Neuromodulation and rehabilitation with brain-computer interfaces and Spinal Cord Stimulation

Consequences of spinal cord injury (SCI) are often severe and life-altering. Recovery of hand and arm function is consistently reported by SCI individuals as their greatest priority in terms of rehabilitation. Yet current strategies provide poor-to-modest outcomes. Innovation is required to improve traditional approaches to upper limb rehabilitation. The current view is that, due to the multi-faceted nature of SCI pathology, effective treatment will take a combinational approach. This thesis brings together two emerging and promising technologies—transcutaneous spinal cord stimulation (tSCS) and brain-computer interfaces (BCIs)—in order to judge their complimentary nature as tools for neurophysiological assessment and rehabilitation following SCI. There is growing evidence that cervical tSCS combined with intensive physical training can lead to lasting functional improvements in individuals with chronic SCI. The mechanisms underpinning tSCS-facilitated recovery, however, are still a matter of ongoing research, with conflicting reports of the impact of tSCS on cortical and spinal excitability. Evoked and reflexes have so far been the primary method of quantifying corticospinal excitability. The research undertaken in this thesis first explores electroencephalography (EEG) as a potential complementary method for assessing neuromodulation following tSCS. Due the novelty of the research, a preliminary investigation was undertaken to establish the feasibility of EEG monitoring during cervical tSCS. In a cohort of twenty-one able-bodied individuals, it was demonstrated that tSCS presented as low-latency, high-amplitude artefacts in EEG time series, at a rate equal to the stimulation frequency. Descriptive statistics were used to characterise the impact of tSCS, and judge the effectiveness of noise-attenuation techniques. Results showed that, with artefact-suppression, EEG recorded during tSCS could be returned to levels statistically similar to that of EEG acquired without tSCS interference. Additionally, it was established that neural components, such as the individual alpha frequency, were recoverable, demonstrating the feasibility of EEG as a tool for tracking cortical activity during tSCS. A subsequent study was conducted to investigate the neuromodulatory potential of tSCS on cortical activity. EEG was recorded during upper limb movements in 30 individuals both with and without concurrent cervical tSCS. Stimulation was delivered to the cervical region of the neck at intensities matching the individual’s highest tolerance without causing pain. It was found that cortical oscillatory dynamics were unaffected over a cohort of neurologically intact participants. However, a weak inhibitory effect was measured amoing individuals who received the highest stimulation intensities. A final study was devised to explore the potential of movement priming for tSCS-facilitated upper limb therapy in an individual with chronic AIS A cervical SCI. Movement priming was achieved by encouraging the participant to engage in repetitive bimanual hand movements with respect to their sensorimotor cortical activity as measured with EEG. A BCI provided real time feedback of the participant’s motor engagement in the form of a computer game, allowing them to actively engage regardless of impairment level. The participant first underwent an initial phase of 15 sessions of tSCS training alone followed by a second phase of 15 sessions of BCI priming and tSCS training. The participant’s strength and dexterity improved across both phases of the study. BCI priming may have contributed to an enhanced effect in some measures such as improved bilateral finger strength, but due to mixed results across functional measures no firm conclusions can be drawn. Nevertheless, the functional improvements lend greater credibility to cervical tSCS as a strategy for upper limb rehabilitation

A decision tool for radiographer-led abdominal image-guided stereotactic ablative body radiotherapy – Experience from a single institution

A decision tool for radiographer-led image-guided radiotherapy (IGRT) using cone-beam CT (CBCT) for abdominal stereotactic radiotherapy was developed and successfully implemented in a single department. The confidence of 7 therapeutic radiographers when undertaking online CBCT review increased, and the pooled median online match time was reduced by 1 m 8 s. While this may be advantageous for abdominal SABR, further evaluation of this work in a larger cohort is required to validate these results

EEG correlates of self-managed neurofeedback treatment of central neuropathic pain in chronic spinal cord injury

