Brain lateralization in children with upper-limb reduction deficiency.

BACKGROUND: The purpose of the current study was to determine the influence of upper-limb prostheses on brain activity and gross dexterity in children with congenital unilateral upper-limb reduction deficiencies (ULD) compared to typically developing children (TD). METHODS: Five children with ULD (3 boys, 2 girls, 8.76 ± 3.37 years of age) and five age- and sex-matched TD children (3 boys, 2 girls, 8.96 ± 3.23 years of age) performed a gross manual dexterity task (Box and Block Test) while measuring brain activity (functional near-infrared spectroscopy; fNIRS). RESULTS: There were no significant differences (p = 0.948) in gross dexterity performance between the ULD group with prosthesis (7.23 ± 3.37 blocks per minute) and TD group with the prosthetic simulator (7.63 ± 5.61 blocks per minute). However, there was a significant (p = 0.001) difference in Laterality Index (LI) between the ULD group with prosthesis (LI = - 0.2888 ± 0.0205) and TD group with simulator (LI = 0.0504 ± 0.0296) showing in a significant ipsilateral control for the ULD group. Thus, the major finding of the present investigation was that children with ULD, unlike the control group, showed significant activation in the ipsilateral motor cortex on the non-preferred side using a prosthesis during a gross manual dexterity task. CONCLUSIONS: This ipsilateral response may be a compensation strategy in which the existing cortical representations of the non-affected (preferred) side are been used by the affected (non-preferred) side to operate the prosthesis. This study is the first to report altered lateralization in children with ULD while using a prosthesis. Trial registration The clinical trial (ClinicalTrial.gov ID: NCT04110730 and unique protocol ID: IRB # 614-16-FB) was registered on October 1, 2019 ( https://clinicaltrials.gov/ct2/show/NCT04110730 ) and posted on October 1, 2019. The study start date was January 10, 2020. The first participant was enrolled on January 14, 2020, and the trial is scheduled to be completed by August 23, 2023. The trial was updated January 18, 2020 and is currently recruiting.

Identifying Resting-State Functional Connectivity Changes in the Motor Cortex Using fNIRS During Recovery from Stroke.

Resting-state functional imaging has been used to study the functional reorganization of the brain. The application of functional near-infrared spectroscopy (fNIRS) to assess resting-state functional connectivity (rsFC) has already been demonstrated in recent years. The present study aimed to identify the difference in rsFC patterns during the recovery from the upper-limb deficit due to stroke. Twenty patients with mild stroke having an onset of four to eight weeks were recruited from the stroke clinic of our institute and an equal number of healthy volunteers were included in the study after ethical committee approval. The fNIRS signals were recorded bilaterally over the premotor area and supplementary motor area and over the primary motor cortex. Pearson Correlation is the method used to compute rsFC for the healthy group and patient group. For the healthy group, both intra-hemispheric and inter-hemispheric connections were stronger. RSFC analysis demonstrated changes from the healthy pattern for the patient group with an upper-limb deficit. The left hemisphere affected group showed disrupted ipsilesional and an increased contra-lesional connectivity. The longitudinal data analysis of rsFC showed improvement in the connections in the ipsilesional hemisphere between the primary motor area, somatosensory area, and premotor areas. In the future, the rsFC changes during the recovery could be used to predict the extent of recovery from stroke motor deficits.

Resting fMRI as an alternative for task-based fMRI for language lateralization in temporal lobe epilepsy patients: a study using independent component analysis.

PURPOSE: Our aim is to investigate whether rs-fMRI can be used as an effective technique to study language lateralization. We aim to find out the most appropriate language network among different networks identified using ICA. METHODS: Fifteen healthy right-handed subjects, sixteen left, and sixteen right temporal lobe epilepsy patients prospectively underwent MR scanning in 3T MRI (GE Discovery™ MR750w), using optimized imaging protocol. We obtained task-fMRI data using a visual-verb generation paradigm. Rs-fMRI and language-fMRI analysis were conducted using FSL software. Independent component analysis (ICA) was used to estimate rs-fMRI networks. Dice coefficient was calculated to examine the similarity in activated voxels of a common language template and the rs-fMRI language networks. Laterality index (LI) was calculated from the task-based language activation and rs-fMRI language network, for a range of LI thresholds at different z scores. RESULTS: Measurement of hemispheric language dominance with rs-fMRI was highly concordant with task-fMRI results. Among the evaluated z scores for a range of LI thresholds, rs-fMRI yielded a maximum accuracy of 95%, a sensitivity of 83%, and specificity of 92.8% for z = 2 at 0.05 LI threshold. CONCLUSION: The present study suggests that rs-fMRI networks obtained using ICA technique can be used as an alternative for task-fMRI language laterality. The novel aspect of the work is suggestive of optimal thresholds while applying rs-fMRI, is an important endeavor given that many patients with epilepsy have co-morbid cognitive deficits. Thus, an accurate method to determine language laterality without requiring a patient to complete the language task would be advantageous.

