Children with cerebral palsy have altered oscillatory activity in the motor and visual cortices during a knee motor task

Affective touch enhances low gamma activity during hand proprioceptive perception in children with different neurodevelopmental conditions

Background

Gamma wave activity in the sensorimotor cortex is a critical neural mechanism associated with proprioceptive processing, which is essential for motor coordination, balance, and spatial orientation. The modulation of gamma oscillations by different types of tactile stimuli, including affective touch, is not well understood, particularly in children with neurodevelopmental disorders such as cerebral palsy and autism spectrum disorder.

Aims

This study aims to explore how affective touch influences gamma oscillatory activity and proprioceptive performance in children with typical development, cerebral palsy and autism spectrum disorders.

Methods and procedures

EEG data were recorded from participants during passive wrist mobilizations under three conditions: following an affective touch stimulus, after a non-affective touch stimulus, and with no tactile stimulation. Time-frequency analysis of low gamma activity (30-45 Hz) on the left somatosensory cortex was conducted for each condition. Proprioceptive performance was assessed through participants' accuracy in identifying wrist positions. Proprioception and pleasantness of affective and non-affective touch were also assessed.

Results

Affective touch increased proprioceptive gamma power density. Children with cerebral palsy had poorer proprioception and higher brain gamma power density for processing movement than children with typical development or autism, and their proprioception worsened with non-affective touch.

Conclusion and implications

These findings highlight the potential of affective touch to modulate gamma oscillatory activity and enhance proprioceptive function, particularly in children with cerebral palsy. The results underscore the importance of incorporating emotionally meaningful sensory inputs in therapeutic interventions to support proprioceptive and motor function in children with neurodevelopmental disorders.

Magnetoencephalography for the pediatric population, indications, acquisition and interpretation for the clinician

Magnetoencephalography (MEG) is an imaging technique that enables the assessment of cortical activity via direct measures of neurophysiology. It is a non-invasive and passive technique that is completely painless. MEG has gained increasing prominence in the field of pediatric neuroimaging. This dedicated review article for the pediatric population summarizes the fundamental technical and clinical aspects of MEG for the clinician. We discuss methods tailored for children to improve data quality, including child-friendly MEG facility environments and strategies to mitigate motion artifacts. We provide an in-depth overview on accurate localization of neural sources and different analysis methods, as well as data interpretation. The contemporary platforms and approaches of two quaternary pediatric referral centers are illustrated, shedding light on practical implementations in clinical settings. Finally, we describe the expanding clinical applications of MEG, including its pivotal role in presurgical evaluation of epilepsy patients, presurgical mapping of eloquent cortices (somatosensory and motor cortices, visual and auditory cortices, lateralization of language), its emerging relevance in autism spectrum disorder research and potential future clinical applications, and its utility in assessing mild traumatic brain injury. In conclusion, this review serves as a comprehensive resource of clinicians as well as researchers, offering insights into the evolving landscape of pediatric MEG. It discusses the importance of technical advancements, data acquisition strategies, and expanding clinical applications in harnessing the full potential of MEG to study neurological conditions in the pediatric population.

Motor practice related changes in the sensorimotor cortices of youth with cerebral palsy

The altered sensorimotor cortical dynamics seen in youth with cerebral palsy appear to be tightly coupled with their motor performance errors and uncharacteristic mobility. Very few investigations have used these cortical dynamics as potential biomarkers to predict the extent of the motor performance changes that might be seen after physical therapy or in the design of new therapeutic interventions that target a youth's specific neurophysiological deficits. This cohort investigation was directed at evaluating the practice dependent changes in the sensorimotor cortical oscillations exhibited by youth with cerebral palsy as a step towards addressing this gap. We used magnetoencephalography to image the changes in the cortical oscillations before and after youth with cerebral palsy (N = 25; age = 15.2 ± 4.5 years; Gross Motor Function Classification Score Levels I-III) and neurotypical controls (N = 18; age = 14.6 ± 3.1 years) practiced a knee extension isometric target-matching task. Subsequently, structural equation modelling was used to assess the multivariate relationship between changes in beta (16-22 Hz) and gamma (66-82 Hz) oscillations and the motor performance after practice. The structural equation modelling results suggested youth with cerebral palsy who had a faster reaction time after practice tended to also have a stronger peri-movement beta oscillation in the sensorimotor cortices following practicing. The stronger beta oscillations were inferred to reflect greater certainty in the selected motor plan. The models also indicated that youth with cerebral palsy who overshot the targets less and matched the targets sooner tended to have a stronger execution-related gamma response in the sensorimotor cortices after practice. This stronger gamma response may represent improve activation of the sensorimotor neural generators and/or alterations in the GABAergic interneuron inhibitory-excitatory dynamics. These novel neurophysiological results provide a window on the potential neurological changes governing the practice-related outcomes in the context of the physical therapy.

Alpha oscillations during visual selective attention are aberrant in youth and adults with cerebral palsy

Our understanding of the neurobiology underlying cognitive dysfunction in persons with cerebral palsy is very limited, especially in the neurocognitive domain of visual selective attention. This investigation utilized magnetoencephalography and an Eriksen arrow-based flanker task to quantify the dynamics underlying selective attention in a cohort of youth and adults with cerebral palsy (n = 31; age range = 9 to 47 yr) and neurotypical controls (n = 38; age range = 11 to 49 yr). The magnetoencephalography data were transformed into the time-frequency domain to identify neural oscillatory responses and imaged using a beamforming approach. The behavioral results indicated that all participants exhibited a flanker effect (greater response time for the incongruent compared to congruent condition) and that individuals with cerebral palsy were slower and less accurate during task performance. We computed interference maps to focus on the attentional component and found aberrant alpha (8 to 14 Hz) oscillations in the right primary visual cortices in the group with cerebral palsy. Alpha and theta (4 to 7 Hz) oscillations were also seen in the left and right insula, and these oscillations varied with age across all participants. Overall, persons with cerebral palsy exhibit deficiencies in the cortical dynamics serving visual selective attention, but these aberrations do not appear to be uniquely affected by age.

