Christian Ethier

Restoration of grasp following paralysis through brain-controlled stimulation of muscles

Patients with spinal cord injury lack the connections between brain and spinal cord circuits that are essential for voluntary movement. Clinical systems that achieve muscle contraction through functional electrical stimulation (FES) have proven to be effective in allowing patients with tetraplegia to regain control of hand movements and to achieve a greater measure of independence in daily activities. In existing clinical systems, the patient uses residual proximal limb movements to trigger pre-programmed stimulation that causes the paralysed muscles to contract, allowing use of one or two basic grasps. Instead, we have developed an FES system in primates that is controlled by recordings made from microelectrodes permanently implanted in the brain. We simulated some of the effects of the paralysis caused by C5 or C6 spinal cord injury by injecting rhesus monkeys with a local anaesthetic to block the median and ulnar nerves at the elbow. Then, using recordings from approximately 100 neurons in the motor cortex, we predicted the intended activity of several of the paralysed muscles, and used these predictions to control the intensity of stimulation of the same muscles. This process essentially bypassed the spinal cord, restoring to the monkeys voluntary control of their paralysed muscles. This achievement is a major advance towards similar restoration of hand function in human patients through brain-controlled FES. We anticipate that in human patients, this neuroprosthesis would allow much more flexible and dexterous use of the hand than is possible with existing FES systems.

The comparable size and overlapping nature of upper limb distal and proximal muscle representations in the human motor cortex

The purpose of this study was to determine the relative size and location of proximal and distal upper limb muscle representations in the human motor cortex. Motor‐evoked potentials (MEPs) evoked by transcranial magnetic stimulation were recorded in the proximal muscle anterior deltoid (AD) and in the distal muscles extensor carpi radialis (ECR) and first dorsal interosseus (1DI). The coil was moved in steps of 1 cm along a grid drawn on a tight‐fitting polyester cap placed on the subjects head. At each location, four stimuli were delivered at 1.2 times the active motor threshold (AMT), and MEPs averaged in real‐time. The peak‐to‐peak amplitude of each muscles mean MEP was measured at each stimulation site. The area of a muscles representation was measured by a pixel‐counting algorithm. The optimal point of each muscles areal representation, which corresponds to the locus near which the largest MEPs are obtained, was determined by fitting a 3D Lorentzian function to the data points. The optimal point of distal muscles tended to be situated more laterally along the motor strip than that of proximal muscles. However, there was no statistically significant difference between the size of the areal representations and they overlapped considerably. Additionally, in another five subjects, using a small 45‐mm coil placed in a hyper‐focal orientation, maps were obtained at a stimulus intensity of 1.1–1.15 times the AMT of the muscle with the lowest threshold, usually the 1DI. Even in this very stringent condition, the mapped representations of the AD, ECR and 1DI overlapped, notwithstanding that sharp demarcations between borders were also apparent. These observations demonstrate that stimulus spread alone does not explain the overlap of muscle representations. These results show that commonly used proximal and distal upper‐limb muscles, taken individually, are controlled by motor cortical territories of approximately equal size that significantly overlap despite differences in the location of their optimal points.

Linear Summation of Cat Motor Cortex Outputs

Recruitment of movement-related muscle synergies involves the functional linking of motor cortical points. We asked how the outputs of two simultaneously stimulated motor cortical points would interact. To this end, experiments were done in ketamine-anesthetized cats. When prolonged (e.g., 500 ms) trains of intracortical microstimulation were applied in the primary motor cortex, stimulus currents as low as 10–20 μA evoked coordinated movements of the contralateral forelimb. Paw kinematics in three dimensions and the electromyographic (EMG) activity of eight muscles were simultaneously recorded. We show that the EMG outputs of two cortical points simultaneously stimulated are additive. The movements were represented as displacement vectors pointing from initial to final paw position. The displacement vectors resulting from simultaneous stimulation of two cortical points pointed in nearly the same direction as the algebraic resultant vector. Linear summation of outputs was also found when inhibition at one of the cortical points was reduced by GABAA receptor antagonists. A simple principle emerges from these results. Notwithstanding the underlying complex neuronal circuitry, motor cortex outputs combine nearly linearly in terms of movement direction and muscle activation patterns. Importantly, simultaneous activation does not change the nature of the output at each point. An additional implication is that not all possible movements need be explicitly represented in the motor cortex; a large number of different movements may be synthesized from a smaller repertoire.