Neurobehavioral consequences of repetitive head impacts in Para swimming: A case report.

Para swimmers with limb deficiency are faced with the particular situation that they must use their head to finish each competition by a hit to the wall. Repetitive head impacts may impair behavioral and brain functions. We therefore investigated neurobehavioral functions of a Para swimmer with dysmelia before and after repetitive head impacts (T1) and without (T2). Average head impact at T1 constituted 13.6 g with a mean impact force of 6689.9 N. Behavioral and brain functions decreased from pre to post at T1 but not at T2. Para swimmers with limb deficiency are therefore affected from the same consequences onto brain health that are observed after repeated sport-related concussions.

Explainable artificial intelligence model to predict brain states from fNIRS signals.

Objective: Most Deep Learning (DL) methods for the classification of functional Near-Infrared Spectroscopy (fNIRS) signals do so without explaining which features contribute to the classification of a task or imagery. An explainable artificial intelligence (xAI) system that can decompose the Deep Learning mode's output onto the input variables for fNIRS signals is described here. Approach: We propose an xAI-fNIRS system that consists of a classification module and an explanation module. The classification module consists of two separately trained sliding window-based classifiers, namely, (i) 1-D Convolutional Neural Network (CNN); and (ii) Long Short-Term Memory (LSTM). The explanation module uses SHAP (SHapley Additive exPlanations) to explain the CNN model's output in terms of the model's input. Main results: We observed that the classification module was able to classify two types of datasets: (a) Motor task (MT), acquired from three subjects; and (b) Motor imagery (MI), acquired from 29 subjects, with an accuracy of over 96% for both CNN and LSTM models. The explanation module was able to identify the channels contributing the most to the classification of MI or MT and therefore identify the channel locations and whether they correspond to oxy- or deoxy-hemoglobin levels in those locations. Significance: The xAI-fNIRS system can distinguish between the brain states related to overt and covert motor imagery from fNIRS signals with high classification accuracy and is able to explain the signal features that discriminate between the brain states of interest.

Functional Connectivity of Language Regions of Stroke Patients with Expressive Aphasia During Real-Time Functional Magnetic Resonance Imaging Based Neurofeedback.

Stroke lesions in the language centers of the brain impair the language areas and their connectivity. This article describes the dynamics of functional connectivity (FC) of language areas (FCL) during real-time functional magnetic resonance imaging (RT-fMRI)-based neurofeedback training for poststroke patients with expressive aphasia. The hypothesis is that FCL increases during the upregulation of language areas during neurofeedback training and that the training improves FCL with an increasing number of sessions and restores it toward normalcy. Four test and four control patients with expressive aphasia were recruited for the study along with four healthy volunteers termed as the normal group. The test and normal groups were administered four neurofeedback training sessions in between two test sessions, whereas the control group underwent only the two test sessions. The training session requires the subject to exercise language activity covertly so that it upregulates the feedback signal obtained from the Broca's area (in left inferior frontal gyrus) and amplifies the feedback when it is correlated with the Wernicke's area (in left superior temporal gyrus) using RT-fMRI. FC was measured by Pearson's correlation coefficient. The results indicate that the FC of the test group was weaker in the left hemisphere than that of the normal group, and post-training the connections have strengthened (correlation coefficient increases) in the left hemisphere when compared with the control group. The connections of language areas strengthened in both hemispheres during neurofeedback-based upregulation, and multiple training sessions strengthened new pathways and restored left hemispheric connections toward normalcy.

Functional near-infrared spectroscopy is in moderate accordance with functional MRI in determining lateralisation of frontal language areas.

Purpose Understanding language dominance is crucial in pre-surgical evaluation of patients with epilepsy and in patients having a tumour close to the language area. Functional magnetic resonance imaging (fMRI) studies are well established in evaluating language dominance. Functional near-infrared spectroscopy (fNIRS) is a non-invasive optical imaging modality that offers a convenient and affordable technique to image language-related cortical areas. This study investigates the agreement between results from task-based fMRI and fNIRS in determining language lateralisation. Methods Language laterality indices LIs were calculated from both fMRI and fNIRS measurements of the same individual volunteers by using an identical paradigm. Statistical measures of percentage agreement and kappa value have been calculated for testing agreement and reliability. Results A correlation analysis of the LI values shows a good correlation with r = 0.677 at p < 0.05. Statistical comparison of both fMRI and fNIRS methods for language lateralisation yielded a percentage agreement of 90% and a moderate kappa value of κ = 0.621. Conclusion Our study suggests that fNIRS is in moderate accordance with fMRI in determining lateralisation of the frontal language areas. It implies that the optical imaging technique can provide additional information on functional lateralisation of frontal language areas.