Adults with cerebral palsy exhibit uncharacteristic cortical oscillations during an adaptive sensorimotor control task

Prior research has shown that the sensorimotor cortical oscillations are uncharacteristic in persons with cerebral palsy (CP); however, it is unknown if these altered cortical oscillations have an impact on adaptive sensorimotor control. This investigation evaluated the cortical dynamics when the motor action needs to be changed "on-the-fly". Adults with CP and neurotypical controls completed a sensorimotor task that required either proactive or reactive control while undergoing magnetoencephalography (MEG). When compared with the controls, the adults with CP had a weaker beta (18-24 Hz) event-related desynchronization (ERD), post-movement beta rebound (PMBR, 16-20 Hz) and theta (4-6 Hz) event-related synchronization (ERS) in the sensorimotor cortices. In agreement with normative work, the controls exhibited differences in the strength of the sensorimotor gamma (66-84 Hz) ERS during proactive compared to reactive trials, but similar condition-wise changes were not seen in adults with CP. Lastly, the adults with CP who had a stronger theta ERS tended to have better hand dexterity, as indicated by the Box and Blocks Test and Purdue Pegboard Test. These results may suggest that alterations in the theta and gamma cortical oscillations play a role in the altered hand dexterity and uncharacteristic adaptive sensorimotor control noted in adults with CP.

Disruption of Sensorimotor Cortical Oscillations by Visual Interference Predicts the Altered Motor Performance of Persons with Cerebral Palsy

Emerging evidence indicates that aberrations in sensorimotor cortical oscillations likely play a key role in uncharacteristic motor actions seen in cerebral palsy. This interpretation is largely centered on the assumption that the aberrant cortical oscillations primarily reflect the motor aspects, with less consideration of possible higher-order cognitive connections. To directly probe this view, we examined the impact of cognitive interference on the sensorimotor cortical oscillations seen in persons with cerebral palsy using magnetoencephalography. Persons with cerebral palsy (N = 26, 9-47 years old) and controls (N = 46, 11-49 years) underwent magnetoencephalographic imaging while completing an arrow-based version of the Eriksen flanker task. Structural equation modeling was used to evaluate the relationship between the extent of interference generated by the flanker task and the strength of the sensorimotor cortical oscillations and motor performance. Our results indicated that the impact of cognitive interference on beta and gamma oscillations moderated the interference effect on reaction times in persons with cerebral palsy, above and beyond that seen in controls. Overall, these findings suggest that alterations in sensorimotor oscillatory activity in those with cerebral palsy at least partly reflects top-down control influences on the motor system. Thus, suppression of distracting stimuli should be a consideration when evaluating altered motor actions in cerebral palsy.

Altered excitation-inhibition balance in the primary sensorimotor cortex to proprioceptive hand stimulation in cerebral palsy

OBJECTIVE

Our objective was to clarify the primary sensorimotor (SM1) cortex excitatory and inhibitory alterations in hemiplegic (HP) and diplegic (DP) cerebral palsy (CP) by quantifying SM1 cortex beta power suppression and rebound with magnetoencephalography (MEG).

METHODS

MEG was recorded from 16 HP and 12 DP adolescents, and their 32 healthy controls during proprioceptive stimulation of the index fingers evoked by a movement actuator. The related beta power changes were computed with Temporal Spectral Evolution (TSE). Peak strengths of beta suppression and rebound were determined from representative channels over the SM1 cortex.

RESULTS

Beta suppression was stronger contralateral to the stimulus and rebound was weaker ipsilateral to the stimulation in DP compared to controls. Beta modulation strengths did not differ significantly between HP and the control group.

CONCLUSIONS

The emphasized beta suppression in DP suggests less efficient proprioceptive processing in the SM1 contralateral to the stimulation. Their weak rebound further indicates reduced intra- and/or interhemispheric cortical inhibition, which is a potential neuronal mechanism for their bilateral motor impairments.

SIGNIFICANCE

The excitation-inhibition balance of the SM1 cortex related to proprioception is impaired in diplegic CP. Therefore, the cortical and behavioral proprioceptive deficits should be better diagnosed and considered to better target individualized effective rehabilitation in CP.

Investigation of brain mechanisms underlying upper limb function in bilateral cerebral palsy using EEG

OBJECTIVE

Few studies focus on upper limbs in bilateral cerebral palsy (CP) despite potential bimanual deficits. Electroencephalography (EEG) was utilized to investigate brain mechanisms underlying upper limb tasks in bilateral CP and typical development (TD) and relationships to function.

METHODS

26 (14 CP; 12 TD) completed the Box and Blocks Test and transport task with paper, sponge or mixed blocks, while recording EEG and motion data.

RESULTS

Group effects for path time, path length and Box and Blocks Test revealed bimanual deficits. Four sensorimotor-related EEG clusters were identified. Group effects were found in premotor and dominant motor clusters with greater beta event-related desynchronization (ERD) in CP. Hand and hand by group effects were found in the dominant motor cluster, showing greater ERD with the more affected hand in CP. Condition effects were prominent in the posterior parietal cluster with higher ERD reflecting greater difficulty in force modulation.

CONCLUSIONS

Higher brain activation associated with greater bimanual deficits is similar to our lower limb findings but contrasts studies in TD or unilateral CP linking higher ERD to greater proficiency.

SIGNIFICANCE

Bilateral CP shows overreliance on the dominant hemisphere with the less functional hand and higher brain activity presumably related to excessive intracortical connectivity.

Spontaneous beta power, motor-related beta power and cortical thickness in major depressive disorder with psychomotor disturbance

INTRODUCTION

The psychomotor disturbance is a common symptom in patients with major depressive disorder (MDD). The neurological mechanisms of psychomotor disturbance are intricate, involving alterations in the structure and function of motor-related regions. However, the relationship among changes in the spontaneous activity, motor-related activity, local cortical thickness, and psychomotor function remains unclear.

METHOD

A total of 140 patients with MDD and 68 healthy controls performed a simple right-hand visuomotor task during magnetoencephalography (MEG) scanning. All patients were divided into two groups according to the presence of psychomotor slowing. Spontaneous beta power, movement-related beta desynchronization (MRBD), absolute beta power during movement and cortical characteristics in the bilateral primary motor cortex were compared using general linear models with the group as a fixed effect and age as a covariate. Finally, the moderated mediation model was tested to examine the relationship between brain metrics with group differences and psychomotor performance.

