Relation between Cortical Activation and Effort during Robot-Mediated Walking in Healthy People: A Functional Near-Infrared Spectroscopy Neuroimaging Study (fNIRS)

Julien Bonnal, Fanny Monnet, Ba-Thien Le, Ophélie Pila, Anne-Gaëlle Grosmaire, Canan Ozsancak, Christophe Duret, Pascal Auzou, Julien Bonnal, Fanny Monnet, Ba-Thien Le, Ophélie Pila, Anne-Gaëlle Grosmaire, Canan Ozsancak, Christophe Duret, Pascal Auzou

Abstract

Force and effort are important components of a motor task that can impact rehabilitation effectiveness. However, few studies have evaluated the impact of these factors on cortical activation during gait. The purpose of the study was to investigate the relation between cortical activation and effort required during exoskeleton-mediated gait at different levels of physical assistance in healthy individuals. Twenty-four healthy participants walked 10 m with an exoskeleton that provided four levels of assistance: 100%, 50%, 0%, and 25% resistance. Functional near-infrared spectroscopy (fNIRS) was used to measure cerebral flow dynamics with a 20-channel (plus two reference channels) device that covered most cortical motor regions bilaterally. We measured changes in oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR). According to HbO2 levels, cortical activation only differed slightly between the assisted conditions and rest. In contrast, bilateral and widespread cortical activation occurred during the two unassisted conditions (somatosensory, somatosensory association, primary motor, premotor, and supplementary motor cortices). A similar pattern was seen for HbR levels, with a smaller number of significant channels than for HbO2. These results confirmed the hypothesis that there is a relation between cortical activation and level of effort during gait. This finding should help to optimize neurological rehabilitation strategies to drive neuroplasticity.

Keywords: cortical activation; exoskeleton; functional near-infrared spectroscopy; lower extremity; physical assistance; rehabilitation; training modes.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Atalante® exoskeleton (Wandercraft company, Paris, France). (a) Participant using the exoskeleton Atalante®; (b) mechanical design with ranges of motion.
Figure 2
Figure 2
Position of the optodes. Schematics of the optode locations among the EEG 10/20 system. (a) A total of 18 optodes, including 10 light source (in yellow) and 8 detectors (in blue), were arranged on the scalp to enable 20-channel measurement. There were two additional short channels (CH21 and CH22). (b) The anatomical locations of the optodes were superimposed onto the normalized brain surface in the MNI standard brain template.
Figure 3
Figure 3
Results of the hemodynamic response by level of assistance (A100%, A50%, A0%, A−25%) for each channel. The results are expressed by mean (average of the participants). Graph locations were organized according to the anatomical correspondence using the EEG 10/20 system. The time window analyzed was 45 s, from 10 s before the beginning of the task to 35 s after the task. The red traces indicate HbO2 levels and the blue traces indicate HbR levels. The red boxes indicate a significant difference between rest and task periods for HbO2 levels. The blue boxes indicate a significant difference between rest and task periods for HbR levels. * p < 0.05; ** p < 0.01 (Benjamini–Hochberg correction).
Figure 4
Figure 4
Mean activation maps of cerebral cortex for HbO2 and HbR during gait for each level of assistance (A100%, A50%, A0%, A−25%). The data are t values, t: statistical value of sample t-test with a significance level of p < 0.05 (Benjamini–Hochberg correction). The change from red to yellow indicates that the degree of activation is from low to high. The coordinates in the figure show the activation range of the cerebral cortex in each level of assistance. Only statistically significant responses were illustrated. The data and maps were calculated and generated by NIRS-SPM.
Figure 5
Figure 5
Two-by-two comparisons of HbO2 levels for each level of assistance (A100%, A50%, A0%, A−25%). The data are t values, t: statistical value of sample t-test with a significance level of p < 0.05 (Benjamini–Hochberg correction). The change from red to yellow indicates that the degree of difference is from low to high. Only statistically significant comparisons were illustrated. The data and maps were calculated and generated by NIRS-SPM.

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