Electrocortical underpinnings of error monitoring in health and pathology

It becomes clear from the literature described above (Chapter 1), that the error monitoring mechanisms play a fundamental role in signalling the need for cognitive control. Many studies already provided a consistent evidence on the existence of peculiar ways in which the brain signals this need through electrophysiological changes. However, the following set of empirical studies aims to gain further insight into these complex processes by measuring brain activity changes in situations that alter the way one experience errors. The second Chapter (Chapter 2) consists of a brief commentary that was made in response to an article on the brain activity to action errors. In this commentary we propose new possibilities to explore our topic of interest, by taking advantage of EEG and modern virtual reality facilities. The thesis includes three EEG-VR studies: one on the error-mechanism in healthy participants (Chapter 3) and two studies on error monitoring system in pathological populations (Chapter 4, 5), as main parts of the core of the thesis. As a collateral project, in the Appendix, there is an EEG study on action observation in elite players (Chapter 7). In the first study (Chapter 3), we investigated a very simple but fundamental question. As we saw in the introduction, error-related signatures are evoked when an error occurs. But it is not clear how much of this is due to the occurrence of a violation of the intended goal or simply to the observation of a rare – thus less predictable – event. To this aim, we used a paradigm developed in the former years in our laboratory (Pavone et al., 2016; Spinelli et al., 2017), characterized by a setup in immersive Virtual Reality (VR) and simultaneous EEG recording. Building on the previous findings, we designed an EEG-VR study in which we manipulated the probability of observing errors in actions. In another study (Chapter 4) we investigated how erroneous actions are experienced by people with brain damage and diagnosis of Apraxia. Apraxic patients are people with hemispheric lesions and defective awareness on a variety of aspects that cover perceptuo-motor, cognitive or emotional domains. This study was developed after the results obtained by Canzano and colleagues (2014) in a behavioral study in which apraxic patients were asked to imitate the actions executed by the experimenter and judge their correctness; results revealed that bucco-facial apraxic patients manifest a specific deficit in detecting their own gestural errors when they are explicitly asked to judge them. With the present study we wanted to investigate apraxic brain’ response to action errors, while they embody an avatar in first person perspective (EEG-VR setup). The third study (Chapter 5) investigates the integrity of the error-monitoring system in Parkinson’s Disease and the impact of the dopaminergic treatment in the brain response to errors. To this aim we used the proposed VR action-observation paradigm, in which Parkinson patients observed successful and unsuccessful reach-to-grasp actions in first person perspective while EEG activity was recorded; the same patients were tested while being under dopaminergic treatment and during a dopaminergic withdrawal state. In another chapter we provide a critical overview of the findings of this work (General Discussion, Chapter 6). In the last chapter, the Appendix (Chapter 7), there is a collateral project of another research line of the Laboratory, in which I have being involved. In this study we are investigating the cortical underpinning of elite players during observation of goal-directed actions, in their domain of expertise. We recorded the EEG activity of elite wheelchair basketball players while observing free-throws performed by paraplegic athletes. We expected their brain correlates to be different from novice players and to be able to easily discriminate whether a basketball shot would be successful or unsuccessful (project still ongoing)

Using brain-computer interaction and multimodal virtual-reality for augmenting stroke neurorehabilitation

