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

2. 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

3. 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

4. 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

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

6. 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

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

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

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

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

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

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

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

20. 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

21. Measure – NIRS

22. 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

23. 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

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

25. 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

26. 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

27. Results prediction
Time records prediction

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

29. Thanks for your attention !!

30. 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