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      A Passive Exoskeleton Can Push Your Life Up: Application on Multiple Sclerosis Patients

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          Abstract

          In the present study, we report the benefits of a passive and fully articulated exoskeleton on multiple sclerosis patients by means of behavioral and electrophysiological measures, paying particular attention to the prefrontal cortex activity. Multiple sclerosis is a neurological condition characterized by lesions of the myelin sheaths that encapsulate the neurons of the brain, spine and optic nerve, and it causes transient or progressive symptoms and impairments in gait and posture. Up to 50% of multiple sclerosis patients require walking aids and 10% are wheelchair-bound 15 years following the initial diagnosis. We tested the ability of a new orthosis, the “Human Body Posturizer”, designed to improve the structural and functional symmetry of the body through proprioception, in multiple sclerosis patients. We observed that a single Human Body Posturizer application improved mobility, ambulation and response accuracy, in all of the tested patients. Most importantly, we associated these clinical observations and behavioral effects to changes in brain activity, particularly in the prefrontal cortex.

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          Improved Localizadon of Cortical Activity by Combining EEG and MEG with MRI Cortical Surface Reconstruction: A Linear Approach.

          Abstract We describe a comprehensive linear approach to the problem of imaging brain activity with high temporal as well as spatial resolution based on combining EEG and MEG data with anatomical constraints derived from MRI images. The "inverse problem" of estimating the distribution of dipole strengths over the cortical surface is highly underdetermined, even given closely spaced EEG and MEG recordings. We have obtained much better solutions to this problem by explicitly incorporating both local cortical orientation as well as spatial covariance of sources and sensors into our formulation. An explicit polygonal model of the cortical manifold is first constructed as follows: (1) slice data in three orthogonal planes of section (needle-shaped voxels) are combined with a linear deblurring technique to make a single high-resolution 3-D image (cubic voxels), (2) the image is recursively flood-filled to determine the topology of the gray-white matter border, and (3) the resulting continuous surface is refined by relaxing it against the original 3-D gray-scale image using a deformable template method, which is also used to computationally flatten the cortex for easier viewing. The explicit solution to an error minimization formulation of an optimal inverse linear operator (for a particular cortical manifold, sensor placement, noise and prior source covariance) gives rise to a compact expression that is practically computable for hundreds of sensors and thousands of sources. The inverse solution can then be weighted for a particular (averaged) event using the sensor covariance for that event. Model studies suggest that we may be able to localize multiple cortical sources with spatial resolution as good as PET with this technique, while retaining a much finer grained picture of activity over time.
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            Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls.

            To assess the characteristics of the 6-min walk (6MW) in multiple sclerosis (MS) subjects of varied disability, and controls. To assess the correlation of 6MW to subjective measures of fatigue, health status and ambulation using the modified fatigue impact scale (MFIS), short form-36 Health Questionnaire physical component score and MS walking scale (MSWS). Forty MS expanded disability status scale [(EDSS) 0-6.5] and 20 control subjects were recruited from a MS outpatient clinic. Subjects completed survey material and three 6MWs with 1-h interval rest in a single study visit. There was no practice effect or fatigability with repeat 6MW tests with a one-h rest period between test sessions. The 6MW had excellent intra-[intraclass correlation coefficient (ICC) = 0.95] and inter-rater (ICC = 0.91) reliability. MS subjects demonstrated reduced 6MW distance and speed compared with controls (P < 0.0001). Within the MS population 6MW distance was significantly reduced with increasing disability (P = 0.05). Compared with the EDSS, the 6MW had a stronger correlation to subjective measures of ambulation and physical fatigue: MSWS (r = -0.81 versus 0.69) and MFISphy (0.66 versus 0.63). The 6MW is a feasible, reproducible, and reliable measure in MS. MS subjects demonstrate motor fatigue in both 6MW distance and speed compared with controls. In MS subjects there is an inverse relationship between motor fatigue and disability. 6MW has a strong correlation to subjective measures of ambulation and physical fatigue.
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              A cortical neural prosthesis for restoring and enhancing memory.

              A primary objective in developing a neural prosthesis is to replace neural circuitry in the brain that no longer functions appropriately. Such a goal requires artificial reconstruction of neuron-to-neuron connections in a way that can be recognized by the remaining normal circuitry, and that promotes appropriate interaction. In this study, the application of a specially designed neural prosthesis using a multi-input/multi-output (MIMO) nonlinear model is demonstrated by using trains of electrical stimulation pulses to substitute for MIMO model derived ensemble firing patterns. Ensembles of CA3 and CA1 hippocampal neurons, recorded from rats performing a delayed-nonmatch-to-sample (DNMS) memory task, exhibited successful encoding of trial-specific sample lever information in the form of different spatiotemporal firing patterns. MIMO patterns, identified online and in real-time, were employed within a closed-loop behavioral paradigm. Results showed that the model was able to predict successful performance on the same trial. Also, MIMO model-derived patterns, delivered as electrical stimulation to the same electrodes, improved performance under normal testing conditions and, more importantly, were capable of recovering performance when delivered to animals with ensemble hippocampal activity compromised by pharmacologic blockade of synaptic transmission. These integrated experimental-modeling studies show for the first time that, with sufficient information about the neural coding of memories, a neural prosthesis capable of real-time diagnosis and manipulation of the encoding process can restore and even enhance cognitive, mnemonic processes.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                25 October 2013
                : 8
                : 10
                : e77348
                Affiliations
                [1 ]Department of Human Movement, Social and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
                [2 ]Neuropsychology Unit, IRCCS Santa Lucia Foundation, Rome, Italy
                [3 ]Department of Anatomical, Histological, Forensic Medicine and Locomotor Sciences, University of Rome “La Sapienza”, Rome, Italy
                University of Bologna, Italy
                Author notes

                Competing Interests: The authors declare that Prof. Francesco Di Russo is part of PLOS ONE Editorial Board. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: MR FDR. Performed the experiments: MB RLP MR FRR. Analyzed the data: MB FDR FRR. Contributed reagents/materials/analysis tools: MR FRR. Wrote the paper: FDR MB RLP MR.

                Article
                PONE-D-13-25300
                10.1371/journal.pone.0077348
                3808392
                495d36b2-e757-4e6b-871a-b1e4bc4dd9dc
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 18 June 2013
                : 3 September 2013
                Page count
                Pages: 7
                Funding
                The work was funded by the University of Rome “Foro Italico” ( www.uniroma4.it), research grant number RIC-109/2012. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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