RESULTS

The patients with psychomotor slowing showed higher spontaneous beta power, movement-related beta desynchronization and absolute beta power during movement than patients without psychomotor slowing. Compared with the other two groups, significant decreases were found in cortical thickness of the left primary motor cortex in patients with psychomotor slowing. Our moderated mediation model showed that the increased spontaneous beta power indirectly affected impaired psychomotor performance by abnormal MRBD, and the indirect effects were moderated by cortical thickness.

CONCLUSION

These results suggest that patients with MDD have aberrant cortical beta activity at rest and during movement, combined with abnormal cortical thickness, contributing to the psychomotor disturbance observed in this patient population.

An integrated perspective for the diagnosis and therapy of neurodevelopmental disorders - From an engineering point of view

Neurodevelopmental disorders (NDDs) are complex conditions with largely unknown pathophysiology. While many NDD symptoms are familiar, the cause of these disorders remains unclear and may involve a combination of genetic, biological, psychosocial, and environmental risk factors. Current diagnosis relies heavily on behaviorally defined criteria, which may be biased by the clinical team's professional and cultural expectations, thus a push for new biological-based biomarkers for NDDs diagnosis is underway. Emerging new research technologies offer an unprecedented view into the electrical, chemical, and physiological activity in the brain and with further development in humans may provide clinically relevant diagnoses. These could also be extended to new treatment options, which can start to address the underlying physiological issues. When combined with current speech, language, occupational therapy, and pharmacological treatment these could greatly improve patient outcomes. The current review will discuss the latest technologies that are being used or may be used for NDDs diagnosis and treatment. The aim is to provide an inspiring and forward-looking view for future research in the field.

Movement-related beta ERD and ERS abnormalities in neuropsychiatric disorders

Movement-related oscillations in the beta range (from 13 to 30 Hz) have been observed over sensorimotor areas with power decrease (i.e., event-related desynchronization, ERD) during motor planning and execution followed by an increase (i.e., event-related synchronization, ERS) after the movement's end. These phenomena occur during active, passive, imaged, and observed movements. Several electrophysiology studies have used beta ERD and ERS as functional indices of sensorimotor integrity, primarily in diseases affecting the motor system. Recent literature also highlights other characteristics of beta ERD and ERS, implying their role in processes not strictly related to motor function. Here we review studies about movement-related ERD and ERS in diseases characterized by motor dysfunction, including Parkinson's disease, dystonia, stroke, amyotrophic lateral sclerosis, cerebral palsy, and multiple sclerosis. We also review changes of beta ERD and ERS reported in physiological aging, Alzheimer's disease, and schizophrenia, three conditions without overt motor symptoms. The review of these works shows that ERD and ERS abnormalities are present across the spectrum of the examined pathologies as well as development and aging. They further suggest that cognition and movement are tightly related processes that may share common mechanisms regulated by beta modulation. Future studies with a multimodal approach are warranted to understand not only the specific topographical dynamics of movement-related beta modulation but also the general meaning of beta frequency changes occurring in relation to movement and cognitive processes at large. Such an approach will provide the foundation to devise and implement novel therapeutic approaches to neuropsychiatric disorders.

Simulation Analysis and Study of Gait Stability Related to Motion Joints

Gait stability in exercise is an inevitable and vexing problem in mechanics, artificial intelligence, sports, and rehabilitation medicine research. With the rapid development and popularization of science and technology, it becomes a reality for researchers to obtain large-scale human motion data sets in real time with higher efficiency. However, at present, the analysis of gait stability of moving joints is still based on image recognition technology, which is ten times less accurate and inefficient. In this paper, Vicon 3D motion capture system, dynamometer, and surface electromyography system were used to obtain the parameters of the lower limbs of the subjects. Using Anywhere modeling and simulation system, simulation experiments were carried out, and the reaction force data of lower limb joints under two environments were obtained. The gait characteristics of human gait were analyzed from the angle of internal and external adjustment mechanism. Combining one-way ANOVA and incremental occupancy rate, the adjustment process of gait stability is described comprehensively. The findings of this study can provide a theoretical basis for the research of lower limb con-assistive devices and can guide the design and development of bipedal anthropomorphic robots.

A MEG compatible, interactive IR game paradigm for the study of visuomotor reach-to-target movements in young children and clinical populations: The Target-Touch Motor Task

BACKGROUND

The conventional focus on discrete finger movements (i.e., index finger flexion or button-box key presses) has been an effective method to study neuromotor control using magnetoencephalography (MEG). However, this approach is challenging for young children and not possible for some people with physical disability.

NEW METHOD

We have developed a novel, interactive MEG compatible reach-to-target task to investigate neuromotor function, specifically for use with young children. We used an infrared touch-screen frame to detect responses to targets presented using custom software. The game can be played using a conventional computer monitor or during MEG recordings via projector. We termed this game the Target-Touch Motor Task (TTMT).

RESULTS

We demonstrate that the TTMT is a feasible motor task for use with young children including children with physical impairments. TTMT response-to-target trial counts are also comparable to conventional methods. Artifacts from the touch screen, while present > 100 Hz, did not affect MEG source analysis in the beta band (14-30 Hz). MEG responses during TTMT game play reveal robust cortical activity from expected areas of motor cortex as typically observed following movements of the upper limb.

COMPARISON WITH EXISTING METHOD(S)

The TTMT paradigm allows participation by individuals with a broad range of motor abilities on a reach-to-target' functional task rather than conventional tasks focusing on discrete finger movements.

CONCLUSIONS

The TTMT is well suited for young children and successfully activates expected motor cortical areas. The TTMT opens-up new opportunities for the assessment of motor function across the lifespan, including for children with physical limitations.

