[Arm Motor Function Recovery during Rehabilitation with the Use of Hand Exoskeleton Controlled by Brain-Computer Interface: a Patient with Severe Brain Damage].

We studied the dynamics of motor function recovery in a patient with severe brain damage in the course of neurorehabilitation using hand exoskeleton controlled by brain-computer interface. For estimating the motor function of paretic arm, we used the biomechanical analysis of movements registered during the course of rehabilitation. After 15 weekly sessions of hand exoskeleton control, the following results were obtained: a) the velocity profile of goal-directed movements of paretic hand became bell-shaped, b) the patient began to extend and abduct the hand which was flexed and adducted in the beginning of rehabilitation, and c) the patient began to supinate the forearm which was pronated in the beginning of rehabilitation. The first result is an evidence of the general improvement of the quality of motor control, while the second and third results prove that the spasticity of paretic arm has decreased.

[Rehabilitation of post stroke patients using a bioengineering system "brain-computer interface + exoskeleton"]. / Reabilitatsiia bol'nykh, perenesshikh insul't, s pomoshch'iu bioinzhenernogo kompleksa "interfeis mozg-komp'iuter + ékzoskelet"

Objective. To investigate the possibility of using a bioengineering system, which includes an electroencephalograph and a personal computer with a software for synchronous data transmission, recognition and classification of EEG signals, development of directions for intended actions in real time in the combination with the hand exoskeleton (the bioengineering system "brain-computer interface + exoskeleton"), in motor rehabilitation of post stroke patients with paresis of the upper extremity. Material and methods. Brain-computer interface is a promising field of neurorehabilitation. Rehabilitation treatment, including 8-10 sessions, was conducted in 5 patients with paresis of the upper extremity. All patients had large MRI lesions in cortical/subcortical areas. Results. Positive changes in neurological status measured with the NIHSS, a significant increase in the volume and power of movements in the paretic hand, improvement of coordination and slight decrease in the level of spasticity were found after the treatment. There was an increase in daily activities measured with the Barthel index, mostly due to the improvement of fine motor skills. The level of disability assessed by the modified Rankin scale was changed significantly. Conclusion. The use of "brain-computer interface + exoskeleton" in the rehabilitation of post stroke patients with hand paresis provided positive results that would need to be verified in further studies.

[Primary motor cortex as one of the levels of the construction of movements].

The data obtained during the recent decades led to revision of the dominant in neurophysiology view of primary motor cortex as "the cord area" which transfers the motor commands to the spinal cord. Contrary to this point of view, it was shown that MI primates neurons participate in all stages of organization of motor behavior and that the final postures of complex coordinated movements are represented in the MI map. Characteristics of movements controlled by MI revealed by currently available methods were predicted and explained by N.A. Bernstein about 70 years ago. According to his concept, there are some levels of the construction of movements that exist in the central nervous system. Area 4 (i.e. MI), which is one of them, appeared on the definite stage of evolution for resolving the particular movement tasks. In support of this conception we are showing that: 1) MI controls the movements that differ from the movements of other levels by their characteristics (the mode of operating and the sense content); 2) some voluntary movements can be executed without participation of MI; 3) different motor areas of the cortex are coupled with different aspects of movement behavior.

[Chronic recording of scapular movements in quadruped animal (dog)].

The simple and relatively non-traumatic method of attaching the sensor to the scapular for chronic recording the scapula movements with magnetic tracking device is presented. During experiment the sensor fixed to the skin with the nylon thread passing through the m. deltoideus in the middle part of the scapula. This method provided stable recording of the scapular movements, shown in four dogs with previously learned coordination of head and forelimb movements.

[Role of the motor cortex in the control of axial and proximal muscles in learning].

