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Injuries affecting the central nervous system may disrupt the cortical pathways to muscles causing loss of motor control. Nevertheless, the brain still exhibits sensorimotor rhythms (SMRs) during movement intents or motor imagery (MI), which is the mental rehearsal of the kinesthetics of a movement without actually performing it. Brain-computer interfaces (BCIs) can decode SMRs to control assistive devices and promote functional recovery. Despite rapid advancements in non-invasive BCI systems based on EEG, two persistent challenges remain: First, the instability of SMR patterns due to the non-stationarity of neural signals, which may significantly degrade BCI performance over days and hamper the effectiveness of BCI-based rehabilitation. Second, differentiating MI patterns corresponding to fine hand movements of the same limb is still difficult due to the low spatial resolution of EEG. To address the first challenge, subjects usually learn to elicit reliable SMR and improve BCI control through longitudinal training, so a fundamental question is how to accelerate subject training building upon the SMR neurophysiology. In this study, the investigators hypothesize that conditioning the brain with transcutaneous electrical spinal stimulation, which reportedly induces cortical inhibition, would constrain the neural dynamics and promote focal and strong SMR modulations in subsequent MI-based BCI training sessions - leading to accelerated BCI training. To address the second challenge, the investigators hypothesize that neuromuscular electrical stimulation (NMES) applied contingent to the voluntary activation of the primary motor cortex through MI can help differentiate patterns of activity associated with different hand movements of the same limb by consistently recruiting the separate neural pathways associated with each of the movements within a closed-loop BCI setup. The investigators study the neuroplastic changes associated with training with the two stimulation modalities.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TESS BCI - Standard MI Task | Experimental | Transcutaneous Electrical Spinal Stimulation (TESS) is applied for 20 minutes prior to BCI training sessions. Following TESS, BCI training is performed with visual feedback contingent to motor imagery as detected by a closed-loop BCI. |
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| Visual BCI - Standard MI Task | Active Comparator | Conventional BCI training is performed with visual feedback contingent to the imagination of right versus left hand movements as detected by a closed-loop BCI. |
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| NMES BCI - Difficult MI Task | Experimental | BCI training is performed with NMES instead of Visual feedback. NMES is delivered over the flexors/extensors of the forearm contingent to the imagination of same-hand wrist and fingers flexion versus extension as detected by a closed-loop BCI. |
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| Visual BCI - Difficult MI Task | Active Comparator | Conventional BCI training is performed with visual feedback contingent to the imagination of same-hand wrist and fingers flexion versus extension as detected by a closed-loop BCI. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NMES Feedback | Device | Electroencephalography (EEG) signals will be recorded from subjects as they perform cued tasks for flexing/extending their non-dominant hand. The signals will be processed and classified in real-time using machine learning algorithms to trigger electrical stimulation on the flexors/extensors of the targeted arm contingent to the detection of a subject-specific flexion/extension EEG patterns. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in the BCI command delivery performance | The command delivery accuracy reflects the level of control of the subject when using the BCI. It measures the percentage of trials in which the subject-specific classifier that is used to differentiate the different imagined movements could accumulate enough evidence to support the presence of EEG patterns specifically associated with the imagined movement in those trials. The score is 0-100, and the higher the value, the better the outcome. | immediately after each intervention session and up to one week after all sessions |
| Change in the focality and Strength of SMR Modulation | The focality of sensorimotor rhythm modulation is assessed from EEG using event-related desynchorinzation (ERD) and synchronization (ERS) over the motor area. Continuous measure, the higher the better | immediately after each intervention session and up to one week after all sessions |
| Measure | Description | Time Frame |
|---|---|---|
| Stability of Motor Imagery features | The features corresponding to different motor imagery tasks become more stable at the end of the intervention. | immediately after each intervention session and one-day after all sessions |
| Separability of Motor Imagery features |
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Inclusion Criteria:
Able-bodied participants:
Subjects with motor disabilities
Exclusion Criteria:
Subjects with motor disabilities
All participants
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jose del R. Millan, PhD | Contact | 512-232-8111 | jose.millan@austin.utexas.edu | |
| Hussein Alawieh | Contact | 512-373-0535 | hussein@utexas.edu |
| Name | Affiliation | Role |
|---|---|---|
| Jose del R. Millan, PhD | The University of Texas at Austin | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The University of Texas at Austin | Recruiting | Austin | Texas | 78712 | United States |
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All data will be made available by the online publication date
Data will be placed in public servers for any interested researcher to access it
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| ID | Term |
|---|---|
| D000068079 | Motor Disorders |
| D013119 | Spinal Cord Injuries |
| D009135 | Muscular Diseases |
| D016472 | Motor Neuron Disease |
| D020521 | Stroke |
| D000070642 | Brain Injuries, Traumatic |
| D009069 | Movement Disorders |
| D009103 | Multiple Sclerosis |
| D009461 | Neurologic Manifestations |
| ID | Term |
|---|---|
| D001523 | Mental Disorders |
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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BCI Task x Stimulation Modality
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| Visual Feedback | Device | Electroencephalography (EEG) - recorded from subjects as they perform cued motor imagery (MI) tasks - are classified in real-time using a subject-specific BCI decoder,. The output classification probability of the decoder is accumulated using exponential smoothing and translated into continuous visual feedback by means of a bar - on a computer screen - that moves to the right or left in response to classification of one or the other MI task. |
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| TESS | Device | Transcutaneous Electrical Spinal Stimulation (TESS) is applied over the C5-C6 spinal segment for 20 minutes at 30Hz with 5kHz carrier frequency. |
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The features corresponding to different motor imagery tasks become more separable after the intervention. |
| immediately after each intervention session and one-day after all sessions |
| Changes in motor-evoked potential amplitude | Continuous measure, the higher the better | immediately after each intervention session and one-day after all sessions |
| Changes in electroencephalography functional connectivity | Continuous measure, the more significant changes the better | immediately after each intervention session and one-day after all sessions |
| Change in focality of fMRI activation for different imagined movements | The clusters of significant activation during MI of different movements would be more focal in the associated region of the motor area Continuous measure, the more the better. | immediately after each intervention session and one-day after all sessions |
| More discriminable fMRI activations for different imagined movements | The activation associated with different MI tasks would be more discriminable from BOLD signals. Continuous measure, the more the better. | immediately after each intervention session and one-day after all sessions |
| D020196 | Trauma, Nervous System |
| D014947 | Wounds and Injuries |
| D009140 | Musculoskeletal Diseases |
| D009468 | Neuromuscular Diseases |
| D019636 | Neurodegenerative Diseases |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D001930 | Brain Injuries |
| D006259 | Craniocerebral Trauma |
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D003711 | Demyelinating Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |