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Spasticity is a muscle disorder associated with upper motor neuron syndrome occurring in neurological disorders, such as stroke, multiple sclerosis, spinal cord injury and others. It influences the patient's rehabilitation, interfering with function, limiting independence, causing pain and producing secondary impairments, such as contractures or other complications. Due to the heterogeneity of clinical signs of spasticity, there is no agreement on the most appropriate assessment and measurement modality for the evaluation of treatment outcomes. Observational pilot study involving five post stroke patients. A new robotic device able to automatically assess upper-limb spasticity during passive and active mobilization has been developed. The elbow spasticity of five post stroke patients has been assessed by using the new device and by means of the Modified Ashworth Scale (MAS). After the first assessment, subjects were treated with botulin toxin injections, and then underwent 10 se...

Brain-computer interfaces (BCIs) have the potential to improve functionality in chronic stoke patients when applied over a large number of sessions. Here, we evaluate the effect and the underlying mechanisms of three BCI training sessions in a double-blind-sham-controlled design. The applied BCI is based on Hebbian principles of associativity that hypothesizes that neural assemblies activated in a correlated manner will strengthen synaptic connections. Twenty-two chronic stroke patients were allocated into two training groups. Movement-related cortical potentials (MRCPs) were detected using elecroencephalography during repetitions of foot dorsiflexion. Detection triggered a single electrical stimulation of the common peroneal nerve timed so that the resulting afferent volley arrived at the peak negative phase of the MRCP (BCIassociative group) or randomly (BCInon-associative group). Fugl-Meyer motor assessment (FM), 10-m walking speed, foot and hand tapping frequency and the excitab...

Introduction: Brain Computer Interface (BCI) is a technology that allows to the users the capability to interact with devices by using the voluntary modulation of the brain activity. Objectives: The aim of this paper is to analyze whether the use of the cortical activity estimated from non invasive EEG recordings could be useful to detect mental states and how this technology could be useful in clinical applications. Methods: Estimation of cortical activity was performed on high resolution EEG data related to the imagination of limb movements and detection of P300 gathered in a group of normal healthy subjects and motor-impaired patients by using realistic head models. Cortical activity was estimated in Region of Interest associated with the subject’s Brodmann areas by using depth-weighted minimum norm solutions. Comparisons between surface recorded EEG and the estimated cortical activity were performed. Subjects and patients are asked to interact with different electronic devices of common use by using such BCI system. Results: With the proposed methodology subjects are able to drive several mechanical and electronic devices by modulating their EEG activity related to motor imagery. BCI-based P300 is found a methodology easier to use for patients than motor imagery for driving devices. Conclusions: EEG recordings can be used to drive electronic and mechanical devices in healthy and in a group of motor-impaired patients. The presented approach could extend the possibility for a use of BCI system into the rehabilitation path for those patients.

Investigate if patients with supraspinal lesions have impaired interlimb spinal reflex pathways. The short-latency crossed spinal response will be investigated during sitting from the non-paretic to paretic and paretic to non-paretic extremities at different stimulation intensities in chronic and sub-acute stroke patients. The ipsilateral tibial nerve of the paretic and non-paretic extremities were stimulated at motor threshold, 35% M-max and 85% M-max of the ipsilateral soleus while the contralateral soleus was contracted from 5% to 15% of the maximum voluntary contraction of the paretic soleus. Chronic patients (from both extremities) had significantly less prominent inhibitory responses than healthy controls (post hoc tests: P<.01-P<.05). The responses were significantly modulated by stimulus intensity in healthy controls and chronic patients (P<.001-P<.05) but not sub-acute patients (P>.05). Some sub-acute patients had significantly more variable responses than chronic patients and healthy controls (P<.001-P⩽.05). Short-latency interlimb reflexes are impaired differently in sub-acute vs. chronic patients, are impaired from the non-paretic and paretic extremity, and abnormal when compared to healthy controls. The inappropriate coordination could result in an inability to quickly avoid obstacles following a mechanical disturbance to the ipsilateral extremity. It also indicates that bilateral descending projections affect the response.

Changes in the excitability of the cortical projections to muscles in the upper and lower limbs can be induced in the intact human by paired associative stimulation (PAS). An interstimulus interval (ISI) of 25 ms between peripheral nerve and transcranial magnetic stimuli has been found to be effective when targeting hand muscles. The optimal ISI to induce plasticity changes in the cortical projections to lower limbs is still not well established. The purpose of this study was twofold: first, to investigate the effect of PAS with four different ISIs based on the individual latency of the sensory evoked potential (SEP plus 6, 12, 18 and 24 ms) and second, to evaluate the repeatability of the established optimal ISI. Transcranial magnetic stimulation was used to measure changes in the motor evoked potentials (MEPs) of the soleus (SOL) muscle before and after the PAS interventions. Significant increases in the amplitude of SOL MEPs (88 %) were attained with an ISI of SEP latency plus 18 ms (P32 + 18 ms). The PAS effect was long-lasting, input-specific and supraspinal in origin. The intraclass correlation coefficient to test the repeatability of the PAS intervention with the optimal ISI was 0.85. The results show that the excitability of cortical projections to the soleus muscle can be repeatedly increased after PAS with an optimal ISI of SEP plus 18 ms.