Involvement of the motor cortex in the control of the shoulder and the scapula muscles was studied during acquisition of the novel head-forelimb coordination in dogs. The dogs were trained to raise the forelimb fixed to the lever in order to lift a food-containing cup and keep it elevated during eating with the head tilted down to the feeder. At the early stage of learning, the movement of raising the limb occurred with an anticipatory upward head tilt, whereas the head tilt to the feeder was associated with the lowering of the raised limb. Food consumption required a new coordination, i.e., maintaining the raised limb in a posture with the head lowered. This coordination could only be achieved by learning. This new coordination was critically dependent on the intact motor cortex. It was found that in the natural coordination, raise of the limb involved regular activation of the main flexors of shoulder, i.e., deltoid and teres major muscles, and inconstant participation of teres minor, supra- and infraspinatus, trapezius muscles. Muscles of the latter group were often active during standing but ceased their activity before limb raise. The learned limb raise with the head tilted down occurred with activation of all the mentioned muscles, and some of them changed their activity for the opposite pattern. Lesions in the motor cortex (inclusive the main part of the projection area of the "working" limb) led to a restoration of the natural head-fore- limb coordination and the innate muscle pattern of the limb raise. Thus, in the course of learning, the motor cortex rearranges the innate pattern of coordination of phylogenetically old axial and proximal muscles, which begin to work in a new manner.

The counting function and its representation in the parietal cortex in humans and animals.

Current data provide evidence that the ability to assess numbers is present not only in adult humans, but also in animals and children of preverbal age. Studies of behavior in infants and animals have demonstrated that the perception of number, the discrimination of quantities, and elementary addition and subtraction appear during onto- and phylogenesis before the appearance of speech. Number perception in humans and animals has common features: the greater the difference between numbers, the easier they are to discriminate; for a given difference between numbers, increases in size lead to increased difficulty in discrimination. Clinical data on counting impairments in patients and functional tomography studies of number operations in healthy subjects have shown that the key structures involved in number perception in humans are located in the parietal cortex. As demonstrated by experiments on monkeys and dogs, recognition of number in these species is also associated with the parietal area of the cortex. The similarity of the morphofunctional bases of "counting behavior" in humans and animals suggests that counting can be regarded as a functional mechanism of adaptive behavior which formed during evolution.

Role of the motor cortex in the rearrangement of a natural movement coordination in dogs.

Chronic experiments on dogs were performed to study the activity of the shoulder muscles involved in elevating the forelimb used by the animal to lift a food-containing cup and keep it elevated during eating. At the early stage of acquisition of this operant reaction, limb-lifting occurred with an anticipatory upward head movement; lowering of the head to the feeder was associated with lowering of the lifted limb. The new coordination required for food to be obtained, i.e., maintaining the elevated limb in a posture with the head lowered, could only be achieved as a result of learning. In untrained dogs with the natural coordination, elevation of the limb occurred with activation of the deltoid and teres major muscles, teres minor being active on standing but ceasing its activity before limb elevation. During training the activity of the teres minor muscle changed to the opposite pattern. Limb elevation in the learned coordination was accompanied by activation of all three shoulder flexors. Lesioning of the motor cortex in the projection area of the "working" limb, but not in other areas, led to impairments of the acquired coordination and a new pattern of shoulder muscle activity. These data led to the conclusion that rearrangement of the initial coordination was linked with the formation of a new means of elevating the limb in which the muscle pattern was supported by the motor cortex.

[Computing function and its representation in the parietal cortex in humans and animals].

The currently available evidence suggests that not only adults but children of preverbal age and animals possess the ability to define numbers. The behavioral studies in infants and animals show that number perception, quantity discrimination, and elementary adding and subtraction appear in onto- and phylogenesis prior to language. There are parallels between number processing in animals and humans: a) the ability to discriminate between two numbers improves as the numerical distance between them increases; b) for equal numerical distance, discrimination of two numbers worsens as their numerical size increases. Disorders of "number sense" in brain-lesioned patients and brain-imaging of number processing in healthy subjects showed that the parietal cortex includes the key structures involved in number perception. These structures include the intraparietal sulcus area, angular gyrus and superior lobule. Animal experiments showed that the parietal cortex is also important for "counting behavior" in monkeys (area of the intraparietal sulcus and area 5), dogs (area 5) and cats (area 7). Parallels between functional and morphological bases of number perception in humans and animals suggest that they endow it in evolution as the usual fundamental mechanism of adaptive behavior.