Altered spontaneous cortical activity predicts pain perception in individuals with cerebral palsy

Cerebral palsy is the most common paediatric neurological disorder and results in extensive impairment to the sensorimotor system. However, these individuals also experience increased pain perception, resulting in decreased quality of life. In the present study, we utilized magnetoencephalographic brain imaging to examine whether alterations in spontaneous neural activity predict the level of pain experienced in a cohort of 38 individuals with spastic diplegic cerebral palsy and 67 neurotypical controls. Participants completed 5 min of an eyes closed resting-state paradigm while undergoing a magnetoencephalography recording. The magnetoencephalographic data were then source imaged, and the power within the delta (2–4 Hz), theta (5–7 Hz), alpha (8–12 Hz), beta (15–29 Hz), low gamma (30–59 Hz) and high gamma (60–90 Hz) frequency bands were computed. The resulting power spectral density maps were analysed vertex-wise to identify differences in spontaneous activity between groups. Our findings indicated that spontaneous cortical activity was altered in the participants with cerebral palsy in the delta, alpha, beta, low gamma and high gamma bands across the occipital, frontal and secondary somatosensory cortical areas (all p_FWE < 0.05). Furthermore, we also found that the altered beta band spontaneous activity in the secondary somatosensory cortices predicted heightened pain perception in the individuals with cerebral palsy (P = 0.039). Overall, these results demonstrate that spontaneous cortical activity within individuals with cerebral palsy is altered in comparison to their neurotypical peers and may predict increased pain perception in this patient population. Potentially, changes in spontaneous resting-state activity may be utilized to measure the effectiveness of current treatment approaches that are directed at reducing the pain experienced by individuals with cerebral palsy.

Val66et Polymorphism Is Associated with Altered Motor-Related Oscillatory Activity in Youth with Cerebral Palsy

Brain-derived neurotrophic factor (BDNF) plays a critical role in the capacity for neuroplastic change. A single nucleotide polymorphism of the BDNF gene is well known to alter the activity-dependent release of the protein and may impact the capacity for neuroplastic change. Numerous studies have shown altered sensorimotor beta event-related desynchronization (ERD) responses in youth with cerebral palsy (CP), which is thought to be directly related to motor planning. The objective of the current investigation was to use magnetoencephalography (MEG) to evaluate whether the BDNF genotype affects the strength of the sensorimotor beta ERD seen in youth with CP while youth with CP performed a leg isometric target matching task. In addition, we collected saliva samples and used polymerase chain reaction (PCR) amplification to determine the status of the amino acid fragment containing codon 66 of the BDNF gene. Our genotyping results identified that 25% of the youth with CP had a Val66Met or Met66Met polymorphism at codon 66 of the BDNF gene. Furthermore, we identified that the beta ERD was stronger in youth with CP who had the Val66Met or Met66Met polymorphism in comparison to those without the polymorphism (p = 0.042). Overall, these novel findings suggest that a polymorphism at the BDNF gene may alter sensorimotor cortical oscillations in youth with CP.

Spinal cord microstructural changes are connected with the aberrant sensorimotor cortical oscillatory activity in adults with cerebral palsy

Previous animal models have illustrated that reduced cortical activity in the developing brain has cascading activity-dependent effects on the microstructural organization of the spinal cord. A limited number of studies have attempted to translate these findings to humans with cerebral palsy (CP). Essentially, the aberrations in sensorimotor cortical activity in those with CP could have an adverse effect on the spinal cord microstructure. To investigate this knowledge gap, we utilized magnetoencephalographic (MEG) brain imaging to quantify motor-related oscillatory activity in fourteen adults with CP and sixteen neurotypical (NT) controls. A subset of these participants also underwent cervical-thoracic spinal cord MRI. Our results showed that the strength of the peri-movement beta desynchronization and the post-movement beta rebound were each weaker in the adults with CP relative to the controls, and these weakened responses were associated with poorer task performance. Additionally, our results showed that the strength of the peri-movement beta response was associated with the total cross-sectional area of the spinal cord and the white matter cross-sectional area. Altogether these results suggest that the altered sensorimotor cortical activity seen in CP may result in activity-dependent plastic changes within the spinal cord microstructure, which could ultimately contribute to the sensorimotor deficits seen in this population.

Reproducibility of Rolandic beta rhythm modulation in MEG and EEG

The Rolandic beta rhythm, at ∼20 Hz, is generated in the somatosensory and motor cortices and is modulated by motor activity and sensory stimuli, causing a short lasting suppression that is followed by a rebound of the beta rhythm. The rebound reflects inhibitory changes in the primary sensorimotor (SMI) cortex, and thus it has been used as a biomarker to follow the recovery of patients with acute stroke. The longitudinal stability of beta rhythm modulation is a prerequisite for its use in long-term follow-ups. We quantified the reproducibility of beta rhythm modulation in healthy subjects in a 1-year-longitudinal study both for MEG and EEG at T₀, 1 month (T_1-month, n = 8) and 1 year (T_1-year, n = 19). The beta rhythm (13–25 Hz) was modulated by fixed tactile and proprioceptive stimulations of the index fingers. The relative peak strengths of beta suppression and rebound did not differ significantly between the sessions, and intersession reproducibility was good or excellent according to intraclass correlation-coefficient values (0.70–0.96) both in MEG and EEG. Our results indicate that the beta rhythm modulation to tactile and proprioceptive stimulation is well reproducible within 1 year. These results support the use of beta modulation as a biomarker in long-term follow-up studies, e.g., to quantify the functional state of the SMI cortex during rehabilitation and drug interventions in various neurological impairments.

NEW & NOTEWORTHY The present study demonstrates that beta rhythm modulation is highly reproducible in a group of healthy subjects within a year. Hence, it can be reliably used as a biomarker in longitudinal follow-up studies in different neurological patient groups to reflect changes in the functional state of the sensorimotor cortex.

Therapeutic Lower Extremity Power Training Alters the Sensorimotor Cortical Activity of Individuals with Cerebral Palsy

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Individuals with cerebral palsy underwent therapeutic power training.

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Magnetoencephalography brain imaging was used to assess the neurophysiological changes.

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Clinical assessments included leg extension strength, power, and mobility.

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After therapy, participants with cerebral palsy had improved sensorimotor cortical activity.

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Participants also had improved leg extension strength, power, and mobility.