Local field potentials allow accurate decoding of muscle activity

Local field potentials (LFPs) in primary motor cortex include significant information about reach target location and upper limb movement kinematics. Some evidence suggests that they may be a more robust, longer-lasting signal than action potentials (spikes). Here we assess whether LFPs can also be used to decode upper limb muscle activity, a complex movement-related signal. We record electromyograms from both proximal and distal upper limb muscles from monkeys performing a variety of reach-to-grasp and isometric wrist force tasks. We show that LFPs can be used to decode activity from both proximal and distal muscles with performance rivaling that of spikes. Thus, motor cortical LFPs include information about more aspects of movement than has been previously demonstrated. This provides further evidence suggesting that LFPs could provide a highly informative, long-lasting signal source for neural prostheses.

On the functional organization and operational principles of the motor cortex

Recent studies on the functional organization and operational principles of the motor cortex (MCx), taken together, strongly support the notion that the MCx controls the muscle synergies subserving movements in an integrated manner. For example, during pointing the shoulder, elbow and wrist muscles appear to be controlled as a coupled functional system, rather than singly and separately. The recurrent pattern of intrinsic synaptic connections between motor cortical points is likely part of the explanation for this operational principle. So too is the reduplicated, non-contiguous and intermingled representation of muscles in the MCx. A key question addressed in this article is whether the selection of movement related muscle synergies is a dynamic process involving the moment to moment functional linking of a variety of motor cortical points, or rather the selection of fixed patterns embedded in the MCx circuitry. It will be suggested that both operational principles are probably involved. We also discuss the neural mechanisms by which cortical points may be dynamically linked to synthesize movement related muscle synergies. Separate corticospinal outputs sum linearly and lead to a blending of the movements evoked by activation of each point on its own. This operational principle may simplify the synthesis of motor commands. We will discuss two possible mechanisms that may explain linear summation of outputs. We have observed that the final posture of the arm when pointing to a given spatial location is relatively independent of its starting posture. From this observation and the recurrent nature of the MCx intrinsic connectivity we hypothesize that the basic mode of operation of the MCx is to associate spatial location to final arm posture. We explain how the recurrent network connectivity operates to generate the muscle activation patterns (synergies) required to move the arm and hold it in its final position.

Intrafascicular stimulation of monkey arm nerves evokes coordinated grasp and sensory responses

High-count microelectrode arrays implanted in peripheral nerves could restore motor function after spinal cord injury or sensory function after limb loss. In this study, we implanted Utah Slanted Electrode Arrays (USEAs) intrafascicularly at the elbow or shoulder in arm nerves of rhesus monkeys (n = 4) under isoflurane anesthesia. Input-output curves indicated that pulse-width-modulated single-electrode stimulation in each arm nerve could recruit single muscles with little or no recruitment of other muscles. Stimulus trains evoked specific, natural, hand movements, which could be combined via multielectrode stimulation to elicit coordinated power or pinch grasp. Stimulation also elicited short-latency evoked potentials (EPs) in primary somatosensory cortex, which might be used to provide sensory feedback from a prosthetic limb. These results demonstrate a high-resolution, high-channel-count interface to the peripheral nervous system for restoring hand function after neural injury or disruption or for examining nerve structure.