[The role of the motor cortex in rearrangement of the innate movement coordination in the dog].

In chronical experiments in dogs the pattern of shoulder muscle recruitment was examined during the forelimb flexion by which the animal lifted and held a cup of food during eating. At the early stage of the instrumental reaction learning the forelimb lifting was performed with the anticipatory deviation of the head in up direction, when the head bent down to the foodwell the lifted forelimb lowered. Simultaneous holding of the flexed forelimb and lowered head providing food reinforcement was achieved only by learning. It was found that the forelimb lifting in the innate coordination in untrained dogs was performed with activation of m. deltoideus and m. teres major, whereas m. teres minor was active whilst the dog was standing but the muscle activity was abolished before the limb lifting. In the course of learning m. teres minor activity was changed into opposite one. In the learned coordination the limb lifting was accompanied by the activation of all three shoulder flexors. The lesion of the motor cortex in the area of the "working" forelimb, but not in other areas led to disturbance of the learned coordination and the novel pattern of the shoulder muscle activity. The data obtained led to the following conclusion: the rearrangement of the innate coordination is connected with the formation of the novel way of the forelimb lifting which pattern of muscle recruitment is provided by the motor cortex.

Role of the parietal associative area of the cortex for "counting" behavior in dogs.

Experiments were performed on six dogs to study the effects of simultaneous and separate ablation of fields 5 and 7 of the parietal cortex on "counting" behavior. Dogs were trained to discriminate series of five sound clicks presented with variable interstimulus intervals from similar series consisting of three clicks. A food-related operant response (elevation of the right forepaw to place it on the feeder) was used to develop asymmetrical differentiation; the positive signal was a series of five clicks with variable interstimulus intervals and the negative (unreinforced) stimulus was a series of three clicks. Simultaneous bilateral ablation of fields 5 and 7 of the parietal cortex, like bilateral ablation only of field 5, produced profound impairment of differentiation lasting 2-3 months. Isolated bilateral ablation of field 7 produced no impairment of differentiation. These data led to the conclusion that field 5 of the parietal cortex is important for discriminating the numbers of sequential signals.

[Recording of electromyogram in chronic experiments in dogs].

A connector for chronic recording of EMG activity located on the dog's neck was developed as a row of male pins fixed on a dense band with attached wires of intramuscular electrodes. The wires were subcutaneously led to the connector. The band of the connector was sutured at the corners to the skin of the dorsal surface of the neck. Then the connector was anchored to the neck by a double adhesive tape wrapping like a collar. Compared to scull connectors, our model provided minimum surgical trauma to the animal, the connector or wires of intramuscular electrodes can be replaced if necessary. Localization of the connector did not impede scull and brain surgical operations. The model has been described and tested in the experiments in seven dogs with 8-20 pairs of implanted EMG-recording electrodes within 2-10 weeks.

The roles of various projection areas of the motor cortex in the reorganization of the natural coordination of head and forelimb movements in dogs.

A food-related operant reaction was developed in dogs, in which animals had to maintain tonic elevation of the forelimb to hold a bowl while eating with the head tilted towards the feeder. The acquisition of this reaction involved rearrangement of the natural coordination of head and limb movements which appeared at an early stage of training of the dogs. Forelimb elevation was initially accompanied by anticipatory raising of the head, while lowering of the head led to lowering of the elevated limb. Limb elevation could only be maintained in the posture in which the head was raised. The new coordination required for obtaining food, contrary to the innate coordination and consisting of tonic elevation of the limb with the head lowered, could only be achieved as a result of training. Previous studies have established that lesioning of the primary motor cortex (MI) in the hemisphere contralateral to the working limb leads to stable impairment of the learned coordination, with regression to the initial coordination. The present report describes studies of the effects of local lesions of various projection areas of MI on performance of the learned coordination. Dogs which had acquired the learned operant reaction requiring the new head/limb coordination showed impairment only after lesioning of the representation area of the working limb in the MI; lesioning of the representation area of the head had no such effect.