Objective

To utilize magnetoencephalographic (MEG) brain imaging to examine potential changes in sensorimotor cortical oscillations after therapeutic power training in individuals with cerebral palsy (CP).

Design

Cohort.

Setting

Academic medical center.

Participants

Individuals with CP (N=11; age=15.9±1.1 years; Gross Motor Function Classification System I- III) and neurotypical controls (NTs; N=16; age=14.6±0.8 years).

Interventions

Participants with CP underwent 24 (8 weeks; 3 days a week) sessions of high-velocity lower extremity power training on a leg press. The NTs underwent single baseline MEG assessments.

Main Outcome Measures

Pre-post bilateral leg press 1-repetition maximum and peak power production were used to assess the muscular performance changes. The 10-m walk and 1-minute walk tests were used to assess mobility changes. During MEG recordings, participants used their right leg to complete a goal-directed isometric target-matching task. Advanced beamforming methods were subsequently used to image the strength of the sensorimotor beta oscillatory power.

Results

Before the therapeutic power training, the participants with CP had stronger beta sensorimotor cortical oscillations compared with the NT controls. However, the beta sensorimotor cortical oscillations were weaker and approximated the controls after the participants with CP completed the therapeutic power training protocol. There also was a link between the amount of improvement in leg peak power production and the amount of reduction in sensorimotor cortical oscillations seen after therapy.

Conclusions

Therapeutic power training appears to optimize the sensorimotor cortical oscillations of individuals with CP, and these neuroplastic changes partly contribute to improvements in the leg peak power production of individuals with CP. Therapeutic power training might provide the key ingredients for beneficial neuroplastic change.

Weaker Connectivity of the Cortical Networks Is Linked with the Uncharacteristic Gait in Youth with Cerebral Palsy

Cerebral palsy (CP) is the most prevalent pediatric neurologic impairment and is associated with major mobility deficiencies. This has led to extensive investigations of the sensorimotor network, with far less research focusing on other major networks. The aim of this study was to investigate the functional connectivity (FC) of the main sensory networks (i.e., visual and auditory) and the sensorimotor network, and to link FC to the gait biomechanics of youth with CP. Using resting-state functional magnetic resonance imaging, we first identified the sensorimotor, visual and auditory networks in youth with CP and neurotypical controls. Our analysis revealed reduced FC among the networks in the youth with CP relative to the controls. Notably, the visual network showed lower FC with both the sensorimotor and auditory networks. Furthermore, higher FC between the visual and sensorimotor cortices was associated with larger step length (r = 0.74, p_FDR = 0.04) in youth with CP. These results confirm that CP is associated with functional brain abnormalities beyond the sensorimotor network, suggesting abnormal functional integration of the brain’s motor and primary sensory systems. The significant association between abnormal visuo-motor FC and gait could indicate a link with visuomotor disorders in this patient population.

Cortical oscillations that underlie visual selective attention are abnormal in adolescents with cerebral palsy

Adolescence is a critical period for the development and refinement of several higher-level cognitive functions, including visual selective attention. Clinically, it has been noted that adolescents with cerebral palsy (CP) may have deficits in selectively attending to objects within their visual field. This study aimed to evaluate the neural oscillatory activity in the ventral attention network while adolescents with CP performed a visual selective attention task. Adolescents with CP (N = 14; Age = 15.7 ± 4 years; MACS I-III; GMFCS I-IV) and neurotypical (NT) adolescents (N = 21; Age = 14.3 ± 2 years) performed the Eriksen flanker task while undergoing magnetoencephalographic (MEG) brain imaging. The participants reported the direction of a target arrow that was surrounded by congruent or incongruent flanking arrows. Compared with NT adolescents, adolescents with CP had slower responses and made more errors regarding the direction of the target arrow. The MEG results revealed that adolescents with CP had stronger alpha oscillations in the left insula when the flanking arrows were incongruent. Furthermore, participants that had more errors also tended to have stronger alpha oscillatory activity in this brain region. Altogether these results indicate that the aberrant activity seen in the left insula is associated with diminished visual selective attention function in adolescents with CP.

Children with Cerebral Palsy Have Altered Occipital Cortical Oscillations during a Visuospatial Attention Task

Dynamically allocating neural resources to salient features or objects within our visual space is fundamental to making rapid and accurate decisions. Impairments in such visuospatial abilities have been consistently documented in the clinical literature on individuals with cerebral palsy (CP), although the underlying neural mechanisms are poorly understood. In this study, we used magnetoencephalography (MEG) and oscillatory analysis methods to examine visuospatial processing in children with CP and demographically matched typically developing (TD) children. Our results indicated robust oscillations in the theta (4-8 Hz), alpha (8-14 Hz), and gamma (64-80 Hz) frequency bands in the occipital cortex of both groups during visuospatial processing. Importantly, the group with CP exhibited weaker cortical oscillations in the theta and gamma frequency bands, as well as slower response times and worse accuracy during task performance compared to the TD children. Furthermore, we found that weaker theta and gamma oscillations were related to greater visuospatial performance deficits across both groups. We propose that the weaker occipital oscillations seen in children with CP may reflect poor bottom-up processing of incoming visual information, which subsequently affects the higher-order visual computations essential for accurate visual perception and integration for decision-making.

Motor beta cortical oscillations are related with the gait kinematics of youth with cerebral palsy

OBJECTIVE

It is widely believed that the perinatal brain injuries seen in youth with cerebral palsy (CP) impact neuronal processing of sensory information and the production of leg motor actions during gait. However, very limited efforts have been made to evaluate the connection between neural activity within sensorimotor networks and the altered spatiotemportal gait biomechanics seen in youth with CP. The objective of this investigation was to use magnetoencephalographic (MEG) brain imaging and biomechanical analysis to probe this connection.

METHODS

We examined the cortical beta oscillations serving motor control of the legs in a cohort of youth with CP (N = 20; Age = 15.5 ± 3 years; GMFCS levels I-III) and healthy controls (N = 15; Age = 14.1 ± 3 years) using MEG brain imaging and a goal-directed isometric knee target-matching task. Outside the scanner, a digital mat was used to quantify the spatiotemporal gait biomechanics.

