High Amplitude EEG Motor Potential during Repetitive Foot Movement: Possible Use and Challenges for Futuristic BCIs That Restore Mobility after Spinal Cord Injury

Locked-in syndrome revisited

The locked-in syndrome (LiS) is characterized by quadriplegia with preserved vertical eye and eyelid movements and retained cognitive abilities. Subcategorization, aetiologies and the anatomical foundation of LiS are discussed. The damage of different structures in the pons, mesencephalon and thalamus are attributed to symptoms of classical, complete and incomplete LiS and the locked-in plus syndrome, which is characterized by additional impairments of consciousness, making the clinical distinction to other chronic disorders of consciousness at times difficult. Other differential diagnoses are cognitive motor dissociation (CMD) and akinetic mutism. Treatment options are reviewed and an early, interdisciplinary and aggressive approach, including the provision of psychological support and coping strategies is favoured. The establishment of communication is a main goal of rehabilitation. Finally, the quality of life of LiS patients and ethical implications are considered. While patients with LiS report a high quality of life and well-being, medical professionals and caregivers have largely pessimistic perceptions. The negative view on life with LiS must be overthought and the autonomy and dignity of LiS patients prioritized. Knowledge has to be disseminated, diagnostics accelerated and technical support system development promoted. More well-designed research but also more awareness of the needs of LiS patients and their perception as individual persons is needed to enable a life with LiS that is worth living.

Optimal Selection of EEG Electrodes Using Interval Type-2 Fuzzy-Logic-Based Semiseparating Signaling Game

This article addresses the noise contamination in spatial filtering of brain responses using a novel signaling game-based approach to the optimal selection of EEG electrodes. The proposed method takes the standard common spatial pattern (CSP) filter as an input and produces an optimal electrode set as output for effective classification of different cognitive tasks. The standard CSP algorithms are highly prone to the inclusion of noise in the EEG data and may select noisy electrodes/signal sources that are redundant for a specific cognitive task which, in turn, may lead to a lower classification accuracy. A lot of literature exists in this area of research, most of which deals with adding the regularization term in the standard CSP algorithm. However, all of these methods lack capturing the uncertainty present in the EEG responses due to intrasession and intersession variations of subjective brain response. The novelty of this article lies in designing the fuzzy signaling game-based approach for optimal electrode selection using an interval type-2 fuzzy set, which can capture both the intrasession and intersession variability of EEG responses acquired from a subject's scalp. Experiments are undertaken over a wide variety of possible cognitive task classification problems which reveal that the proposed method yields superior results in electrode selection with respect to classification accuracy. Statistical tests undertaken using the Friedman test also confirm the superiority of the proposed method over its competitors.

Divergent Findings in Brain Reorganization After Spinal Cord Injury: A Review

Spinal cord injury (SCI) leads to a general lack of sensory and motor functions below the level of injury and may promote deafferentation-induced brain reorganization. Functional magnetic resonance imaging (fMRI) has been established as an essential tool in neuroscience research and can precisely map the spatiotemporal distribution of brain activity. Task-based fMRI experiments associated with the tongue, upper limbs, or lower limbs have been used as the primary paradigms to study brain reorganization following SCI. A review of the current literature on the subject shows one common trait: while most articles agree that brain networks are usually preserved after SCI, and that is not the case as some articles describe possible alterations in brain activation after the lesion. There is no consensus if those alterations indeed occur. In articles that show alterations, there is no agreement if they are transient or permanent. Besides, there is no consensus on which areas are most prone to activation changes, or on the intensity and direction (increase vs. decrease) of those possible changes. In this article, we present a critical review of the literature and trace possible reasons for those contradictory findings on brain reorganization following SCI. fMRI studies based on the ankle dorsiflexion, upper-limb, and tongue paradigms are used as case studies for the analyses.

The Advantage of Low-Delta Electroencephalogram Phase Feature for Reconstructing the Center-Out Reaching Hand Movements

It is an emerging frontier of research on the use of neural signals for prosthesis control, in order to restore lost function to amputees and patients after spinal cord injury. Compared to the invasive neural signal based brain-machine interface (BMI), a non-invasive alternative, i.e., the electroencephalogram (EEG)-based BMI would be more widely accepted by the patients above. Ideally, a real-time continuous neuroprosthestic control is required for practical applications. However, conventional EEG-based BMIs mainly deal with the discrete brain activity classification. Until recently, the literature has reported several attempts for achieving the real-time continuous control by reconstructing the continuous movement parameters (e.g., speed, position, etc.) from the EEG recordings, and the low-frequency band EEG is consistently reported to encode the continuous motor control information. Previous studies with executed movement tasks have extensively relied on the amplitude representation of such slow oscillations of EEG signals for building models to decode kinematic parameters. Inspired by the recent successes of instantaneous phase of low-frequency invasive brain signals in the motor control and sensory processing domains, this study examines the extension of such a slow-oscillation phase representation to the reconstructing two-dimensional hand movements, with the non-invasive EEG signals for the first time. The data for analysis are collected on five healthy subjects performing 2D hand center-out reaching along four directions in two sessions. On representative channels over the cortices encoding the execution information of reaching movements, we show that the low-delta EEG phase representation is characterized by higher signal-to-noise ratio and stronger modulation by the movement tasks, compared to the low-delta EEG amplitude representation. Furthermore, we have tested the low-delta EEG phase representation with two commonly used linear decoding models. The results demonstrate that the low-delta EEG phase based decoders lead to superior performance for 2D executed movement reconstruction to its amplitude based counterparts, as well as the other-frequency band amplitude and power based features. Thus, our study contributes to improve the movement reconstruction from EEG by introducing a new feature set based on the low-delta EEG phase patterns, and demonstrates its potential for continuous fine motion control of neuroprostheses.