Movement representation in the primary motor cortex and its contribution to generalizable EMG predictions

It is well known that discharge of neurons in the primary motor cortex (M1) depends on end-point force and limb posture. However, the details of these relations remain unresolved. With the development of brain-machine interfaces (BMIs), these issues have taken on practical as well as theoretical importance. We examined how the M1 encodes movement by comparing single-neuron and electromyographic (EMG) preferred directions (PDs) and by predicting force and EMGs from multiple neurons recorded during an isometric wrist task. Monkeys moved a cursor from a central target to one of eight peripheral targets by exerting force about the wrist while the forearm was held in one of two postures. We fit tuning curves to both EMG and M1 activity measured during the hold period, from which we computed both PDs and the change in PD between forearm postures (ΔPD). We found a unimodal distribution of these ΔPDs, the majority of which were intermediate between the typical muscle response and an unchanging, extrinsic coordinate system. We also discovered that while most neuron-to-EMG predictions generalized well across forearm postures, end-point force measured in extrinsic coordinates did not. The lack of force generalization was due to musculoskeletal changes with posture. Our results show that the dynamics of most of the recorded M1 signals are similar to those of muscle activity and imply that a BMI designed to drive an actuator with dynamics like those of muscles might be more robust and easier to learn than a BMI that commands forces or movements in external coordinates.

Neural mechanism of activity spread in the cat motor cortex and its relation to the intrinsic connectivity

Non technical summary  The motor cortex (MCx) is an important brain region that initiates and controls voluntary movements. Neurons in MCx are anatomically connected by recurrent (feedback) networks. This connectivity pattern allows neurons to communicate reciprocally with each other potentially over distances of 6–7 mm. However, how far such neural activity is actually communicated was not known. We found that the activity of a small cortical point, about 0.4 mm in radius, activates a surrounding territory of approximately 7.22 mm2 in area. This is smaller than the area covered by the anatomical connections, indicating the existence of mechanisms that limit the spread of activity. Nonetheless, such an area contains the representations of a variety of muscles spanning several joints, from digits to shoulder. These results support the hypothesis that the MCx controls the forelimb musculature in small synergistic groups, rather than singly and separately. Understanding motor cortical physiology is important for the design of neuro‐prosthesis to interface the brain to paralysed muscles.

Corticospinal control of antagonistic muscles in the cat

We recently suggested that movement‐related inter‐joint muscle synergies are recruited by selected excitation and selected release from inhibition of cortical points. Here we asked whether a similar cortical mechanism operates in the functional linking of antagonistic muscles. To this end experiments were done on ketamine‐anesthetized cats. Intracortical microstimulation (ICMS) and intramuscular electromyographic recordings were used to find and characterize wrist, elbow and shoulder antagonistic motor cortical points. Simultaneous ICMS applied at two cortical points, each evoking activity in one of a pair of antagonistic muscles, produced co‐contraction of antagonistic muscle pairs. However, we found an obvious asymmetry in the strength of reciprocal inhibition; it was always significantly stronger on physiological extensors than flexors. Following intravenous injection of a single bolus of strychnine, a cortical point at which only a physiological flexor was previously activated also elicited simultaneous activation of its antagonist. This demonstrates that antagonistic corticospinal neurons are closely grouped, or intermingled. To test whether releasing a cortical point from inhibition allows it to be functionally linked with an antagonistic cortical point, one of three GABAA receptor antagonists, bicuculline, gabazine or picrotoxin, was injected iontophoretically at one cortical point while stimulation was applied to an antagonistic cortical point. This coupling always resulted in co‐contraction of the represented antagonistic muscles. Thus, antagonistic motor cortical points are linked by excitatory intracortical connections held in check by local GABAergic inhibition, with reciprocal inhibition occurring at the spinal level. Importantly, the asymmetry of cortically mediated reciprocal inhibition would appear significantly to bias muscle maps obtained by ICMS in favor of physiological flexors.

Brain-controlled neuromuscular stimulation to drive neural plasticity and functional recovery

There is mounting evidence that appropriately timed neuromuscular stimulation can induce neural plasticity and generate functional recovery from motor disorders. This review addresses the idea that coordinating stimulation with a patients voluntary effort might further enhance neurorehabilitation. Studies in cell cultures and behaving animals have delineated the rules underlying neural plasticity when single neurons are used as triggers. However, the rules governing more complex stimuli and larger networks are less well understood. We argue that functional recovery might be optimized if stimulation were modulated by a brain machine interface, to match the details of the patients voluntary intent. The potential of this novel approach highlights the need for a better understanding of the complex rules underlying this form of plasticity.