RESULTS

Our MEG imaging results revealed that the participants with CP exhibited stronger sensorimotor beta oscillations during the motor planning and execution stages compared to the controls. Interestingly, we also found that those with the strongest sensorimotor beta oscillations during motor execution also tended to walk slower and have a reduced cadence.

INTERPRETATION

These results fuel the impression that the beta sensorimotor cortical oscillations that underlie leg musculature control may play a central role in the altered mobility seen in youth with CP.

Cognitive-Motor Interference Heightens the Prefrontal Cortical Activation and Deteriorates the Task Performance in Children With Hemiplegic Cerebral Palsy

OBJECTIVE

To compare the prefrontal cortex (PFC) activation and task performance during single- and dual-task conditions between typically developing (TD) children and children with hemiplegic cerebral palsy (HCP).

DESIGN

A prospective, comparative design.

SETTING

Research laboratory.

PARTICIPANTS

Participants (N=21) included 12 TD children (age, 6.0±1.1y) and 9 children with HCP (age, 7.2±3.1).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

PFC activation was assessed by measuring the concentration of oxygenated hemoglobin while the children performed a shape-matching task with their more affected arm while sitting on a stable (single task) vs dynamic surface (dual task). The task performance was assessed with the total number of shapes matched, dual-task cost, and reaction time (RT).

RESULTS

For both conditions, the children with HCP exhibited greater PFC activation, matched a fewer shapes, and had slower RT than the TD children. These differences were accentuated during the dual-task condition and the dual-task cost was greater. An increase in the PFC activation during the dual-task condition was tightly correlated with a higher dual-task cost in children with HCP (r=0.77, P=.01).

CONCLUSIONS

Children with HCP appear to have a heightened amount of PFC activity while performing a dual task. The greater cortical activity may be a result of the finite attentional resources that are shared between both the motor as well as cognitive demands of the task. The cognitive-motor interference is likely exacerbated in children with HCP because of the structural and functional brain changes as a result of an insult to the developing brain.

Beyond the eye: Cortical differences in primary visual processing in children with cerebral palsy

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Visual processing deficits are common in children with CP.

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MEG was used to image multispectral cortical oscillations during visual processing.

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Compared with controls, children with CP had weaker occipital oscillations.

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Aberrant cortical oscillations likely impact early visual processing abilities.

Despite the growing clinical recognition of visual impairments among people with cerebral palsy (CP), very few studies have evaluated the neurophysiology of the visual circuitry. To this end, the primary aim of this investigation was to use magnetoencephalography and beamforming methods to image the relative change in the alpha–beta and gamma occipital cortical oscillations induced by a spatial grating stimulus (e.g., visual contrast) that was viewed by a cohort of children with CP and typically-developing (TD) children. Our results showed that the high-contrast, visual gratings stimuli induced a decrease in alpha–beta (10 – 20 Hz) activity, and an increase in both low (40 – 56 Hz) and high (60 – 72 Hz) gamma oscillations in the occipital cortices. Compared with the TD children, the strength of the frequency specific cortical oscillations were significantly weaker in the children with CP, suggesting that they had deficient processing of the contrast stimulus. Although CP is largely perceived as a musculoskeletal centric disorder, our results fuel the growing impression that there may also be prominent visual processing deficiencies. These visual processing deficits likely impact the ability to perceive visual changes in the environment.

Children With Unilateral Cerebral Palsy Utilize More Cortical Resources for Similar Motor Output During Treadmill Gait

Children with unilateral cerebral palsy (CP) walk independently although with an asymmetrical, more poorly coordinated pattern compared to their peers. While gait biomechanics in unilateral CP and their alteration from those without CP have been well documented, cortical mechanisms underlying gait remain inadequately understood. To the best of our knowledge, this is the first study utilizing electroencephalography (EEG) during treadmill gait in older children with and without CP. Lower limb surface electromyographic (EMG) data were collected and muscle synergy analyses performed to quantify motor output. Our primary goal was to evaluate the relationships between cortical and muscle activation within and across groups and hemispheres to provide novel insights into neural control of gait and how it may be disrupted by an early unilateral brain injury. Participants included 9 children with unilateral CP, mean age 16.0 ± 2.7 years, and 12 with typical development (TD), mean age 14.8 ± 3.0 years. EEG data were collected during a standing baseline and treadmill walking at self-selected speed. EMG of 16 lower limb muscles were also collected bilaterally and synchronized with EEG. No significant group differences were found in synergy number or structure across groups. Six cortical clusters were identified as having gait-related activation and all contained participants from both CP and TD groups; however, the percent of individuals per group appearing in different clusters varied. Notably, the cluster least represented in CP was the non-dominant motor region. Both groups showed mu-band ERD in the motor clusters during gait although sustained beta-band ERD was not evident in TD. The CP group showed greater cortical activation than TD during walking as measured by mu- and beta-ERD in the dominant and non-dominant motor and parietal regions and elevated low gamma-activity in the frontal and parietal areas, a unique finding in CP. CP showed greater bilateral motor EEG-EMG coherence in the gamma-band with the hallucis longus compared to TD. In summary, individuals with CP display increased cortical activation during gait possibly relating to differences in distal motor control of the more affected side. Strategies that iteratively reduce cortical activation while improving selective motor control are needed in CP.

Changes of Structural Brain Network Following Repetitive Transcranial Magnetic Stimulation in Children With Bilateral Spastic Cerebral Palsy: A Diffusion Tensor Imaging Study

