Brain functional activity during gait in normal subjects: a SPECT study

Abnormal arm swing movements in Parkinson's disease: onset, progression and response to L-Dopa

BACKGROUND

Reduced arm swing movements during gait are an early motor manifestation of Parkinson's disease (PD). The clinical evolution, response to L-Dopa and pathophysiological underpinning of abnormal arm swing movements in PD remain largely unclear. By using a network of wearable sensors, this study objectively assesses arm swing movements during gait in PD patients across different disease stages and therapeutic conditions.

METHODS

Twenty healthy subjects (HS) and 40 PD patients, including 20 early-stage and 20 mid-advanced subjects, underwent a 6-m Timed Up and Go test while monitored through a network of wearable inertial sensors. Arm swing movements were objectively evaluated in both hemibodies and different upper limb joints (shoulder and elbow), using specific time-domain (range of motion and velocity) and frequency-domain measures (harmonics and total harmonic distortion). To assess the effects of L-Dopa, patients under chronic dopaminergic therapy were randomly examined when OFF and ON therapy. Finally, clinical-behavioral correlations were investigated, primarily focusing on the relationship between arm swing movements and cardinal L-Dopa-responsive motor signs, including bradykinesia and rigidity.

RESULTS

Compared to HS, the whole group of PD patients showed reduced range of motion and velocity, alongside increased asymmetry of arm swing movements during gait. Additionally, a distinct increase in total harmonic distortion was found in patients. The kinematic changes were prominent in the early stage of the disease and progressively worsened owing to the involvement of the less affected hemibody. The time- and frequency-domain abnormalities were comparable in the two joints (i.e., shoulder and elbow). In the subgroup of patients under chronic dopaminergic treatment, L-Dopa restored patterns of arm swing movements. Finally, the kinematic alterations in arm swing movements during gait correlated with the clinical severity of bradykinesia and rigidity.

CONCLUSIONS

Arm swing movements during gait in PD are characterized by narrow, slow, and irregular patterns. As the disease progresses, arm swing movements deteriorate also in the less affected hemibody, without any joint specificity. The positive response to L-Dopa along with the significant correlation between kinematics and bradykinesia/rigidity scores points to the involvement of dopaminergic pathways in the pathophysiology of abnormal arm swing movements in PD.

Freezing of gait in Parkinson's disease is related to imbalanced stopping-related cortical activity

Freezing of gait, characterized by involuntary interruptions of walking, is a debilitating motor symptom of Parkinson's disease that restricts people's autonomy. Previous brain imaging studies investigating the mechanisms underlying freezing were restricted to scan people in supine positions and yielded conflicting theories regarding the role of the supplementary motor area and other cortical regions. We used functional near-infrared spectroscopy to investigate cortical haemodynamics related to freezing in freely moving people. We measured functional near-infrared spectroscopy activity over multiple motor-related cortical areas in 23 persons with Parkinson's disease who experienced daily freezing ('freezers') and 22 age-matched controls during freezing-provoking tasks including turning and doorway passing, voluntary stops and actual freezing. Crucially, we corrected the measured signals for confounds of walking. We first compared cortical activity between freezers and controls during freezing-provoking tasks without freezing (i.e. turning and doorway passing) and during stops. Secondly, within the freezers, we compared cortical activity between freezing, stopping and freezing-provoking tasks without freezing. First, we show that turning and doorway passing (without freezing) resemble cortical activity during stopping in both groups involving activation of the supplementary motor area and prefrontal cortex, areas known for their role in inhibiting actions. During these freezing-provoking tasks, the freezers displayed higher activity in the premotor areas than controls. Secondly, we show that, during actual freezing events, activity in the prefrontal cortex was lower than during voluntary stopping. The cortical relation between the freezing-provoking tasks (turning and doorway passing) and stopping may explain their susceptibility to trigger freezing by activating a stopping mechanism. Besides, the stopping-related activity of the supplementary motor area and prefrontal cortex seems to be out of balance in freezers. In this paper, we postulate that freezing results from a paroxysmal imbalance between the supplementary motor area and prefrontal cortex, thereby extending upon the current role of the supplementary motor area in freezing pathophysiology.

Mobile neuroimaging: What we have learned about the neural control of human walking, with an emphasis on EEG-based research

Our understanding of the neural control of human walking has changed significantly over the last twenty years and mobile brain imaging methods have contributed substantially to current knowledge. High-density electroencephalography (EEG) has the advantages of being lightweight and mobile while providing temporal resolution of brain changes within a gait cycle. Advances in EEG hardware and processing methods have led to a proliferation of research on the neural control of locomotion in neurologically intact adults. We provide a narrative review of the advantages and disadvantages of different mobile brain imaging methods, then summarize findings from mobile EEG studies quantifying electrocortical activity during human walking. Contrary to historical views on the neural control of locomotion, recent studies highlight the widespread involvement of many areas, such as the anterior cingulate, posterior parietal, prefrontal, premotor, sensorimotor, supplementary motor, and occipital cortices, that show active fluctuations in electrical power during walking. The electrocortical activity changes with speed, stability, perturbations, and gait adaptation. We end with a discussion on the next steps in mobile EEG research.

Central imaging based on near-infrared functional imaging technology can be useful to plan management in patients with chronic lateral ankle instability

BACKGROUND

Near infrared brain functional imaging (FNIRS) has been used for the evaluation of brain functional areas, the imaging differences of central activation of cognitive-motor dual tasks between patients with chronic lateral ankle instability (CLAI) and healthy population remain unclear. This study aimed to evaluated the role of central imaging based on FNIRS technology on the plan management in patients with CLAI, to provide insights to the clinical treatment of CLAI.

METHODS

CLAI patients treated in our hospital from January 1, 2021 to June 31, 2022 were selected. Both CLAI patients and health controls were intervened with simple task and cognitive-motor dual task under sitting and walking conditions, and the changes of oxygenated hemoglobin concentration in bilateral prefrontal cortex (PFC), premotor cortex (PMC) and auxiliary motor area (SMA) were collected and compared.

RESULTS

A total of 23 participants were enrolled. There were significant differences in the fNIRS ΔHbO2 of barefoot subtractive walking PFC-R and barefoot subtractive walking SMA-R between experimental and control group (all P < 0.05). There was no significant difference in ΔHbO2 between the experimental group and the control group in other states (P > 0.05). There was no significant difference in ΔHbO2 between the experimental group and the control group in each state of the brain PMC region.

CONCLUSION

Adaptive alterations may occur within the relevant brain functional regions of individuals with CLAI. The differential activation observed between the PFC and the SMA could represent a compensatory mechanism emerging from proprioceptive afferent disruptions following an initial ankle sprain.

Can cerebellar theta-burst stimulation improve balance function and gait in stroke patients? A randomized controlled trial

BACKGROUND

The cerebellum is a key structure involved in balance and motor control, and has become a new stimulation target in brain regulation technology. Interference theta-burst simulation (iTBS) is a novel simulation mode of repetitive transcranial magnetic simulation. However, the impact of cerebellar iTBS on balance function and gait in stroke patients is still unknown.

AIM

The aim of this study was to determine whether cerebellar iTBS can improve function, particularly balance and gait, in patients with post-stroke hemiplegia.

DESIGN

This study is a randomized, double-blind, sham controlled clinical trial.

SETTING

The study was carried out at the Department of Rehabilitation Medicine in a general hospital.

POPULATION

Patients with stroke with first unilateral lesions were enrolled in the study.

METHODS

Thirty-six patients were randomly assigned to the cerebellar iTBS group or sham stimulation group. The cerebellar iTBS or pseudo stimulation site is the ipsilateral cerebellum on the paralyzed side, which is completed just before daily physical therapy. The study was conducted five times a week for two consecutive weeks. All patients were assessed before the intervention (T0) and at the end of 2 weeks of treatment (T1), respectively. The primary outcome was the Berg Balance Scale (BBS), while secondary outcome measures included the Fugl Meyer Lower Limb Assessment Scale (FMA-LE), timed up and go (TUG), Barthel Index (BI), and gait analysis.

