Exploring high-density corticomuscular networks after stroke to enable a hybrid Brain-Computer Interface for hand motor rehabilitation

Brain-hemispheric differences in the premotor area for motor planning: An approach based on corticomuscular connectivity during motor decision-making

This study investigates the role of the premotor area (PMA) in motor planning during decision-making, focusing on differences between brain hemispheres. A cross-sectional assessment was conducted involving seventeen right-handed participants who performed tasks requiring responses with either hand to visual stimuli. Motion capture, EEG and EMG signals were collected to analyze corticomuscular coherence (CMC) in the beta and gamma bands across four motor-related cortical areas. Findings revealed significant beta-band CMC between anterior deltoids and contralateral PMA before stimulus onset in simple reaction tasks. Moreover, significant beta-band CMC was observed between the left anterior deltoid and the right PMA during the motor planning phase, prior to the onset of muscle contraction, corresponding with shorter planning times. This connectivity pattern was consistent across both simple and complex reaction tasks, indicating that the PMA plays a crucial role during decision-making. Notably, motor planning for the right hand did not exhibit the same connectivity pattern, suggesting more complex cognitive processes. These results emphasize the distinct functional roles of the left and right hemispheres in motor planning and underscore the importance of CMC in understanding the neural mechanisms underlying motor control. This study contributes to the theoretical framework of motor decision-making and offers insights for future research on motor planning and rehabilitation strategies.

Electroencephalogram features reflect effort corresponding to graded finger extension: implications for hemiparetic stroke

Brain-computer interfaces (BCIs) offer disabled individuals the means to interact with devices by decoding the electroencephalogram (EEG). However, decoding intent in fine motor tasks can be challenging, especially in stroke survivors with cortical lesions. Here, we attempt to decode graded finger extension from the EEG in stroke patients with left-hand paresis and healthy controls. Participants extended their fingers to one of four levels: low, medium, high, or 'no-go' (none), while hand, muscle (electromyography: EMG), and brain (EEG) activity were monitored. Event-related desynchronization (ERD) was measured as the change in 8-30 Hz EEG power during movement. Classifiers were trained on EEG features, EMG power, or both (EEG+EMG) to decode finger extension, and accuracy assessed via four-fold cross-validation for each hand of each participant. Mean accuracy exceeded chance (25%) for controls (n = 11) at 62% for EMG, 60% for EEG, and 71% for EEG+EMG on the left hand; and 67%, 60%, and 74%, respectively, on the right hand. Accuracies were similar on the unimpaired right hand for the stroke group (n = 3): 61%, 68%, and 78%, respectively. But on the paretic left hand, EMG only discriminated no-go from movement above chance (41%); in contrast, EEG gave 65% accuracy (68% for EEG+EMG), comparable to the non-paretic hand. The median ERD was significant (p < 0.01) over the cortical hand area in both groups and increased with each level of finger extension. But while the ERD favored the hemisphere contralateral to the active hand as expected, it was ipsilateral for the left hand of stroke due to the lesion in the right hemisphere, which may explain its discriminative ability. Hence, the ERD captures effort in finger extension regardless of success or failure at the task; and harnessing residual EMG improves the correlation. This marker could be leveraged in rehabilitative protocols that focus on fine motor control.

Decoding the brain-machine interaction for upper limb assistive technologies: advances and challenges

Understanding how the brain encodes upper limb movements is crucial for developing control mechanisms in assistive technologies. Advances in assistive technologies, particularly Brain-machine Interfaces (BMIs), highlight the importance of decoding motor intentions and kinematics for effective control. EEG-based BMI systems show promise due to their non-invasive nature and potential for inducing neural plasticity, enhancing motor rehabilitation outcomes. While EEG-based BMIs show potential for decoding motor intention and kinematics, studies indicate inconsistent correlations with actual or planned movements, posing challenges for achieving precise and reliable prosthesis control. Further, the variability in predictive EEG patterns across individuals necessitates personalized tuning to improve BMI efficiency. Integrating multiple physiological signals could enhance BMI precision and reliability, paving the way for more effective motor rehabilitation strategies. Studies have shown that brain activity adapts to gravitational and inertial constraints during movement, highlighting the critical role of neural adaptation to biomechanical changes in creating control systems for assistive devices. This review aims to provide a comprehensive overview of recent progress in deciphering neural activity patterns associated with both physiological and assisted upper limb movements, highlighting avenues for future exploration in neurorehabilitation and brain-machine interface development.

