Personalized protocol and scoring scale for functional electrical stimulation of the hand: A pilot feasibility study

BACKGROUND: Complex personalized Functional Electrical Stimulation (FES) protocols for calibrating parameters and electrode positioning have been proposed, most being time-consuming or technically cumbersome for clinical settings. Therefore, there is a need for new personalized FES protocols that generate comfortable, functional hand movements, while being feasible for clinical translation. OBJECTIVE: To develop a personalized FES protocol, comprising electrode placement and parameter selection, to generate hand opening (HO), power grasp (PW) and precision grip (PG) movements, and compare in a pilot feasibility study its performance to a non-personalized protocol based on standard FES guidelines. METHODS: Two FES protocols, one personalized (P1) and one non-personalized (P2), were used to produce hand movements in twenty-three healthy participants. FES-induced movements were assessed with a new scoring scale which comprises items for selectivity, functionality, and comfort. RESULTS: Higher FES-HSS scores were obtained with P1 for all movements: HO (p= 0.00013), PW (p= 0.00007), PG (p= 0.00460). Electrode placement time was significantly shorter for P2 (p= 0.00003). Comfort scores were similar for both protocols. CONCLUSIONS: The personalized protocol for electrode placement and parameter selection enabled functional FES-induced hand movements and presented advantages over a non-personalized protocol. This protocol warrants further investigation to confirm its suitability for developing upper-limb rehabilitation interventions with clinical translational potential.

Detection of Resting-State Functional Connectivity from High-Density Electroencephalography Data: Impact of Head Modeling Strategies

Recent technological advances have been permitted to use high-density electroencephalography (hdEEG) for the estimation of functional connectivity and the mapping of resting-state networks (RSNs). The reliable estimate of activity and connectivity from hdEEG data relies on the creation of an accurate head model, defining how neural currents propagate from the cortex to the sensors placed over the scalp. To the best of our knowledge, no study has been conducted yet to systematically test to what extent head modeling accuracy impacts on EEG-RSN reconstruction. To address this question, we used 256-channel hdEEG data collected in a group of young healthy participants at rest. We first estimated functional connectivity in EEG-RSNs by means of band-limited power envelope correlations, using neural activity estimated with an optimized analysis workflow. Then, we defined a series of head models with different levels of complexity, specifically testing the effect of different electrode positioning techniques and head tissue segmentation methods. We observed that robust EEG-RSNs can be obtained using a realistic head model, and that inaccuracies due to head tissue segmentation impact on RSN reconstruction more than those due to electrode positioning. Additionally, we found that EEG-RSN robustness to head model variations had space and frequency specificity. Overall, our results may contribute to defining a benchmark for assessing the reliability of hdEEG functional connectivity measures.

Could Relative Movement Between the Adductor Muscles and the Skin Invalidate Surface Electromyography Measurement?

The superficial hip adductor muscles are situated in close proximity to each other. Therefore, relative movement between the overlying skin and the muscle belly could lead to a shift in the position of surface electromyography (EMG) electrodes and contamination of EMG signals with activity from neighboring muscles. The aim of this study was to explore whether hip movements or isometric contraction could lead to relative movement between the overlying skin and 3 adductor muscles: adductor magnus, adductor longus, and adductor gracilis. The authors also sought to investigate isometric torque–EMG relationships for the 3 adductor muscles. Ultrasound measurement showed that EMG electrodes maintained a position which was at least 5 mm within the muscle boundary across a range of hip flexion–extension angles and across different contraction levels. The authors also observed a linear relationship between torque and EMG amplitude. This is the first study to use ultrasound to track the relative motion between skin and muscle and provides new insight into electrode positioning. The findings provide confidence that ultrasound-based positioning of EMG electrodes can be used to derive meaningful information on output from the adductor muscles and constitute a step toward recognized guidelines for surface EMG measurement of the adductors.