Introduction: Bilateral spastic cerebral palsy (BSCP) is the most common subtype of cerebral palsy (CP), which is characterized by various motor and cognitive impairments, as well as emotional instability. However, the neural basis of these problems and how repetitive transcranial magnetic stimulation (rTMS) can make potential impacts on the disrupted structural brain network in BSCP remain unclear. This study was aimed to explore the topological characteristics of the structural brain network in BSCP following the treatment of rTMS. Methods: Fourteen children with BSCP underwent 4 weeks of TMS and 15 matched healthy children (HC) were enrolled. Diffusion tensor imaging (DTI) data were acquired from children with bilateral spastic cerebral palsy before treatment (CP1), children with bilateral spastic cerebral palsy following treatment (CP2) and HC. The graph theory analysis was applied to construct the structural brain network. Then nodal clustering coefficient (C _i ) and shortest path length (L _i ) were measured and compared among groups. Results: Brain regions with significant group differences in C _i were located in the left precental gyrus, middle frontal gyrus, calcarine fissure, cuneus, lingual gyrus, postcentral gyrus, inferior parietal gyri, angular gyrus, precuneus, paracentral lobule and the right inferior frontal gyrus (triangular part), insula, posterior cingulate gyrus, precuneus, paracentral lobule, pallidum. In addition, significant differences were detected in the L _i of the left precental gyrus, lingual gyrus, superior occipital gyrus, middle occipital gyrus, superior parietal gyrus, precuneus and the right median cingulate gyrus, posterior cingulate gyrus, hippocampus, putamen, thalamus. Post hoc t-test revealed that the CP2 group exhibited increased C _i in the right inferior frontal gyrus, pallidum and decreased L _i in the right putamen, thalamus when compared with the CP1 group. Conclusion: Significant differences of node-level metrics were found in various brain regions of BSCP, which indicated a disruption in structural brain connectivity in BSCP. The alterations of the structural brain network provided a basis for understanding of the pathophysiological mechanisms of motor and cognitive impairments in BSCP. Moreover, the right inferior frontal gyrus, putamen, thalamus could potentially be biomarkers for predicting the efficacy of TMS.

The Strength of the Movement-related Somatosensory Cortical Oscillations Differ between Adolescents and Adults

Adolescents demonstrate increasing mastery of motor actions with age. One prevailing hypothesis is that maturation of the somatosensory system during adolescence contributes to the improved motor control. However, limited efforts have been made to determine if somatosensory cortical processing is different in adolescents during movement. In this study, we used magnetoencephalographic brain imaging to begin addressing this knowledge gap by applying an electrical stimulation to the tibial nerve as adolescents (Age = 14.8 ± 2.5 yrs.) and adults (Age = 36.8 ± 5.0 yrs.) produced an isometric ankle plantarflexion force, or sat with no motor activity. Our results showed strong somatosensory cortical oscillations for both conditions in the alpha-beta (8–30 Hz) and gamma (38–80 Hz) ranges that occurred immediately after the stimulation (0–125 ms), and a beta (18–26 Hz) oscillatory response shortly thereafter (300–400 ms). Compared with the passive condition, all of these frequency specific cortical oscillations were attenuated while producing the ankle force. The attenuation of the alpha-beta response was greater in adolescents, while the adults had a greater attenuation of the beta response. These results imply that altered attenuation of the somatosensory cortical oscillations might be central to the under-developed somatosensory processing and motor performance characteristics in adolescents.

Hand Motor Actions of Children With Cerebral Palsy Are Associated With Abnormal Sensorimotor Cortical Oscillations

Background. The neuroimaging literature on cerebral palsy (CP) has predominantly focused on identifying the structural aberrations (eg, fiber track integrity), with very few studies examining neural activity within the key networks that serve the production of hand movements. Objective. We aimed to start to fill this knowledge gap by using magnetoencephalographic brain imaging to quantify the temporal dynamics of the sensorimotor oscillations during a hand motor action. Methods: Children with CP (n = 12; MACS [Manual Abilities Classification System] levels I-III) and typically developing (TD) children (n = 26) performed an arrow-based version of the Eriksen flanker task where a button press was performed with either the second or third digit of the right hand depending on the arrow's direction. Results: Overall, the children with CP were less accurate and had slower reaction times compared with the TD children. These behavioral differences were closely linked with aberrant sensorimotor cortical oscillations seen in the children with CP. Compared with the TD children, the children with CP had a weaker gamma (68-82 Hz) response during motor execution and a weaker post-movement beta rebound (PMBR; 14-26 Hz) response on movement termination. Moreover, we observed a significant correlation between the amplitude of the gamma and PMBR with reaction time, with weaker gamma and PMBR responses being linked with slower reaction times. Conclusions: Overall, these results suggest that aberrations in motor-related gamma and beta cortical oscillations are associated with the impaired hand motor actions seen in children with CP.

Mu rhythm: State of the art with special focus on cerebral palsy

Various specific early rehabilitation strategies are proposed to decrease functional disabilities in patients with cerebral palsy (CP). These strategies are thought to favour the mechanisms of brain plasticity that take place after brain injury. However, the level of evidence is low. Markers of brain plasticity would favour validation of these rehabilitation programs. In this paper, we consider the study of mu rhythm for this goal by describing the characteristics of mu rhythm in adults and children with typical development, then review the current literature on mu rhythm in CP. Mu rhythm is composed of brain oscillations recorded by electroencephalography (EEG) or magnetoencephalography (MEG) over the sensorimotor areas. The oscillations are characterized by their frequency, topography and modulation. Frequency ranges within the alpha band (∼10Hz, mu alpha) or beta band (∼20Hz, mu beta). Source location analyses suggest that mu alpha reflects somatosensory functions, whereas mu beta reflects motor functions. Event-related desynchronisation (ERD) followed by event-related (re-)synchronisation (ERS) of mu rhythm occur in association with a movement or somatosensory input. Even if the functional role of the different mu rhythm components remains incompletely understood, their maturational trajectory is well described. Increasing age from infancy to adolescence is associated with increasing ERD as well as increasing ERS. A few studies characterised mu rhythm in adolescents with spastic CP and showed atypical patterns of modulation in most of them. The most frequent findings in patients with unilateral CP are decreased ERD and decreased ERS over the central electrodes, but atypical topography may also be found. The patterns of modulations are more variable in bilateral CP. Data in infants and young children with CP are lacking and studies did not address the questions of intra-individual reliability of mu rhythm modulations in patients with CP nor their modification after motor learning. Better characterization of mu rhythm in CP, especially in infants and young children, is warranted before considering this rhythm as a potential neurophysiological marker of brain plasticity.

