Central neuropathic pain in paraplegia alters movement related potentials

Objectives: Spinal Cord Injured (SCI) persons with and without Central Neuropathic Pain (CNP) show different oscillatory brain activities during imagination of movement. This study investigates whether they also show differences in movement related cortical potentials (MRCP). Methods: SCI paraplegic patients with no CNP (n = 8), with CNP in their lower limbs (n = 8), and healthy control subjects (n = 10) took part in the study. EEG clustering involved independent component analysis, equivalent current dipole fitting, and Measure Projection to define cortical domains that have functional modularity during the motor imagery task. Results: Three domains were identified: limbic system, sensory-motor cortex and visual cortex. The MRCP difference between the groups of SCI with and without CNP was reflected in a domain located in the limbic system, while the difference between SCI patients and control subjects was in the sensorimotor domain. Differences in MRCP morphology between patients and healthy controls were visible for both paralysed and non paralysed limbs. Conclusion: SCI but not CNP affects the movement preparation, and both SCI and CNP affect sensory processes. Significance: Rehabilitation strategies of SCI patients based on MRCP should take into account the presence of CNP

Predicting Upper Limb Motor Impairment Recovery after Stroke: A Mixture Model

Objective: Spontaneous recovery is an important determinant of upper extremity recovery after stroke and has been described by the 70% proportional recovery rule for the Fugl–Meyer motor upper extremity (FM-UE) scale. However, this rule is criticized for overestimating the predictability of FM-UE recovery. Our objectives were to develop a longitudinal mixture model of FM-UE recovery, identify FM-UE recovery subgroups, and internally validate the model predictions. Methods: We developed an exponential recovery function with the following parameters: subgroup assignment probability, proportional recovery coefficient rk, time constant in weeks τk, and distribution of the initial FM-UE scores. We fitted the model to FM-UE measurements of 412 first-ever ischemic stroke patients and cross-validated endpoint predictions and FM-UE recovery cluster assignment. Results: The model distinguished 5 subgroups with different recovery parameters (r1 = 0.09, τ1 = 5.3, r2 = 0.46, τ2 = 10.1, r3 = 0.86, τ3 = 9.8, r4 = 0.89, τ4 = 2.7, r5 = 0.93, τ5 = 1.2). Endpoint FM-UE was predicted with a median absolute error of 4.8 (interquartile range [IQR] = 1.3–12.8) at 1 week poststroke and 4.2 (IQR = 1.3–9.8) at 2 weeks. Overall accuracy of assignment to the poor (subgroup 1), moderate (subgroups 2 and 3), and good (subgroups 4 and 5) FM-UE recovery clusters was 0.79 (95% equal-tailed interval [ETI] = 0.78–0.80) at 1 week poststroke and 0.81 (95% ETI = 0.80–0.82) at 2 weeks. Interpretation: FM-UE recovery reflects different subgroups, each with its own recovery profile. Cross-validation indicates that FM-UE endpoints and FM-UE recovery clusters can be well predicted. Results will contribute to the understanding of upper limb recovery patterns in the first 6 months after stroke. ANN NEUROL 2020

Advanced Statistical Machine Learning Methods for the Analysis of Neurophysiologic Data with Medical Application

Transcranial magnetic stimulation procedures use a magnetic field to carry a short-lasting electrical current pulse into the brain, where it stimulates neurons, particularly in superficial regions of the cerebral cortex. It is a powerfull tool to calculate several parameters related to the intracortical excitability and inhibition of the motor cortex. The cortical silent period (CSP), evoked by magnetic stimulation, corresponds to the suppression of muscle activity for a short period after a muscle response to a magnetic stimulation. The duration of the CSP is paramount to assess intracortical inhibition, and it is known to be correlated with the prognosis of stroke patients’ motor ability. Current mechanisms to estimate the duration of the CSP are mostly based on the analysis of raw electromyographical (EMG) signal and they are very sensitive to the presence of noise. This master thesis is devoted to the analysis of the EMG signal of stroke patients under rehabilitation. The use of advanced statistical machine learning techniques that behave robustly in the presence of noise for this analysis allows us to accurately estimate signal parameters such as the CSP. The research reported in this thesis provides us with a first evidence about their applicability in other areas of neuroscience

