This thesis describes studies assessing the ability of somatosensory evoked potentials (SEPs) to predict outcome following severe brain injury by examining outcome and determining the predictive value of SEPs directly and in comparison to alternative tests in both patients and systematic reviews of the literature. Outcome was assessed using a functional and quality of life measure. It changed over time and was influenced by age, mechanism, timing and the type of outcome measure. When 5 year functional outcome was used, sensitivity and specificity for the initial SEPs were 63.2% and 93.3% with a positive predictive value of 92.3% for favourable outcome and 66.7%, 94.7% and 90.9% for unfavourable outcome prediction. SEPs predictive performance varied and was better in patients with 1 year outcomes, when outcome was measured with the quality of life tool and in patients suffering hypoxicischaemic encephalopathy. Importantly, only twelve false positives were identified in the systematic review of 55 studies from 903 patients with bilaterally absent SEPs. Eight of these false positives suffered focal lesions of the brain stem, large cerebral fluid collections or recent decompressive craniectomy which cause SEPs to be absent because of a mechanical disruption to the electrical signal. Comparisons between SEPs and other tests in the patient cohort and wider literature showed that SEPs were the best overall predictors of outcome but were outperformed by some clinical tests in specific areas. Specificity for unfavourable outcome prediction was better for ICP, CPP and the last pupillary response. In patients with any cause of brain injury, the combination of SEPs and Motor responses provided the best predictions for unfavourable outcome while for favourable outcome the best overall prediction and specificity were achieved with a combination of either SEPs or Motor responses and the best sensitivity with pupillary responses alone or a combination of either SEPs or Pupillary responses. The studies in this thesis provide a detailed evaluation of SEPs and showed that SEPs have a place in the prediction of outcome, alone or in combination with existing tests. Overall, they are superior to clinical tests and can be easily obtained at the bedside and in the presence of pharmacological paralysis and analgesia/sedation.

Bibliography: leaves 156-173 / x, 173 leaves, [6] leaves of plates : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.M.)--University of Adelaide, 1986