Bibliometric analysis of global research on the rehabilitation of spinal cord injury in the past two decades

Purpose

We aimed to build a model to qualitatively and quantitatively evaluate publications of research of spinal cord injury rehabilitation from 1997 to 2016.

Methods

Data were obtained from the Web of Science Core Collection on October 6, 2017. We conducted a qualitative and quantitative analysis of publication outputs, journals, authors, institutions, countries, cited references, keywords, and terms by bibliometric methods and bibliometric software packages.

Results

We identified 5,607 publications on rehabilitation of spinal cord injury from 1997 to 2016, and found that the annual publication rate increased with time. The Archives of Physical Medicine and Rehabilitation published the largest number of literature, the most active country was USA, the most active institution was University of Washington, and Post MWM was the leading author. Keyword analysis indicated that life satisfaction, muscle strength, wheelchair training, walking, gait, and others were the hot spots of these research studies, whereas classification, exoskeleton, plasticity, and old adult were research frontiers.

Conclusion

This bibliometric study revealed that research on rehabilitation of spinal cord injury is a well-developed and promising research field. Global scientific research cooperation is close. However, higher quality research is needed. Our findings provide valuable information for researchers to identify better perspectives and develop the future research direction.

HD-EEG Based Classification of Motor-Imagery Related Activity in Patients With Spinal Cord Injury

Brain computer interfaces (BCIs) are thought to revolutionize rehabilitation after SCI, e.g., by controlling neuroprostheses, exoskeletons, functional electrical stimulation, or a combination of these components. However, most BCI research was performed in healthy volunteers and it is unknown whether these results can be translated to patients with spinal cord injury because of neuroplasticity. We sought to examine whether high-density EEG (HD-EEG) could improve the performance of motor-imagery classification in patients with SCI. We recorded HD-EEG with 256 channels in 22 healthy controls and 7 patients with 14 recordings (4 patients had more than one recording) in an event related design. Participants were instructed acoustically to either imagine, execute, or observe foot and hand movements, or to rest. We calculated Fast Fourier Transform (FFT) and full frequency directed transfer function (ffDTF) for each condition and classified conditions pairwise with support vector machines when using only 2 channels over the sensorimotor area, full 10-20 montage, high-density montage of the sensorimotor cortex, and full HD-montage. Classification accuracies were comparable between patients and controls, with an advantage for controls for classifications that involved the foot movement condition. Full montages led to better results for both groups (p < 0.001), and classification accuracies were higher for FFT than for ffDTF (p < 0.001), for which the feature vector might be too long. However, full-montage 10–20 montage was comparable to high-density configurations. Motor-imagery driven control of neuroprostheses or BCI systems may perform as well in patients as in healthy volunteers with adequate technical configuration. We suggest the use of a whole-head montage and analysis of a broad frequency range.

Imagine There Is No Plegia. Mental Motor Imagery Difficulties in Patients with Traumatic Spinal Cord Injury

In rehabilitation of patients with spinal cord injury (SCI), imagination of movement is a candidate tool to promote long-term recovery or to control futuristic neuroprostheses. However, little is known about the ability of patients with spinal cord injury to perform this task. It is likely that without the ability to effectively perform the movement, the imagination of movement is also problematic. We therefore examined, whether patients with SCI experience increased difficulties in motor imagery (MI) compared to healthy controls. We examined 7 male patients with traumatic spinal cord injury (aged 23–70 years, median 53) and 20 healthy controls (aged 21–54 years, median 30). All patients had incomplete SCI, with AIS (ASIA Impairment Scale) grades of C or D. All had cervical lesions, except one who had a thoracic injury level. Duration after injury ranged from 3 to 314 months. We performed the Movement Imagery Questionnaire Revised as well as the Beck Depression Inventory in all participants. The self-assessed ability of patients to visually imagine movements ranged from 7 to 36 (Md = 30) and tended to be decreased in comparison to healthy controls (ranged 16–49, Md = 42.5; W = 326.5, p = 0.055). Also, the self-assessed ability of patients to kinesthetically imagine movements (range = 7–35, Md = 31) differed significantly from the control group (range = 23–49, Md = 41; W = 337.5, p = 0.0047). Two patients yielded tendencies for depressive mood and they also reported most problems with movement imagination. Statistical analysis however did not confirm a general relationship between depressive mood and increased difficulty in MI across both groups. Patients with spinal cord injury seem to experience difficulties in imagining movements compared to healthy controls. This result might not only have implications for training and rehabilitation programs, but also for applications like brain-computer interfaces used to control neuroprostheses, which are often based on the brain signals exhibited during the imagination of movements.