[Role of the parietal associative cortex in "counting" behavior of dogs].

Influence of the combined and isolated lesions of areas 5 and 7 of the parietal cortex on the counting behavior was studied in experiments with 6 dogs. Instrumental feeding reaction (lifting and placing the forepaw on the foodwell) was established. The positive conditioned stimulus was a series of 5 clicks with variable interclicks intervals and the negative (non-reinforced) conditioned stimulus was a series of 3 clicks, so that asymmetrical differentiation was elaborated. Combined bilateral lesions of areas 5 and 7 and an isolated lesion of area 5 resulted in a severe impairment of the numerical discrimination for two months, whereas the isolated lesion of area 7 did not lead to any problems in differentiation. The conclusion was made that area 5 is critical for numerical discrimination of sequential stimuli.

[Influence of the neck muscles deafferentation on the natural head-forelimb coordination in dogs].

We studied the influence of the neck muscles deafferentation on the natural head-forelimb coordination. This coordination exists in intact dogs at the early stage of acquisition of the instrumental feeding reaction of tonic forelimb flexion aimed at holding a cup with meat during eating when the head is bent down to foodwell. In untrained dogs, the forelimb flexion is preceded by lifting the head bent down to the food; the following lowering of the head leads to extension of the flexed forelimb. For performing the instrumental reaction, the innate coordination has to be rearranged into the opposite one. It is achieved only by learning. It was shown that deafferentation of the neck muscles, which leads to a loss of the neck reflex, did not destroy the innate coordination and did not facilitate its rearrangement during the instrumental conditioning.

[Role of different projection areas of the motor cortex in reorganization of the innate head-forelimb coordination in dogs].

Dogs were trained to perform the forelimb tonic flexion in order to lift a cup with meat from a bottom of the foodwell and hold it during eating with the head bent down to the cup. It is known that conditioning of the instrumental reaction is based on reorganization of the innate head-forelimb coordination into the opposite one. In untrained dogs, the forelimb flexion is accompanied by the anticipatory lifting of the head bent down to the foodwell. The following lowering of the head leads to an extension of the flexed forelimb. Tonic forelimb flexion is possible if the head is in the up position. Simultaneous holding of the flexed forelimb and lowered head providing food reinforcement is achieved only by learning. It was shown earlier that the lesion of the motor cortex contralateral to the "working" forelimb led to a prolonged disturbance of the elaborated coordination and reappearance of the innate coordination. In the present work we studied the influence of local lesions of the projection areas in the motor cortex, such as a "working" forelimb area, bilateral representation of the neck, and the medial part of the motor cortex, on the learned instrumental feeding reaction. It was found that only the lesion of the forelimb but not neck projection led to a disturbance of the learned head-forelimb movement coordination.

[Natural head-forelimb coordination in dogs after vestibular de-afferentation]. / Estestvennaia koordinatsiia dvizhenii golovy i perednei lapy u sobaki posle vykliucheniia vestibuliarnoi afferentatsii.

We studied the influence of the vestibular lesion on the natural head--forelimb coordination. This coordination exists in intact dogs at the early stage of acquisition of the instrumental feeding reaction of tonic forelimb flexion in order to hold a cup with meat during eating when the head is bent down to foodwell. In untrained dogs, the forelimb flexion is preceded by lifting the head bent down to the food; the following lowering of the head leads to extension of the flexed forelimb. For performing the instrumental reaction, the innate coordination has to be rearranged into the opposite one. It is achieved only by learning. After the lesion of the primary motor cortex contralateral to the "working" forelimb in trained dogs, the innate coordination reappears, whereas the learned coordination breaks down steadily. It was shown that bilateral vestibular lesion do not disturb the innate coordination in intact dogs at the early stage of learning and in trained dogs after the motor cortex lesion. It was concluded that the studied natural head--forelimb coordination is not connected with the vestibular reflex.

