Walking naturally after spinal cord injury using a brain-spine interface.

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis1,2. Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals3 and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking4-6. A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.

A systematic review of the effects of transcranial photobiomodulation on brain activity in humans.

In recent years, transcranial photobiomodulation (tPBM) has been developing as a promising method to protect and repair brain tissues against damages. The aim of our systematic review is to examine the results available in the literature concerning the efficacy of tPBM in changing brain activity in humans, either in healthy individuals, or in patients with neurological diseases. Four databases were screened for references containing terms encompassing photobiomodulation, brain activity, brain imaging, and human. We also analysed the quality of the included studies using validated tools. Results in healthy subjects showed that even after a single session, tPBM can be effective in influencing brain activity. In particular, the different transcranial approaches - using a focal stimulation or helmet for global brain stimulation - seemed to act at both the vascular level by increasing regional cerebral blood flow (rCBF) and at the neural level by changing the activity of the neurons. In addition, studies also showed that even a focal stimulation was sufficient to induce a global change in functional connectivity across brain networks. Results in patients with neurological disease were sparser; nevertheless, they indicated that tPBM could improve rCBF and functional connectivity in several regions. Our systematic review also highlighted the heterogeneity in the methods and results generated, together with the need for more randomised controlled trials in patients with neurological diseases. In summary, tPBM could be a promising method to act on brain function, but more consistency is needed in order appreciate fully the underlying mechanisms and the precise outcomes.

Space-Time-Frequency Multi-Sensor Analysis for Motor Cortex Localization Using Magnetoencephalography.

Brain source imaging and time frequency mapping (TFM) are commonly used in magneto/electro encephalography (M/EEG) imaging. However, these methods suffer from important limitations. Source imaging is based on an ill-posed inverse problem leading to instability of source localization solutions, has a limited capacity to localize high frequency oscillations and loses its robustness for induced responses (ill-defined trigger). The drawback of TFM is that it involves independent analysis of signals from a number of frequency bands, and from co-localized sensors. In the present article, a regression-based multi-sensor space-time-frequency analysis (MSA) approach, which integrates co-localized sensors and/or multi-frequency information, is proposed. To estimate task-specific brain activations, MSA uses cross-validated, shifted, multiple Pearson correlation, calculated from the time-frequency transformed brain signal and the binary signal of stimuli. The results are projected from the sensor space onto the cortical surface. To assess MSA performance, the proposed method was compared to the weighted minimum norm estimate (wMNE) source imaging method, in terms of spatial selectivity and robustness against an ill-defined trigger. Magnetoencephalography (MEG) recordings were performed in fourteen subjects during two motor tasks: finger tapping and elbow flexion/extension. In particular, our results show that the MSA approach provides good localization performance when compared to wMNE and statistically significant improvement of robustness against ill-defined trigger.

An exoskeleton controlled by an epidural wireless brain-machine interface in a tetraplegic patient: a proof-of-concept demonstration.

BACKGROUND: Approximately 20% of traumatic cervical spinal cord injuries result in tetraplegia. Neuroprosthetics are being developed to manage this condition and thus improve the lives of patients. We aimed to test the feasibility of a semi-invasive technique that uses brain signals to drive an exoskeleton. METHODS: We recruited two participants at Clinatec research centre, associated with Grenoble University Hospital, Grenoble, France, into our ongoing clinical trial. Inclusion criteria were age 18-45 years, stability of neurological deficits, a need for additional mobility expressed by the patient, ambulatory or hospitalised monitoring, registration in the French social security system, and signed informed consent. The exclusion criteria were previous brain surgery, anticoagulant treatments, neuropsychological sequelae, depression, substance dependence or misuse, and contraindications to magnetoencephalography (MEG), EEG, or MRI. One participant was excluded because of a technical problem with the implants. The remaining participant was a 28-year-old man, who had tetraplegia following a C4-C5 spinal cord injury. Two bilateral wireless epidural recorders, each with 64 electrodes, were implanted over the upper limb sensorimotor areas of the brain. Epidural electrocorticographic (ECoG) signals were processed online by an adaptive decoding algorithm to send commands to effectors (virtual avatar or exoskeleton). Throughout the 24 months of the study, the patient did various mental tasks to progressively increase the number of degrees of freedom. FINDINGS: Between June 12, 2017, and July 21, 2019, the patient cortically controlled a programme that simulated walking and made bimanual, multi-joint, upper-limb movements with eight degrees of freedom during various reach-and-touch tasks and wrist rotations, using a virtual avatar at home (64·0% [SD 5·1] success) or an exoskeleton in the laboratory (70·9% [11·6] success). Compared with microelectrodes, epidural ECoG is semi-invasive and has similar efficiency. The decoding models were reusable for up to approximately 7 weeks without recalibration. INTERPRETATION: These results showed long-term (24-month) activation of a four-limb neuroprosthetic exoskeleton by a complete brain-machine interface system using continuous, online epidural ECoG to decode brain activity in a tetraplegic patient. Up to eight degrees of freedom could be simultaneously controlled using a unique model, which was reusable without recalibration for up to about 7 weeks. FUNDING: French Atomic Energy Commission, French Ministry of Health, Edmond J Safra Philanthropic Foundation, Fondation Motrice, Fondation Nanosciences, Institut Carnot, Fonds de Dotation Clinatec.

Recursive Exponentially Weighted N-way Partial Least Squares Regression with Recursive-Validation of Hyper-Parameters in Brain-Computer Interface Applications.

A tensor-input/tensor-output Recursive Exponentially Weighted N-Way Partial Least Squares (REW-NPLS) regression algorithm is proposed for high dimension multi-way (tensor) data treatment and adaptive modeling of complex processes in real-time. The method unites fast and efficient calculation schemes of the Recursive Exponentially Weighted PLS with the robustness of tensor-based approaches. Moreover, contrary to other multi-way recursive algorithms, no loss of information occurs in the REW-NPLS. In addition, the Recursive-Validation method for recursive estimation of the hyper-parameters is proposed instead of conventional cross-validation procedure. The approach was then compared to state-of-the-art methods. The efficiency of the methods was tested in electrocorticography (ECoG) and magnetoencephalography (MEG) datasets. The algorithms are implemented in software suitable for real-time operation. Although the Brain-Computer Interface applications are used to demonstrate the methods, the proposed approaches could be efficiently used in a wide range of tasks beyond neuroscience uniting complex multi-modal data structures, adaptive modeling, and real-time computational requirements.