Ichiro Miyai

Cortical mapping of gait in humans: a near-infrared spectroscopic topography study.

While we have a fair understanding of how and where forelimb-hand manipulative movements are controlled by the neocortex, due to functional imaging studies, we know little about the control of bipedal movements such as walking because of technical difficulties. We succeeded in visualizing cortical activation patterns of human gait by measuring relative changes in local hemoglobin oxygenation using a recently developed near-infrared spectroscopic (NIRS) topography technique. Walking activities were bilaterally associated with increased levels of oxygenated and total hemoglobin in the medial primary sensorimotor cortices and the supplementary motor areas. Alternating foot movements activated similar but less broad regions. Gait imagery increased activities caudally located in the supplementary motor areas. These findings provide new insight into cortical control of human locomotion. NIRS topography might be also useful for evaluating cerebral activation patterns during pathological gait and rehabilitative intervention.

Prefrontal and premotor cortices are involved in adapting walking and running speed on the treadmill: an optical imaging study

We investigated changes of regional activation in the frontal cortices as assessed by changes of hemoglobin oxygenation during walking at 3 and 5 km/h and running at 9 km/h on a treadmill using a near-infrared spectroscopic (NIRS) imaging technique. During the acceleration periods immediately preceded reaching the steady walking or running speed, the levels of oxygenated hemoglobin (oxyHb) increased, but those of deoxygenated hemoglobin (deoxyHb) did not in the frontal cortices. The changes were greater at the higher locomotor speed in the bilateral prefrontal cortex and the premotor cortex, but there were less speed-associated changes in the sensorimotor cortices. The medial prefrontal activation was most prominent during the running task. These results indicate that the prefrontal and premotor cortices are involved in adapting to locomotor speed on the treadmill. These areas might predominantly participate in the control of running rather than walking.

Premotor cortex is involved in restoration of gait in stroke

Cortical activation during hemiplegic gait was assessed in six nonambulatory patients with severe stroke (four men, two women; four with right and two with left hemiplegia; 57 years old and 3 months after stroke on average), using a near‐infrared spectroscopic imaging system. Each patient performed tasks of treadmill walking (0.2km/hr), alternated with rest every 30 seconds for four repetitions, under partial body weight support, either with mechanical assistance in swinging the paretic leg control (CON) or with a facilitation technique that enhanced swinging of the paretic leg (FT), provided by physical therapists. Gait performance was associated with increased oxygenated hemoglobin levels in the medial primary sensorimotor cortex in the unaffected hemisphere greater than in the affected hemisphere. Both cortical mappings and quantitative data showed that the premotor activation in the affected hemisphere was enhanced during hemiplegic gait. There was also a prominent activation in the presupplementary motor area. Overall cortical activations and gait performance were greater in walking with FT than with CON. These indicate that multiple motor areas including the premotor cortex and presupplementary motor area might play important roles in restoration of gait in patients with severe stroke.

Role of the prefrontal cortex in human balance control

Although recent studies have demonstrated cortical involvement in human balance control, there is insufficient information regarding the regions of the cerebral cortex that contribute to human balance control and their mechanism of action. Using a functional near-infrared spectroscopic system, we investigated perturbation-related cortical activation. External perturbations were provided with and without the preceding auditory warning signals 2 s before the perturbation. Statistical analysis by applying the general linear model showed significant activation in the prefrontal cortex, including the dorsolateral prefrontal cortex and frontal eye field after external perturbation, regardless of the preceding auditory warning signals. A time-line analysis revealed similar temporal profiles for prefrontal activation in 2 different conditions. Based on the contrast between the 2 conditions, we detected enhanced activation in the right posterior parietal cortex and supplementary motor area in the condition where the auditory warning signals were provided. We presumed that prefrontal involvement may be relevant to adequate allocation of visuospatial attention. Our results may facilitate the understanding of cortical mechanisms for balance control in humans and the underlying pathophysiology of falls.