Current implications of EEG and fNIRS as functional neuroimaging techniques for motor recovery after stroke

Persistent motor deficits are highly prevalent among post-stroke survivors, contributing significantly to disability. Despite the prevalence of these deficits, the precise mechanisms underlying motor recovery after stroke remain largely elusive. The exploration of motor system reorganization using functional neuroimaging techniques represents a compelling yet challenging avenue of research. Quantitative electroencephalography (qEEG) parameters, including the power ratio index, brain symmetry index, and phase synchrony index, have emerged as potential prognostic markers for overall motor recovery post-stroke. Current evidence suggests a correlation between qEEG parameters and functional motor outcomes in stroke recovery. However, accurately identifying the source activity poses a challenge, prompting the integration of EEG with other neuroimaging modalities, such as functional near-infrared spectroscopy (fNIRS). fNIRS is nowadays widely employed to investigate brain function, revealing disruptions in the functional motor network induced by stroke. Combining these two methods, referred to as integrated fNIRS-EEG, neural activity and hemodynamics signals can be pooled out and offer new types of neurovascular coupling-related features, which may be more accurate than the individual modality alone. By harnessing integrated fNIRS-EEG source localization, brain connectivity analysis could be applied to characterize cortical reorganization associated with stroke, providing valuable insights into the assessment and treatment of post-stroke motor recovery.

Brain and muscle derived features to discriminate simple hand motor tasks for a rehabilitative BCI: comparative study on healthy and post-stroke individuals

Objective.Brain-Computer Interfaces targeting post-stroke recovery of the upper limb employ mainly electroencephalography to decode movement-related brain activation. Recently hybrid systems including muscular activity were introduced. We compared the motor task discrimination abilities of three different features, namely event-related desynchronization/synchronization (ERD/ERS) and movement-related cortical potential (MRCP) as brain-derived features and cortico-muscular coherence (CMC) as a hybrid brain-muscle derived feature, elicited in 13 healthy subjects and 13 stroke patients during the execution/attempt of two simple hand motor tasks (finger extension and grasping) commonly employed in upper limb rehabilitation protocols.Approach. We employed a three-way statistical design to investigate whether their ability to discriminate the two movements follows a specific temporal evolution along the movement execution and is eventually different among the three features and between the two groups. We also investigated the differences in performance at the single-subject level.Main results. The ERD/ERS and the CMC-based classification showed similar temporal evolutions of the performance with a significant increase in accuracy during the execution phase while MRCP-based accuracy peaked at movement onset. Such temporal dynamics were similar but slower in stroke patients when the movements were attempted with the affected hand (AH). Moreover, CMC outperformed the two brain features in healthy subjects and stroke patients when performing the task with their unaffected hand, whereas a higher variability across subjects was observed in patients performing the tasks with their AH. Interestingly, brain features performed better in this latter condition with respect to healthy subjects.Significance.Our results provide hints to improve the design of Brain-Computer Interfaces for post-stroke rehabilitation, emphasizing the need for personalized approaches tailored to patients' characteristics and to the intended rehabilitative target.

Beta-Band Cortico-Muscular Phase Coherence in Hemiparetic Stroke

Following a stroke, compensation for the loss of ipsilesional corticospinal and corticobulbar projections, results in increased reliance on contralesional motor pathways during paretic arm movement. Better understanding outcomes of post-stroke contralesional cortical adaptation outcomes may benefit more targeted post-stroke motor rehabilitation interventions. This proof-of-concept study involves eight healthy controls and ten post-stroke participants. Electroencephalographic (EEG) and deltoid electromyographic (EMG) data were collected during an upper-limb task. Phase coupling between beta-band motor cortex EEG and deltoid EMG was assessed using the Multi-Phase Locking Value (M-PLV) method. Different from classic cortico-muscular coherence, M-PLV allows for the calculation of dynamic phase coherence and delays, and is not affected by the non-stationary nature of EEG/EMG signals. Nerve conduction delay from the contralateral motor cortex to the deltoid muscle of the paretic arm was estimated. Our results show the ipsilateral (contralesional) motor cortex beta-band phase coherence behavior is altered in stroke participants, with significant differences in ipsilateral EEG-EMG coherence values, ipsilateral time course percentage above the significance threshold, and ipsilateral time course area above the significance threshold. M-PLV phase coherence analysis provides evidence for post-stroke contralesional motor adaptation, highlighting its increased role in the paretic shoulder abduction task. Nerve conduction delay between the motor cortices and deltoid muscle is significantly higher in stroke participants. Beta-band M-PLV phase coherence analysis shows greater phase-coherence distribution convergence between the ipsilateral (contralesional) and contralateral (ipsilesional) motor cortices in stroke participants, which is interpretable as evidence of maladaptive neural adaptation resulting from a greater reliance on the contralesional motor cortices.