RESULTS

After 2 weeks of intervention, the BBS, FMA-LE, TUG, and BI score in both the iTBS group and the sham group were significantly improved compared to the baseline (all P<0.05). Also, there was a significant gait parameter improvement including the cadence, stride length, velocity, step length compared to the baseline (P<0.05) in the iTBS group, but only significant improvement in cadence was identified in the sham group (P<0.05). Intergroup comparison showed that the BBS (P<0.001), FMA-LE (P<0.001), and BI (P=0.002) in the iTBS group were significantly higher than those in the sham group, and the TUG in the iTBS was significantly lower than that in the sham group (P=0.002). In addition, there were significant differences in cadence (P=0.029), strip length (P=0.046), gain velocity (P=0.002), and step length of affected lower limb (P=0.024) between the iTBS group and the sham iTBS group.

CONCLUSIONS

Physical therapy is able to improve the functional recovery in hemiplegic patients after stroke, but the cerebellar iTBS can facilitate and accelerate the recovery, particularly the balance function and gait. Cerebellar iTBS could be an efficient and facilitative treatment for patients with stroke.

CLINICAL REHABILITATION IMPACT

Cerebellar iTBS provides a convenient and efficient treatment modality for functional recovery of patients with stroke, especially balance function and gait.

Exercise Influences the Brain's Metabolic Response to Chronic Cocaine Exposure in Male Rats

Cocaine use is associated with negative health outcomes: cocaine use disorders, speedballing, and overdose deaths. Currently, treatments for cocaine use disorders and overdose are non-existent when compared to opioid use disorders, and current standard cocaine use disorder treatments have high dropout and recidivism rates. Physical exercise has been shown to attenuate addiction behavior as well as modulate brain activity. This study examined the differential effects of chronic cocaine use between exercised and sedentary rats. The effects of exercise on brain glucose metabolism (BGluM) following chronic cocaine exposure were assessed using Positron Emission Tomography (PET) and [18F]-Fluorodeoxyglucose (FDG). Compared to sedentary animals, exercise decreased metabolism in the SIBF primary somatosensory cortex. Activation occurred in the amygdalopiriform and piriform cortex, trigeminothalamic tract, rhinal and perirhinal cortex, and visual cortex. BGluM changes may help ameliorate various aspects of cocaine abuse and reinstatement. Further investigation is needed into the underlying neuronal circuits involved in BGluM changes and their association with addiction behaviors.

Motor imagery ability scores are related to cortical activation during gait imagery

Motor imagery (MI) is the mental execution of actions without overt movements that depends on the ability to imagine. We explored whether this ability could be related to the cortical activity of the brain areas involved in the MI network. To this goal, brain activity was recorded using high-density electroencephalography in nineteen healthy adults while visually imagining walking on a straight path. We extracted Event-Related Desynchronizations (ERDs) in the θ, α, and β band, and we measured MI ability via (i) the Kinesthetic and Visual Imagery Questionnaire (KVIQ), (ii) the Vividness of Movement Imagery Questionnaire-2 (VMIQ), and (iii) the Imagery Ability (IA) score. We then used Pearson's and Spearman's coefficients to correlate MI ability scores and average ERD power (avgERD). Positive correlations were identified between VMIQ and avgERD of the middle cingulum in the β band and with avgERD of the left insula, right precentral area, and right middle occipital region in the θ band. Stronger activation of the MI network was related to better scores of MI ability evaluations, supporting the importance of testing MI ability during MI protocols. This result will help to understand MI mechanisms and develop personalized MI treatments for patients with neurological dysfunctions.

Compensatory increase in ipsilesional supplementary motor area and premotor connectivity is associated with greater gait impairments: a personalized fMRI analysis in chronic stroke

Background

Balance and mobility impairments are prevalent post-stroke and a large number of survivors require walking assistance at 6 months post-stroke which diminishes their overall quality of life. Personalized interventions for gait and balance rehabilitation are crucial. Recent evidence indicates that stroke lesions in primary motor pathways, such as corticoreticular pathways (CRP) and corticospinal tract (CST), may lead to reliance on alternate motor pathways as compensation, but the current evidence lacks comprehensive knowledge about the underlying neural mechanisms.

Methods

In this study, we investigate the functional connectivity (FC) changes within the motor network derived from an individualized cortical parcellation approach in 33 participants with chronic stroke compared to 17 healthy controls. The correlations between altered motor FC and gait deficits (i.e., walking speed and walking balance) were then estimated in the stroke population to understand the compensation mechanism of the motor network in motor function rehabilitation post-stroke.

Results

Our results demonstrated significant FC increases between ipsilesional medial supplementary motor area (SMA) and premotor in stroke compared to healthy controls. Furthermore, we also revealed a negative correlation between ipsilesional SMA-premotor FC and self-selected walking speed, as well as the Functional Gait Assessment (FGA) scores.

Conclusion

The increased FC between the ipsilesional SMA and premotor regions could be a compensatory mechanism within the motor network following a stroke when the individual can presumably no longer rely on the more precise CST modulation of movements to produce a healthy walking pattern. These findings enhance our understanding of individualized motor network FC changes and their connection to gait and walking balance impairments post-stroke, improving stroke rehabilitation interventions.

Endogenous Opioids and Exercise-Related Hypoalgesia: Modern Models, Measurement, and Mechanisms of Action

This chapter will focus on the role exercise appears to have on activation and modulating factors within the central nervous system related to endogenous like opioids and its possible contribution to exercise-induced hypoalgesia. The implications for the exercise-mediated alterations of CNS activation factors related to opioids, specifically endorphins and enkephalins, will be presented. In this update, we discuss utilization of new technology and methods to monitor mechanisms of opioid involvement to suggest their contribution with exercise mediated hypoalgesia as well as their relationships to alterations of perceptions of pain and mood. Several special populations were included to suggest that not all individuals will respond to the exercise by mediating hypoalgesia. Factors that may confound the current understanding and suggestions from the recent literature will be presented as well as suggestions for future investigations.

Gait Abnormalities in Children with Phelan-McDermid Syndrome

Background: Phelan-McDermid syndrome is a genetic disorder caused by haploinsufficiency of the SHANK3 gene on chromosome 22q13.3 and is characterized by autism spectrum disorder, intellectual disability, speech and language abnormalities, hypotonia, and mild dysmorphic features. Early literature in Phelan-McDermid syndrome did not include gait abnormalities as part of the syndrome although recent prospective studies report that the prevalence of gait abnormalities ranges from 55% to 94%. We compared gait abnormalities in individuals with Phelan-McDermid syndrome, idiopathic autism spectrum disorder, and typically developing controls, and explored associations between gait abnormalities, autism spectrum disorder, and intellectual functioning. Method: The study cohort consists of 67 participants between the ages of 3 and 18 years, divided into 3 groups: Phelan-McDermid syndrome (n  =  46), idiopathic autism spectrum disorder (n  =  11), and typically developing controls (n  =  10). Gait was recorded using a video camera and scored across 26 gait features using a "Gait Clinical Observations scale" designed specifically for this study. Results: Gait abnormalities were significantly higher in the Phelan-McDermid syndrome group as compared to idiopathic autism spectrum disorder or typically developing controls. The number of gait abnormalities across groups was also significantly correlated with Intellectual Quotient/Developmental Quotient (IQ/DQ). In analysis of covariance including IQ/DQ, the effect of group was not significant, but the effect of IQ/DQ was significant. Conclusions: Overall differences in gait abnormalities were determined by the degree of intellectual disability, which was significantly higher in Phelan-McDermid syndrome.

Gait-combined closed-loop brain stimulation can improve walking dynamics in Parkinsonian gait disturbances: a randomised-control trial

OBJECTIVE

Gait disturbance lowers activities of daily living in patients with Parkinson's disease (PD) and related disorders. However, the effectiveness of pharmacological, surgical and rehabilitative treatments is limited. We recently developed a novel neuromodulation approach using gait-combined closed-loop transcranial electrical stimulation (tES) for healthy volunteers and patients who are post-stroke, and achieved significant entrainment of gait rhythm and an increase in gait speed. Here, we tested the efficacy of this intervention in patients with Parkinsonian gait disturbances.

METHODS

Twenty-three patients were randomly assigned to a real intervention group using gait-combined closed-loop oscillatory tES over the cerebellum at the frequency of individualised comfortable gait rhythm, and to a sham control group.

RESULTS

Ten intervention sessions were completed for all patients and showed that the gait speed (F (1, 21)=13.0, p=0.002) and stride length (F (1, 21)=8.9, p=0.007) were significantly increased after tES, but not after sham stimulation. Moreover, gait symmetry measured by swing phase time (F (1, 21)=11.9, p=0.002) and subjective feelings about freezing (F (1, 21)=14.9, p=0.001) were significantly improved during gait.

