Human Ipsilateral Motor Physiology and Neuroprosthetic Applications in Chronic Stroke

Improving the recovery of lost motor function in hemiplegic chronic stroke survivors is a critical need to improve the lives of these patients. Over the last several decades, neuroprosthetic systems have emerged as novel tools with the potential to restore function in a variety of patient populations. While traditional neuroprosthetics have focused on using neural activity contralateral to a moving limb for device control, an alternative control signal may be necessary to develop brain-computer interface (BCI) systems in stroke survivors that suffer damage to the cortical hemisphere contralateral to the affected limb. While movement-related neural activity also occurs in the hemisphere ipsilateral to a moving limb, it is uncertain if these signals can be used within BCI systems. This dissertation examines the motor activity ipsilateral to a moving limb and the potential use of these signals for neuroprosthetic applications in chronic stroke survivors. Patients performed three-dimensional (3D) reaching movements with the arm ipsilateral to an electrocorticography (ECoG) array in order to assess the extent of kinematic information that can be decoded from the cortex ipsilateral to a moving limb. Additionally, patients performed the same task with the arm contralateral to the same ECoG arrays, allowing us to compare the neural representations of contralateral and ipsilateral limb movements. While spectral power changes related to ipsilateral arm movements begin later and are lower in amplitude than power changes related to contralateral arm movements, 3D kinematics from both contralateral and ipsilateral arm trajectories can be decoded with similar accuracies. The ability to decode movement kinematics from the ipsilateral cortical hemisphere demonstrates the potential to use these signals within BCI applications for controlling multiple degrees of freedom. Next we examined the relationship between electrode invasiveness and signal quality. The ability to decode movement kinematics from neural activity was significantly decreased in simulated electroencephalography (EEG) signals relative to ECoG signals, indicating that invasive signals would be necessary to implement BCI systems with multiple degrees of freedom. For ECoG signals, the human dura also causes a significant decrease in signal quality when electrodes with small spatial sizes are used. This tradeoff between signal quality and electrode invasiveness should therefore be taken into account when designing ECoG BCI systems. Finally, chronic stroke survivors used activity associated with affected hand motor intentions, recorded from their unaffected hemisphere using EEG, to control simple BCI systems. This demonstrates that motor signals from the ipsilateral hemisphere are viable for BCI applications, not only in motor-intact patients, but also in chronic stroke survivors. Taken together, these experiments provide initial demonstrations that it is possible to develop BCI systems using the unaffected hemisphere in stroke survivors with multiple degrees of freedom. Further development of these BCI systems may eventually lead to improving function for a significant population of patients

Association between lesion location and sensorimotor rhythms in stroke - a systematic review with narrative synthesis

BACKGROUND: Stroke causes alterations in the sensorimotor rhythms (SMRs) of the brain. However, little is known about the influence of lesion location on the SMRs. Understanding this relationship is relevant for the use of SMRs in assistive and rehabilitative therapies, such as Brain-Computer Interfaces (BCIs).. METHODS: We reviewed current evidence on the association between stroke lesion location and SMRs through systematically searching PubMed and Embase and generated a narrative synthesis of findings. RESULTS: We included 12 articles reporting on 161 patients. In resting-state studies, cortical and pontine damage were related to an overall decrease in alpha (∼8-12 Hz) and increase in delta (∼1-4 Hz) power. In movement paradigm studies, attenuated alpha and beta (∼15-25 Hz) event-related desynchronization (ERD) was shown in stroke patients during (attempted) paretic hand movement, compared to controls. Stronger reductions in alpha and beta ERD in the ipsilesional, compared to contralesional hemisphere, were observed for cortical lesions. Subcortical stroke was found to affect bilateral ERD and ERS, but results were highly variable. CONCLUSIONS: Findings suggest a link between stroke lesion location and SMR alterations, but heterogeneity across studies and limited lesion location descriptions precluded a meta-analysis. SIGNIFICANCE: Future research would benefit from more uniformly defined outcome measures, homogeneous methodologies, and improved lesion location reporting

Rehabilitation of gait after stroke: a review towards a top-down approach

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity

柔軟な両腕運動制御を実現する計算論的神経機構

学位の種別:課程博士University of Tokyo(東京大学

Brain-Machine Interface for Reaching: Accounting for Target Size, Multiple Motor Plans, and Bimanual Coordination