Arm muscle synergies enhance hand posture prediction in combination with forearm muscle synergies

Objective.We analyze and interpret arm and forearm muscle activity in relation with the kinematics of hand pre-shaping during reaching and grasping from the perspective of human synergistic motor control.Approach.Ten subjects performed six tasks involving reaching, grasping and object manipulation. We recorded electromyographic (EMG) signals from arm and forearm muscles with a mix of bipolar electrodes and high-density grids of electrodes. Motion capture was concurrently recorded to estimate hand kinematics. Muscle synergies were extracted separately for arm and forearm muscles, and postural synergies were extracted from hand joint angles. We assessed whether activation coefficients of postural synergies positively correlate with and can be regressed from activation coefficients of muscle synergies. Each type of synergies was clustered across subjects.Main results.We found consistency of the identified synergies across subjects, and we functionally evaluated synergy clusters computed across subjects to identify synergies representative of all subjects. We found a positive correlation between pairs of activation coefficients of muscle and postural synergies with important functional implications. We demonstrated a significant positive contribution in the combination between arm and forearm muscle synergies in estimating hand postural synergies with respect to estimation based on muscle synergies of only one body segment, either arm or forearm (p< 0.01). We found that dimensionality reduction of multi-muscle EMG root mean square (RMS) signals did not significantly affect hand posture estimation, as demonstrated by comparable results with regression of hand angles from EMG RMS signals.Significance.We demonstrated that hand posture prediction improves by combining activity of arm and forearm muscles and we evaluate, for the first time, correlation and regression between activation coefficients of arm muscle and hand postural synergies. Our findings can be beneficial for myoelectric control of hand prosthesis and upper-limb exoskeletons, and for biomarker evaluation during neurorehabilitation.

A hybrid brain-muscle-machine interface for stroke rehabilitation: Usability and functionality validation in a 2-week intensive intervention

Introduction: The primary constraint of non-invasive brain-machine interfaces (BMIs) in stroke rehabilitation lies in the poor spatial resolution of motor intention related neural activity capture. To address this limitation, hybrid brain-muscle-machine interfaces (hBMIs) have been suggested as superior alternatives. These hybrid interfaces incorporate supplementary input data from muscle signals to enhance the accuracy, smoothness and dexterity of rehabilitation device control. Nevertheless, determining the distribution of control between the brain and muscles is a complex task, particularly when applied to exoskeletons with multiple degrees of freedom (DoFs). Here we present a feasibility, usability and functionality study of a bio-inspired hybrid brain-muscle machine interface to continuously control an upper limb exoskeleton with 7 DoFs. Methods: The system implements a hierarchical control strategy that follows the biologically natural motor command pathway from the brain to the muscles. Additionally, it employs an innovative mirror myoelectric decoder, offering patients a reference model to assist them in relearning healthy muscle activation patterns during training. Furthermore, the multi-DoF exoskeleton enables the practice of coordinated arm and hand movements, which may facilitate the early use of the affected arm in daily life activities. In this pilot trial six chronic and severely paralyzed patients controlled the multi-DoF exoskeleton using their brain and muscle activity. The intervention consisted of 2 weeks of hBMI training of functional tasks with the system followed by physiotherapy. Patients' feedback was collected during and after the trial by means of several feedback questionnaires. Assessment sessions comprised clinical scales and neurophysiological measurements, conducted prior to, immediately following the intervention, and at a 2-week follow-up. Results: Patients' feedback indicates a great adoption of the technology and their confidence in its rehabilitation potential. Half of the patients showed improvements in their arm function and 83% improved their hand function. Furthermore, we found improved patterns of muscle activation as well as increased motor evoked potentials after the intervention. Discussion: This underscores the significant potential of bio-inspired interfaces that engage the entire nervous system, spanning from the brain to the muscles, for the rehabilitation of stroke patients, even those who are severely paralyzed and in the chronic phase.

Deep learning-based framework for real-time upper limb motion intention classification using combined bio-signals

This research study proposes a unique framework that takes input from a surface electromyogram (sEMG) and functional near-infrared spectroscopy (fNIRS) bio-signals. These signals are trained using convolutional neural networks (CNN). The framework entails a real-time neuro-machine interface to decode the human intention of upper limb motions. The bio-signals from the two modalities are recorded for eight movements simultaneously for prosthetic arm functions focusing on trans-humeral amputees. The fNIRS signals are acquired from the human motor cortex, while sEMG is recorded from the human bicep muscles. The selected classification and command generation features are the peak, minimum, and mean ΔHbO and ΔHbR values within a 2-s moving window. In the case of sEMG, wavelength, peak, and mean were extracted with a 150-ms moving window. It was found that this scheme generates eight motions with an enhanced average accuracy of 94.5%. The obtained results validate the adopted research methodology and potential for future real-time neural-machine interfaces to control prosthetic arms.