CONCLUSIONS

These findings showed that gait-combined closed-loop tES over the cerebellum improved Parkinsonian gait disturbances, possibly through the modulation of brain networks generating gait rhythms. This new non-pharmacological and non-invasive intervention could be a breakthrough in restoring gait function in patients with PD and related disorders.

Assessing white matter microstructural changes in idiopathic normal pressure hydrocephalus using voxel-based R2* relaxometry analysis

Background

R2* relaxometry and quantitative susceptibility mapping can be combined to distinguish between microstructural changes and iron deposition in white matter. Here, we aimed to explore microstructural changes in the white matter associated with clinical presentations such as cognitive impairment in patients with idiopathic normal-pressure hydrocephalus (iNPH) using R2* relaxometry analysis in combination with quantitative susceptibility mapping.

Methods

We evaluated 16 patients clinically diagnosed with possible or probable iNPH and 18 matched healthy controls (HC) who were chosen based on similarity in age and sex. R2* and quantitative susceptibility mapping were compared using voxel-wise and atlas-based one-way analysis of covariance (ANCOVA). Finally, partial correlation analyses were performed to assess the relationship between R2* and clinical presentations.

Results

R2* was lower in some white matter regions, including the bilateral superior longitudinal fascicle and sagittal stratum, in the iNPH group compared to the HC group. The voxel-based quantitative susceptibility mapping results did not differ between the groups. The atlas-based group comparisons yielded negative mean susceptibility values in almost all brain regions, indicating no clear paramagnetic iron deposition in the white matter of any subject. R2* and cognitive performance scores between the left superior longitudinal fasciculus (SLF) and right sagittal stratum (SS) were positively correlated. In addition to that, R2* and gait disturbance scores between left SS were negatively correlated.

Conclusion

Our analysis highlights the microstructural changes without iron deposition in the SLF and SS, and their association with cognitive impairment and gait disturbance in patients with iNPH.

Faster Walking Speeds Require Greater Activity from the Primary Motor Cortex in Older Adults Compared to Younger Adults

Gait speed declines with age and slower walking speeds are associated with poor health outcomes. Understanding why we do not walk faster as we age, despite being able to, has implications for rehabilitation. Changes in regional oxygenated haemoglobin (HbO2) across the frontal lobe were monitored using functional near infrared spectroscopy in 17 young and 18 older adults while they walked on a treadmill for 5 min, alternating between 30 s of walking at a preferred and fast (120% preferred) speed. Gait was quantified using a triaxial accelerometer (lower back). Differences between task (preferred/fast) and group (young/old) and associations between regional HbO2 and gait were evaluated. Paired tests indicated increased HbO2 in the supplementary motor area (right) and primary motor cortex (left and right) in older adults when walking fast (p < 0.006). HbO2 did not significantly change in the young when walking fast, despite both groups modulating gait. When evaluating the effect of age (linear mixed effects model), greater increases in HbO2 were observed for older adults when walking fast (prefrontal cortex, premotor cortex, supplementary motor area and primary motor cortex) compared to young adults. In older adults, increased step length and reduced step length variability were associated with larger increases in HbO2 across multiple regions when walking fast. Walking fast required increased activation of motor regions in older adults, which may serve as a therapeutic target for rehabilitation. Widespread increases in HbO2 across the frontal cortex highlight that walking fast represents a resource-intensive task as we age.

Gait parameter fitting and adaptive enhancement based on cerebral blood oxygen information

Accurate recognition of patients' movement intentions and real-time adjustments are crucial in rehabilitation exoskeleton robots. However, some patients are unable to utilize electromyography (EMG) signals for this purpose due to poor or missing signals in their lower limbs. In order to address this issue, we propose a novel method that fits gait parameters using cerebral blood oxygen signals. Two types of walking experiments were conducted to collect brain blood oxygen signals and gait parameters from volunteers. Time domain, frequency domain, and spatial domain features were extracted from brain hemoglobin. The AutoEncoder-Decoder method is used for feature dimension reduction. A regression model based on the long short-term memory (LSTM) model was established to fit the gait parameters and perform incremental learning for new individual data. Cross-validation was performed on the model to enhance individual adaptivity and reduce the need for individual pre-training. The coefficient of determination (R2) for the gait parameter fit was 71.544%, with a mean square error (RMSE) of less than 3.321%. Following adaptive enhancement, the coefficient of R2 increased by 6.985%, while the RMSE decreased by 0.303%. These preliminary results indicate the feasibility of fitting gait parameters using cerebral blood oxygen information. Our research offers a new perspective on assisted locomotion control for patients who lack effective myoelectricity, thereby expanding the clinical application of rehabilitation exoskeleton robots. This work establishes a foundation for promoting the application of Brain-Computer Interface (BCI) technology in the field of sports rehabilitation.

Effect of Trunk Solution® on hemodynamics in the supplementary motor area during walking

[Purpose] Humans keep their trunks vertical while walking. This defining characteristic is known as upright bipedalism. Research on the neural control of locomotion indicates that not only subcortical structures, but also the cerebral cortex, especially the supplementary motor area (SMA), is involved in locomotion. A previous study suggested that SMA may contribute to truncal upright posture-control during walking. Trunk Solution^® (TS) is a trunk orthosis designed to support the trunk in decreasing the low back load. We hypothesized that the trunk orthosis might reduce the burden of truncal control on the SMA. The objective of this study was, therefore, to determine the effect of trunk orthosis on the SMA during walking. [Participants and Methods] Thirteen healthy participants were enrolled in the study. We measured the hemodynamics of the SMA during walking with functional near-infrared spectroscopy (fNIRS). The participants performed two gait tasks on a treadmill: (A) independent gait (usual gait) and (B) supported gait while wearing the TS. [Results] During (A) independent gait, the hemodynamics of the SMA exhibited no significant changes. During (B) gait with truncal support, the SMA hemodynamics decreased significantly. [Conclusion] TS may reduce the burden of truncal control on the SMA during walking.

Classifying Unstable and Stable Walking Patterns Using Electroencephalography Signals and Machine Learning Algorithms

Analyzing unstable gait patterns from Electroencephalography (EEG) signals is vital to develop real-time brain-computer interface (BCI) systems to prevent falls and associated injuries. This study investigates the feasibility of classification algorithms to detect walking instability utilizing EEG signals. A 64-channel Brain Vision EEG system was used to acquire EEG signals from 13 healthy adults. Participants performed walking trials for four different stable and unstable conditions: (i) normal walking, (ii) normal walking with medial-lateral perturbation (MLP), (iii) normal walking with dual-tasking (Stroop), (iv) normal walking with center of mass visual feedback. Digital biomarkers were extracted using wavelet energy and entropies from the EEG signals. Algorithms like the ChronoNet, SVM, Random Forest, gradient boosting and recurrent neural networks (LSTM) could classify with 67 to 82% accuracy. The classification results show that it is possible to accurately classify different gait patterns (from stable to unstable) using EEG-based digital biomarkers. This study develops various machine-learning-based classification models using EEG datasets with potential applications in detecting unsteady gait neural signals and intervening by preventing falls and injuries.

Are Motor Imagery Ability scores related to cortical activity during gait imagery?

Motor imagery (MI) is the mental execution of actions without overt movements that depends on the ability to imagine. We explored whether this ability could be related to the cortical activity of the brain areas involved in the MI network. To this goal, brain activity was recorded using high-density electroencephalography (hdEEG) in nineteen healthy adults while visually imagining walking on a straight path. We extracted Event-Related Desynchronizations (ERDs) in the β band, and we measured MI ability via (i) the Kinesthetic and Visual Imagery Questionnaire (KVIQ), (ii) the Vividness of Movement Imagery Questionnaire-2 (VMIQ), and (iii) the Imagery Ability (IA) score. We then used Pearson's and Spearman's coefficients to correlate MI ability scores and average ERD power (avgERD). VMIQ was positively correlated with avgERD of frontal and cingulate areas, whereas IA SCORE was positively correlated with avgERD of left inferior frontal and superior temporal regions. Stronger activation of the MI network was related to better scores of MI ability evaluations, supporting the importance of testing MI ability during MI protocols. This result will help to understand MI mechanisms and develop personalized MI treatments for patients with neurological dysfunctions.

