Assessing attention and cognitive function in completely locked-in state with event-related brain potentials and epidural electrocorticography.

OBJECTIVE: Patients in the completely locked-in state (CLIS), due to, for example, amyotrophic lateral sclerosis (ALS), no longer possess voluntary muscle control. Assessing attention and cognitive function in these patients during the course of the disease is a challenging but essential task for both nursing staff and physicians. APPROACH: An electrophysiological cognition test battery, including auditory and semantic stimuli, was applied in a late-stage ALS patient at four different time points during a six-month epidural electrocorticography (ECoG) recording period. Event-related cortical potentials (ERP), together with changes in the ECoG signal spectrum, were recorded via 128 channels that partially covered the left frontal, temporal and parietal cortex. MAIN RESULTS: Auditory but not semantic stimuli induced significant and reproducible ERP projecting to specific temporal and parietal cortical areas. N1/P2 responses could be detected throughout the whole study period. The highest P3 ERP was measured immediately after the patient's last communication through voluntary muscle control, which was paralleled by low theta and high gamma spectral power. Three months after the patient's last communication, i.e., in the CLIS, P3 responses could no longer be detected. At the same time, increased activity in low-frequency bands and a sharp drop of gamma spectral power were recorded. SIGNIFICANCE: Cortical electrophysiological measures indicate at least partially intact attention and cognitive function during sparse volitional motor control for communication. Although the P3 ERP and frequency-specific changes in the ECoG spectrum may serve as indicators for CLIS, a close-meshed monitoring will be required to define the exact time point of the transition.

Rehabilitation of gait after stroke: a review towards a top-down approach.

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity.The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI).From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process.

ERD-based online brain-machine interfaces (BMI) in the context of neurorehabilitation: optimizing BMI learning and performance.

Event-related desynchronization (ERD) of sensori-motor rhythms (SMR) can be used for online brain-machine interface (BMI) control, but yields challenges related to the stability of ERD and feedback strategy to optimize BMI learning.Here, we compared two approaches to this challenge in 20 right-handed healthy subjects (HS, five sessions each, S1-S5) and four stroke patients (SP, 15 sessions each, S1-S15). ERD was recorded from a 275-sensor MEG system. During daily training,motor imagery-induced ERD led to visual and proprioceptive feedback delivered through an orthotic device attached to the subjects' hand and fingers. Group A trained with a heterogeneous reference value (RV) for ERD detection with binary feedback and Group B with a homogenous RV and graded feedback (10 HS and 2 SP in each group). HS in Group B showed better BMI performance than Group A (p < 0.001) and improved BMI control from S1 to S5 (p = 0.012) while Group A did not. In spite of the small n, SP in Group B showed a trend for a higher BMI performance (p = 0.06) and learning was significantly better (p < 0.05). Using a homogeneous RV and graded feedback led to improved modulation of ipsilesional activity resulting in superior BMI learning relative to use of a heterogeneous RV and binary feedback.

Chronic stroke recovery after combined BCI training and physiotherapy: a case report.

A case of partial recovery after stroke and its associated brain reorganization in a chronic patient after combined brain computer interface (BCI) training and physiotherapy is presented. A multimodal neuroimaging approach based on fMRI and diffusion tensor imaging was used to investigate plasticity of the brain motor system in parallel with longitudinal clinical assessments. A convergent association between functional and structural data in the ipsilesional premotor areas was observed. As a proof of concept investigation, these results encourage further research on a specific role of BCI on brain plasticity and recovery after stroke.

Decoding of individuated finger movements using surface electromyography.

Upper limb prostheses are increasingly resembling the limbs they seek to replace in both form and functionality, including the design and development of multifingered hands and wrists. Hence, it becomes necessary to control large numbers of degrees of freedom (DOFs), required for individuated finger movements, preferably using noninvasive signals. While existing control paradigms are typically used to drive a single-DOF hook-based configurations, dexterous tasks such as individual finger movements would require more elaborate control schemes. We show that it is possible to decode individual flexion and extension movements of each finger (ten movements) with greater than 90% accuracy in a transradial amputee using only noninvasive surface myoelectric signals. Further, comparison of decoding accuracy from a transradial amputee and able-bodied subjects shows no statistically significant difference ( p < 0.05) between these subjects. These results are encouraging for the development of real-time control strategies based on the surface myoelectric signal to control dexterous prosthetic hands.

Towards the control of individual fingers of a prosthetic hand using surface EMG signals.

The fast pace of development of upper-limb prostheses requires a paradigm shift in EMG-based controls. Traditional control schemes are only capable of providing 2 degrees of freedom, which is insufficient for dexterous control of individual fingers. We present a framework where myoelectric signals from natural hand and finger movements can be decoded with a high accuracy. 32 surface-EMG electrodes were placed on the forearm of an able-bodied subject while performing individual finger movements. Using time-domain feature extraction methods as inputs to a neural network classifier, we show that 12 individuated flexion and extension movements of the fingers can be decoded with an accuracy higher than 98%. To our knowledge, this is the first instance in which such movements have been successfully decoded using surface-EMG. These preliminary findings provide a framework that will allow the results to be extended to non-invasive control of the next generation of upper-limb prostheses for amputees.

A brain-computer interface with vibrotactile biofeedback for haptic information.

BACKGROUND: It has been suggested that Brain-Computer Interfaces (BCI) may one day be suitable for controlling a neuroprosthesis. For closed-loop operation of BCI, a tactile feedback channel that is compatible with neuroprosthetic applications is desired. Operation of an EEG-based BCI using only vibrotactile feedback, a commonly used method to convey haptic senses of contact and pressure, is demonstrated with a high level of accuracy. METHODS: A Mu-rhythm based BCI using a motor imagery paradigm was used to control the position of a virtual cursor. The cursor position was shown visually as well as transmitted haptically by modulating the intensity of a vibrotactile stimulus to the upper limb. A total of six subjects operated the BCI in a two-stage targeting task, receiving only vibrotactile biofeedback of performance. The location of the vibration was also systematically varied between the left and right arms to investigate location-dependent effects on performance. RESULTS AND CONCLUSION: Subjects are able to control the BCI using only vibrotactile feedback with an average accuracy of 56% and as high as 72%. These accuracies are significantly higher than the 15% predicted by random chance if the subject had no voluntary control of their Mu-rhythm. The results of this study demonstrate that vibrotactile feedback is an effective biofeedback modality to operate a BCI using motor imagery. In addition, the study shows that placement of the vibrotactile stimulation on the biceps ipsilateral or contralateral to the motor imagery introduces a significant bias in the BCI accuracy. This bias is consistent with a drop in performance generated by stimulation of the contralateral limb. Users demonstrated the capability to overcome this bias with training.