Restoration of Upper Limb Voluntary Motor Function in Chronic Severe Hemiplegia Using a Brain-Computer Interface-Triggered Functional Electrical Stimulation Therapy

Jovanovic, Lazar I.; Desai, Naaz; Márquez-Chin, César

doi:10.1109/smc.2019.8914024

Cited by 10 publications

(39 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, careful selection of stimulation frequencies can have a critical impact for inducing neurophysiological changes in the CNS during electrical stimulation. In our experiments, we typically used stimulation frequencies between 20 and 40 Hz for activation of upper-limb [ 58 , 59 , 62 , 80 , 88 , 144 ], lower-limb [ 87 , 147 ], as well as trunk muscles [ 86 ].…”

Section: Electrical Stimulation Of Muscles and Nervesmentioning

confidence: 99%

“…The objective of this offline step is to select a combination of electrode sites and frequency bands that would be used for online control. The classifiers typically detect event related desynchronization (ERD) of brain oscillatory activity [ 58 ], which is typically present before motor tasks [ 44 ]. During rest, brain activity in the sensorimotor areas can be characterized by synchronous oscillatory patterns, while prior to the movement onset or before attempted or imagined movements, desynchronization (ERD) of specific frequency bands occurs [ 111 ].…”

Section: Brain-controlled Electrical Stimulation Of Muscles and Nervementioning

confidence: 99%

“…Overall, ERD can be a reliable biomarker for detecting motor cortical activity using EEG recordings, and it has been shown to reflect excitability of the primary motor cortex [ 139 ] and spinal motoneurons [ 140 ]. Considering that ERD frequency characteristics are subject-specific [ 111 ], a common procedure is to plot the time–frequency signal power to help manually identify the ERD frequency bands that will be used for online control for each participant (e.g., [ 34 , 58 , 80 , 97 ]). This emphasized the necessity of the calibration step, while re-calibration is commonly required prior to each training session.…”

Section: Brain-controlled Electrical Stimulation Of Muscles and Nervementioning

confidence: 99%

“…Synchronized activations of cortical and peripheral networks may also facilitate associative Hebbian learning. Indeed, recent applications in rehabilitation of CNS injuries are starting to show convincing evidence of cortical neuroplasticity and improved motor function after use of BCI-controlled FES [ 17 , 34 , 58 , 66 , 74 , 80 , 93 , 107 ]. However, despite evidence supporting recovery of voluntary function after FEST and BCI-controlled FES, little is known about the changes that occur in the CNS during and after electrical stimulation of muscles and nerves and why synchronization of cortical and muscle activations through BCI may be relevant in rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

et al. 2020

Self Cite

View full text Add to dashboard Cite

Delivering short trains of electric pulses to the muscles and nerves can elicit action potentials resulting in muscle contractions. When the stimulations are sequenced to generate functional movements, such as grasping or walking, the application is referred to as functional electrical stimulation (FES). Implications of the motor and sensory recruitment of muscles using FES go beyond simple contraction of muscles. Evidence suggests that FES can induce short- and long-term neurophysiological changes in the central nervous system by varying the stimulation parameters and delivery methods. By taking advantage of this, FES has been used to restore voluntary movement in individuals with neurological injuries with a technique called FES therapy (FEST). However, long-lasting cortical re-organization (neuroplasticity) depends on the ability to synchronize the descending (voluntary) commands and the successful execution of the intended task using a FES. Brain-computer interface (BCI) technologies offer a way to synchronize cortical commands and movements generated by FES, which can be advantageous for inducing neuroplasticity. Therefore, the aim of this review paper is to discuss the neurophysiological mechanisms of electrical stimulation of muscles and nerves and how BCI-controlled FES can be used in rehabilitation to improve motor function.

show abstract

Section: Electrical Stimulation Of Muscles and Nervesmentioning

confidence: 99%

Section: Brain-controlled Electrical Stimulation Of Muscles and Nervementioning

confidence: 99%

Section: Brain-controlled Electrical Stimulation Of Muscles and Nervementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Given currently dissatis ed outcomes and large HICH populations, we need additional intervention to limb hemiplegia [32][33][34][35].Rationales behind the previous C7-to-C7 transfer for the paretic upper limb are beginning to be accepted and understood as scalability [36][37][38][39][40].Reinnervation of the denervated muscles,γ-circuit interruption,and establishing a new pathway remarkably contributed to a motor recovery post-transfer [41,42]. Contralateral lumbar neurotization engaging the similar mechanisms was considered available for a lower limb paresis after central neurological injury.Thus,in this project,we would rather extend the L4-to-L4 transfer to hindlimb hemiplegia than other transfer modalities in rats.…”