The effect of backpack weight on the performance of basic short-term/working memory tasks while walking along a pre-determined route

This study investigated possible backpack weight effects on the performance of three basic short-term/working memory (STM/WM) tasks conducted concurrently with the physical task of route walking. The STM/WM tasks were the Corsi block-tapping, digit span, and 3-back tasks, and, were employed to examine the visuo-spatial sketchpad, phonological loop and central executive components of the WM system. Four backpack weight levels (0%, 15%, 25% and 40% of body mass) were considered. Thirty participants conducted the three experimental tasks requiring physical-cognitive multitasking. Data analyses revealed that: (1) increased backpack weight resulted in decreases in the performance of the Corsi block-tapping and the 3-back task, but (2) backpack weight did not significantly affect the digit span task performance. The study results suggest that reducing backpack weight could benefit the performance of various cognitive tasks during route walking. The study findings may be useful for the ergonomics design of body-worn equipment and human-system interfaces.Practitioner summary: This study examined the backpack weight effects on the performance of three basic short-term/working memory tasks conducted concurrently with the physical task of route walking. The study revealed that reducing backpack weight could benefit various cognitive tasks during physical-cognitive multitasking, especially cognitive tasks that require visuospatial processing and executive control.

The Effect of Non-invasive Brain Stimulation on Gait in Healthy Young and Older Adults: A Systematic Review of the Literature

BACKGROUND AND OBJECTIVES

Walking is an important function which requires coordinated activity of sensory-motor neural networks. Noninvasive brain stimulation (NIBS) is a safe neuromodulatory technique with motor function-improving effects. This study aimed to determine the effect of different types of NIBS interventions explored in randomized controlled trials on gait in healthy young and older adults.

METHODS

Based on the PRISMA approach, we conducted an electronic search in PubMed, Web of Science, Scopus, and PEDro for randomized clinical trials assessing the effect of NIBS on gait in healthy young and older adults and performed a narrative review.

RESULTS

Fourteen studies were included in this systematic review. According to the outcomes, transcranial direct current stimulation (tDCS) over the motor cortex and transcranial alternating current stimulation (tACS) over the cerebellum seem to be promising for improving gait characteristics such as speed, synchronization, and variability. Furthermore, tDCS over the dorsolateral prefrontal cortex (DLPFC) improved gait speed and reduced gait parameter variability under dual-task conditions. Only one repetitive transcranial magnetic stimulation was available, which showed no effects. No studies were available for transcranial random noise stimulation, and transcranial pulsed current stimulation. Moreover, the intervention parameters of the included studies were heterogeneous, and studies comparing directly specific intervention protocols were missing.

CONCLUSION

NIBS is a promising approach to improve gait in healthy young and older adults. Anodal tDCS over the motor areas and DLPFC, and tACS over the cerebellum have shown positive effects on gait.

Case report: A novel approach of closed-loop brain stimulation combined with robot gait training in post-stroke gait disturbance

Most post-stroke patients have long-lasting gait disturbances that reduce their daily activities. They often show impaired hip and knee joint flexion and ankle dorsiflexion of the lower limbs during the swing phase of gait, which is controlled by the corticospinal tract from the primary motor cortex (M1). Recently, we reported that gait-synchronized closed-loop brain stimulation targeting swing phase-related activity in the affected M1 can improve gait function in post-stroke patients. Subsequently, a gait-training robot (Orthobot^®) was developed that could assist lower-limb joint movements during the swing phase of gait. Therefore, we investigated whether gait-synchronized closed-loop brain stimulation combined with robot-assisted training targeting the swing phase could enhance the recovery of post-stroke gait disturbance. A 57-year-old female patient with chronic post-stroke hemiparesis underwent closed-loop brain stimulation combined with robot-assisted training for 10 min 2 years after left pons infarction. For closed-loop brain stimulation, we used transcranial oscillatory electrical current stimulation over the lesioned M1 foot area with 1.5 mA of DC offset and 0-3 mA of sine-wave formed currents triggered by the paretic heel contact to set the maximum current just before the swing phase (intervention A; two times repeated, A1 and A2). According to the N-of-1 study design, we also performed sham stimulation (intervention B) and control stimulation not targeting the swing phase (intervention C) combined with robot-assisted training in the order of A1-B-A2-C interventions. As a result, we found larger improvements in gait speed, the Timed Up and Go test result, and muscle strength after the A1 and A2 interventions than after the B and C interventions. After confirming the short-term effects, we performed an additional long-term intervention twice a week for 5 weeks, for a total of 10 sessions. Gait parameters also largely improved after long-term intervention. Gait-synchronized closed-loop brain stimulation combined with robot-assisted training targeting the swing phase of gait may promote the recovery of gait function in post-stroke patients. Further studies with a larger number of patients are necessary.

Case report: Backward gait training combined with gait-synchronized cerebellar transcranial alternating current stimulation in progressive supranuclear palsy

Progressive supranuclear palsy (PSP) is characterized by recurrent falls caused by postural instability, and a backward gait is considered beneficial for postural instability. Furthermore, a recent approach for rehabilitation combined with gait-oriented synchronized stimulation using non-invasive transcranial patterned stimulation could be promising for balance function. Here, we present a case of PSP with backward gait training combined with gait-synchronized transcranial alternating current stimulation (tACS). A 70-year-old woman with PSP-Richardson's syndrome underwent backward gait training combined with synchronized cerebellar tACS. Initially, she underwent short-term intervention with combined training of backward gait with synchronized cerebellar tACS, asynchronized, or sham stimulation according to the N-of-1 study design. Synchronized tACS training demonstrated a decrease in postural instability, whereas asynchronized or sham stimulation did not. The additional long-term interventions of combined backward gait training with synchronized cerebellar tACS demonstrated further decrease in postural instability with improvements in gait speed, balance function, and fall-related self-efficacy in daily life. The present case describes a novel approach for motor symptoms in a patient with PSP. Backward gait training with synchronized cerebellar tACS may be a promising therapeutic approach.

Stride-to-stride time intervals are independently affected by the temporal pattern and probability distribution of visual cues

The temporal structure of the variability of the stride-to-stride time intervals during paced walking is affected by the underlying autocorrelation function (ACF) of the pacing signal. This effect could be accounted for by differences in the underlying probability distribution function (PDF) of the pacing signal. We investigated the isolated and combined effect of the ACF and PDF of the pacing signals on the temporal structure of the stride-to-stride time intervals during visually guided paced overground walking. Ten young, healthy participants completed four walking trials while synchronizing their footstep to a visual pacing signal with a temporal pattern of either pink or white noise (different ACF) and either a Gaussian or normal probability distribution (different PDF). The scaling exponent from the Detrended Fluctuation Analysis was used to quantify the temporal structure of the stride-to-stride time intervals. The ACF and PDF of the pacing signals had independent effects on the scaling exponent of the stride-to-stride time intervals. The scaling exponent was higher during the pink noise pacing trials compared to the white noise pacing trials and higher during the trials with the Gaussian probability distribution compared to the uniform distribution. The results suggest that the sensorimotor system in healthy young individuals has an affinity towards external cues with a pink noise pattern and a Gaussian probability distribution during paced walking.

Brain Alterations in Aged OVT73 Sheep Model of Huntington's Disease: An MRI Based Approach

BACKGROUND

Huntington's disease (HD) is a fatal neurodegenerative autosomal dominant disorder with prevalence of 1 : 20000 that has no effective treatment to date. Translatability of candidate therapeutics could be enhanced by additional testing in large animal models because of similarities in brain anatomy, size, and immunophysiology. These features enable realistic pre-clinical studies of biodistribution, efficacy, and toxicity.

OBJECTIVE AND METHODS

Here we non-invasively characterized alterations in brain white matter microstructure, neurochemistry, neurological status, and mutant Huntingtin protein (mHTT) levels in cerebrospinal fluid (CSF) of aged OVT73 HD sheep.

RESULTS

Similar to HD patients, CSF mHTT differentiates HD from normal sheep. Our results are indicative of a decline in neurological status, and alterations in brain white matter diffusion and spectroscopy metric that are more severe in aged female HD sheep. Longitudinal analysis of aged female HD sheep suggests that the decline is detectable over the course of a year. In line with reports of HD human studies, white matter alterations in corpus callosum correlates with a decline in gait of HD sheep. Moreover, alterations in the occipital cortex white matter correlates with a decline in clinical rating score. In addition, the marker of energy metabolism in striatum of aged HD sheep, shows a correlation with decline of clinical rating score and eye coordination.

