Brain Activation of CP is Different Than Peers during Motor Imagery in Sit-To-Stand, Stand-To-Sit and Walking tasks Ting-Yuan Huang

Introduction Motor imagery (MI): Mentally perform a movement without Proprioception input Muscular movements output Jeannerod, et al., 1999; Mulder, 2007 MI is performs from a ‘first- person’ perspective De Lange et al., 2006; Ter Horst et al.,2010

Introduction MI is based on motor theories of the internal models Miall et al., 1996; Wolpert,1997 CP group accounted as the Internal Modeling Deficit: Impaired to build-up healthy internal models to perform well MI

Introduction Motor deficits in cerebral palsy (CP) may not only be related to difficulty in motor execution, but also to difficulty in mental planning Gordon, et al., 2006; Steenbergen, et al., 2006 Left hemisphere is dominance for action planning and motor imagery Haaland, et al.,2000; Schluter, et al., 2001 拿杯子 左右腦有差別 但目前還是只有做在小動作 精細動作像是手指頭動作或者是簡單的手部動作

Introduction – Neuroimaging Neuronal activation Electrical signals pass between cells Oxygen consumption Local cerebral blood flow (CBF) Oxygen delivery

Introduction – Neuroimaging Direct activation related to electrical activity of the brain Electroencephalography (EEG) Magnetoelectroencephalography (MEG) Consequent haemodynamic response Positron emission tomography (PET) Functional magnetic resonance imaging (fMRI) Functional near infrared spectroscopy (fNIRS) PET MEG

Introduction – Neuroimaging Temporal: EEG > NIRS > fMRI Spatial: fMRI > NIRS > EEG DTI Walsh and Cowey, 2000

Introduction – NIRS Measurement Oxy-haemoglobin (HbO2) Deoxy-haemoglobin (HHb) Total-haemoglobin (HbT) Villringer and Chance, 1997

NIRS - General principles HbO2 and HHb chromophores have different absorption properties of near infrared light Khan, 2009

NIRS - General principles The light travelling from sources to detectors through the skin, skull and underlying brain tissue Elwell, 1995; Jobsis, 1977

NIRS - General principles Stimulus onset and neuronal activation induces an increase in HbO2 and lesser decrease in HHb Lloyd-Fox et al., 2010

Introduction – NIRS Advantage Inexpensive and portable Spatially localized of hemodynamic activity Ideally suited for motor research (suited to motion)

Introduction – MI Training (MIT) Identification of abnormal motor cortex activation patterns in children with cerebral palsy by functional near-infrared spectroscopy The same neuromuscular structures that are activated during physical practice are also activated during MIT Bilal Khan, 2010 Effect of motor imagery training on symmetrical use of knee extensors during sit-to-stand and stand-to-sit tasks in post-stroke hemiparesis Oh et al., 2010

Purpose To understand if the child with cerebral palsy can do motor imagery during sit-to-stand, stand- to-sit and walking tasks like their normal peers

Hypothesis CP may have poor motor imagery ability Slower Lacks of accurate CP may have a step-by-step planning strategy Steenbergen et al.,2004 Motor learning vs. relearning

Methods – Participants Cerebral palsy Hemiplegia Diplegia GMFCS level I or II Level I - Walks without Limitations Level II - Walks with Limitations Typically development Age, gender and handedness matched

Methods – Participants The Kaufman Brief Intelligence Test 2 (KBIT-2) 3 scores: verbal; nonverbal; and a composite IQ Alan S. Kaufman and Nadeen L. Kaufman Peabody Picture Vocabulary Test (PPVT) Lloyd M. Dunn & Leota M. Dunn Gross Motor Function Measure (GMFM-88) Dianne J. Russell

Typically development Methods – Tasks Typically development Motor imagery Sit to stand Stand to sit Walking task Motor execution Cerebral palsy

Methods – Procedure Sit to stand from chair Stand to sit down to the chair Walking forward for 6 meters Motor execution Motor imagery Measurements Timer NIRS Force plate Camera

Methods – Instructions Sit-to-stand 5 stages Preparation Sit-to-stand tasks Weight shifting during standing Stand-to-sit tasks Completion Walk task Walking straight and looking forward

Measure – NIRS

Measure – NIRS Brodmann areas Defined and numbered by the German neurologist Korbinian Brodmann by using the Nissl stain Brodmann分區是一個根據細胞結構將大腦皮層劃分為一系列解剖區域的系統。神經解剖學中所謂細胞結構（Cytoarchitecture），是指在染色的腦組織中觀察到的神經元的組織方式。 Brodmann分區最早由德國神經科醫生科比尼安·布洛德曼（Korbinian Brodmann）提出。他的分區系統包括每個半球的52個區域。其中一些區域今天已經被細分，例如23區被分為23a和23b區等。 從物種間差異來講，同一分區號碼在不同的物種間並不一定代表相似的區域。 Zwicker et al., 2010

Measure – NIRS Brain active areas during MI Area 4 - Primary Motor Cortex Area 5 - Somatosensory Association Cortex Area 6 - Premotor, Supplementary Motor Cortex Zwicker et al., 2010 All electrodes were referenced to the left mastoid online and re-referenced offline to the linked mastoids. The impedance of the electrodes was kept below 10 kOhm. EEG and EOG signals were amplified using two 32- channel Brain Amp DC EEG amplifiers. The signal was sampled at 500 Hz and filtered online with an 80 Hz high cut-off filter and a 10 s time-constant. Khan et al., 2010

Measure – NIRS NIRS optodes positions Khan et al., 2010

Measure – NIRS Time interval between tasks or for one task Baseline data collection (30 sec)  Tasks  Cool down (30 sec) Lloyd-Fox et al., 2010

Results prediction Motion time NIRS Camera Force plate Imagery time Motor execution time NIRS The brain activity Camera Force plate Weight shifting during position transfer

Results prediction Time records prediction

Results prediction Brain activity prediction Motor learning vs. relearning Different active area, timing and amplitude Elka et al., 2010

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Analyzing Standard t-tests ANOVA Evaluate the significance of stimulus-correlated changes in the signals ANOVA Compare the shape (in time) of the response to different stimuli and/or groups of participants