Background: Neurofeedback (NFB) is a neuromodulatory technique that enables voluntary modulation of brain activity in order to treat neurological condition, such as central neuropathic pain (CNP). A distinctive feature of this technique is that it actively involves participants in the therapy. In this feasibility study, we present results of participant self-managed NFB treatment of CNP. Methods: Fifteen chronic spinal cord injured (SCI) participants (13M, 2F), with chronic CNP equal or greater than 4 on the Visual Numeric Scale, took part in the study. After initial training in hospital (up to 4 sessions), they practiced NF at home, on average 2–3 times a week, over a period of several weeks (min 4, max 20). The NFB protocol consisted of upregulating the alpha (9–12 Hz) and downregulating the theta (4–8 Hz) and the higher beta band (20–30 Hz) power from electrode location C4, for 30 min. The output measures were pain before and after NFB, EEG before and during NFB and pain questionnaires. We analyzed EEG results and show NFB strategies based on the Power Spectrum Density of each single participant. Results: Twelve participants achieved statistically significant reduction in pain and in eight participants this reduction was clinically significant (larger than 30%). The most successfully regulated frequency band during NFB was alpha. However, most participants upregulated their individual alpha band, that had an average dominant frequency at αp = 7.6 ± 0.8 Hz (median 8 Hz) that is lower than the average of the general population, which is around 10 Hz. Ten out of fifteen participants significantly upregulated their individual alpha power (αp ± 2 Hz) as compared to 4 participants who upregulated the power in the fixed alpha band (8–12 Hz). Eight out of the twelve participants who achieved a significant reduction of pain, significantly upregulated their individual alpha band power. There was a significantly larger increase in alpha power (p < 0.0001) and decrease of theta power (p < 0.04) in participant specific rather than in fixed frequency bands. Conclusion: Neurofeedback is a neuromodulatory technique that gives participants control over their pain and can be self-administered at home. Regulation of individual frequency band was related to a significant reduction in pain

Morphology of the canine omentum, part 1: arterial landmarks that define the omentum

Although the omentum remains an enigmatic organ, research during the last decades has revealed its fascinating functions including fat storage, fluid drainage, immune activity, angiogenesis and adhesion. While clinicians both in human and veterinary medicine are continuously exploring new potential omental applications, detailed anatomical data on the canine omentum are currently lacking, and information is often retrieved from human medicine. In this study, the topographic anatomy of the canine greater and lesser omentum is explored in depth. Current nomenclature is challenged, and a more detailed terminology is proposed. Consistent arteries that are contained within folds of the superficial omental wall are documented, described and named, as they can provide the anatomical landmarks that are necessary for unambiguous scientific communication on the canine omentum. In an included dissection video, the conclusions and in situ findings described in this study are demonstrated

Effect of cervical transcutaneous spinal cord stimulation on sensorimotor cortical activity during upper-limb movements in healthy individuals

Transcutaneous spinal cord stimulation (tSCS) can improve upper-limb motor function after spinal cord injury. A number of studies have attempted to deduce the corticospinal mechanisms which are modulated following tSCS, with many relying on transcranial magnetic stimulation to provide measures of corticospinal excitability. Other metrics, such as cortical oscillations, may provide an alternative and complementary perspective on the physiological effect of tSCS. Hence, the present study recorded EEG from 30 healthy volunteers to investigate if and how cortical oscillatory dynamics are altered by 10 min of continuous cervical tSCS. Participants performed repetitive upper-limb movements and resting-state tasks while tSCS was delivered to the posterior side of the neck as EEG was recorded simultaneously. The intensity of tSCS was tailored to each participant based on their maximum tolerance (mean: 50 ± 20 mA). A control session was conducted without tSCS. Changes to sensorimotor cortical activity during movement were quantified in terms of event-related (de)synchronisation (ERD/ERS). Our analysis revealed that, on a group level, there was no consistency in terms of the direction of ERD modulation during tSCS, nor was there a dose-effect between tSCS and ERD/ERS. Resting-state oscillatory power was compared before and after tSCS but no statistically significant difference was found in terms of alpha peak frequency or alpha power. However, participants who received the highest stimulation intensities had significantly weakened ERD/ERS (10% ERS) compared to when tSCS was not applied (25% ERD; p = 0.016), suggestive of cortical inhibition. Overall, our results demonstrated that a single 10 min session of tSCS delivered to the cervical region of the spine was not sufficient to induce consistent changes in sensorimotor cortical activity among the entire cohort. However, under high intensities there may be an inhibitory effect at the cortical level. Future work should investigate, with a larger sample size, the effect of session duration and tSCS intensity on cortical oscillations