CONCLUSION

This data suggests that OVT73 HD sheep can serve as a pre-manifest large animal model of HD providing a platform for pre-clinical testing of HD therapeutics and non-invasive tracking of the efficacy of the therapy.

Cerebral Blood Deoxygenation by a Postural Change Detected by Near-Infrared Spectroscopy Has a Close Association with Cerebral Infarction

BACKGROUND

The recent introduction of near-infrared spectroscopy has enabled the monitoring of cerebral blood flow in real-time. Previous studies have shown that blood flow velocity is a predictor of cardiovascular disease. We hypothesized that cerebral oxygenation with a change in posture is a predictor for cerebral infarction. We designed a cross-sectional study to investigate the relationship between postural-related changes in cerebral oxygenation and a history of chronic cerebral infarction.

METHODS

A total of 100 consecutive participants were enrolled in this study. We evaluated changes in cerebral oxygenation with a change in posture from the supine to the upright position in the bilateral forehead. The association between a decline in cerebral oxygenation and chronic cerebral infarction was analyzed with multiple logistic regression adjusted for covariates.

RESULTS

Cerebral blood oxygenation increased in 52 participants and decreased in 48 participants with a postural change. The prevalence of decreased cerebral oxygenation was 76.3% in participants with chronic cerebral infarction. Multiple logistic regression analysis showed that a decline in cerebral oxygenation upon a postural change was strongly associated with chronic cerebral infarction (adjusted odds ratio: 3.42, p = 0.025).

CONCLUSIONS

Cerebral blood oxygenation upon a postural change could be a useful predictor for cerebral infarction.

Corticospinal Excitability Quantification During a Visually-Guided Precision Walking Task in Humans: Potential for Neurorehabilitation

The corticospinal tract has been shown to be involved in normal walking in humans. However, its contribution during more challenging locomotor tasks is still unclear. As the corticospinal tract can be a potential target to promote gait recovery after neurological injury, it is of primary importance to quantify its use during human walking. The aims of the current study were to: (1) quantify the effects of precision walking on corticospinal excitability as compared to normal walking; (2) assess if corticospinal modulation is related to task difficulty or participants' performance. Sixteen healthy participants walked on a treadmill during 2 tasks: regular walking (simple task) and stepping onto virtual targets (precision task). Virtual targets appeared randomly at 3 different step lengths: preferred, and ±20%. To assess corticospinal excitability, 25 motor evoked potentials (MEPs) were recorded from the tibialis anterior muscle in each task during walking. Performance for each participant (global success score; % of target hit) and task difficulty related to step length adjustments (success score for each step length) were also calculated. MEP size was larger during the precision task in all participants (mean increase of 93% ± 72%; P < .05) compared to the simple task. There was a correlation between MEP facilitation and individual performance (r = -.64; P < .05), but no difference in MEP size associated with task difficulty (P > .05). In conclusion, corticospinal excitability exhibits a large increase during the precision task. This effect needs to be confirmed in neurological populations to potentially provide a simple and non-invasive approach to increase corticospinal drive during gait rehabilitation.

Abnormal neural oscillations during gait and dual-task in Parkinson’s disease

Gait dysfunctions are debilitating motor symptoms of Parkinson’s disease (PD) and may result in frequent falling with health complications. The contribution of the motor-cognitive network to gait disturbance can be studied more thoroughly by challenging motor-cognitive dual-task gait performances. Gait is a complex motor task that requires an appropriate contribution from motor and cognitive networks, reflected in frequency modulations among several cortical and subcortical networks. Electrophysiological recordings by scalp electroencephalography and implanted deep brain stimulation (DBS) electrodes have unveiled modulations of specific oscillatory patterns in the cortical-subcortical circuits in PD. In this review, we summarize oscillatory contributions of the cortical, basal ganglia, mesencephalic locomotor, and cerebellar regions during gait and dual-task activities in PD. We detail the involvement of the cognitive network in dual-task settings and compare how abnormal oscillations in the specific frequency bands in the cortical and subcortical regions correlate with gait deficits in PD, particularly freezing of gait (FOG). We suggest that altered neural oscillations in different frequencies can cause derangements in broader brain networks, so neuromodulation and pharmacological therapies should be considered to normalize those network oscillations to improve challenged gait and dual-task motor functions in PD. Specifically, the theta and beta bands in premotor cortical areas, subthalamic nucleus, as well as alpha band activity in the brainstem prepontine nucleus, modulate under clinically effective levodopa and DBS therapies, improving gait and dual-task performance in PD with FOG, compared to PD without FOG and age-matched healthy control groups.

Alterations of structure and functional connectivity of visual brain network in patients with freezing of gait in Parkinson’s disease

Freezing of gait (FOG) is a disabling gait disorder common in advanced stage of Parkinson’s disease (PD). The gait performance of PD-FOG patients is closely linked with visual processing. Here, we aimed to investigate the structural and functional change of visual network in PD-FOG patients. Seventy-eight PD patients (25 with FOG, 53 without FOG) and 29 healthy controls (HCs) were included. All the participants underwent structural 3D T1-weighted magnetic resonance imaging (MRI) and resting state functional MRI scan. Our results demonstrated a significant decrease of right superior occipital gyrus gray matter density in PD-FOG relative to non-FOG (NFOG) patients and healthy controls (PD-FOG vs. PD-NFOG: 0.33 ± 0.04 vs. 0.37 ± 0.05, p = 0.005; PD-FOG vs. HC: 0.37 ± 0.05 vs. 0.39 ± 0.06, p = 0.002). Functional MRI revealed a significant decrease of connectivity between right superior occipital gyrus and right paracentral lobule in PD-FOG compared to PD-NFOG (p = 0.045). In addition, the connectivity strength was positively correlated with gray matter density of right superior occipital gyrus (r = 0.471, p = 0.027) and negatively associated with freezing of gait questionnaire (FOGQ) score (r = -0.562, p = 0.004). Our study suggests that the structural and functional impairment of visual-motor network might underlie the neural mechanism of FOG in PD.

Non-invasive brain stimulation for improving gait, balance, and lower limbs motor function in stroke

Objectives

This systematic review and meta-analysis aim to summarize and analyze the available evidence of non-invasive brain stimulation/spinal cord stimulation on gait, balance and/or lower limb motor recovery in stroke patients.

Methods

The PubMed database was searched from its inception through to 31/03/2021 for randomized controlled trials investigating repetitive transcranial magnetic stimulation or transcranial/trans-spinal direct current/alternating current stimulation for improving gait, balance and/or lower limb motor function in stroke patients.

Results

Overall, 25 appropriate studies (including 657 stroke subjects) were found. The data indicates that non-invasive brain stimulation/spinal cord stimulation is effective in supporting recovery. However, the effects are inhomogeneous across studies: (1) transcranial/trans-spinal direct current/alternating current stimulation induce greater effects than repetitive transcranial magnetic stimulation, and (2) bilateral application of non-invasive brain stimulation is superior to unilateral stimulation.

Conclusions

The current evidence encourages further research and suggests that more individualized approaches are necessary for increasing effect sizes in stroke patients.

Detection and assessment of Parkinson's disease based on gait analysis: A survey

Neurological disorders represent one of the leading causes of disability and mortality in the world. Parkinson's Disease (PD), for example, affecting millions of people worldwide is often manifested as impaired posture and gait. These impairments have been used as a clinical sign for the early detection of PD, as well as an objective index for pervasive monitoring of the PD patients in daily life. This review presents the evidence that demonstrates the relationship between human gait and PD, and illustrates the role of different gait analysis systems based on vision or wearable sensors. It also provides a comprehensive overview of the available automatic recognition systems for the detection and management of PD. The intervening measures for improving gait performance are summarized, in which the smart devices for gait intervention are emphasized. Finally, this review highlights some of the new opportunities in detecting, monitoring, and treating of PD based on gait, which could facilitate the development of objective gait-based biomarkers for personalized support and treatment of PD.

Transcranial Magnetic Stimulation during Gait: A Review of Methodological and Technological Challenges

Transcranial magnetic stimulation (TMS) is widely used for therapeutic and research purposes such as cognitive studies, treatment of psychiatric disorders, and Parkinson's disease. In research, TMS is perhaps the only technique that can establish a functional connection between brain regions and task performance. In gait research, often TMS is used to identify the extent to which leg motor cortex is involved in different phases on gait cycle. However, using TMS in gait can be challenging for several technical reasons and physiological variations. The objective of this narrative review is to summarize literature in the field of TMS and gait research and present comprehensive challenges. A comprehensive literature search was conducted in PubMed and Google Scholar to identify all relevant literature on TMS and gait. Several critical challenges could potentially impact the findings. For instance, the use of different protocols to obtain motor threshold. This review presents some of the critical challenges in applying TMS during gait. It is important to be aware of these variations and utilize strategies to mitigate some challenges.

