Reactivating the Dormant Motor Cortex After Spinal Cord Injury With EEG Neurofeedback: A Case Study With a Chronic, Complete C4 Patient

Abstract

Chronic spinal cord injury (SCI) patients present poor motor cortex activation during movement attempts. The reactivation of this brain region can be beneficial for them, for instance, allowing them to use brain-machine interfaces for motor rehabilitation or restoration. These brain-machine interfacess generally use electroencephalography (EEG) to measure the cortical activation during the attempts of movement, quantifying it as the event-related desynchronization (ERD) of the alpha/mu rhythm. Based on previous evidence showing that higher tonic EEG alpha power is associated with higher ERD, we hypothesized that artificially increasing the alpha power over the motor cortex of these patients could enhance their ERD (ie, motor cortical activation) during movement attempts. We used EEG neurofeedback (NF) to enhance the tonic EEG alpha power, providing real-time visual feedback of the alpha oscillations measured over the motor cortex. This approach was evaluated in a C4, ASIA A, SCI patient (9 months after the injury) who did not present ERD during the movement attempts of his paralyzed hands. The patient performed 4 NF sessions (in 4 consecutive days) and screenings of his EEG activity before and after each session. After the intervention, the patient presented a significant increase in the alpha power over the motor cortex, and a significant enhancement of the mu ERD in the contralateral motor cortex when he attempted to close the assessed right hand. As a proof of concept investigation, this article shows how a short NF intervention might be used to enhance the motor cortical activation in patients with chronic tetraplegia.

Brain-Computer Interface Priming for Cervical Transcutaneous Spinal Cord Stimulation Therapy: An Exploratory Case Study

“…Indeed, it was expected that beta-band ERD would be relatively weaker at the beginning of the priming phase and show gradual strengthening over the course of the study. This would mirror similar work by Lopez-Larraz et al which showed that ERD was significantly enhanced in a chronic C4 AIS A tetraplegic individual following four sessions of upper-alpha band neurofeedback training (25). Instead ERD was strong throughout the study and comparable to the activity of able-bodied individuals (46,53).…”

“…However, given that the individual in this current study exhibited maximal values of cortical activation at the beginning and throughout the study, it may be that supraspinal excitability was already at its greatest extent, making priming a superfluous addition. Potentially, priming of the nature described herein would benefit only those with impaired cortical activity, such as the variety described by Lopez-Larazz et al, and others (24,25,50).…”

Towards a mechanistic approach for the development of non‐invasive brain‐computer interfaces for motor rehabilitation

“…a bar changing its dimensions according to ongoing rhythmic cortical activity. Previous studies have suggested that neurofeedback training sessions aimed to increase the presence of sensorimotor rhythms in spinal cord injured patients can indeed produce plastic changes resulting in greater desynchronization of sensorimotor rhythms during motor processing (this is possible indirect evidence for increased recruitment of motor cortical rhythms during motor processing states) (López-Larraz et al 2018a). However, while extensive research has been dedicated to validating neurofeedback training BCIs for non-motor conditions, the use of these techniques for motor restoration has received little attention.…”

“…In patients with lesions to the CNS leading to limb paresis, sensorimotor rhythms tend to be distorted (López‐Larraz et al . 2015, 2018 a ).…”

Behavioral Medicine Methods in Treatment of Somatic Conditions

“…EEG neurofeedback is widely used to treat epilepsy [ 62 ]; it is also being administered in novel capacities to treat conditions such as fibromyalgia [ 63 ] or chronic prostatitis [ 64 ] and is commonly adopted in rehabilitation, for example, in patients with amyotrophic lateral sclerosis (ALS) [ 65 ], stroke [ 66 ], spinal cord [ 67 ], and traumatic brain injuries [ 68 , 69 ].…”