateral sclerosis, brainstem stroke). BCIs allow to intentionally modulate brain activity, to train specific brain functions, and to control prosthetic devices, and thus, this technology can also improve the outcome of rehabilitation programs in persons who have suffered from a central nervous system injury (ie, stroke leading to motor or cognitive impairment). Overall, the BCI researcher is challenged to interact with people with severe disabilities and professionals in the field of neurorehabilitation. This implies a deep understanding of the disabled condition on the one hand, and it requires extensive knowledge on the physiology and function of the human brain on the other. For these reasons, a multidisciplinary approach and the continuous involvement of BCI users in the design, development, and testing of new systems are desirable. In this chapter, we will focus on noninvasive EEG-based systems and their clinical applications, highlighting crucial issues to foster BCI translation outside laboratories to eventually become a technology usable in real-life realm.

Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical activity.

BACKGROUND: Previous studies reported controversial results about the efficacy of video-game based therapy (VGT) in improving neurorehabilitation outcomes in children with cerebral palsy (CP). AIM: Primary aim was to investigate the effectiveness of VGT with respect to conventional therapy (CT) in improving upper limb motor outcomes in a group of children with CP. Secondary aim was to quantify if VGT leads children to perform a higher number of movements. DESIGN: A cross-over randomized controlled trial (RCT) for investigating the primary aim and a cross-sectional study for investigating the secondary aim of this study. SETTINGS: Outpatients. INCLUSION CRITERIA: clinical diagnosis of CP, age between 4 and 14 years, level of GMFC between I and IV. EXCLUSION CRITERIA: QI<35, severe comorbidities, incapacity to stand even with an external support. METHODS: Twenty-two children with CP (6.89±1.91-year old) were enrolled in a cross-over RCT with 16 sessions of VGT (using Xbox with Kinect device) and then 16 of CT or vice versa. Upper limb functioning was assessed using the Quality of Upper Extremities Skills Test (QUEST) and hand abilities using Abilhand-kids score. According to the secondary aim of this study a secondary cross-sectional study has been performed. Eight children with CP (6.50±1.60-year old) were enrolled into a trial in which five wireless triaxial accelerometers were positioned on their forearms, legs and trunk for quantifying the physical activity during VGT vs. CT. RESULTS: QUEST scores significantly improved only after VGT (P=0.003), and not after CT (P=0.056). The reverse occurred for Abilhand-kids scores (P=0.165 vs. P=0.013, respectively). Quantity of performed movements was three times higher in VGT than in CT (+198%, P=0.027). CONCLUSION: VGT resulted effective in improving the motor functions of upper limb extremities in children with CP, conceivably for the increased quantity of limb movements, but failed in improving the manual abilities for performing activities of daily living which benefited more from CT. CLINICAL REHABILITATION IMPACT: VGT performed using the X-Box with Kinect device could enhance the number of upper limb movements in children with CP during rehabilitation and in turn improving upper limb motor skills, but CT remained superior for improving performances in manual activities of daily living.

Effect of inter-trials variability on the estimation of cortical connectivity by Partial Directed Coherence.

Partial Directed Coherence (PDC) is a powerful estimator of effective connectivity. In neuroscience it is used in different applications with the aim to investigate the communication between brain regions during the execution of different motor or cognitive tasks. When multiple trials are available, PDC can be computed over multiple realizations, provided that the assumption of stationarity across trials is verified. This allows to improve the amount of data, which is an important constraint for the estimation accuracy. However, the stationarity of the data across trials is not always guaranteed, especially when dealing with patients. In this study we investigated how the inter-trials variability of an EEG dataset affects the PDC accuracy. Effects of density variations and of changes of connectivity values across trials were first investigated with a simulation study and then tested on real EEG data collected from two post-stroke patients during a motor imagery task and characterized by different inter-trials variability. Results showed the effect of different factors on the PDC accuracy and the robustness of such estimator in a range of conditions met in practical applications.