Review of Active Extracorporeal Medical Devices to Counteract Freezing of Gait in Patients with Parkinson Disease

Parkinson Disease (PD) primarily affects older adults. It is the second-most common neurodegenerative disease after Alzheimer’s disease. Currently, more than 10 million people suffer from PD, and this number is expected to grow, considering the increasing global longevity. Freezing of Gait (FoG) is a symptom present in approximately 80% of advanced-stage PD’s patients. FoG episodes alter the continuity of gait, and may be the cause of falls that can lead to injuries and even death. The recent advances in the development of hardware and software systems for the monitoring, stimulus, or rehabilitation of patients with FoG has been of great interest to researchers because detection and minimization of the duration of FoG events is an important factor in improving the quality of life. This article presents a review of the research on non-invasive medical devices for FoG, focusing on the acquisition, processing, and stimulation approaches used.

Frequency-dependent modulation of neural oscillations across the gait cycle

Balance and walking are fundamental to support common daily activities. Relatively accurate characterizations of normal and impaired gait features were attained at the kinematic and muscular levels. Conversely, the neural processes underlying gait dynamics still need to be elucidated. To shed light on gait‐related modulations of neural activity, we collected high‐density electroencephalography (hdEEG) signals and ankle acceleration data in young healthy participants during treadmill walking. We used the ankle acceleration data to segment each gait cycle in four phases: initial double support, right leg swing, final double support, left leg swing. Then, we processed hdEEG signals to extract neural oscillations in alpha, beta, and gamma bands, and examined event‐related desynchronization/synchronization (ERD/ERS) across gait phases. Our results showed that ERD/ERS modulations for alpha, beta, and gamma bands were strongest in the primary sensorimotor cortex (M1), but were also found in premotor cortex, thalamus and cerebellum. We observed a modulation of neural oscillations across gait phases in M1 and cerebellum, and an interaction between frequency band and gait phase in premotor cortex and thalamus. Furthermore, an ERD/ERS lateralization effect was present in M1 for the alpha and beta bands, and in the cerebellum for the beta and gamma bands. Overall, our findings demonstrate that an electrophysiological source imaging approach based on hdEEG can be used to investigate dynamic neural processes of gait control. Future work on the development of mobile hdEEG‐based brain–body imaging platforms may enable overground walking investigations, with potential applications in the study of gait disorders.

The Motor Engram of Functional Connectivity Generated by Acute Whole-Body Dynamic Balance Training

PURPOSE

Whole-body dynamic balance is necessary for both athletic activities and activities of daily living. This study aimed to investigate the effect of acute dynamic balance training on neural networks.

METHODS

We evaluated resting-state functional connectivity (rs-FC), white matter fiber density, fiber-bundle cross-section, and gray matter volume in 28 healthy young adults (14 women) before and after 30 min of slackline training using a randomized, counterbalanced crossover design.

RESULTS

The rs-FC between the left lateral prefrontal cortex (PFC) and the foot area of the primary sensorimotor (SM1) cortex increased significantly after slackline training compared with that after a control condition involving ergometer-based aerobic exercise. In addition, changes in rs-FC between the left lateral PFC and the primary sensorimotor were correlated with performance changes after training (i.e., offline process) rather than online learning. We also observed a main effect of time between the hippocampus and the cingulate cortex, including the anterior areas, and between the bilateral lateral PFC. Although we observed no structural changes, fiber density in the commissural fiber pathway before the first balance assessment was correlated with initial balance capability.

CONCLUSIONS

Our findings demonstrate that acute whole-body dynamic balance training alters specific rs-FC, and that this change is associated with performance changes after training. In addition, rs-FC changes in cognitive regions were modulated by both acute dynamic balance training and aerobic exercise. These findings have the potential to influence various fields (e.g., sports neuroscience, neurorehabilitation) and may aid in the development of methods that can improve motor and cognitive performance.

Neural oscillations during motor imagery of complex gait: an HdEEG study

The aim of this study was to investigate differences between usual and complex gait motor imagery (MI) task in healthy subjects using high-density electroencephalography (hdEEG) with a MI protocol. We characterized the spatial distribution of α- and β-bands oscillations extracted from hdEEG signals recorded during MI of usual walking (UW) and walking by avoiding an obstacle (Dual-Task, DT). We applied a source localization algorithm to brain regions selected from a large cortical-subcortical network, and then we analyzed α and β bands Event-Related Desynchronizations (ERDs). Nineteen healthy subjects visually imagined walking on a path with (DT) and without (UW) obstacles. Results showed in both gait MI tasks, α- and β-band ERDs in a large cortical-subcortical network encompassing mostly frontal and parietal regions. In most of the regions, we found α- and β-band ERDs in the DT compared with the UW condition. Finally, in the β band, significant correlations emerged between ERDs and scores in imagery ability tests. Overall we detected MI gait-related α- and β-band oscillations in cortical and subcortical areas and significant differences between UW and DT MI conditions. A better understanding of gait neural correlates may lead to a better knowledge of pathophysiology of gait disturbances in neurological diseases.

A multi-step blind source separation approach for the attenuation of artifacts in mobile high-density electroencephalography data

Objective.Electroencephalography (EEG) is a widely used technique to address research questions about brain functioning, from controlled laboratorial conditions to naturalistic environments. However, EEG data are affected by biological (e.g. ocular, myogenic) and non-biological (e.g. movement-related) artifacts, which-depending on their extent-may limit the interpretability of the study results. Blind source separation (BSS) approaches have demonstrated to be particularly promising for the attenuation of artifacts in high-density EEG (hdEEG) data. Previous EEG artifact removal studies suggested that it may not be optimal to use the same BSS method for different kinds of artifacts.Approach.In this study, we developed a novel multi-step BSS approach to optimize the attenuation of ocular, movement-related and myogenic artifacts from hdEEG data. For validation purposes, we used hdEEG data collected in a group of healthy participants in standing, slow-walking and fast-walking conditions. During part of the experiment, a series of tone bursts were used to evoke auditory responses. We quantified event-related potentials (ERPs) using hdEEG signals collected during an auditory stimulation, as well as the event-related desynchronization (ERD) by contrasting hdEEG signals collected in walking and standing conditions, without auditory stimulation. We compared the results obtained in terms of auditory ERP and motor-related ERD using the proposed multi-step BSS approach, with respect to two classically used single-step BSS approaches.Main results. The use of our approach yielded the lowest residual noise in the hdEEG data, and permitted to retrieve stronger and more reliable modulations of neural activity than alternative solutions. Overall, our study confirmed that the performance of BSS-based artifact removal can be improved by using specific BSS methods and parameters for different kinds of artifacts.Significance.Our technological solution supports a wider use of hdEEG-based source imaging in movement and rehabilitation studies, and contributes to the further development of mobile brain/body imaging applications.

Respiratory function modulated during execution, observation, and imagination of walking via SII

The Mirror Neurons System (MNS) consists of brain areas active during actions execution, as well as observation-imagination of the same actions. MNS represents a potential mechanism by which we understand other's action goals. We investigated MNS activation for legs actions, and its interaction with the autonomic nervous system. We performed a physiological and fMRI investigation on the common neural structures recruited during the execution, observation, and imagination of walking, and their effects on respiratory activity. Bilateral SMA were activated by all three tasks, suggesting that these areas are responsible for the core of the MNS effect for walking. Moreover, we observed in bilateral parietal opercula (OP1, secondary somatosensory cortex-SII) evidence of an MNS subtending walking execution-observation-imagination that also modulated the respiratory function. We suggest that SII, in modulating the vegetative response during motor activity but also during observation-imagination, consists of a re-enacting function which facilitates the understanding of motor actions.

Dance-based exergaming on postural stability and kinematics in people with chronic stroke - A preliminary study

INTRODUCTION

The study evaluated the feasibility, and compliance of a dance-based exergaming (DBExG) on postural stability (PS) and lower extremity (LE) kinematics, along with post-intervention changes in gait function and falls self-efficacy in people with chronic stroke (PwCS).