A Computational Parcellated Brain Model for Electric Field Analysis in Transcranial Direct Current Stimulation

Recent years have seen the use of increasingly realistic electric field (EF) models to further our knowledge of the bioelectric basis of noninvasive brain techniques such as transcranial direct current stimulation (tDCS). Such models predict a poor spatial resolution of tDCS, showing a non-focal EF distribution with similar or even higher magnitude values far from the presumed targeted regions, thus bringing into doubt the classical criteria for electrode positioning. In addition to magnitude, the orientation of the EF over selected neural targets is thought to play a key role in the neuromodulation response. This chapter offers a summary of recent works which have studied the effect of simulated EF magnitude and orientation in tDCS, as well as providing new results derived from an anatomically representative parcellated brain model based on finite element method (FEM). The results include estimates of mean and peak tangential and normal EF values over different cortical regions and for various electrode montages typically used in clinical applications.

Variability of Muscle Synergies in Hand Grasps: Analysis of Intra- and Inter-Session Data

Background. Muscle synergy analysis is an approach to understand the neurophysiological mechanisms behind the hypothesized ability of the Central Nervous System (CNS) to reduce the dimensionality of muscle control. The muscle synergy approach is also used to evaluate motor recovery and the evolution of the patients’ motor performance both in single-session and longitudinal studies. Synergy-based assessments are subject to various sources of variability: natural trial-by-trial variability of performed movements, intrinsic characteristics of subjects that change over time (e.g., recovery, adaptation, exercise, etc.), as well as experimental factors such as different electrode positioning. These sources of variability need to be quantified in order to resolve challenges for the application of muscle synergies in clinical environments. The objective of this study is to analyze the stability and similarity of extracted muscle synergies under the effect of factors that may induce variability, including inter- and intra-session variability within subjects and inter-subject variability differentiation. The analysis was performed using the comprehensive, publicly available hand grasp NinaPro Database, featuring surface electromyography (EMG) measures from two EMG electrode bracelets. Methods. Intra-session, inter-session, and inter-subject synergy stability was analyzed using the following measures: variance accounted for (VAF) and number of synergies (NoS) as measures of reconstruction stability quality and cosine similarity for comparison of spatial composition of extracted synergies. Moreover, an approach based on virtual electrode repositioning was applied to shed light on the influence of electrode position on inter-session synergy similarity. Results. Inter-session synergy similarity was significantly lower with respect to intra-session similarity, both considering coefficient of variation of VAF (approximately 0.2–15% for inter vs. approximately 0.1% to 2.5% for intra, depending on NoS) and coefficient of variation of NoS (approximately 6.5–14.5% for inter vs. approximately 3–3.5% for intra, depending on VAF) as well as synergy similarity (approximately 74–77% for inter vs. approximately 88–94% for intra, depending on the selected VAF). Virtual electrode repositioning revealed that a slightly different electrode position can lower similarity of synergies from the same session and can increase similarity between sessions. Finally, the similarity of inter-subject synergies has no significant difference from the similarity of inter-session synergies (both on average approximately 84–90% depending on selected VAF). Conclusion. Synergy similarity was lower in inter-session conditions with respect to intra-session. This finding should be considered when interpreting results from multi-session assessments. Lastly, electrode positioning might play an important role in the lower similarity of synergies over different sessions.

Electrode positioning to investigate the changes of the thoracic bioimpedance caused by aortic dissection – a simulation study

Impedance cardiography (ICG) is a non-invasive method to evaluate several cardiodynamic parameters by measuring the cardiac-synchronous changes in the dynamic transthoracic electrical impedance. ICG allows us to identify and quantify conductivity changes inside the thorax by measuring the impedance on the thorax during a cardiac cycle. Pathologic changes in the aorta, like aortic dissection, will alter the aortic shape as well as the blood flow and consequently, the impedance cardiogram. This fact distorts the evaluated cardiodynamic parameters, but it could lead to the possibility to identify aortic pathology. A 3D numerical simulation model is used to compute the impedance changes on the thorax surface in case of the type B aortic dissection. A sensitivity analysis is applied using this simulation model to investigate the suitability of different electrode configurations considering several patient-specific cases. Results show that the remarkable pathological changes in the aorta caused by aortic dissection alters the impedance cardiogram significantly.