Practice modulates motor-related beta oscillations differently in adolescents and adults

KEY POINTS

Magnetoencephalography data were acquired during a leg force task in pre-/post-practice sessions in adolescents and adults. Strong peri-movement alpha and beta oscillations were mapped to the cortex. Following practice, performance improved and beta oscillations were altered. Beta oscillations decreased in the sensorimotor cortex in adolescents after practice, but increased in adults. No pre-/post-practice differences were detected for alpha oscillations.

ABSTRACT

There is considerable evidence that there are motor performance and practice differences between adolescents and adults. Behavioural studies have suggested that these motor performance differences are simply due to experience. However, the neurophysiological nexus for these motor performance differences remains unknown. The present study investigates the short-term changes (e.g. fast motor learning) in the alpha and beta event-related desynchronizations (ERDs) associated with practising an ankle plantarflexion motor action. To this end, we utilized magnetoencephalography to identify changes in the alpha and beta ERDs in healthy adolescents (n = 21; age = 14 ± 2.1 years) and middle-aged adults (n = 22; age = 36.6 ± 5 years) after practising an isometric ankle plantarflexion target-matching task. After practice, all of the participants matched more targets and matched the targets faster, and had improved accuracy, faster reaction times and faster force production. However, the motor performance of the adults exceeded what was seen in the adolescents regardless of practice. In conjunction with the behavioural results, the strength of the beta ERDs across the motor planning and execution stages was reduced after practice in the sensorimotor cortices of the adolescents, but was stronger in the adults. No pre-/post-practice changes were found in the alpha ERDs. These outcomes suggest that there are age-dependent changes in the sensorimotor cortical oscillations after practising a motor task. We suspect that these noted differences might be related to familiarity with the motor task, GABA levels and/or maturational differences in the integrity of the white matter fibre tracts that comprise the respective cortical areas.

Children with cerebral palsy display altered neural oscillations within the visual MT/V5 cortices

Cortical visual processing in visual MT/V5 is necessary for tracking movement and performing reliable visuomotor transformations. Although the role of this cortical area is well recognized, the activity of the visual MT/V5 cortical area in children with cerebral palsy (CP) has not been examined nor has its potential role in the atypical motor actions of these children been considered. This study used magnetoencephalography to image the neural activity in the motion-sensitive MT/V5 cortices of typically developing (TD) children (n = 21; mean age 14 yrs. ± 2, 12 males) and children with CP (n = 21; mean age 16 yrs. ± 4, 13 males) as they viewed a horizontally moving stimulus. Behavioral measures of visual perception were additionally assessed by having the participants press a button when the visual stimulus changed to moving in vertical direction. Our results showed that the horizontal movement of the visual stimulus evoked changes in the strength of the theta-alpha (5-10 Hz) and alpha-beta (8-20 Hz) oscillations in the visual MT/V5 area of all participants. Compared with the TD children, the children with CP had weaker alpha-beta oscillations in the visual MT/V5 cortices. In addition, the children with CP took longer to perceive a directional change of the visual stimulus and made more errors in detecting the change. Lastly, weaker alpha-beta oscillations were correlated with slower detection of the change in motion direction and less accuracy in identifying the change. This study shows that the uncharacteristic neural oscillations in the visual MT/V5 cortical area may partially account for the abnormal perceptions and motor decisions seen in children with CP.

Neurophysiological changes in the visuomotor network after practicing a motor task

Although it is well appreciated that practicing a motor task updates the associated internal model, it is still unknown how the cortical oscillations linked with the motor action change with practice. The present study investigates the short-term changes (e.g., fast motor learning) in the α- and β-event-related desynchronizations (ERD) associated with the production of a motor action. To this end, we used magnetoencephalography to identify changes in the α- and β-ERD in healthy adults after participants practiced a novel isometric ankle plantarflexion target-matching task. After practicing, the participants matched the targets faster and had improved accuracy, faster force production, and a reduced amount of variability in the force output when trying to match the target. Parallel with the behavioral results, the strength of the β-ERD across the motor-planning and execution stages was reduced after practice in the sensorimotor and occipital cortexes. No pre/postpractice changes were found in the α-ERD during motor planning or execution. Together, these outcomes suggest that fast motor learning is associated with a decrease in β-ERD power. The decreased strength likely reflects a more refined motor plan, a reduction in neural resources needed to perform the task, and/or an enhancement of the processes that are involved in the visuomotor transformations that occur before the onset of the motor action. These results may augment the development of neurologically based practice strategies and/or lead to new practice strategies that increase motor learning. NEW & NOTEWORTHY We aimed to determine the effects of practice on the movement-related cortical oscillatory activity. Following practice, we found that the performance of the ankle plantarflexion target-matching task improved and the power of the β-oscillations decreased in the sensorimotor and occipital cortexes. These novel findings capture the β-oscillatory activity changes in the sensorimotor and occipital cortexes that are coupled with behavioral changes to demonstrate the effects of motor learning.

Oscillatory dynamics in the dorsal and ventral attention networks during the reorienting of attention

The ability to reorient attention within the visual field is central to daily functioning, and numerous fMRI studies have shown that the dorsal and ventral attention networks (DAN, VAN) are critical to such processes. However, despite the instantaneous nature of attentional shifts, the dynamics of oscillatory activity serving attentional reorientation remain poorly characterized. In this study, we utilized magnetoencephalography (MEG) and a Posner task to probe the dynamics of attentional reorienting in 29 healthy adults. MEG data were transformed into the time-frequency domain and significant oscillatory responses were imaged using a beamformer. Voxel time series were then extracted from peak voxels in the functional beamformer images. These time series were used to quantify the dynamics of attentional reorienting, and to compute dynamic functional connectivity. Our results indicated strong increases in theta and decreases in alpha and beta activity across many nodes in the DAN and VAN. Interestingly, theta responses were generally stronger during trials that required attentional reorienting relative to those that did not, while alpha and beta oscillations were more dynamic, with many regions exhibiting significantly stronger responses during non-reorienting trials initially, and the opposite pattern during later processing. Finally, stronger functional connectivity was found following target presentation (575-700 ms) between bilateral superior parietal lobules during attentional reorienting. In sum, these data show that visual attention is served by multiple cortical regions within the DAN and VAN, and that attentional reorienting processes are often associated with spectrally-specific oscillations that have largely distinct spatiotemporal dynamics.