Electroencephalography as a Biomarker for Functional Recovery in Spinal Cord Injury Patients

Abstract

BackgroundFunctional changes after spinal cord injury (SCI) are related to changes in cortical plasticity. These changes can be measured with electroencephalography (EEG) and has potential to be used as a clinical biomarker.MethodIn this longitudinal study participants underwent a total of 30 sessions of robotic-assisted gait training (RAGT) over a course of 6 weeks. The duration of each session was 30 min. Resting state EEG was recorded before and after 30-session rehabilitation therapy. To measure gait, we used the Walking Index for Spinal Cord Injury Scale, 10-Meter- Walking Test, Timed-Up-and-Go, and 6-Min-Walking Test. Balance was measured using Berg Balance Scale.ResultsFifteen participants with incomplete SCI who had AIS C or D injuries based on American Spinal Cord Injury Association Impairment Scale classification were included in this study. Mean age was 35.7 years (range 17–51) and the mean time since injury was 17.08 (range 4–37) months. All participants showed clinical improvement with the rehabilitation program. EEG data revealed that high beta EEG activity in the central area had a negative correlation with gait (p = 0.049; β coefficient: −0.351; and adj-R2: 0.23) and balance (p = 0.043; β coefficient: −0.158; and adj-R2:0.24) measured at baseline, in a way that greater high beta EEG power was related to worse clinical function at baseline. Moreover, improvement in gait and balance had negative correlations with the change in alpha/theta ratio in the parietal area (Gait: p = 0.049; β coefficient: −0.351; adj-R2: 0.23; Balance: p = 0.043; β coefficient: −0.158; and adj-R2: 0.24).ConclusionIn SCI, functional impairment and subsequent improvement following rehabilitation therapy with RAGT correlated with the change in cortical activity measured by EEG. Our results suggest that EEG alpha/theta ratio may be a potential surrogate marker of functional improvement during rehabilitation. Future studies are necessary to improve and validate these findings as a neurophysiological biomarker for SCI rehabilitation.

Brain-Computer Interface Controlled Functional Electrical Stimulation: Evaluation With Healthy Subjects and Spinal Cord Injury Patients

“…This is usually associated with a reorganization of oscillatory activity that compensates for the alteration caused by the spinal cord injury [63]. However, determining the correlation between alterations in brain oscillatory activity patterns observed in ERD/ERS analysis results, SCI patient's clinical state and the performance of BCI systems reliably might be challenging [64]- [66]. Therefore, a quantitative measurement based on the results obtained from ERD-ERD analysis could help to understand the impact of BCI systems in rehabilitation therapy.…”