METHODS

Fifteen PwCS underwent DBExG for six weeks using Kinect "Just Dance 3." Pre- to post- changes were recorded during DBExG assessment on a fast-paced song (130 bpm) using an 8-camera motion capture system to assess PS (center of mass [CoM] excursions [EXs] in the anterior-posterior [AP] and mediolateral [ML] directions) and LE kinematics (hip, knee, and ankle joint angle EXs). Gait function was also assessed with gait parameters, such as gait speed, cadence, and gait symmetry on an electronic walkway. Falls self-efficacy was recorded with Falls Efficacy Scale (FES).

RESULTS

The AP and ML CoM EXs and paretic joint angle EXs significantly increased pre- to post- DBExG assessment (p < .05). Gait parameters, and falls self-efficacy measures significantly changed pre- to post- DBExG (p < .05).

CONCLUSIONS

Results exhibited the feasibility of the proposed DBExG for positively impacting postural stability, and kinematics, along with increasing gait function and falls self-efficacy among PwCS.

Research on blood oxygen activity in cerebral cortical motor function areas with adjustment intention during gait

BACKGROUND

The study of the neural mechanism of human gait control can provide a theoretical basis for the treatment of walking disorders or the improvement of rehabilitation strategies, and further promote the functional rehabilitation of patients with movement disorders. However, the performance and changes of cerebral cortex activity corresponding to gait adjustment intentions are still not clear.

OBJECTIVE

The purpose of this study was to detect the blood oxygen activation characterization of the cerebral cortex motor function area when people have the intention to adjust gait during walking.

METHODS

Thirty young volunteers (21 ± 1 years old) performed normal walking, speed increase, speed reduction, step increase, and step reduction, during which oxygenated hemoglobin (HbO), deoxygenated hemoglobin (HbR), and total oxyhemoglobin (HbT) information in the prefrontal cortex (PFC), premotor cortex (PMC), supplementary motor area (SMA) was continuous monitored using near-infrared brain functional imaging.

RESULTS

(1) With the intention to adjust gait, the HbO concentration in the SMA increased significantly, while the HbT concentration in the medial-PFC decreased significantly. (2) In the HbO concentration, step reduction is more activated than the step increase in the left-PMC (p= 0.0130); step adjustment is more activated than speed adjustment in the right-PMC (p= 0.0067). In the HbR concentration, the speed reduction is more activated than the speed increase in the left-PFC (p= 0.0103).

CONCLUSIONS

When the intention of gait adjustment occurs, the increase of HbO concentration in the SMA indicates the initial stage of gait adjustment will increase the cognitive-locomotor demand of the brain. The left brain area meets the additional nerve needs of speed adjustment. The preliminary findings of this study can lay an important theoretical foundation for the realization of gait control based on fNIRS-BCI technology.

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.

Effects of Attentional Control on Gait and Inter-Joint Coordination During Dual-Task Walking

In the process of walking, attentional resources are flexibly allocated to deal with varying environmental constraints correlated with attentional control (AC). A dual-task paradigm was used to investigate the effects of AC on gait and inter-joint coordination. Fifty students volunteered to participate in this study. Based on the reaction time (RT) in the Stroop task, the top 15 participants were assigned to the High Attentional Control (HAC) group, while the last 15 participants were assigned to the Low Attentional Control (LAC) group. The participants in the two groups were randomly asked to perform three tasks: (i) single 2-back working memory task (ST 2-back); (ii) single walking task (ST walking); and (iii) dual task (DT). Cognitive outcomes and gait spatiotemporal parameters were measured. Continuous relative phase (CRP), derived from phase angles of two adjacent joints, was used to assess inter-joint coordination. The LAC group exhibited significant task effects regarding RT, correct rate (CR), step width, gait cycle, step time, forefoot contact times, heel-forefoot times, hip-knee mean absolute relative phase (MARP), and deviation phase (DP) in the stance and swing phases (p < 0.05). In the HAC group, significant task effects were only detected in RT and foot progression angle of the left foot (p < 0.05). Under the three task conditions, the LAC group exhibited a higher CR in ST, longer heel contact times, and longer heel-forefoot times when compared with the LAC group (p < 0.05). Compared with the LAC group, the HAC group exhibited significantly smaller (closer to zero) MARP and weaker hip-knee DP values in the swing phase across all gait conditions (p < 0.05). In the stance phase, the HAC group had smaller MARP (closer to zero) values when compared with the LAC group (p < 0.05). In conclusion, the ability to maintain gait control and modulate inter-joint coordination patterns in young adults is affected by the level of attentional control in accommodating gait disturbances. AC is correlated with the performance of motor control, which theoretically supports the competitive selection of athletes and fall prevention strategies for a specific population.

Revisiting the acute effects of resistance exercise on motor imagery ability

Motor imagery (MI) shares psychological and physiological similarities with the physical practice of the same action. Yet, it remains unclear whether fatigue elicited by exercise impairs MI ability. Fourteen participants performed MI of a self-paced walking sequence of 22 m before and after a resistance exercise eliciting muscle fatigue from upper and lower limbs, selectively. We indexed MI ability using psychometric and behavioral methods. Electromyography of the quadriceps was also recorded during physical practice trials of the walking sequence. For both experimental conditions, we recorded improved temporal congruence between MI and physical practice of the walking sequence (9.89 %, 95 % CI [7.03, 12.75], p < 0.01). Vividness decreased immediately after the fatiguing exercise (6.35 %, 95 % CI [5.18, 7.51], p < 0.05), before rapidly returning to pre-fatigue values during recovery trials. The results challenge the hypothesis of an effect of acute fatigue elicited by a resistance exercise on MI ability, i.e. restricted to MI tasks focusing fatigued effectors. The beneficial effects of fatigue conditions on the psychometric and behavioral indexes of MI ability are discussed in the broader context of psychobiological fatigue models linking perceived exertion with the reallocation of attentional resources. The general perception of fatigue, rather than local muscle fatigue, appeared linked to the acute effects of resistance exercise on MI ability.

Artificial intelligence in single photon emission computed tomography (SPECT) imaging: a narrative review

Artificial intelligence (AI) has been widely applied to medical imaging. The use of AI for emission computed tomography, particularly single-photon emission computed tomography (SPECT) emerged nearly 30 years ago but has been accelerated in recent years due to the development of AI technology. In this review, we will describe and discuss the progress of AI technology in SPECT imaging. The applications of AI are dispersed in disease prediction and diagnosis, post-reconstruction image denoising, attenuation map generation, and image reconstruction. These applications are relevant to many disease categories such as the neurological disorders, kidney failure, cancer, heart disease, etc. This review summarizes these applications so that SPECT researchers can have a reference overview of the role of AI in current SPECT studies. For each application, we followed the timeline to present the evolution of AI’s usage and offered insights on how AI was combined with the knowledge of underlying physics as well as traditional non-learning techniques. Ultimately, AI applications are critical to the progress of modern SPECT technology because they provide compensations for many deficiencies in conventional SPECT imaging methods and demonstrate unparalleled success. Nonetheless, AI also has its own challenges and limitations in the medical field, including SPECT imaging. These fundamental questions are discussed, and possible future directions and countermeasures are suggested.

Neurological and behavioral features of locomotor imagery in the blind

In people with normal sight, mental simulation (motor imagery) of an experienced action involves a multisensory (especially kinesthetic and visual) emulation process associated with the action. Here, we examined how long-term blindness influences sensory experience during motor imagery and its neuronal correlates by comparing data obtained from blind and sighted people. We scanned brain activity with functional magnetic resonance imaging (fMRI) while 16 sighted and 14 blind male volunteers imagined either walking or jogging around a circle of 2 m radius. In the training before fMRI, they performed these actions with their eyes closed. During scanning, we explicitly instructed the blindfolded participants to generate kinesthetic motor imagery. After the experimental run, they rated the degree to which their motor imagery became kinesthetic or spatio-visual. The imagery of blind people was more kinesthetic as per instructions, while that of the sighted group became more spatio-visual. The imagery of both groups commonly activated bilateral frontoparietal cortices including supplementary motor areas (SMA). Despite the lack of group differences in degree of brain activation, we observed stronger functional connectivity between the SMA and cerebellum in the blind group compared to that in the sighted group. To conclude, long-term blindness likely changes sensory emulation during motor imagery to a more kinesthetic mode, which may be associated with stronger functional coupling in kinesthetic brain networks compared with that in sighted people. This study adds valuable knowledge on motor cognition and mental imagery processes in the blind.

