The Cortical Response Evoked by Robotic Wrist Perturbations Reflects Level of Proprioceptive Impairment After Stroke

Background: Proprioception is important for regaining motor function in the paretic upper extremity after stroke. However, clinical assessments of proprioception are subjective and require verbal responses from the patient to applied proprioceptive stimuli. Cortical responses evoked by robotic wrist perturbations and measured by electroencephalography (EEG) may be an objective method to support current clinical assessments of proprioception.Objective: To establish whether evoked cortical responses reflect proprioceptive deficits as assessed by clinical scales and whether they predict upper extremity motor function at 26 weeks after stroke.Methods: Thirty-one patients with stroke were included. In week 1, 3, 5, 12, and 26 after stroke, the upper extremity sections of the Erasmus modified Nottingham Sensory Assessment (EmNSA-UE) and the Fugl-Meyer Motor Assessment (FM-UE) and the EEG responses (64 channels) to robotic wrist perturbations were measured. The extent to which proprioceptive input was conveyed to the affected hemisphere was estimated by the signal-to-noise ratio (SNR) of the evoked response. The relationships between SNR and EmNSA-UE as well as SNR and time after stroke were investigated using linear regression. Receiver-operating-characteristic curves were used to compare the predictive values of SNR and EmNSA-UE for predicting whether patients regained some selective motor control (FM-UE > 22) or whether they could only move their paretic upper extremity within basic limb synergies (FM-UE ≤ 22) at 26 weeks after stroke.Results: Patients (N = 7) with impaired proprioception (EmNSA-UE proprioception score < 8) had significantly smaller SNR than patients with unimpaired proprioception (N = 24) [EmNSA-UE proprioception score = 8, t(29) = 2.36, p = 0.03]. No significant effect of time after stroke on SNR was observed. Furthermore, there was no significant difference in the predictive value between EmNSA-UE and SNR for predicting motor function at 26 weeks after stroke.Conclusion: The SNR of the evoked cortical response does not significantly change as a function of time after stroke and differs between patients with clinically assessed impaired and unimpaired proprioception, suggesting that SNR reflects persistent damage to proprioceptive pathways. A similar predictive value with respect to EmNSA-UE suggests that SNR may be used as an objective predictor next to clinical sensory assessments for predicting motor function at 26 weeks after stroke.

Key Factors in the Cortical Response to Transcranial Electrical Stimulations—A Multi-Scale Modeling Study

Transcranial electrode stimulation (tES), one of the techniques used to apply non-invasive brain stimulation (NIBS), modulates cortical activities by delivering weak electric currents through scalp-attached electrodes. This emerging technique has gained increasing attention recently; however, the results of tES vary greatly depending upon subjects and the stimulation paradigm, and its cellular mechanism remains uncertain. In particular, there is a controversy over the factors that determine the cortical response to tES. Some studies have reported that the electric field's (EF) orientation is the determining factor, while others have demonstrated that the EF magnitude itself is the crucial factor. In this work, we conducted an in-depth investigation of cortical activity in two types of electrode montages used widely-the conventional (C)-tES and high-definition (HD)-tES-as well as two stimulation waveforms-direct current (DC) and alternating current (AC). To do so, we constructed a multi-scale model by coupling an anatomically realistic human head model and morphologically realistic multi-compartmental models of three types of cortical neurons (layer 2/3 pyramidal neuron, layer 4 basket cell, layer 5 pyramidal neuron). Then, we quantified the neuronal response to the C-/HD-tDCS/tACS and explored the relation between the electric field (EF) and the radial field's (RF: radial component of EF) magnitude and the cortical neurons' threshold. The EF tES induced depended upon the electrode montage, and the neuronal responses were correlated with the EF rather than the RF's magnitude. The electrode montages and stimulation waveforms caused a small difference in threshold, but the higher correlation between the EF's magnitude and the threshold was consistent. Further, we observed that the neurons' morphological features affected the degree of the correlation highly. Thus, the EF magnitude was a key factor in the responses of neurons with arborized axons. Our results demonstrate that the crucial factor in neuronal excitability depends upon the neuron models' morphological and biophysical properties. Hence, to predict the cellular targets of NIBS precisely, it is necessary to adopt more advanced neuron models that mimic realistic morphological and biophysical features of actual human cells.

Cortical compensation for hearing loss, but not age, in neural tracking of the fundamental frequency of the voice

Auditory processing is affected by advancing age and hearing loss, but the underlying mechanisms are still unclear. We investigated the effects of age and hearing loss on temporal processing of naturalistic stimuli in the auditory system. We employed a recently developed objective measure for neural phase-locking to the fundamental frequency of the voice (f0) which uses continuous natural speech as a stimulus, i.e. 'f0 tracking'. F0-tracking responses from 54 normal hearing and 14 hearing impaired adults of varying ages were analysed. The responses were evoked by a Flemish story with a male talker and contained contributions from both subcortical and cortical sources. Results indicated that advancing age was related to smaller responses with less cortical response contributions. This is consistent with an age-related decrease in neural phase-locking ability at frequencies in the range of the f0, possibly due to decreased inhibition in the auditory system. Conversely, hearing impaired subjects displayed larger responses compared to age-matched normal hearing controls. This was due to additional cortical response contributions in the 38-50 ms latency range, which were stronger for participants with more severe hearing loss. This is consistent with hearing-loss induced cortical reorganisation and recruitment of additional neural resources to aid in speech perception.