Investigating the effects of a sensorimotor rhythm-based BCI training on the cortical activity elicited by mental imagery.

OBJECTIVE: It is well known that to acquire sensorimotor (SMR)-based brain-computer interface (BCI) control requires a training period before users can achieve their best possible performances. Nevertheless, the effect of this training procedure on the cortical activity related to the mental imagery ability still requires investigation to be fully elucidated. The aim of this study was to gain insights into the effects of SMR-based BCI training on the cortical spectral activity associated with the performance of different mental imagery tasks. APPROACH: Linear cortical estimation and statistical brain mapping techniques were applied on high-density EEG data acquired from 18 healthy participants performing three different mental imagery tasks. Subjects were divided in two groups, one of BCI trained subjects, according to their previous exposure (at least six months before this study) to motor imagery-based BCI training, and one of subjects who were naive to any BCI paradigms. MAIN RESULTS: Cortical activation maps obtained for trained and naive subjects indicated different spectral and spatial activity patterns in response to the mental imagery tasks. Long-term effects of the previous SMR-based BCI training were observed on the motor cortical spectral activity specific to the BCI trained motor imagery task (simple hand movements) and partially generalized to more complex motor imagery task (playing tennis). Differently, mental imagery with spatial attention and memory content could elicit recognizable cortical spectral activity even in subjects completely naive to (BCI) training. SIGNIFICANCE: The present findings contribute to our understanding of BCI technology usage and might be of relevance in those clinical conditions when training to master a BCI application is challenging or even not possible.

Influence of P300 latency jitter on event related potential-based brain-computer interface performance.

OBJECTIVE: Several ERP-based brain-computer interfaces (BCIs) that can be controlled even without eye movements (covert attention) have been recently proposed. However, when compared to similar systems based on overt attention, they displayed significantly lower accuracy. In the current interpretation, this is ascribed to the absence of the contribution of short-latency visual evoked potentials (VEPs) in the tasks performed in the covert attention modality. This study aims to investigate if this decrement (i) is fully explained by the lack of VEP contribution to the classification accuracy; (ii) correlates with lower temporal stability of the single-trial P300 potentials elicited in the covert attention modality. APPROACH: We evaluated the latency jitter of P300 evoked potentials in three BCI interfaces exploiting either overt or covert attention modalities in 20 healthy subjects. The effect of attention modality on the P300 jitter, and the relative contribution of VEPs and P300 jitter to the classification accuracy have been analyzed. MAIN RESULTS: The P300 jitter is higher when the BCI is controlled in covert attention. Classification accuracy negatively correlates with jitter. Even disregarding short-latency VEPs, overt-attention BCI yields better accuracy than covert. When the latency jitter is compensated offline, the difference between accuracies is not significant. SIGNIFICANCE: The lower temporal stability of the P300 evoked potential generated during the tasks performed in covert attention modality should be regarded as the main contributing explanation of lower accuracy of covert-attention ERP-based BCIs.

Self-calibration algorithm in an asynchronous P300-based brain-computer interface.

OBJECTIVE: Reliability is a desirable characteristic of brain-computer interface (BCI) systems when they are intended to be used under non-experimental operating conditions. In addition, their overall usability is influenced by the complex and frequent procedures that are required for configuration and calibration. Earlier studies examined the issue of asynchronous control in P300-based BCIs, introducing dynamic stopping and automatic control suspension features. This report proposes and evaluates an algorithm for the automatic recalibration of the classifier's parameters using unsupervised data. APPROACH: Ten healthy subjects participated in five P300-based BCI sessions throughout a single day. First, we examined whether continuous adaptation of control parameters improved the accuracy of the asynchronous system over time. Then, we assessed the performance of the self-calibration algorithm with respect to the no-recalibration and supervised calibration conditions with regard to system accuracy and communication efficiency. MAIN RESULTS: Offline tests demonstrated that continuous adaptation of the control parameters significantly increased the communication efficiency of asynchronous P300-based BCIs. The self-calibration algorithm correctly assigned labels to unsupervised data with 95% accuracy, effecting communication efficiency that was comparable with that of supervised repeated calibration. SIGNIFICANCE: Although additional online tests that involve end-users under non-experimental conditions are needed, these preliminary results are encouraging, from which we conclude that the self-calibration algorithm is a promising solution to improve P300-based BCI usability and reliability.