Exploring the Landscape of Ubiquitous In-home Health Monitoring: A Comprehensive Survey

Ubiquitous in-home health monitoring systems have become popular in recent years due to the rise of digital health technologies and the growing demand for remote health monitoring. These systems enable individuals to increase their independence by allowing them to monitor their health from the home and by allowing more control over their well-being. In this study, we perform a comprehensive survey on this topic by reviewing a large number of literature in the area. We investigate these systems from various aspects, namely sensing technologies, communication technologies, intelligent and computing systems, and application areas. Specifically, we provide an overview of in-home health monitoring systems and identify their main components. We then present each component and discuss its role within in-home health monitoring systems. In addition, we provide an overview of the practical use of ubiquitous technologies in the home for health monitoring. Finally, we identify the main challenges and limitations based on the existing literature and provide eight recommendations for potential future research directions toward the development of in-home health monitoring systems. We conclude that despite extensive research on various components needed for the development of effective in-home health monitoring systems, the development of effective in-home health monitoring systems still requires further investigation.Comment: 35 pages, 5 figure

Advanced Statistical Machine Learning Methods for the Analysis of Neurophysiologic Data with Medical Application

Transcranial magnetic stimulation procedures use a magnetic field to carry a short-lasting electrical current pulse into the brain, where it stimulates neurons, particularly in superficial regions of the cerebral cortex. It is a powerfull tool to calculate several parameters related to the intracortical excitability and inhibition of the motor cortex. The cortical silent period (CSP), evoked by magnetic stimulation, corresponds to the suppression of muscle activity for a short period after a muscle response to a magnetic stimulation. The duration of the CSP is paramount to assess intracortical inhibition, and it is known to be correlated with the prognosis of stroke patients’ motor ability. Current mechanisms to estimate the duration of the CSP are mostly based on the analysis of raw electromyographical (EMG) signal and they are very sensitive to the presence of noise. This master thesis is devoted to the analysis of the EMG signal of stroke patients under rehabilitation. The use of advanced statistical machine learning techniques that behave robustly in the presence of noise for this analysis allows us to accurately estimate signal parameters such as the CSP. The research reported in this thesis provides us with a first evidence about their applicability in other areas of neuroscience

Assisting Drinking With an Affordable BCI-Controlled Wearable Robot and Electrical Stimulation: A Preliminary Investigation

Background The aim of the present study is to demonstrate, through tests with healthy volunteers, the feasibility of potentially assisting individuals with neurological disorders via a portable assistive technology for the upper extremities (UE). For this purpose the task of independently drinking a glass of water was selected, as it is one of the most basic and vital activities of the daily living that is unfortunately not achievable by individuals severely affected by stroke. Methods To accomplish the aim of this study we introduce a wearable and portable system consisting of a novel lightweight Robotic Arm Orthosis (RAO), a Functional Electrical Stimulation (FES) system, and a simple wireless Brain-Computer Interface (BCI). This system is able to process electroencephalographic (EEG) signals and translate them into motions of the impaired arm. Five healthy volunteers participated in this study and were asked to simulate stroke patient symptoms with no voluntary control of their hand and arm. The setup was designed such as the volitional movements of the healthy volunteers’ UE did not interfere with the evaluation of the proposed assistive system. The drinking task was split into eleven phases of which seven were executed by detecting EEG-based signals through the BCI. The user was asked to imagine UE motion related to the specific phase of the task to be assisted. Once detected by the BCI the phase was initiated. Each phase was then terminated when the BCI detected the volunteers clenching their teeth. Results The drinking task was completed by all five participants with an average time of 127 seconds with a standard deviation of 23 seconds. The incremental motions of elbow extension and elbow flexion were the primary limiting factors for completing this task faster. The BCI control along with the volitional motions also depended upon the users pace, hence the noticeable deviation from the average time. Conclusion Through tests conducted with healthy volunteers, this study showed that our proposed system has the potential for successfully assisting individuals with neurological disorders and hemiparetic stroke to independently drink from a glass

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