As disturbed binocular functions in small children may lead to severe amblyopia it is of interest to detect it as early as possible. Most tests for binocular functions, however, demand active cooperation and may be unreliable in children up to 4-5 years of age. This study therefore aims to employ visual evoked potentials (VEP) to enable the examiner to evaluate the binocular function in a subject without need of active cooperation from the subject. Initially we studied the relation of suprathreshold contrast to the latency of the transient pattern VEP (tpVEP). Although suprathreshold contrast independently influenced the tpVEP latency, interindividual variation was too large to suggest tpVEP as a possible method for objectively measuring contrast sensitivity in a subject. The tpVEP latency in normal and microstrabismic adult subjects was examined. It was significantly shorter with binocular viewing in normals, but not in the microstrabismic group. Contrast sensitivity and tpVEP latency was examined in adults, both with normal binocularity and with microstrabismus, using both luminance (black-and-white) contrast and colour contrast patterns. The tpVEP latency to colour contrast, like that to luminance contrast, is shorter in normal subjects who view the stimulus binocularly. Interindividual variation or overlap between the normal and microstrabismic groups did not improve with colour contrast. The most significant features of the tpVEP are amplitude and latency. Depending on stimulus conditions, the response may show variations in configuration, amplitude and, to a lesser degree, latency. To decrease the influence of such variations steady-state VEP (ssVEP) can be used. The stimulus is presented in a fast repetitive manner, yielding a VEP response shaped as a continuous curve. The frequency components of this curve can be analysed using Fast Fourier Analysis. Fast Fourier analysis of ssVEP in children aged 8-15 years with normal binocularity and with microstrabismus showed that the power of the second harmonic (the double frequency of stimulus frequency) of the response with binocular viewing was larger than with monocular viewing, both in normals and microstrabismic subjects. For higher stimulus frequencies, microstrabismic subjects showed a significantly lower power of the second harmonic compared with subjects with normal binocularity, when the stimulus was presented binocularly. Finally, Fast Fourier analysed ssVEP in pre-school children aged 4-5 years was studied. A normal group was compared with a group with microstrabismus and a group with significant amblyopia. Amblyopic subjects had significant interocular differences in the first harmonic. We confirmed the significant difference found between microstrabismic subjects and subjects with normal binocularity regarding the second harmonic’s power with higher temporal frequency binocular stimulation, although at a slightly lower frequency than for older children. A low power of the second harmonic in the ssVEP to a binocular stimulus with high temporal frequency is a strong indicator of disturbed binocular function. / För att förhindra amblyopi (ensidig synsvaghet) hos barn är det viktigt att upptäcka störningar i samsynsfunktionerna så tidigt som möjligt. Samsynstester kräver dock aktiv medverkan och kan ge osäkra resultat hos barn upp till 4-5 års ålder. Den här avhandlingen studerar möjligheterna att utifrån tidsmässiga (temporala) egenskaper hos visual evoked potentials (VEP) undersöka samsynsfunktioner objektivt, utan att den undersökte behöver medverka aktivt. Första delstudien visar att ett synstimulus kontrastnivå i relation till kontrastkänslighetströskeln oberoende påverkar latensen i VEP, men variationer mellan individer gör metoden olämplig som objektiv kontrastkänslighetstest. Andra delstudien jämför latensen i VEP hos individer med normal samsyn med den hos personer med mikroskelning. Stimulering av båda ögonen gav signifikant kortare latens än stimulering av ett öga hos normala, men inte hos mikroskelare. I den tredje delstudien jämfördes känslighet för luminanskontrast och färgkontrast hos individer med normal samsyn och personer med mikroskelning. Både luminansmönster (svart-vita) och färgkontrastmönster upptäcktes vid lägre kontrast om båda ögonen stimulerades istället för ett i taget hos normalseende. Mikroskelare uppfattade mönstren sämre med båda ögonen än med ett öga (det dominanta). Latensen i VEP mättes i båda grupperna för både luminans- och färgkontrastmönster. Båda typerna av kontrast gav förkortning av latensen när båda ögonen stimulerades vid normal samsyn, men denna förkortning uteblev hos mikroskelare. Både luminans- och färgkontrast gav för varierande resultat för att utnyttja metoden för objektiv undersökning av samsynen. Fourier-analys innebär att en kurvform delas upp i sinuskurvor med olika frekvens, amplitud och fas. Om ett stimulus växlar hastigt får man ett steady-state VEP (ssVEP), dvs en kontinuerligt vågformad VEP-kurva, som kan delas upp i delsinuskurvor med Fourieranalys. Detta gör att man särskilt kan studera frekvenser som är relaterade till stimuleringsfrekvensen, till exempel grundton och övertoner (multipler av grundtonsfrekvensen). Barn 8-15 år gamla, med normal samsyn och med mikroskelning undersöktes med ssVEP i det fjärde delarbetet. Den första övertonen (= ”second harmonic”) var statistiskt signifikant svagare hos mikroskelare jämfört med normala individer, när stimuleringsfrekvensen var hög. Det femte och sista delarbetet undersökte ssVEP hos 4-5 år gamla förskolebarn på motsvarande sätt. I denna studie deltog också en grupp barn med amblyopi (synsvaghet) på ena ögat. På en något lägre stimuleringsfrekvens bekräftades den svagare första övertonen hos barnen med mikroskelning jämfört med barnen med normal samsyn. De amblyopa barnen visade tydligast förändringar vid lägre stimuleringsfrekvenser och i ssVEP:s grundtonsfrekvens (= ”first harmonic” eller ”fundamental harmonic”). Resultaten i de olika grupperna är så pass åtskilda att metoden verkar lämpa sig för objektiv undersökning av samsynsfunktioner, i det att en svag första överton i binokulärt ssVEP utlöst av hög stimuleringsfrekvens inger en stark misstanke om störd samsyn, medan en stor skillnad i grundtonens styrka i höger respektive vänster ögas ssVEP tyder på amblyopi.

Neck pain has the potential to result in altered afferent input to the central nervous system which may thereby result in altered sensorimotor integration and eventually further disability. One “at risk” population for neck pain may be university students, particularly given the growing use of laptop computers in the university setting. This thesis presents two pilot studies which aim to develop and assess instruments to use as screening tools for risk factors associated with neck pain. The first study explores the environment in which university students utilize their laptop computers and the relationship to known risk factors for neck pain. A new questionnaire, The Student Laptop Use and Neck Pain Risk Questionnaire (SLUNPRQ) was created to measure the presence of risk factors known to increase the risk of developing neck pain. This questionnaire was piloted for reliability using test- retest measures. Results indicated that the SLUNPRQ had good reliability based on Cohen’s Kappa scores. A modified questionnaire was developed based on questions with either low reliability or ambiguous answers and is ready for further testing. The second study sought to determine if dual somatosensory evoked potential (SEP) ratios changed with long term chiropractic care. This was part of the overall goal of finding neural markers that could identify those who are at risk for developing neck pain. This study sought to determine the feasibility of using dual SEPs to evaluate changes in neural markers of sensorimotor integration after 12 weeks of chiropractic care and demonstrated that dual SEPs shows potential as a marker to screen individuals at risk of neck pain as the SEP markers showed improvement after long term chiropractic care. / UOIT

