Floriana Pichiorri

Brain-computer interface boosts motor imagery practice during stroke recovery

Motor imagery (MI) is assumed to enhance poststroke motor recovery, yet its benefits are debatable. Brain–computer interfaces (BCIs) can provide instantaneous and quantitative measure of cerebral functions modulated by MI. The efficacy of BCI‐monitored MI practice as add‐on intervention to usual rehabilitation care was evaluated in a randomized controlled pilot study in subacute stroke patients.

Sensorimotor rhythm-based brain?computer interface training: the impact on motor cortical responsiveness

The main purpose of electroencephalography (EEG)-based brain-computer interface (BCI) technology is to provide an alternative channel to support communication and control when motor pathways are interrupted. Despite the considerable amount of research focused on the improvement of EEG signal detection and translation into output commands, little is known about how learning to operate a BCI device may affect brain plasticity. This study investigated if and how sensorimotor rhythm-based BCI training would induce persistent functional changes in motor cortex, as assessed with transcranial magnetic stimulation (TMS) and high-density EEG. Motor imagery (MI)-based BCI training in naïve participants led to a significant increase in motor cortical excitability, as revealed by post-training TMS mapping of the hand muscles cortical representation; peak amplitude and volume of the motor evoked potentials recorded from the opponens pollicis muscle were significantly higher only in those subjects who develop a MI strategy based on imagination of hand grasping to successfully control a computer cursor. Furthermore, analysis of the functional brain networks constructed using a connectivity matrix between scalp electrodes revealed a significant decrease in the global efficiency index for the higher-beta frequency range (22-29 Hz), indicating that the brain network changes its topology with practice of hand grasping MI. Our findings build the neurophysiological basis for the use of non-invasive BCI technology for monitoring and guidance of motor imagery-dependent brain plasticity and thus may render BCI a viable tool for post-stroke rehabilitation.

Relationship Between Electrical Brain Responses to Motor Imagery and Motor Impairment in Stroke

Background and Purpose— New strategies like motor imagery based brain–computer interfaces, which use brain signals such as event-related desynchronization (ERD) or event-related synchronization (ERS) for motor rehabilitation after a stroke, are undergoing investigation. However, little is known about the relationship between ERD and ERS patterns and the degree of stroke impairment. The aim of this work was to clarify this relationship. Methods— EEG during motor imagery and execution were measured in 29 patients with first-ever monolateral stroke causing any degree of motor deficit in the upper limb. The strength and laterality of the ERD or ERS patterns were correlated with the scores of the European Stroke Scale, the Medical Research Council, and the Modified Ashworth Scale. Results— Mean age of the patients was 58±15 years; mean time from the incident was 4±4 months. Stroke lesions were cortical (n=8), subcortical (n=11), or mixed (n=10), attributable to either an ischemic event (n=26) or a hemorrhage (n=3), affecting the right (n=16) or left (n=13) hemisphere. Higher impairment was related to stronger ERD in the unaffected hemisphere and higher spasticity was related to stronger ERD in the affected hemisphere. Both were related to a relatively stronger ERS in the affected hemisphere. Conclusion— The results of this study may have implications for the design of potential poststroke rehabilitation interventions based on brain–computer interface technologies that use neurophysiological signals like ERD or ERS as neural substrates for the mutual interaction between brain and machine and, ultimately, help stroke patients to regain motor control.