Removal of the skin blood flow artifact in functional near-infrared spectroscopic imaging data through independent component analysis.

We investigate whether the functional near-infrared spectroscopic (fNIRS) signal includes a signal from the changing skin blood flow. During a locomotor task on a treadmill, changes in the hemodynamic response in the front-parietal area of healthy human subjects are simultaneously recorded using an fNIRS imaging system and a laser Doppler tissue blood flow meter. Independent component analysis (ICA) for fNIRS signals is performed. The skin blood flow changes during locomotor tasks on a treadmill. The activated spatial distribution of one of the components separated by ICA reveals an overall increase in fNIRS channels. To evaluate the uniformity of the activated spatial distribution, we define a new statistical value-the coefficient of spatial uniformity (CSU). The CSU value is a highly discriminating value (e.g., 2.82) compared with values of other components (e.g., 1.41, 1.10, 0.96, 0.61, and 0.58). In addition, the independent component signal corresponding to the activated spatial distribution is similar to changes in skin blood flow measured with the laser Doppler tissue blood flow meter. The coefficient of correlation indicates strong correlation. Localized activation areas around the premotor and medial somatosensory cortices are shown more clearly by eliminating the extracted component.

Frontal regions involved in learning of motor skill—A functional NIRS study

To investigate cerebral mechanisms underlying learning of motor skill, we assessed serial changes of cortical activation patterns during a pursuit rotor (PR) task in 18 right-handed, healthy subjects using a functional near-infrared spectroscopy (fNIRS) system. Subjects performed the task with the right hand for 30 s alternated with 30-s rest for 8 repetitions (cycle1 to 8). Gains in motor skill were evaluated by time for keeping the stylus on the target (max 30 s), surface EMG patterns and trajectories of the arm. Performance improved with repetitions of the task cycles (12.9/17.1/19.3/20.0/21.1/22.2/23.6/23.9 s on average) and reached plateau at the 7th cycle. Reciprocal EMG patterns and steady trajectories were associated with acquisition of the motor skill. Task-related increases of oxygenated hemoglobin (oxyHb) were observed in the channels covering the sensorimotor cortex (SMC), premotor and prefrontal regions. There were also task-related decreases of deoxygenated hemoglobin (deoxyHb) in these areas although the changes were smaller compared with those of oxyHb. The center of task-related increases of oxyHb was initially located in the presupplementary motor area (preSMA) and shifted caudally to the supplementary motor area (SMA) with cycle repetitions. The ratios of oxyHb changes in preSMA to SMA significantly decreased with task repetitions. DeoxyHb changes confirmed the activation patterns. These data suggest that preSMA plays an important role in the early phase of motor learning while the SMA might be more involved in the late learning phase of the motor skill.

Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases.

Objective. To investigate short- and long-term effects of intensive rehabilitation on ataxia, gait, and activities of daily living (ADLs) in patients with degenerative cerebellar disease. Methods. A total of 42 patients with pure cerebellar degeneration were randomly assigned to the immediate group or the delayed-entry control group. The immediate group received 2 hours of inpatient physical and occupational therapy, focusing on coordination, balance, and ADLs, on weekdays and 1 hour on weekends for 4 weeks. The control group received the same intervention after a 4-week delay. Short-term outcome was compared between the immediate and control groups. Long-term evaluation was done in both groups at 4, 12, and 24 weeks after the intervention. Outcome measures included the assessment and rating of ataxia, Functional Independence Measure, gait speed, cadence, functional ambulation category, and number of falls. Results. The immediate group showed significantly greater functional gains in ataxia, gait speed, and ADLs than the control group. Improvement of truncal ataxia was more prominent than limb ataxia. The gains in ataxia and gait were sustained at 12 weeks and 24 weeks, respectively. At least 1 measure was better than at baseline at 24 weeks in 22 patients. Conclusions. Short-term benefit of intensive rehabilitation was evident in patients with degenerative cerebellar diseases. Although functional status tended to decline to the baseline level within 24 weeks, gains were maintained in more than half of the participants.

