Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation

Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and functional restoration

Noninvasive Modalities Used in Spinal Cord Injury Rehabilitation

In the past three decades, research on plasticity after spinal cord injury (SCI) has led to a gradual shift in SCI rehabilitation: the former focus on learning compensatory strategies changed to functional neurorecovery, that is, promoting restoration of function through the use of affected limbs. This paradigm shift contributed to the development of technology-based interventions aiming to promote neurorecovery through repetitive training. This chapter presents an overview of a range of noninvasive modalities that have been used in rehabilitation after SCI. Among others, we present repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface electrical stimulation tools such as transcutaneous electrical spinal cord stimulation (tcSCS), transcutaneous electrical nerve stimulation (TENS), and functional electrical stimulation (FES), as well as its integration with cycling training and assistive robotic devices. The most recent results attained and the potential relevance of these new techniques to strengthen the efficacy of the residual neuronal pathways and improve spasticity are also presented. Future efforts toward the widespread clinical application of these modalities include more advances in the technology, together with the knowledge obtained from basic research and clinical trials. This can ultimately lead to novel customized interventions that meet specific needs of SCI patients

The separate neural control of hand movements and contact forces

To manipulate an object, we must simultaneously control the contact forces exerted on the object and the movements of our hand. Two alternative views for manipulation have been proposed: one in which motions and contact forces are represented and controlled by separate neural processes, and one in which motions and forces are controlled jointly, by a single process. To evaluate these alternatives, we designed three tasks in which subjects maintained a specified contact force while their hand was moved by a robotic manipulandum. The prescribed contact force and hand motions were selected in each task to induce the subject to attain one of three goals: (1) exerting a regulated contact force, (2) tracking the motion of the manipulandum, and (3) attaining both force and motion goals concurrently. By comparing subjects' performances in these three tasks, we found that behavior was captured by the summed actions of two independent control systems: one applying the desired force, and the other guiding the hand along the predicted path of the manipulandum. Furthermore, the application of transcranial magnetic stimulation impulses to the posterior parietal cortex selectively disrupted the control of motion but did not affect the regulation of static contact force. Together, these findings are consistent with the view that manipulation of objects is performed by independent brain control of hand motions and interaction forces

Multi-locus transcranial magnetic stimulation system for electronically targeted brain stimulation

Background: Transcranial magnetic stimulation (TMS) allows non-invasive stimulation of the cortex. In multi-locus TMS (mTMS), the stimulating electric field (E-field) is controlled electronically without coil movement by adjusting currents in the coils of a transducer. Objective: To develop an mTMS system that allows adjusting the location and orientation of the E-field maximum within a cortical region. Methods: We designed and manufactured a planar 5-coil mTMS transducer to allow controlling the maximum of the induced E-field within a cortical region approximately 30 mm in diameter. We developed electronics with a design consisting of independently controlled H-bridge circuits to drive up to six TMS coils. To control the hardware, we programmed software that runs on a field-programmable gate array and a computer. To induce the desired E-field in the cortex, we developed an optimization method to calculate the currents needed in the coils. We characterized the mTMS system and conducted a proof-of-concept motor-mapping experiment on a healthy volunteer. In the motor mapping, we kept the transducer placement fixed while electronically shifting the E-field maximum on the precentral gyrus and measuring electromyography from the contralateral hand. Results: The transducer consists of an oval coil, two figure-of-eight coils, and two four-leaf-clover coils stacked on top of each other. The technical characterization indicated that the mTMS system performs as designed. The measured motor evoked potential amplitudes varied consistently as a function of the location of the E-field maximum. Conclusion: The developed mTMS system enables electronically targeted brain stimulation within a cortical region. (c) 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Peer reviewe

Design of a robotic transcranial magnetic stimulation system

Transcranial Magnetic Stimulation (TMS) is an excellent and non-invasive technique for studying the human brain. Accurate placement of the magnetic coil is required by this technique in order to induce a specific cortical activity. Currently, the coil is manually held in most of stimulation procedures, which does not achieve the precise clinical evaluation of the procedure. This thesis proposes a robotic TMS system to resolve these problems as a robot has excellent locating and holding capabilities. The proposed system can track in real-time the subject’s head position and simultaneously maintain a constant contact force between the coil and the subject’s head so that it does not need to be restrained and thus ensure the accuracy of the stimulation result. Requirements for the robotic TMS system are proposed initially base on analysis of a serial of TMS experiments on real subjects. Both hardware and software design are addressed according to these requirements in this thesis. An optical tracking system is used in the system for guiding and tracking the motion of the robot and inadvertent small movements of the subject’s head. Two methods of coordinate system registration are developed base on DH and Tsai-lenz’s method, and it is found that DH method has an improved accuracy (RMS error is 0.55mm). In addition, the contact force is controlled using a Force/Torque sensor; and a combined position and force tracking controller is applied in the system. This combined controller incorporates the position tracking and conventional gain scheduling force control algorithms to monitor both position and force in real-time. These algorithms are verified through a series of experiments. And it is found that the maximum position and force error are 3mm and 5N respectively when the subject moves at a speed of 20mm/s. Although the performance still needs to be improved to achieve a better system, the robotic system has shown the significant advantage compared with the manual TMS system. Keywords—Transcranial Magnetic Stimulation, Robot arm, Medical system, Calibration, TrackingEThOS - Electronic Theses Online ServiceGBUnited Kingdo

Design of a robotic transcranial magnetic stimulation system

Transcranial Magnetic Stimulation (TMS) is an excellent and non-invasive technique for studying the human brain. Accurate placement of the magnetic coil is required by this technique in order to induce a specific cortical activity. Currently, the coil is manually held in most of stimulation procedures, which does not achieve the precise clinical evaluation of the procedure. This thesis proposes a robotic TMS system to resolve these problems as a robot has excellent locating and holding capabilities. The proposed system can track in real-time the subject’s head position and simultaneously maintain a constant contact force between the coil and the subject’s head so that it does not need to be restrained and thus ensure the accuracy of the stimulation result. Requirements for the robotic TMS system are proposed initially base on analysis of a serial of TMS experiments on real subjects. Both hardware and software design are addressed according to these requirements in this thesis. An optical tracking system is used in the system for guiding and tracking the motion of the robot and inadvertent small movements of the subject’s head. Two methods of coordinate system registration are developed base on DH and Tsai-lenz’s method, and it is found that DH method has an improved accuracy (RMS error is 0.55mm). In addition, the contact force is controlled using a Force/Torque sensor; and a combined position and force tracking controller is applied in the system. This combined controller incorporates the position tracking and conventional gain scheduling force control algorithms to monitor both position and force in real-time. These algorithms are verified through a series of experiments. And it is found that the maximum position and force error are 3mm and 5N respectively when the subject moves at a speed of 20mm/s. Although the performance still needs to be improved to achieve a better system, the robotic system has shown the significant advantage compared with the manual TMS system. Keywords—Transcranial Magnetic Stimulation, Robot arm, Medical system, Calibration, TrackingEThOS - Electronic Theses Online ServiceGBUnited Kingdo