EEG-based Brain-Computer Interface to support post-stroke motor rehabilitation of the upper limb

Brain-Computer Interfaces (BCIs) process brain activity in real time, and mediate non-muscular interaction between and individual and the environment. The subserving algorithms can be used to provide a quantitative measurement of physiological or pathological cognitive processes - such as Motor Imagery (MI) - and feed it back the user. In this paper we propose the clinical application of a BCI-based rehabilitation device, to promote motor recovery after stroke. The BCI-based device and the therapy exploiting its use follow the same principles that drive classical neuromotor rehabilitation, and (i) provides the physical therapist with a monitoring instrument, to assess the patients participation in the rehabilitative cognitive exercise; (ii) assists the patient in the practice of MI. The device was installed in the ward of a rehabilitation hospital and a group of 29 patients were involved in its testing. Among them, eight have already undergone a one month training with the device, as an add-on to the regular therapy. An improved system, which includes analysis of Electromyographic (EMG) patterns and Functional Electrical Stimulation (FES) of the arm muscles, is also under clinical evaluation. We found that the rehabilitation exercise based on BCI mediated neurofeedback mechanisms enables a better engagement of motor areas with respect to motor imagery alone and thus it can promote neuroplasticity in brain regions affected by a cerebrovascular accident. Preliminary results also suggest that the functional outcome of motor rehabilitation may be improved by the use of the proposed device.

Differences in short-term primary motor cortex synaptic potentiation as assessed by repetitive transcranial magnetic stimulation in migraine patients with and without aura

&NA; To find out more about glutamatergic and gabaergic transmission in migraine, in this study we investigated glutamate‐dependent short‐term synaptic potentiation and GABA‐dependent inhibitory cortical interneuron excitability as assessed by 5 Hz‐rTMS delivered over primary motor cortex (M1) (motor evoked potential, MEP, amplitude facilitation and cortical silent period, CSP, duration lengthening) in migraine patients with (MA) and without aura (MwoA) and healthy controls. We studied 37 patients with migraine (19 MA and 18 MwoA) and 19 healthy control subjects. 5 Hz‐rTMS was delivered at 120% resting motor threshold to the hand motor area of the left hemisphere with the target muscle at rest and during contraction. Three of the MA patients were also tested at the end of visual aura during a spontaneous migraine attack. ANOVA showed that the MEP significantly increased in size and CSP significantly lengthened during 5 Hz‐rTMS in the three groups tested. The 5 Hz‐rTMS‐induced MEP facilitation differed significantly being highest in MA patients. In the three patients tested both ictally and interictally the MEP increased during the interictal session but remained unchanged when the visual aura ended. Our study shows that the neurophysiological feature that differentiates MA patients from MwoA patients and healthy controls is an abnormal M1 susceptibility to 5 Hz‐rTMS both outside and during the attack suggesting that glutamate‐dependent short‐term M1 cortical potentiation patterns differ in migraine with and without aura.

Multiscale topological properties of functional brain networks during motor imagery after stroke

In recent years, network analyses have been used to evaluate brain reorganization following stroke. However, many studies have often focused on single topological scales, leading to an incomplete model of how focal brain lesions affect multiple network properties simultaneously and how changes on smaller scales influence those on larger scales. In an EEG-based experiment on the performance of hand motor imagery (MI) in 20 patients with unilateral stroke, we observed that the anatomic lesion affects the functional brain network on multiple levels. In the beta (13-30 Hz) frequency band, the MI of the affected hand (Ahand) elicited a significantly lower smallworldness and local efficiency (Eloc) versus the unaffected hand (Uhand). Notably, the abnormal reduction in Eloc significantly depended on the increase in interhemispheric connectivity, which was in turn determined primarily by the rise of regional connectivity in the parieto-occipital sites of the affected hemisphere. Further, in contrast to the Uhand MI, in which significantly high connectivity was observed for the contralateral sensorimotor regions of the unaffected hemisphere, the regions with increased connectivity during the Ahand MI lay in the frontal and parietal regions of the contralaterally affected hemisphere. Finally, the overall sensorimotor function of our patients, as measured by Fugl-Meyer Assessment (FMA) index, was significantly predicted by the connectivity of their affected hemisphere. These results improve on our understanding of stroke-induced alterations in functional brain networks.

