Studies in Human Performance and Experience: Neuroscience and Functional Brain Imaging

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurotechnology and Neuroimaging".

Deadline for manuscript submissions: closed (30 April 2021) | Viewed by 48081

Special Issue Editor


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Guest Editor
School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA
Interests: neuroimaging; biomedical signal processing; functional brain imaging; near-infrared spectroscopy; traumatic brain injury, anesthesia care; human performance; human autonomy teaming; learning and training
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Special Issue Information

Dear Colleagues,

The past two decades have seen the growing importance of technologies deployed to provide measures of cognitive functioning as well as measures of stress, fatigue, or emotion in field settings. From the aerospace industry to healthcare, there are numerous unmet needs that can be addressed by properly adapting these technologies and methodologies. Quantitative assessments of joint human–autonomy performance, the provision of analytics for the design of curricula, and scenarios to enable adaptive and personalized training are just few examples illustrating the potential role of these technologies. This trend also provides us with an opportunity to apply such technologies in more contextually real and dynamic environments.

The measurement of neurophysiological changes in real time during complex, real world tasks can help us evaluate decision-making and reliably compare the workload burden of next-generation systems versus legacy systems in various domains. The goal of this Special Issue is to present a collection of studies focusing on neuroimaging and key cognitive areas of interest when attempting to explore the correlation between neurophysiological state, task load, and level of expertise. We are soliciting a number of studies in which wearable physiological and neuro-physiological sensors and neuroimaging devices, such as functional near-infrared spectroscopy (fNIRS), electroencephalogram (EEG), functional magnetic resonance imaging (fMRI), eye tracking, and galvanic skin response (GSR), are used to evaluate human performance and training in real operational settings.

Dr. Kurtulus Izzetoglu
Guest Editor

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Keywords

  • functional brain imaging
  • fNIRS
  • fMRI
  • EEG
  • eye tracking
  • learning
  • training
  • human–autonomy teaming

Published Papers (13 papers)