Near-infrared Spectroscopy–mediated Neurofeedback Enhances Efficacy of Motor Imagery–based Training in Poststroke Victims A Pilot Study

Background and Purpose— Despite the findings that motor imagery and execution are supposed to share common neural networks, previous studies using imagery-based rehabilitation have revealed inconsistent results. In the present study, we investigated whether feedback of cortical activities (neurofeedback) using near-infrared spectroscopy could enhance the efficacy of imagery-based rehabilitation in stroke patients. Methods— Twenty hemiplegic patients with subcortical stroke received 6 sessions of mental practice with motor imagery of the distal upper limb in addition to standard rehabilitation. Subjects were randomly allocated to REAL and SHAM groups. In the REAL group, cortical hemoglobin signals detected by near-infrared spectroscopy were fed back during imagery. In the SHAM group, irrelevant randomized signals were fed back. Upper limb function was assessed using the finger and arm subscales of the Fugl-Meyer assessment and the Action Research Arm Test. Results— The hand/finger subscale of the Fugl-Meyer assessment showed greater functional gain in the REAL group, with a significant interaction between time and group (F2,36=15.5; P<0.001). A significant effect of neurofeedback was revealed even in severely impaired subjects. Imagery-related cortical activation in the premotor area was significantly greater in the REAL group than in the SHAM group (T58=2.4; P<0.05). Conclusions— Our results suggest that near-infrared spectroscopy–mediated neurofeedback may enhance the efficacy of mental practice with motor imagery and augment motor recovery in poststroke patients with severe hemiparesis.

Neurofeedback Using Real-Time Near-Infrared Spectroscopy Enhances Motor Imagery Related Cortical Activation

Accumulating evidence indicates that motor imagery and motor execution share common neural networks. Accordingly, mental practices in the form of motor imagery have been implemented in rehabilitation regimes of stroke patients with favorable results. Because direct monitoring of motor imagery is difficult, feedback of cortical activities related to motor imagery (neurofeedback) could help to enhance efficacy of mental practice with motor imagery. To determine the feasibility and efficacy of a real-time neurofeedback system mediated by near-infrared spectroscopy (NIRS), two separate experiments were performed. Experiment 1 was used in five subjects to evaluate whether real-time cortical oxygenated hemoglobin signal feedback during a motor execution task correlated with reference hemoglobin signals computed off-line. Results demonstrated that the NIRS-mediated neurofeedback system reliably detected oxygenated hemoglobin signal changes in real-time. In Experiment 2, 21 subjects performed motor imagery of finger movements with feedback from relevant cortical signals and irrelevant sham signals. Real neurofeedback induced significantly greater activation of the contralateral premotor cortex and greater self-assessment scores for kinesthetic motor imagery compared with sham feedback. These findings suggested the feasibility and potential effectiveness of a NIRS-mediated real-time neurofeedback system on performance of kinesthetic motor imagery. However, these results warrant further clinical trials to determine whether this system could enhance the effects of mental practice in stroke patients.

Effect of body weight support on cortical activation during gait in patients with stroke

Treadmill training with body weight support (BWS) was shown to improve locomotion after stroke. We investigated whether BWS affected cortical activation during gait using an optical imaging system. In six patients with subcortical stroke, BWS lowered activation in the sensorimotor cortex (SMC) as assessed by task-related changes of oxygenated hemoglobin levels (P<0.01). The changes of SMC activation correlated with those of cadence (P<0.05). Improvement of asymmetry in SMC activation also correlated with improvement of asymmetric gait (P<0.05). In five age-matched controls, BWS increased overall activation (P<0.05) but did not modify gait parameters and there was no correlation between gait parameters and SMC activation. It is suggested that BWS might improve efficacy of SMC function in patients with stroke.