Multiband fMRI as a plausible, time-saving technique for resting-state data acquisition: Study on functional connectivity mapping using graph theoretical measures.

BACKGROUND AND OBJECTIVES: Ensuring patient comfort and compliance by emphasizing reduced time frame for image acquisition, without compromising image quality is the key aspect with functional MRI examination. Multiband resting state fMRI (MB-rsfMRI) is a fairly new technique that potentially shortens MR image acquisition time by providing increased number of time points. The study aims to compare signal characteristics as well as the functional connectivity using conventional resting-state fMRI (rsfMRI) with that of MB-rsfMRI technique. MATERIALS AND METHODS: 9 healthy volunteers have prospectively undergone conventional resting-state fMRI and Multiband rsfMRI scanning technique in a 3T GE scanner (Discovery MR750w™). We compared the temporal SNR (tSNR) of conventional rs-fMRI with that of MB-rsfMRI. We looked at the language network connectivity and small world network characteristics from graph theoretical measures to compare the two techniques. RESULTS: We computed the tSNR of conventional resting-state fMRI (rsfMRI) and MB-rsfMRI technique. A strong positive correlation was seen between graph theoretical measures from MB-rsfMRI and conventional rsfMRI (Pearson Correlation, r = 0.99). Both techniques showed similar small world network characteristics in healthy controls. CONCLUSION: The present study demonstrates negligible differences between the conventional-rsfMRI and MB-rsfMRI acquisitions on the computed graph theoretic measures. Accordingly current analysis proves that MB-rs-fMRI may be used as a time reducing acquisition technique that enables mapping of functional connectivity with similar outcome as conventional rs-fMRI in healthy subjects.

Resting-State Seed-Based Analysis: An Alternative to Task-Based Language fMRI and Its Laterality Index.

BACKGROUND AND PURPOSE: Language is a cardinal function that makes human unique. Preservation of language function poses a great challenge for surgeons during resection. The aim of the study was to assess the efficacy of resting-state fMRI in the lateralization of language function in healthy subjects to permit its further testing in patients who are unable to perform task-based fMRI. MATERIALS AND METHODS: Eighteen healthy right-handed volunteers were prospectively evaluated with resting-state fMRI and task-based fMRI to assess language networks. The laterality indices of Broca and Wernicke areas were calculated by using task-based fMRI via a voxel-value approach. We adopted seed-based resting-state fMRI connectivity analysis together with parameters such as amplitude of low-frequency fluctuation and fractional amplitude of low-frequency fluctuation (fALFF). Resting-state fMRI connectivity maps for language networks were obtained from Broca and Wernicke areas in both hemispheres. We performed correlation analysis between the laterality index and the z scores of functional connectivity, amplitude of low-frequency fluctuation, and fALFF. RESULTS: Pearson correlation analysis between signals obtained from the z score of fALFF and the laterality index yielded a correlation coefficient of 0.849 (P < .05). Regression analysis of the fALFF with the laterality index yielded an R2 value of 0.721, indicating that 72.1% of the variance in the laterality index of task-based fMRI could be predicted from the fALFF of resting-state fMRI. CONCLUSIONS: The present study demonstrates that fALFF can be used as an alternative to task-based fMRI for assessing language laterality. There was a strong positive correlation between the fALFF of the Broca area of resting-state fMRI with the laterality index of task-based fMRI. Furthermore, we demonstrated the efficacy of fALFF for predicting the laterality of task-based fMRI.

Resting state fMRI: A review on methods in resting state connectivity analysis and resting state networks.

The inquisitiveness about what happens in the brain has been there since the beginning of humankind. Functional magnetic resonance imaging is a prominent tool which helps in the non-invasive examination, localisation as well as lateralisation of brain functions such as language, memory, etc. In recent years, there is an apparent shift in the focus of neuroscience research to studies dealing with a brain at 'resting state'. Here the spotlight is on the intrinsic activity within the brain, in the absence of any sensory or cognitive stimulus. The analyses of functional brain connectivity in the state of rest have revealed different resting state networks, which depict specific functions and varied spatial topology. However, different statistical methods have been introduced to study resting state functional magnetic resonance imaging connectivity, yet producing consistent results. In this article, we introduce the concept of resting state functional magnetic resonance imaging in detail, then discuss three most widely used methods for analysis, describe a few of the resting state networks featuring the brain regions, associated cognitive functions and clinical applications of resting state functional magnetic resonance imaging. This review aims to highlight the utility and importance of studying resting state functional magnetic resonance imaging connectivity, underlining its complementary nature to the task-based functional magnetic resonance imaging.