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17 pages, 6724 KiB  
Article
Studying Brain Activation during Skill Acquisition via Robot-Assisted Surgery Training
by Kurtulus Izzetoglu, Mehmet Emin Aksoy, Atahan Agrali, Dilek Kitapcioglu, Mete Gungor and Aysun Simsek
Brain Sci. 2021, 11(7), 937; https://doi.org/10.3390/brainsci11070937 - 16 Jul 2021
Cited by 6 | Viewed by 2328
Abstract
Robot-assisted surgery systems are a recent breakthrough in minimally invasive surgeries, offering numerous benefits to both patients and surgeons including, but not limited to, greater visualization of the operation site, greater precision during operation and shorter hospitalization times. Training on robot-assisted surgery (RAS) [...] Read more.
Robot-assisted surgery systems are a recent breakthrough in minimally invasive surgeries, offering numerous benefits to both patients and surgeons including, but not limited to, greater visualization of the operation site, greater precision during operation and shorter hospitalization times. Training on robot-assisted surgery (RAS) systems begins with the use of high-fidelity simulators. Hence, the increasing demand of employing RAS systems has led to a rise in using RAS simulators to train medical doctors. The aim of this study was to investigate the brain activity changes elicited during the skill acquisition of resident surgeons by measuring hemodynamic changes from the prefrontal cortex area via a neuroimaging sensor, namely, functional near-infrared spectroscopy (fNIRS). Twenty-four participants, who are resident medical doctors affiliated with different surgery departments, underwent an RAS simulator training during this study and completed the sponge suturing tasks at three different difficulty levels in two consecutive sessions/blocks. The results reveal that cortical oxygenation changes in the prefrontal cortex were significantly lower during the second training session (Block 2) compared to the initial training session (Block 1) (p < 0.05). Full article
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18 pages, 3159 KiB  
Article
Working Memory Performance under a Negative Affect Is More Susceptible to Higher Cognitive Workloads with Different Neural Haemodynamic Correlates
by Ying Xing Feng, Masashi Kiguchi, Wei Chun Ung, Sarat Chandra Dass, Ahmad Fadzil Mohd Hani, Tong Boon Tang and Eric Tatt Wei Ho
Brain Sci. 2021, 11(7), 935; https://doi.org/10.3390/brainsci11070935 - 15 Jul 2021
Cited by 2 | Viewed by 2805
Abstract
The effect of stress on task performance is complex, too much or too little stress negatively affects performance and there exists an optimal level of stress to drive optimal performance. Task difficulty and external affective factors are distinct stressors that impact cognitive performance. [...] Read more.
The effect of stress on task performance is complex, too much or too little stress negatively affects performance and there exists an optimal level of stress to drive optimal performance. Task difficulty and external affective factors are distinct stressors that impact cognitive performance. Neuroimaging studies showed that mood affects working memory performance and the correlates are changes in haemodynamic activity in the prefrontal cortex (PFC). We investigate the interactive effects of affective states and working memory load (WML) on working memory task performance and haemodynamic activity using functional near-infrared spectroscopy (fNIRS) neuroimaging on the PFC of healthy participants. We seek to understand if haemodynamic responses could tell apart workload-related stress from situational stress arising from external affective distraction. We found that the haemodynamic changes towards affective stressor- and workload-related stress were more dominant in the medial and lateral PFC, respectively. Our study reveals distinct affective state-dependent modulations of haemodynamic activity with increasing WML in n-back tasks, which correlate with decreasing performance. The influence of a negative effect on performance is greater at higher WML, and haemodynamic activity showed evident changes in temporal, and both spatial and strength of activation differently with WML. Full article
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22 pages, 2409 KiB  
Article
EEG-Based Tool for Prediction of University Students’ Cognitive Performance in the Classroom
by Mauricio A. Ramírez-Moreno, Mariana Díaz-Padilla, Karla D. Valenzuela-Gómez, Adriana Vargas-Martínez, Juan C. Tudón-Martínez, Rubén Morales-Menendez, Ricardo A. Ramírez-Mendoza, Blas L. Pérez-Henríquez and Jorge de J. Lozoya-Santos
Brain Sci. 2021, 11(6), 698; https://doi.org/10.3390/brainsci11060698 - 26 May 2021
Cited by 17 | Viewed by 4835
Abstract
This study presents a neuroengineering-based machine learning tool developed to predict students’ performance under different learning modalities. Neuroengineering tools are used to predict the learning performance obtained through two different modalities: text and video. Electroencephalographic signals were recorded in the two groups during [...] Read more.