Time varying effective connectivity for describing brain network changes induced by a memory rehabilitation treatment.

In clinical practice, cognitive impairment is often observed after stroke. The efficacy of rehabilitative interventions is routinely assessed by means of a neuropsychological test battery. Nowadays, more evidences indicate that the neuroplasticity which occurs after stroke can be better understood by investigating changes in brain networks. In this study we applied advanced methodologies for effective connectivity estimation in combination with graph theory approach, to define EEG derived descriptors of brain networks underlying memory tasks. In particular, we proposed such descriptors to identify substrates of efficacy of a Brain-Computer Interface (BCI) controlled neurofeedback intervention to improve cognitive function after stroke. Electroencephalographic (EEG) data were collected from two stroke patients before and after a neurofeedback-based training for memory deficits. We show that the estimated brain connectivity indices were sensitive to different training intervention outcomes, thus suggesting an effective support to the neuropsychological assessment in the evaluation of the changes induced by the BCI-based cognitive rehabilitative intervention.

A new descriptor of neuroelectrical activity during BCI-assisted motor imagery-based training in stroke patients.

In BCI applications for stroke rehabilitation, BCI systems are used with the aim of providing patients with an instrument that is capable of monitoring and reinforcing EEG patterns generated by motor imagery (MI). In this study we proposed an offline analysis on data acquired from stroke patients subjected to a BCI-assisted MI training in order to define an index for the evaluation of MI-BCI training session which is independent from the settings adopted for the online control and which is able to describe the properties of neuroelectrical activations across sessions. Results suggest that such index can be adopted to sort the trails within a session according to the adherence to the task.

Individual cortical connectivity changes after stroke: a resampling approach to enable statistical assessment at single-subject level.

One of the main limitations commonly encountered when dealing with the estimation of brain connectivity is the difficulty to perform a statistical assessment of significant changes in brain networks at a single-subject level. This is mainly due to the lack of information about the distribution of the connectivity estimators at different conditions. While group analysis is commonly adopted to perform a statistical comparison between conditions, it may impose major limitations when dealing with the heterogeneity expressed by a given clinical condition in patients. This holds true particularly for stroke when seeking for quantitative measurements of the efficacy of any rehabilitative intervention promoting recovery of function. The need is then evident of an assessment which may account for individual pathological network configuration associated with different level of patients' response to treatment; such network configuration is highly related to the effect that a given brain lesion has on neural networks. In this study we propose a resampling-based approach to the assessment of statistically significant changes in cortical connectivity networks at a single subject level. First, we provide the results of a simulation study testing the performances of the proposed approach under different conditions. Then, to show the sensitivity of the method, we describe its application to electroencephalographic (EEG) data recorded from two post-stroke patients who showed different clinical recovery after a rehabilitative intervention.

Investigating statistical differences in connectivity patterns properties at single subject level: a new resampling approach.

Methods based on the multivariate autoregressive (MVAR) approach are commonly used for effective connectivity estimation as they allow to include all available sources into a unique model. To ensure high levels of accuracy for high model dimensions, all the observations are used to provide a unique estimation of the model, and thus of the network and its properties. The unavailability of a distribution of connectivity values for a single experimental condition prevents to perform statistical comparisons between different conditions at a single subject level. This is a major limitation, especially when dealing with the heterogeneity of clinical conditions presented by patients. In the present paper we proposed a novel approach to the construction of a distribution of connectivity in a single subject case. The proposed approach is based on small perturbations of the networks properties and allows to assess significant changes in brain connectivity indexes derived from graph theory. Its feasibility and applicability were investigated by means of a simulation study and an application to real EEG data.