Is transfer of acquired coordination of head and forepaw movements possible in dogs?

Dogs were trained to tonic elevation of the forepaw and to use a lever to lift and maintain in position a food-containing cup during eating, this being accompanied by inclination of the head towards the feeder. In the conditions used here, the pretraining situation was that dogs would elevate the paw with an anticipatory upward movement of the lowered head; when the head tilted to the feeder, the paw flexed. The effect of special training, in which the initial coordination of the head and paw movements were remodeled, was that the animals maintained the paw elevated with the head in the lowered position. Dogs trained to perform the operant response with one paw did not transfer the acquired reaction when the "working" paw was changed. After the first training, the initial coordination was changed only between movements of the head and the "working" limb, but not between head movements and the non-trained paw. Remodeling of the initial movement coordination of the head with the second paw also occurred only as a result of the learning process.

Instrumentalization of movements evoked by stimulation of the motor cortex by food reinforcement in dogs.

The possibility that hindlimb movements (elevations) evoked by stimulation of the corresponding contralateral area of the motor cortex could be instrumentalized by reinforcement with food was demonstrated, contradicting some previously published data. Operant movements (interstimulus voluntary high elevations of the hindlimb) were acquired as a result of consistent combinations: cortical stimulation - movement - food. Acquisition required more than 50-200 combinations. Delivery of food was accompanied by a click at exactly the moment at which the hindlimb reached the required height. The click became the food-related conditioned signal and served as a secondary operant reinforcement, which facilitated acquisition of the operant movement. These results support the view that the motor cortex can have an immediate role in forming "operant" temporary connections (motivation-movement) and that simple operant movements can be initiated via this arc.

Somatosensory evoked potentials during natural and learning rearrangements of posture accompanied by limb elevation in dogs.

Changes in the functional state of the sensorimotor cortex associated with reorganization of the natural pattern of postural rearrangement before limb elevation (the "diagonal" patten and of an artificial rearrangement (the "unilateral" pattern) were studied in dogs. The state of cortical structures on postural rearrangement was assessed in terms of the pattern of somatosensory evoked potentials produced in response to stimulation of the forelimb during postural preparation of the animal for elevating the hindlimb (acquired avoidance response to a sound signal). Evoked potentials during the natural postural preparation (the "diagonal" pattern) were compared with those during the altered pattern of postural preparation (the "unilateral" pattern), this preparation taking place prior to elevation of the limb. Controls consisted of evoked potentials in the resting state. Decreases were seen in the latencies and amplitudes of most components of evoked potentials during postural rearrangement. In general, changes in evoked potentials were less marked in the "unilateral" pattern than in the "diagonal" pattern, though the differences were significant only for the amplitude of the first negative component. Changes in evoked potentials were similar regardless of whether the supporting forces of the limb to which the test stimulus was applied increased or decreased during postural rearrangement. It is suggested that differences in evoked potentials may reflect changes in the interaction between neuronal populations within the sensorimotor cortex during reorganization of the pattern of postural rearrangement associated with learning.

[Is it possible to transfer learned coordination of head and forepaw movements in dogs]. / Bozmozhen li perenos vyrabotannoi koordinatsii dvizhenii golovy i perednei lapy u sobak?

Dogs were trained for tonic forelimb flexion fixed to a lever in order to hold a cup with meat during eating, when the head was bent down to a foodwell. Before learning, the forelimb flexion is accompanied by the anticipatory lifting of the head bent down to the foodwell; following lowering of the head leads to an extension of the flexed forelimb. Simultaneous holding of the flexed forelimb and lowered head is achieved by learning. During the original learning, the innate head-forelimb coordination was rearranged into the opposite one. After the initial instrumental learning, the "working" forelimb was changed to test whether a transfer of the learned head-forelimb coordination would occur. It was shown that the execution of the instrumental reaction by the untrained forelimb was impossible, because the innate coordination between the head and this forelimb persisted. It could also be rearranged by learning. The involvement of the motor cortex in the unilateral rearrangement of the innate head-forelimb movement coordination is discussed.