This study presents a neuroengineering-based machine learning tool developed to predict students’ performance under different learning modalities. Neuroengineering tools are used to predict the learning performance obtained through two different modalities: text and video. Electroencephalographic signals were recorded in the two groups during learning tasks, and performance was evaluated with tests. The results show the video group obtained a better performance than the text group. A correlation analysis was implemented to find the most relevant features to predict students’ performance, and to design the machine learning tool. This analysis showed a negative correlation between students’ performance and the (theta/alpha) ratio, and delta power, which are indicative of mental fatigue and drowsiness, respectively. These results indicate that users in a non-fatigued and well-rested state performed better during learning tasks. The designed tool obtained 85% precision at predicting learning performance, as well as correctly identifying the video group as the most efficient modality. Full article
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12 pages, 4745 KiB  
Article
Tablet Use Affects Preschoolers’ Executive Function: fNIRS Evidence from the Dimensional Change Card Sort Task
by Hui Li, Dandan Wu, Jinfeng Yang, Jiutong Luo, Sha Xie and Chunqi Chang
Brain Sci. 2021, 11(5), 567; https://doi.org/10.3390/brainsci11050567 - 29 Apr 2021
Cited by 13 | Viewed by 3748
Abstract
This study aims to examine the impact of heavy use of tablets on preschoolers’ executive function during the Dimensional Change Card Sort (DCCS) task using the functional near-infrared spectroscopy (fNIRS). Altogether, 38 Chinese preschoolers (Mage = 5.0 years, SD = 0.69 [...] Read more.
This study aims to examine the impact of heavy use of tablets on preschoolers’ executive function during the Dimensional Change Card Sort (DCCS) task using the functional near-infrared spectroscopy (fNIRS). Altogether, 38 Chinese preschoolers (Mage = 5.0 years, SD = 0.69 years, 17 girls) completed the tasks before the COVID-19 lockdown. Eight children never used tablets, while 16 children were diagnosed as the ‘heavy-user’. The results indicated that: (1) the ‘non-user’ outperformed the ‘heavy-user’ with a significantly higher correct rate in the DCCS task; (2) the two groups differed significantly in the activation of the prefrontal cortex (BA 9): the ‘non-user’ pattern is normal and healthy, whereas the ‘heavy-user’ pattern is not normal and needs further exploration. Full article
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20 pages, 12566 KiB  
Article
Single-Trial Recognition of Video Gamer’s Expertise from Brain Haemodynamic and Facial Emotion Responses
by Ana R. Andreu-Perez, Mehrin Kiani, Javier Andreu-Perez, Pratusha Reddy, Jaime Andreu-Abela, Maria Pinto and Kurtulus Izzetoglu
Brain Sci. 2021, 11(1), 106; https://doi.org/10.3390/brainsci11010106 - 14 Jan 2021
Cited by 13 | Viewed by 3239
Abstract
With an increase in consumer demand of video gaming entertainment, the game industry is exploring novel ways of game interaction such as providing direct interfaces between the game and the gamers’ cognitive or affective responses. In this work, gamer’s brain activity has been [...] Read more.
With an increase in consumer demand of video gaming entertainment, the game industry is exploring novel ways of game interaction such as providing direct interfaces between the game and the gamers’ cognitive or affective responses. In this work, gamer’s brain activity has been imaged using functional near infrared spectroscopy (fNIRS) whilst they watch video of a video game (League of Legends) they play. A video of the face of the participants is also recorded for each of a total of 15 trials where a trial is defined as watching a gameplay video. From the data collected, i.e., gamer’s fNIRS data in combination with emotional state estimation from gamer’s facial expressions, the expertise level of the gamers has been decoded per trial in a multi-modal framework comprising of unsupervised deep feature learning and classification by state-of-the-art models. The best tri-class classification accuracy is obtained using a cascade of random convolutional kernel transform (ROCKET) feature extraction method and deep classifier at 91.44%. This is the first work that aims at decoding expertise level of gamers using non-restrictive and portable technologies for brain imaging, and emotional state recognition derived from gamers’ facial expressions. This work has profound implications for novel designs of future human interactions with video games and brain-controlled games. Full article
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16 pages, 3087 KiB  
Article
Individual Differences in Hemodynamic Responses Measured on the Head Due to a Long-Term Stimulation Involving Colored Light Exposure and a Cognitive Task: A SPA-fNIRS Study
by Hamoon Zohdi, Felix Scholkmann and Ursula Wolf
Brain Sci. 2021, 11(1), 54; https://doi.org/10.3390/brainsci11010054 - 05 Jan 2021
Cited by 20 | Viewed by 3618
Abstract
When brain activity is measured by neuroimaging, the canonical hemodynamic response (increase in oxygenated hemoglobin ([O2Hb]) and decrease in deoxygenated hemoglobin ([HHb]) is not always seen in every subject. The reason for this intersubject-variability of the responses is still not completely [...] Read more.