<p>Brain-machine interfaces (BMIs) offer the potential to assist millions of people worldwide suffering from immobility due to loss of limbs, paralysis, and neurodegenerative diseases. BMIs function by decoding neural activity from intact cortical brain regions in order to control external devices in real-time. While there has been exciting progress in the field over the past 15 years, the vast majority of the work has focused on restoring of motor function of a single limb. In the work presented in this thesis, I first investigate the expanded role of primary sensory (S1) and motor (M1) cortex during reaching movements. By varying target size during reaching movements, I discovered the cortical correlates of the speed-accuracy tradeoff known as Fitts' law. Similarly, I analyzed cortical motor processing during tasks where the motor plan is quickly reprogrammed. In each study, I found that parameters relevant to the reach, such as target size or alternative movement plans, could be extracted by neural decoders in addition to simple kinematic parameters such as velocity and position. As such, future BMI functionality could expand to account for relevant sensory information and reliably decode intended reach trajectories, even amidst transiently considered alternatives.</p><p> The second portion of my thesis work was the successful development of the first bimanual brain-machine interface. To reach this goal, I expanded the neural recordings system to enable bilateral, multi-site recordings from approximately 500 neurons simultaneously. In addition, I upgraded the experiment to feature a realistic virtual reality end effector, customized primate chair, and eye tracking system. Thirdly, I modified the tuning function of the unscented Kalman filter (UKF) to conjointly represent both arms in a single 4D model. As a result of widespread cortical plasticity in M1, S1, supplementary motor area (SMA), and posterior parietal cortex (PPC), the bimanual BMI enabled rhesus monkeys to simultaneously control two virtual limbs without any movement of their own body. I demonstrate the efficacy of the bimanual BMI in both a subject with prior task training using joysticks and a subject naïve to the task altogether, which simulates a common clinical scenario. The neural decoding algorithm was selected as a result of a methodical comparison between various neural decoders and decoder settings. I lastly introduce a two-stage switching model with a classify step and predict step which was designed and tested to generalize decoding strategies to include both unimanual and bimanual movements.</p>Dissertatio

Interictal Network Dynamics in Paediatric Epilepsy Surgery

Epilepsy is an archetypal brain network disorder. Despite two decades of research elucidating network mechanisms of disease and correlating these with outcomes, the clinical management of children with epilepsy does not readily integrate network concepts. For example, network measures are not used in presurgical evaluation to guide decision making or surgical management plans. The aim of this thesis was to investigate novel network frameworks from the perspective of a clinician, with the explicit aim of finding measures that may be clinically useful and translatable to directly benefit patient care. We examined networks at three different scales, namely macro (whole brain diffusion MRI), meso (subnetworks from SEEG recordings) and micro (single unit networks) scales, consistently finding network abnormalities in children being evaluated for or undergoing epilepsy surgery. This work also provides a path to clinical translation, using frameworks such as IDEAL to robustly assess the impact of these new technologies on management and outcomes. The thesis sets up a platform from which promising computational technology, that utilises brain network analyses, can be readily translated to benefit patient care

Development of A Versatile Multichannel CWNIRS Instrument for Optical Brain-Computer Interface Applications

This thesis describes the design, development, and implementation of a versatile multichannel continuous-wave near-infrared spectroscopy (CWNIRS) instrument for brain-computer interface (BCI) applications. Specifically, it was of interest to assess what gains could be achieved by using a multichannel device compared to the single channel device implemented by Coyle in 2004. Moreover, the multichannel approach allows for the assessment of localisation of functional tasks in the cerebral cortex, and can identify lateralisation of haemodynamic responses to motor events. The approach taken to extend single channel to multichannel was based on a software-controlled interface. This interface allowed flexibility in the control of individual optodes including their synchronisation and modulation (AM, TDM, CDMA). Furthermore, an LED driver was developed for custom-made triple-wavelength LEDs. The system was commissioned using a series of experiments to verify the performance of individual components in the system. The system was then used to carry out a set of functional studies including motor imagery and cognitive tasks. The experimental protocols based on motor imagery and overt motor tasks were verified by comparison with fMRI. The multichannel approach identified stroke rehabilitation as a new application area for optical BCI. In addition, concentration changes in deoxyhaemoglobin were identified as being a more localised indicator of functional activity, which is important for effective BCI design. An assessment was made on the effect of the duration of the stimulus period on the haemodynamic signals. This demonstrated the possible benefits of using a shorter stimulus period to reduce the adverse affects of low blood pressure oscillations. i

Development of A Versatile Multichannel CWNIRS Instrument for Optical Brain-Computer Interface Applications

This thesis describes the design, development, and implementation of a versatile multichannel continuous-wave near-infrared spectroscopy (CWNIRS) instrument for brain-computer interface (BCI) applications. Specifically, it was of interest to assess what gains could be achieved by using a multichannel device compared to the single channel device implemented by Coyle in 2004. Moreover, the multichannel approach allows for the assessment of localisation of functional tasks in the cerebral cortex, and can identify lateralisation of haemodynamic responses to motor events. The approach taken to extend single channel to multichannel was based on a software-controlled interface. This interface allowed flexibility in the control of individual optodes including their synchronisation and modulation (AM, TDM, CDMA). Furthermore, an LED driver was developed for custom-made triple-wavelength LEDs. The system was commissioned using a series of experiments to verify the performance of individual components in the system. The system was then used to carry out a set of functional studies including motor imagery and cognitive tasks. The experimental protocols based on motor imagery and overt motor tasks were verified by comparison with fMRI. The multichannel approach identified stroke rehabilitation as a new application area for optical BCI. In addition, concentration changes in deoxyhaemoglobin were identified as being a more localised indicator of functional activity, which is important for effective BCI design. An assessment was made on the effect of the duration of the stimulus period on the haemodynamic signals. This demonstrated the possible benefits of using a shorter stimulus period to reduce the adverse affects of low blood pressure oscillations. i