Integrated 3D motion analysis with functional magnetic resonance neuroimaging to identify neural correlates of lower extremity movement

BACKGROUND

To better understand the neural drivers of aberrant motor control, methods are needed to identify whole brain neural correlates of isolated joints during multi-joint lower-extremity coordinated movements. This investigation aimed to identify the neural correlates of knee kinematics during a unilateral leg press task.

NEW METHOD

The current study utilized an MRI-compatible motion capture system in conjunction with a lower extremity unilateral leg press task during fMRI. Knee joint kinematics and brain activity were collected concurrently and averaged range of motion were modeled as covariates to determine the neural substrates of knee out-of-plane (frontal) and in-plane (sagittal) range of motion.

RESULTS

Increased out-of-plane (frontal) range of motion was associated with altered brain activity in regions important for attention, sensorimotor control, and sensorimotor integration (z >3.1, p < .05), but no such correlates were found with in-plane (sagittal) range of motion (z >3.1, p > .05). Comparison with Existing Method(s): Previous studies have either presented overall brain activation only, or utilized biomechanical data collected outside MRI in a standard biomechanics lab for identifying single-joint neural correlates.

CONCLUSIONS

The study shows promise for the MRI-compatible system to capture lower-extremity biomechanical data collected concurrently during fMRI, and the present data identified potentially unique neural drivers of aberrant biomechanics. Future research can adopt these methods for patient populations with CNS-related movement disorders to identify single-joint kinematic neural correlates that may adjunctively supplement brain-body therapeutic approaches.

tDCS and motor training in individuals with central nervous system disease: A systematic review

BACKGROUND

Transcranial direct current stimulation (tDCS) is a promising tool for patients with neurological disorders, as it increases cortical excitability, motor learning and functionality. The studies up to date have focused on the tDCS parameters while the effects of the motor training have not yet been fully addressed. The purpose of this study is to present a systematic review of all studies related to tDCS in conjunction with motor training (MT) to improve gait performance, functionality, mobility and balance in individuals with non-progressive central nervous system diseases.

METHODS

Seven databases were searched for articles from inception to October 2018. The search strategy followed Collaboration guidelines. The Physiotherapy Evidence Database (PEDro) Scale and Cochrane Collaboration's tool for assessing the risk of bias were applied to evaluate methodological quality.

RESULTS

Four hundred and sixteen recorded were screened. Ten studies met the inclusion criteria. All studies were randomized controlled trials, two of them had a crossover design and other two were pilot studies. Three paper analyzed children and adolescents with cerebral palsy, seven papers analyzed adults and elderly post stroke. tDCS with MT lead to significant results.

CONCLUSIONS

This review found limited evidence for the use of tDCS with MT for in children with CP and adults post stroke, due to the small number of studies as well as their methodological heterogeneity. In the absence of more robust evidence, further studies with a consistent methodological design are needed to endorse the clinical application of tDCS with motor training.

Premotor Cortex Provides a Substrate for the Temporal Transformation of Information During the Planning of Gait Modifications

We tested the hypothesis that the premotor cortex (PMC) in the cat contributes to the planning and execution of visually guided gait modifications. We analyzed single unit activity from 136 cells localized within layer V of cytoarchitectonic areas 6iffu and that part of 4δ within the ventral bank of the cruciate sulcus while cats walked on a treadmill and stepped over an obstacle that advanced toward them. We found a rich variety of discharge patterns, ranging from limb-independent cells that discharged several steps in front of the obstacle to step-related cells that discharged either during steps over the obstacle or in the steps leading up to that step. We propose that this population of task-related cells within this region of the PMC contributes to the temporal evolution of a planning process that transforms global information of the presence of an obstacle into the precise spatio-temporal limb adjustment required to negotiate that obstacle.

Wearable hip-assist robot modulates cortical activation during gait in stroke patients: a functional near-infrared spectroscopy study

Background

Gait dysfunction is common in post-stroke patients as a result of impairment in cerebral gait mechanism. Powered robotic exoskeletons are promising tools to maximize neural recovery by delivering repetitive walking practice.

Objectives

The purpose of this study was to investigate the modulating effect of the Gait Enhancing and Motivating System-Hip (GEMS-H) on cortical activation during gait in patients with chronic stroke. Methods. Twenty chronic stroke patients performed treadmill walking at a self-selected speed either with assistance of GEMS-H (GEMS-H) or without assistance of GEMS-H (NoGEMS-H). Changes in oxygenated hemoglobin (oxyHb) concentration in the bilateral primary sensorimotor cortex (SMC), premotor cortices (PMC), supplemental motor areas (SMA), and prefrontal cortices (PFC) were recorded using functional near infrared spectroscopy.

Results

Walking with the GEMS-H promoted symmetrical SMC activation, with more activation in the affected hemisphere than in NoGEMS-H conditions. GEMS-H also decreased oxyHb concentration in the late phase over the ipsilesional SMC and bilateral SMA (P < 0.05).

Conclusions

The results of the present study reveal that the GEMS-H promoted more SMC activation and a balanced activation pattern that helped to restore gait function. Less activation in the late phase over SMC and SMA during gait with GEMS-H indicates that GEMS-H reduces the cortical participation of stroke gait by producing rhythmic hip flexion and extension movement and allows a more coordinate and efficient gait patterns.

Trial registration NCT03048968. Registered 06 Feb 2017

Neural correlates of standing imagery and execution in Parkinsonian patients: The relevance to striatal dopamine dysfunction

It has been reported that the cerebellar vermis is equally involved in both motor imagery about axial movement and the actual execution of postural balance in healthy human subjects, but this finding is yet to be explored in Parkinson's disease (PD). We therefore investigated the neuronal responses during observation of standing posture, imagination of standing and the assumption of an upright posture in ten drug-naïve PD patients using positron emission tomography (PET) with [15O]H2O and evaluated dopamine dysfunction by measuring the level of dopamine transporter binding of [11C]CFT. Within-group statistical parametric mapping (SPM) analysis showed similar cerebellar activation during imagination of standing and its real execution between the PD and control groups (12 healthy subjects); i.e., increases in regional cerebral blood flow (rCBF) were observed in the anterior cerebellar vermis during motor imagination and the posterior vermis during standing. A comparison between the groups showed that the motor execution of standing significantly activated the superior part of the posterior vermis (declive VI) and the paracentral sulcus region in the PD patients, while the prefrontal cortices were deactivated during standing (p<0.001 uncorrected). Correlation analysis within the PD group revealed that the postural rCBF increases in the cerebellar vermis (pyramis) were negatively correlated with putaminal [11C]CFT binding (p<0.01, r = 0.94) and that the postural rCBF reductions in the orbitofrontal cortex were positively correlated with caudate [11C]CFT binding (p<0.05, r = 0.70). These results suggest that while the neural circuits for postural imagery and execution are intact in PD, standing performance, which requires more recruitment of dopaminergic control, may result in compensatory overstimulation of the cerebellar vermis and paracentral foot area in PD patients. Hyperactivity in these areas along with mesocortical hypofunction may be pathophysiological aspects of postural control in PD patients. Hence, our findings would help understand the modifications observed within the neural networks in relationship with postural performance, and possible compensatory mechanisms in PD.

Differentiating the Brain's involvement in Executed and Imagined Stepping using fMRI

The purpose of this study was to extend the extant literature regarding brain areas that are activated during executed and imagined lower limb movement. Past research suggests that stepping, as a cyclical movement, should activate the motor control areas of the brain that integrates smooth movements with spinal cord nerves. The neuronal activity needed to imagine that same activity is likely to recruit additional sensory-motor areas that provide initiation and inhibition signals, making this task take on a neuronal activity pattern that is more similar to discrete movements. To assess this research question, 16 participants took part in the current study where they executed and imagined stepping, with movement at the hip, knee, and ankle joints, while viewing a computer-generated image of a human walking. A block design with a total of 10 blocks for rest and task for each condition was used. Rest blocks lasted 18 seconds, followed by an 18-second display of the visual stimulus. Results showed that in the executed condition, areas of the brain that are most prominently associated with sensory-motor activity were activated. In the imagined condition areas of the brain associated with movement control, inhibition of movement, and the integration of sensory input and motor output (parietal and occipital) were also activated. These findings contribute to the literature identifying brain areas that are activated in lower limb locomotion.