When brain activity is measured by neuroimaging, the canonical hemodynamic response (increase in oxygenated hemoglobin ([O2Hb]) and decrease in deoxygenated hemoglobin ([HHb]) is not always seen in every subject. The reason for this intersubject-variability of the responses is still not completely understood. This study is performed with 32 healthy subjects, using the systemic physiology augmented functional near-infrared spectroscopy (SPA-fNIRS) approach. We investigate the intersubject variability of hemodynamic and systemic physiological responses, due to a verbal fluency task (VFT) under colored light exposure (CLE; blue and red). Five and seven different hemodynamic response patterns were detected in the subgroup analysis of the blue and red light exposure, respectively. We also found that arterial oxygen saturation and mean arterial pressure were positively correlated with [O2Hb] at the prefrontal cortex during the CLE-VFT independent of the color of light and classification of the subjects. Our study finds that there is substantial intersubject-variability of cerebral hemodynamic responses, which is partially explained by subject-specific systemic physiological changes induced by the CLE-VFT. This means that both subgroup analyses and the additional assessment of systemic physiology are of crucial importance to achieve a comprehensive understanding of the effects of a CLE-VFT on human subjects. Full article
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22 pages, 9440 KiB  
Article
Examining Mental Workload in a Spatial Navigation Transfer Game via Functional near Infrared Spectroscopy
by Tamara Galoyan, Kristen Betts, Hovag Abramian, Pratusha Reddy, Kurtulus Izzetoglu and Patricia A. Shewokis
Brain Sci. 2021, 11(1), 45; https://doi.org/10.3390/brainsci11010045 - 04 Jan 2021
Cited by 5 | Viewed by 4499
Abstract
The goal of this study was to examine the effects of task-related variables, such as the difficulty level, problem scenario, and experiment week, on performance and mental workload of 27 healthy adult subjects during problem solving within the spatial navigation transfer (SNT) game. [...] Read more.
The goal of this study was to examine the effects of task-related variables, such as the difficulty level, problem scenario, and experiment week, on performance and mental workload of 27 healthy adult subjects during problem solving within the spatial navigation transfer (SNT) game. The study reports task performance measures such as total time spent on a task (TT) and reaction time (RT); neurophysiological measures involving the use of functional near-infrared spectroscopy (fNIRS); and a subjective rating scale for self-assessment of mental workload (NASA TLX) to test the related hypothesis. Several within-subject repeated-measures factorial ANOVA models were developed to test the main hypothesis. The results revealed a number of interaction effects for the dependent measures of TT, RT, fNIRS, and NASA TLX. The results showed (1) a decrease in TT and RT across the three levels of difficulty from Week 1 to Week 2; (2) an increase in TT and RT for high and medium cognitive load tasks as compared to low cognitive load tasks in both Week 1 and Week 2; (3) an overall increase in oxygenation from Week 1 to Week 2. These findings confirmed that both the behavioral performance and mental workload were sensitive to task manipulations. Full article
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15 pages, 1614 KiB  
Article
Evidence of fNIRS-Based Prefrontal Cortex Hypoactivity in Obesity and Binge-Eating Disorder
by Sarah A. Rösch, Ricarda Schmidt, Michael Lührs, Ann-Christine Ehlis, Swen Hesse and Anja Hilbert
Brain Sci. 2021, 11(1), 19; https://doi.org/10.3390/brainsci11010019 - 26 Dec 2020
Cited by 20 | Viewed by 4335
Abstract
Obesity (OB) and associated binge-eating disorder (BED) show increased impulsivity and emotional dysregulation. Albeit well-established in neuropsychiatric research, functional near-infrared spectroscopy (fNIRS) has rarely been used to study OB and BED. Here, we investigated fNIRS-based food-specific brain signalling, its association with impulsivity and [...] Read more.
Obesity (OB) and associated binge-eating disorder (BED) show increased impulsivity and emotional dysregulation. Albeit well-established in neuropsychiatric research, functional near-infrared spectroscopy (fNIRS) has rarely been used to study OB and BED. Here, we investigated fNIRS-based food-specific brain signalling, its association with impulsivity and emotional dysregulation, and the temporal variability in individuals with OB with and without BED compared to an age- and sex-stratified normal weight (NW) group. Prefrontal cortex (PFC) responses were recorded in individuals with OB (n = 15), OB + BED (n = 13), and NW (n = 12) in a passive viewing and a response inhibition task. Impulsivity and emotional dysregulation were self-reported; anthropometrics were objectively measured. The OB and NW groups were measured twice 7 days apart. Relative to the NW group, the OB and OB + BED groups showed PFC hyporesponsivity across tasks, whereas there were few significant differences between the OB and OB + BED groups. Greater levels of impulsivity were significantly associated with stronger PFC responses, while more emotional dysregulation was significantly associated with lower PFC responses. Temporal differences were found in the left orbitofrontal cortex responses, yet in opposite directions in the OB and NW groups. This study demonstrated diminished fNIRS-based PFC responses across OB phenotypes relative to a NW group. The association between impulsivity, emotional dysregulation, and PFC hypoactivity supports the assumption that BED constitutes a specific OB phenotype. Full article
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12 pages, 1327 KiB  
Article
Investigation of Functional Connectivity Differences between Voluntary Respirations via Mouth and Nose Using Resting State fMRI
by Ju-Yeon Jung, Chan-A Park, Yeong-Bae Lee and Chang-Ki Kang