The main objective of this study was to characterize the stretch reflex response of the human thigh muscles to an unexpected knee flexion at the transition from stance to swing during walking. Eleven healthy subjects walked on a treadmill at their preferred speed. Reliable and constant knee flexions (6-12 degrees amplitude, 230-350 degrees /s velocity, 220 ms duration) were applied during the late swing and early stance phase of human walking by rotating the knee joint with a specifically designed portable stretch apparatus affixed to the left knee. Responses from rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), medial hamstrings (MH) and medial gastrocnemius (GM) were recorded via bipolar surface electromyograms (EMG). The onset of the response in the RF, VL and VM, remained stable and independent of the time in the step cycle when the stretch was applied. Across all subjects the response onset (mean +/- SD) occurred at 23+/-1, 24+/-1 and 23+/-1 ms for RF, VL and VM, respectively. The duration of the initial response was 90-110 ms, at which time the EMG signal returned towards baseline levels. Three reflex response windows, labelled the short latency reflex (SLR), the medium latency reflex (MLR) and the late latency reflex response (LLR), were analysed. The medium and late reflex responses of all knee extensors increased significantly ( p=0.008) as the gait cycle progressed from swing to stance. This was not related to the background EMG activity. In contrast, during standing at extensor EMG levels similar to those attained during walking the reflex responses were dependent on background EMG. During walking, LLR amplitudes expressed as a function of the background activity were on average two to three times greater than SLR and MLR reflex amplitudes. Distinct differences in SLR and LLR amplitude were observed for RF, VL and VM but not in the MLR amplitude. This may be related to the different pathways mediating the SLR, MLR and LLR components of the stretch response. As for the knee extensor antagonists, they exhibited a response to the stretch of the quadriceps at latencies short enough to be monosynaptic. This is in agreement with the suggestion by Eccles and Lundberg (1958) that there may be functional excitatory connections between the knee extensors and flexors in mammals.

In this paper, we present a brain-computer interface (BCI) driven motorized ankle-foot orthosis (BCI-MAFO), intended for stroke rehabilitation, and we demonstrate its efficacy in inducing cortical neuroplasticity in healthy subjects with a short intervention procedure (∼15 min). This system detects imaginary dorsiflexion movements within a short latency from scalp EEG through the analysis of movement-related cortical potentials (MRCPs). A manifold-based method, called locality preserving projection, detected the motor imagery online with a true positive rate of 73.0 ± 10.3%. Each detection triggered the MAFO to elicit a passive dorsiflexion. In nine healthy subjects, the size of the motor-evoked potential (MEP) elicited by transcranial magnetic stimulation increased significantly immediately following and 30 min after the cessation of this BCI-MAFO intervention for ∼15 min ( p = 0.009 and , respectively), indicating neural plasticity. In four subjects, the size of the short latency stretch reflex component did not change following the intervention, suggesting that the site of the induced plasticity was cortical. All but one subject also performed two control conditions where they either imagined only or where the MAFO was randomly triggered. Both of these control conditions resulted in no significant changes in MEP size (p = 0.38 and p = 0.15). The proposed system provides a fast and effective approach for inducing cortical plasticity through BCI and has potential in motor function rehabilitation following stroke.

During human walking, precise coordination between the two legs is required in order to react promptly to any sudden hazard that could threaten stability. The networks involved in this coordination are not yet completely known, but a direct spinal connection between soleus (SOL) muscles has recently been revealed. For this response to be functional, as previously suggested, we hypothesize that it will be accompanied by a reaction in synergistic muscles, such as gastrocnemius lateralis (GL), and that a reversal of the response would occur when an opposite reaction is required. In the present study, surface EMGs of contralateral SOL and GL were analyzed after tibial nerve (TN), sural nerve (SuN), and medial plantar nerve (MpN) stimulation during two tasks in which opposite reactions are functionally expected: normal walking (NW), just before ipsilateral heel strike, and hybrid walking (HW) (legs walking in opposite directions), at ipsilateral push off and contralateral touchdown. Earl...

Reflex responses of tibialis anterior motor units to stretch stimuli were investigated in human subjects. Three types of stretch stimuli were applied (tap-like, ramp-and-hold, and half-sine stretch). Stimulus-induced responses in single motor units were analyzed using the classical technique, which involved building average surface electromyogram (SEMG) and peristimulus time histograms (PSTH) from the discharge times of motor units and peristimulus frequencygrams (PSF) from the instantaneous discharge rates of single motor units. With the use of SEMG and PSTH, the tap-like stretch stimulus induced five separate reflex responses, on average. With the same single motor unit data, the PSF technique indicated that the tap stimulus induced only three reflex responses. Similar to the finding using the tap-like stretch stimuli, ramp-and-hold stimuli induced several peaks and troughs in the SEMG and PSTH. The PSF analyses displayed genuine increases in discharge rates underlying the peaks b...

Short-latency spinally mediated interlimb reflex pathways were recently reported between the left and right soleus muscles in the human lower-limb during sitting. The aim of the current study was to establish if these pathways were observed during a functional motor task such as human gait and modulated by the gait cycle phase and/or electrical stimulation intensity. The second aim was to elucidate on the afferents involved. Two interventions were investigated. First was ipsilateral tibial nerve (iTN) stimulation at motor threshold (MT), 35% of the maximal peak-to-peak M-wave (M-Max) and 85% M-Max (85M-Max) with stimuli applied at 60×, 70×, 80×, 90×, and 100% of the gait cycle of the ipsilateral leg. Second was ipsilateral sural nerve (SuN) and medial plantar nerve (MpN) stimulation at 1, 2, and 3 perceptual threshold at 90% of the gait cycle. The root mean squared (RMS) of the contralateral soleus (cSOL) responses were analyzed in a time window, 40–55 ms (or 45–60 ms for subjects &...