What does clean EEG look like

Lack of a clear analytical metric for identifying artifact free, clean electroencephalographic (EEG) signals inhibits robust comparison of different artifact removal methods and lowers confidence in the results of EEG analysis. An algorithm is presented for identifying clean EEG epochs by thresholding statistical properties of the EEG. Thresholds are trained on EEG datasets from both healthy subjects and stroke/spinal cord injury patient populations via differential evolution (DE).

Brain Computer Interface for Hand Motor Function Restoration and Rehabilitation

Long-term disability is often associated with persistent impairment of an upper limb. In this respect, neurological rehabilitation aims to lessen motor impairment and related disability either by restoring functions with the help of assistive devices to aid daily living activities or by applying rehabilitative protocols based on task-specific training and practice to enhance recovery of motor functions. Brain–computer interface technology is a promising rehabilitation device in every such sense. On the one hand, BCI systems can be utilized to bypass central nervous system injury by controlling neuroprosthetics for patient’s arm to manage reach and grasp functional activities in peripersonal space. On the other, BCI technology can encourage motor training and practice by offering an on-line feedback about brain signals associated with mental practice, motor intention and other neural recruitment strategies, and thus helping to guide neuroplasticity associated with post-stroke motor impairment and its recovery. This chapter aims to provide a focused overview of non invasive-BCI technology advancement to serve patients in the field of restoration and recovery of hand motor function impairment accompanying spinal cord injuries and stroke.

Physiological characterization of human muscle acetylcholine receptors from ALS patients.

Amyotrophic lateral sclerosis (ALS) is characterized by progressive degeneration of motor neurons leading to muscle paralysis. Research in transgenic mice suggests that the muscle actively contributes to the disease onset, but such studies are difficult to pursue in humans and in vitro models would represent a good starting point. In this work we show that tiny amounts of muscle from ALS or from control denervated muscle, obtained by needle biopsy, are amenable to functional characterization by two different technical approaches: “microtransplantation” of muscle membranes into Xenopus oocytes and culture of myogenic satellite cells. Acetylcholine (ACh)-evoked currents and unitary events were characterized in oocytes and multinucleated myotubes. We found that ALS acetylcholine receptors (AChRs) retain their native physiological characteristics, being activated by ACh and nicotine and blocked by α-bungarotoxin (α-BuTX), d-tubocurarine (dTC), and galantamine. The reversal potential of ACh-evoked currents and the unitary channel behavior were also typical of normal muscle AChRs. Interestingly, in oocytes injected with muscle membranes derived from ALS patients, the AChRs showed a significant decrease in ACh affinity, compared with denervated controls. Finally, riluzole, the only drug currently used against ALS, reduced, in a dose-dependent manner, the ACh-evoked currents, indicating that its action remains to be fully characterized. The two methods described here will be important tools for elucidating the role of muscle in ALS pathogenesis and for developing drugs to counter the effects of this disease.

Isolated Distal Myopathy of the Upper Limbs Associated With Mitochondrial DNA Depletion and Polymerase γ Mutations

OBJECTIVE To describe an unusual clinical phenotype in an adult harboring 2 compound heterozygous polymerase γ (POLG) mutations. DESIGN Case report. SETTING University-based outpatient neurology clinic and pathology and genetics laboratory. PATIENT A 27-year-old man presenting with isolated distal myopathy of the upper extremities in the absence of sensory disturbances. RESULTS Histochemical analysis of a muscle biopsy specimen showed numerous cytochrome c oxidase-deficient fibers. Molecular analysis revealed marked depletion of muscle mitochondrial DNA in the absence of multiple mitochondrial DNA deletions. Sequence analysis of the POLG gene revealed heterozygous sequence variants in compound c.1156C>T (p.R386C) and c.2794C>T (p.H932Y) segregating with clinical disease in the family. The p.R386C change appears to be a novel mutation. CONCLUSION Our case broadens the phenotypic spectrum of disorders associated with POLG mutations and highlights the complex relationship between genotype and phenotype in POLG-related disease.