Brain Sci. 2020, 10(10), 704; https://doi.org/10.3390/brainsci10100704 - 03 Oct 2020
Cited by 5 | Viewed by 3555
Abstract
The problems of mouth breathing have been well-studied, but the neural correlates of functional connectivity (FC) still remain unclear. We examined the difference in FC between the two types of breathing. For our study, 21 healthy subjects performed voluntary mouth and nasal breathing [...] Read more.
The problems of mouth breathing have been well-studied, but the neural correlates of functional connectivity (FC) still remain unclear. We examined the difference in FC between the two types of breathing. For our study, 21 healthy subjects performed voluntary mouth and nasal breathing conditions during a resting state functional magnetic resonance imaging (fMRI). The region of interest (ROI) analysis of FC in fMRI was conducted using a MATLAB-based imaging software. The resulting analysis showed that mouth breathing had widespread connections and more left lateralization. Left inferior temporal gyrus had the most left lateralized connections in mouth breathing condition. Furthermore, the central opercular cortex FC showed a significant relationship with mouth breathing. For nasal breathing, the sensorimotor area had symmetry FC pattern. These findings suggest that various FCs difference appeared between two breathing conditions. The impacts of these differences need to be more investigated to find out potential link with cognitive decline in mouth breathing syndrome. Full article
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15 pages, 875 KiB  
Article
Inter-Session Reliability of Functional Near-Infrared Spectroscopy at the Prefrontal Cortex While Walking in Multiple Sclerosis
by Kim-Charline Broscheid, Dennis Hamacher, Juliane Lamprecht, Michael Sailer and Lutz Schega
Brain Sci. 2020, 10(9), 643; https://doi.org/10.3390/brainsci10090643 - 17 Sep 2020
Cited by 12 | Viewed by 3212
Abstract
Many established technologies are limited in analyzing the executive functions in motion, especially while walking. Functional near-infrared spectroscopy (fNIRS) fills this gap. The aim of the study is to investigate the inter-session reliability (ISR) of fNIRS-derived parameters at the prefrontal cortex while walking [...] Read more.
Many established technologies are limited in analyzing the executive functions in motion, especially while walking. Functional near-infrared spectroscopy (fNIRS) fills this gap. The aim of the study is to investigate the inter-session reliability (ISR) of fNIRS-derived parameters at the prefrontal cortex while walking in people with multiple sclerosis (MS) and healthy control (HC) individuals. Twenty people with MS/HC individuals walked a 12 m track back and forth over 6 min. The primary outcomes were the absolute and relative reliability of the mean, slope coefficient (SC), and area under the curve (A) of the oxy-/deoxyhemoglobin concentrations (HbO/HbR) in the Brodmann areas (BA) 9/46/10. The SC and the A of HbO exhibited a fair ISR in BA10 in people with MS. For the mean and A of the HbR, almost all areas observed revealed a fair ISR. Overall, the ISR was better for HbR than HbO. A fair to excellent ISR was found for most BA of the prefrontal cortex in HC individuals. In total, the ISR of the analyzed fNIRS-derived parameters was limited. To improve the ISR, confounders such as fatigue and mind wandering should be minimized. When reporting the ISR, the focus should be on the mean/A rather than SC. Full article
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15 pages, 3962 KiB  
Article
Global Neural Activities Changes under Human Inhibitory Control Using Translational Scenario
by Rupesh Kumar Chikara and Li-Wei Ko
Brain Sci. 2020, 10(9), 640; https://doi.org/10.3390/brainsci10090640 - 16 Sep 2020
Cited by 2 | Viewed by 2488
Abstract
This study presents a new approach to exploring human inhibition in a realistic scenario. In previous inhibition studies, the stimulus design of go/no-go task generally used a simple symbol for the go and stop signals. We can understand the neural activity of inhibition [...] Read more.
This study presents a new approach to exploring human inhibition in a realistic scenario. In previous inhibition studies, the stimulus design of go/no-go task generally used a simple symbol for the go and stop signals. We can understand the neural activity of inhibition through simple symbol scenario. In the real world, situations of human inhibition are more complex than performing an experiment in the laboratory scale. How to explore the neural activities of inhibition in a realistic environment is more complex. Consequently, we designed a battlefield scenario to investigate the neural activities of inhibition in a more realistic environmental setting. The battlefield scenario provides stronger emotion, motivation and real-world experiences for participants during inhibition. In the battlefield scenario, the signs of fixation, go and stop were replaced by images of a sniper scope, a target and a non-target. The battlefield scenario is a shooting game between the enemy and the soldiers. In battlefield scenario participants played the role of the soldiers for shooting target and to stop shooting when a non-target appeared. Electroencephalography (EEG) signals from twenty participants were acquired and analyzed using independent component analysis (ICA) and dipole source localization method. The results of event-related potential (ERP) showed a significant modulation of the peaks N1, N2 and P3 in the frontal and cingulate cortices under inhibitory control. The partially overlapping ERP N2 and P3 waves were associated with inhibition in the frontal cortex. The ERP N2, N1 and P3 waves in the cingulate cortex are related to sustained attention, motivation, emotion and inhibitory control. In addition, the event-related spectral perturbation (ERSP) results shows that the powers of the delta and theta bands increased significantly in the frontal and cingulate cortices under human inhibitory control. The EEG-ERP waves and power spectra in the frontal and cingulate cortices were found more increased than in the parietal, occipital, left and right motor cortices after successful stop. These findings provide new insights to understand the global neural activities changes during human inhibitory control with realistic environmental scenario. Full article