The effect of normalization of Partial Directed Coherence on the statistical assessment of connectivity patterns: a simulation study.

Partial Directed Coherence (PDC) is a spectral multivariate estimator for effective connectivity, relying on the concept of Granger causality. Even if its original definition derived directly from information theory, two modifies were introduced in order to provide better physiological interpretations of the estimated networks: i) normalization of the estimator according to rows, ii) squared transformation. In the present paper we investigated the effect of PDC normalization on the performances achieved by applying the statistical validation process on investigated connectivity patterns under different conditions of Signal to Noise ratio (SNR) and amount of data available for the analysis. Results of the statistical analysis revealed an effect of PDC normalization only on the percentages of type I and type II errors occurred by using Shuffling procedure for the assessment of connectivity patterns. No effects of the PDC formulation resulted on the performances achieved during the validation process executed instead by means of Asymptotic Statistic approach. Moreover, the percentages of both false positives and false negatives committed by Asymptotic Statistic are always lower than those achieved by Shuffling procedure for each type of normalization.

Aged-related changes in brain activity classification with respect to age by means of graph indexes.

Recent studies have investigated changes in the human brain network organization during the normal aging. A reduction of the connectivity between brain areas was demonstrated by combining neuroimaging technologies and graph theory. Clustering, characteristic path length and small-worldness are key topological measures and they are widely used in literature. In this paper we propose a new methodology that combine advanced techniques of effective connectivity estimation, graph theoretical approach and classification by SVM method. EEG signals recording during rest condition from 20 young subjects and 20 mid-aged adults were studied. Partial Directed Coherence was computed by means of General Linear Kalman Filter and graph indexes were extracted from estimated patterns. At last small-worldness was used as feature for the SVM classifier. Results show that topological differences of brain networks exist between young and mid-aged adults: small-worldness is significantly different between the two populations and it can be used to classify the subjects with respect to age with an accuracy of 69%.

Frontal EEG theta changes assess the training improvements of novices in flight simulation tasks.

The aim of the study is to analyze the variation of the EEG power spectra in theta band when a novice starts to learn a new task. In particular, the goal is to find out the differences from the beginning of the training to the session in which the performance level is good enough for considering him/her able to complete the task without any problems. While the novices were engaged in the flight simulation tasks we recorded the brain activity by using high resolution EEG techniques as well as neurophysiologic variables such as heart rate (HR) and eye blinks rate (EBR). Results show clear changes in the EEG power spectra in theta band over the frontal brain areas, either over the left, the midline and the right side, during the learning process of the task. These results are also supported by the autonomic signals of HR and EBR, by the performances' trends and by the questionnaires for the evaluation of the perceived workload level.

A new statistical approach for the extraction of adjacency matrix from effective connectivity networks.

Graph theory is a powerful mathematical tool recently introduced in neuroscience field for quantitatively describing the main properties of investigated connectivity networks. Despite the technical advancements provided in the last few years, further investigations are needed for overcoming actual limitations in the field. In fact, the absence of a common procedure currently applied for the extraction of the adjacency matrix from a connectivity pattern has been leading to low consistency and reliability of ghaph indexes among the investigated population. In this paper we proposed a new approach for adjacency matrix extraction based on a statistical threshold as valid alternative to empirical approaches, extensively used in Neuroscience field (i.e. fixing the edge density). In particular we performed a simulation study for investigating the effects of the two different extraction approaches on the topological properties of the investigated networks. In particular, the comparison was performed on two different datasets, one composed by uncorrelated random signals (null-model) and the other one by signals acquired on a mannequin head used as a phantom (EEG null-model). The results highlighted the importance to use a statistical threshold for the adjacency matrix extraction in order to describe the real existing topological properties of the investigated networks. The use of an empirical threshold led to an erroneous definition of small-world properties for the considered connectivity patterns.