Chlorinated Pool Attendance, Atopy, and the Risk of Asthma during Childhood

The pool chlorine hypothesis postulates that the rise in childhood asthma in the developed world could result at least partly from the increasing exposure of children to toxic gases and aerosols contaminating the air of indoor chlorinated pools. To further assess this hypothesis, we explored the relationships between childhood asthma, atopy, and cumulated pool attendance (CPA). We studied 341 schoolchildren 10–13 years of age who attended at a variable rate the same public pool in Brussels (trichloramine in air, 0.3–0.5 mg/m(3)). Examination of the children included a questionnaire, an exercise-induced bronchoconstriction (EIB) test, and the measurement of exhaled nitric oxide (eNO) and total and aeroallergen-specific serum IgE. CPA by children (range, 0–1,818 hr) emerged among the most consistent predictors of asthma (doctor diagnosed or screened with the EIB test) and of elevated eNO, ranking immediately after atopy and family history of asthma or hay fever. Although the risk of elevated eNO increased with CPA [odds ratio (OR) = 1.30; 95% confidence interval (CI), 1.10–1.43] independently of total or specific serum IgE, the probability of developing asthma increased with CPA only in children with serum IgE > 100 kIU/L (OR for each 100-hr increase in CPA = 1.79; 95% CI, 1.07–2.72). All these effects were dose related and most strongly linked to pool attendance before 6–7 years of age. Use of indoor chlorinated pools especially by young children interacts with atopic status to promote the development of childhood asthma. These findings further support the hypothesis implicating pool chlorine in the rise of childhood asthma in industrialized countries

CV17018

This report provides the main results of the 2017 underwater television survey on the ‘Labadie, Jones and Cockburn Banks’ ICES assessment area; Functional Unit 20-21. This was the fourth survey to achieve full coverage of the full area. The 2017 survey was multi-disciplinary in nature collecting UWTV, CTD and other ecosystem data. A total of 86 UWTV stations were completed at 6 nmi intervals over a randomised isometric grid design. The mean burrow density was 0.44 burrows/m2 compared with 0.18 burrows/m2 in 2016. The 2017 geostatistical abundance estimate was 4.4±0.01 billion a 236% increase on the abundance for 2016 with a CV of 4% which is well below the upper limit of 20% recommended by SGNEPS 2012. Highest densities were generally observed throughout the ground, and there were also high densities observed close to boundaries. Using the 2017 abundance estimate and updated stock data implies catch of 8,673 tonnes and landings of 6,553 tonnes in 2018 when MSY approach is applied (assuming that discard rates and fishery selection patterns do not change from the average of 2014–2016). One species of sea-pen were recorded as present at the stations surveyed Virgilaria mirabilis. Trawl marks were observed at 32% of the stations surveyed

Massive Empyema Associated With Transient Hypogammaglobulinemia of Infancy and IgA Deficiency

Transient hypogammaglobulinemia of infancy (THI) is originally defined as a physiological maturation defect of immunoglobulin G (IgG) production that occurs at 3-6 months of age and lasts until 18 to 36 months of age. We report here on a 22-month-old child with THI and IgA deficiency, who had massive pneumococcal empyema. Her depressed IgG level returned to normal within 6 months, but IgA level was still low at 6 yr of age. Although THI is an age-dependent and self-limiting disorder, severe infection that includes an atypical presentation of an infection may occur in some patients and this requires evaluation with immunologic study