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16 pages, 1494 KiB  
Article
Short-Term Effects of Meditation on Sustained Attention as Measured by fNIRS
by Meltem Izzetoglu, Patricia A. Shewokis, Kathryn Tsai, Phillip Dantoin, Kathryn Sparango and Katherine Min
Brain Sci. 2020, 10(9), 608; https://doi.org/10.3390/brainsci10090608 - 04 Sep 2020
Cited by 14 | Viewed by 5670
Abstract
Cognitive abilities such as attention, memory, processing time, perception, and reasoning can be augmented using some type of intervention. Within the broad range of conventional and unconventional intervention methods used in cognitive enhancement, meditation is one of those that is safe, widely practiced [...] Read more.
Cognitive abilities such as attention, memory, processing time, perception, and reasoning can be augmented using some type of intervention. Within the broad range of conventional and unconventional intervention methods used in cognitive enhancement, meditation is one of those that is safe, widely practiced by many since ancient times, and has been shown to reduce stress and improve psychological health and cognitive functioning. Various neuroimaging studies using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) have shown functional and structural changes due to meditation in different types of meditation practices and on various groups of meditators. Recently, a few studies on meditation have used functional near infrared spectroscopy (fNIRS) to study the effects of meditation on cerebral hemodynamics. In this study, we examined the short-term effects of loving-kindness (LK) meditation on sustained attention using behavioral performance measures, physiological outcomes, and cognitive activity as measured by fNIRS in first-time meditators during Stroop color word task (SCWT) performance. Our results indicated that behavioral outcomes, assessed mainly on response time (RT) during SCWT performance, showed a significant decrease after meditation. As expected, physiological measures, primarily pulse pressure (PP) measured after meditation dropped significantly as compared to the before meditation measurement. For the hemodynamic measures of oxygenated-hemoglobin (HbO2), deoxygenated-hemoglobin (Hb), and total-hemoglobin (HbT), our findings show significant differences in SCWT performance before and after meditation. Our results suggest that LK meditation can result in improvements in cognitive, physiological, and behavioral outcomes of first-time meditators after a short-term session. Full article
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15 pages, 3230 KiB  
Case Report
Functional Neural Changes after Low-Frequency Bilateral Globus Pallidus Internus Deep Brain Stimulation for Post-Hypoxic Cortical Myoclonus: Voxel-Based Subtraction Analysis of Serial Positron Emission
by Myung Ji Kim, So Hee Park, Kyoung Heo, Jin Woo Chang, Joong Il Kim and Won Seok Chang
Brain Sci. 2020, 10(10), 730; https://doi.org/10.3390/brainsci10100730 - 13 Oct 2020
Cited by 4 | Viewed by 2217
Abstract
Post-hypoxic myoclonus (PHM) and Lance–Adams syndrome (LAS) are rare conditions following cardiopulmonary resuscitation. The aim of this study was to identify functional activity in the cerebral cortex after a hypoxic event and to investigate alterations that could be modulated by deep brain stimulation [...] Read more.
Post-hypoxic myoclonus (PHM) and Lance–Adams syndrome (LAS) are rare conditions following cardiopulmonary resuscitation. The aim of this study was to identify functional activity in the cerebral cortex after a hypoxic event and to investigate alterations that could be modulated by deep brain stimulation (DBS). A voxel-based subtraction analysis of serial positron emission tomography (PET) scans was performed in a 34-year-old woman with chronic medically refractory PHM that improved with bilateral globus pallidus internus (Gpi) DBS implanted three years after the hypoxic event. The patient required low-frequency stimulation to show myoclonus improvement. Using voxel-based statistical parametric mapping, we identified a decrease in glucose metabolism in the prefrontal lobe including the dorsolateral, orbito-, and inferior prefrontal cortex, which was suspected to be the origin of the myoclonus from postoperative PET/magnetic resonance imaging (MRI) after DBS. Based on the present study results, voxel-based subtraction of PET appears to be a useful approach for monitoring patients with PHM treated with DBS. Further investigation and continuous follow-up on the use of PET analysis and DBS treatment for patients with PHM are necessary to help understanding the pathophysiology of PHM, or LAS. Full article
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