Every year millions of people suffer from stroke resulting to initial paralysis, slow motor recovery and chronic conditions that require continuous reha bilitation and therapy. The increasing socio-economical and psychological impact of stroke makes it necessary to find new approaches to minimize its sequels, as well as novel tools for effective, low cost and personalized reha bilitation. The integration of current ICT approaches and Virtual Reality (VR) training (based on exercise therapies) has shown significant improve ments. Moreover, recent studies have shown that through mental practice and neurofeedback the task performance is improved. To date, detailed in formation on which neurofeedback strategies lead to successful functional recovery is not available while very little is known about how to optimally utilize neurofeedback paradigms in stroke rehabilitation. Based on the cur rent limitations, the target of this project is to investigate and develop a novel upper-limb rehabilitation system with the use of novel ICT technolo gies including Brain-Computer Interfaces (BCI’s), and VR systems. Here, through a set of studies, we illustrate the design of the RehabNet frame work and its focus on integrative motor and cognitive therapy based on VR scenarios. Moreover, we broadened the inclusion criteria for low mobility pa tients, through the development of neurofeedback tools with the utilization of Brain-Computer Interfaces while investigating the effects of a brain-to-VR interaction.Todos os anos, milho˜es de pessoas sofrem de AVC, resultando em paral isia inicial, recupera¸ca˜o motora lenta e condic¸˜oes cr´onicas que requerem re abilita¸ca˜o e terapia cont´ınuas. O impacto socioecon´omico e psicol´ogico do AVC torna premente encontrar novas abordagens para minimizar as seque las decorrentes, bem como desenvolver ferramentas de reabilita¸ca˜o, efetivas, de baixo custo e personalizadas. A integra¸c˜ao das atuais abordagens das Tecnologias da Informa¸ca˜o e da Comunica¸ca˜o (TIC) e treino com Realidade Virtual (RV), com base em terapias por exerc´ıcios, tem mostrado melhorias significativas. Estudos recentes mostram, ainda, que a performance nas tare fas ´e melhorada atrav´es da pra´tica mental e do neurofeedback. At´e a` data, na˜o existem informac¸˜oes detalhadas sobre quais as estrat´egias de neurofeed back que levam a uma recupera¸ca˜o funcional bem-sucedida. De igual modo, pouco se sabe acerca de como utilizar, de forma otimizada, o paradigma de neurofeedback na recupera¸c˜ao de AVC. Face a tal, o objetivo deste projeto ´e investigar e desenvolver um novo sistema de reabilita¸ca˜o de membros supe riores, recorrendo ao uso de novas TIC, incluindo sistemas como a Interface C´erebro-Computador (ICC) e RV. Atrav´es de um conjunto de estudos, ilus tramos o design do framework RehabNet e o seu foco numa terapia motora e cognitiva, integrativa, baseada em cen´arios de RV. Adicionalmente, ampli amos os crit´erios de inclus˜ao para pacientes com baixa mobilidade, atrav´es do desenvolvimento de ferramentas de neurofeedback com a utilizac¸˜ao de ICC, ao mesmo que investigando os efeitos de uma interac¸˜ao c´erebro-para-RV

Proceedings of the 3rd international conference on disability, virtual reality and associated technologies (ICDVRAT 2000)

The proceedings of the conferenc

Proceedings of the 9th international conference on disability, virtual reality and associated technologies (ICDVRAT 2012)

The proceedings of the conferenc

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Multimodal neuroimaging of vestibular and postural networks: Investigating the pathophysiology of idiopathic dizziness in older adults

Successful ageing - the preservation of good performance into old age, is an aspiration for many and a challenge for society. Modifiable factors which account for ageing-related functional decline should thus be identified and reduced. As life expectancy increases, brain ageing and its functional consequences become an increasingly important target for research and intervention. Cerebral small vessel disease, largely driven by vascular risk factors, has emerged as a strong contributor to cognitive and balance decline in late life. Though the early effects of cerebral small vessel disease on cognition are increasingly better understood, its symptomatic effects on other functional systems are not well characterised. In this thesis, I investigated the long recognised, but pathophysiologically enigmatic syndrome of dizziness in older adults, not accounted for by neurological disease or vestibular dysfunction. I considered the hypothesis that this ‘idiopathic dizziness’ is secondary to cerebral small vessel disease through its deleterious effects on white matter networks which subserve vestibular perceptual processes and/or the control of balance. I first defined the functional anatomy of the core human vestibular cortex by its functional connectivity (Chapter 3). I related the resulting anatomical subregions to behavioural and task neuroimaging data to define a vestibular network involved in self-motion perception. I proceeded to characterise the syndrome of idiopathic dizziness using clinical, cognitive and behavioural (vestibular function, balance and gait) data from patients and controls (Chapter 4). I combined this data with structural and diffusion magnetic resonance imaging data to investigate the pathophysiology of idiopathic dizziness. I found that frontal white matter tracts relevant to the control of balance had lower integrity in patients with idiopathic dizziness than controls. These findings occurred in the context of excess vascular risk, and markers of cerebral small vessel disease. Additionally, I found vestibular function and perception were normal in patients with idiopathic dizziness. The results suggest disrupted balance control may underpin idiopathic dizziness in cerebral small vessel disease. I proceeded to investigate whether neural correlates of balance control were altered in idiopathic dizziness as a model for mild balance impairment in cerebral small vessel disease (Chapter 5). To do this, I applied electroencephalography during quiet standing and related brain activity to spontaneous sway. I showed idiopathic dizziness was linked to altered cortical activity in relation to balance control, and this cortical activity was influenced by the burden of cerebral small vessel disease. Additionally, patients with idiopathic dizziness uniquely engaged a low frequency postural connectivity network, consistent with a different mode of postural control. Overall, the results within this thesis show a relationship between idiopathic dizziness and vascular injury to frontal tracts involved in the control of balance in cerebral small vessel disease. Small vessel disease may disrupt the cortical control of balance as a basis for symptoms in this syndrome.Open Acces