Section: Discussionmentioning

confidence: 99%

Customized Neurotization for Hindlimb Hemiplegia After a Hemorrhagic Stroke

Qian

Zheng

Shi

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Hemiplegia after hypertensive intracerebral hemorrhage(HICH) is prevalent,devasta-ting,and currently unable to intervene satisfactorily.Established success in neurotization spurs our interest in restoring skilled lower-limb movement.Here,we explored whether contralesional L4 transfer to ipsilesional L4 root,featuring simultaneous invigoration of flexors and extensors,reanimated dexterous locomotion for the hemiplegic hindlimb after HICH.Methods We manufactured eligible rat models by injecting autologous vein blood into the left posterior limb of internal capsule (PLIC) and randomized thirty rats into three groups. We did not transect but expose bilateral L4 in group A (sham operation) after injection of saline,and infused equal blood followed by bilateral L4 transection and contralateral L4 transfer,in group B and group C,respectively.Behavioral,ultrastru-ctural,immunofluorescent,and electromyographic assessments were applied to efficacy analysis.MRI localized the PLIC impact.Results We could see marked reduction in movements and capture a denervated potential in the right hindlimb of model rats (P༞0.05).In the walking tests,group C exhibited an initially high slip,but,later, a larger increment in accuracy on the paretic side, compared to group B and group A(P༜0.001).Also,at Week 17,rats gained ∼58.2% accuracy and actuated ankle motions in group C(P༞0.05). In the retrograde tracing,at Week 9,fluoro-gold labeled motoneurons had been numerously present in the left anterior horn of the spinal cord from the L4-to-L4 root.Histological and ultra-microstructural assessments certified efficient axons regeneration.Electrom-yography and pawprint analysis implied the denervated muscles were reliably reinnervated,and myodynamia improvement(p>0.05).Conclusions Contralateral L4 transfer could render favorable outcomes for major joints,particularly for the ankle,therefore efficaciously repaired the hemiplegic hindlimb after HICH.

show abstract

KITE-BCI: A brain-computer interface system for functional electrical stimulation therapy

Jovanovic

Popović

Márquez-Chin

2021

The Journal of Spinal Cord Medicine

Self Cite

View full text Add to dashboard Cite

Context/Objective Integrating brain-computer interface (BCI) technology with functional electrical stimulation therapy (FEST) is an emerging strategy for upper limb motor rehabilitation after spinal cord injury (SCI). Despite promising results, the combined use of these technologies (BCI-FEST) in clinical practice is minimal. To address this issue, we developed KITE-BCI, a BCI system specifically designed for clinical application and integration with dynamic FEST. In this paper, we report its technical features and performance. In addition, we discuss the differences in distributions of the BCI- and therapist-triggered stimulation latencies. Design Two single-arm 40-session interventional studies to test the feasibility of BCI-controlled FEST for upper limb motor rehabilitation in individuals with cervical SCI Setting Rehabilitation programs within the University and Lyndhurst Centres of the Toronto Rehabilitation Institute – University Health Network, Toronto, Canada Participants Five individuals with sub-acute (< 6 months post-injury) SCI at the C4-C5 level, AIS B-D, and three individuals with chronic (> 24 months post-injury) SCI at C4 level, AIS B-C. Outcome Measures We measured BCI setup duration, and to characterize the performance of KITE-BCI, we recorded BCI sensitivity, defined as the percentage of successful BCI activations out of the total number of cued movements. Results The overall BCI sensitivities were 74.46% and 79.08% for the sub-acute and chronic groups, respectively. The average KITE-BCI setup duration across the two studies was 11 min and 13 s. Conclusion KITE-BCI demonstrates a clinically viable single-channel BCI system for integration with FEST resulting in a versatile technology-enhanced upper limb motor rehabilitation strategy after SCI.

show abstract

Restoration of Upper Limb Voluntary Motor Function in Chronic Severe Hemiplegia Using a Brain-Computer Interface-Triggered Functional Electrical Stimulation Therapy

Cited by 10 publications

References 24 publications

Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

Customized Neurotization for Hindlimb Hemiplegia After a Hemorrhagic Stroke

KITE-BCI: A brain-computer interface system for functional electrical stimulation therapy

Contact Info

Product

Resources

About