Altered afferent input resulting from neck joint dysfunction has become a growing area of study. Cervical spine manipulation, specifically in individuals with subclinical neck pain (SNCP); induces neurological changes, suggesting it has a positive neuromodulatory effect on brain processing. The effects of manipulation on motor learning in individuals with SCNP have not been investigated until now. Studies in this thesis sought to develop and investigate a novel motor training task to be coupled with cervical spine manipulation to investigate its effects on individual’s ability to process new task information. The studies revealed significant changes in neural activity specific to the cerebellum and sensorimotor integration following a complex motor training task as compared to a simple repetitive task, suggesting that those specific regions are involved in processing of more complex motor skill learning tasks. This novel task was then coupled with manipulation which revealed significant activation increases in cortical and decreases in subcortical brain regions following manipulation. Regions specific to sensorimotor integration (SMI) showed increased activation in both the manipulation and passive head movement control groups, corroborating with the results from the first study. The use of a complex motor training task is a useful tool for determining intervention effects on neural processing in individuals with SCNP. / UOIT

Sensorimotor integration (SMI) is the ability of the central nervous system (CNS) to integrate afferent (incoming) information from different body parts and formulate appropriate motor output to muscles. Effective sensorimotor integration is essential when learning new skills and when performing tasks at home and in the workplace (Rothwell &Rosenkranz, 2005). The overall aim of this thesis is to investigate the effect of acute experimental pain on sensorimotor processing. The primary outcome is the effect of acute experimental pain on somatosensory evoked potential (SEP) peaks. Secondary outcomes include the effect of pain on motor performance and the interactive effect of pain and motor training on SEP peaks. As expected for the placebo condition, no significant differences were found in any of the post-placebo peaks. Contrary to what was expected for the placebo condition, the only peak to be significantly different post-motor learning was the N24 peak. Contrary to what was expected, there were no significant differences for any of the peaks following capsaicin application. One of the secondary outcomes was the interactive effect of pain and motor learning on SEP peaks. The only peak to show any significant differences post-intervention/post-motor learning was the N24 peak. Another secondary outcome was the effect of pain on motor performance. In terms of accuracy, no significant differences were found for either condition following motor learning. However, the data does show a trend towards improved accuracy for the subjects in the intervention group while the subjects in the placebo show a trend towards decreased accuracy. As expected, there was a significant decrease in reaction time for both conditions post-motor learning. However, contrary to what was expected, reaction time decreased to a greater extent in the intervention condition as compared to the placebo condition. It was anticipated that the reaction time would decrease to a greater extent in the placebo condition as it was hypothesized that pain would negatively impact motor performance. It is suspected that the effect of the pain induced by the capsaicin made the motor training task more difficult and participants would have had to focus greater attentional resources to learn the task which lead to the enhanced performance following motor training. / UOIT

This study investigated the neuroplastic changes that accompany speech identification training using magnetoencephalography (MEG). Participants completed three practice sessions over two consecutive days. In the morning group, practice occurred in the morning and evening of the first day, and in the morning of the next day; whereas, in the evening group, practice occured in the evening of the first day, and in the morning and evening of the second day. In both groups, behavioural improvement between the first session and last session was comparable. Neuromagnetic data showed practice-related changes in N1m amplitude between the first and last sessions. A time-of-day (TOD) of practice effect was found for P2m mean amplitude. In both groups, P2m-related changes with practice were greater when consecutive sessions occurred between days than within a day. The results are consistent with the proposal that task-related changes in the P2m wave are an index of perceptual learning.

This study investigated the neuroplastic changes that accompany speech identification training using magnetoencephalography (MEG). Participants completed three practice sessions over two consecutive days. In the morning group, practice occurred in the morning and evening of the first day, and in the morning of the next day; whereas, in the evening group, practice occured in the evening of the first day, and in the morning and evening of the second day. In both groups, behavioural improvement between the first session and last session was comparable. Neuromagnetic data showed practice-related changes in N1m amplitude between the first and last sessions. A time-of-day (TOD) of practice effect was found for P2m mean amplitude. In both groups, P2m-related changes with practice were greater when consecutive sessions occurred between days than within a day. The results are consistent with the proposal that task-related changes in the P2m wave are an index of perceptual learning.

University of Macau / Faculty of Science and Technology / Department of Electrical and Electronics Engineering

Archery can be described as a static sport requiring strength and endurance of the upper body, in particular the shoulder girdle (Mann, 1984 / Mann &amp / Littke, 1989). To get a good record in an archery competition, one requires well-balanced and highly reproducible movements during the shooting (Nishizono, 1987). The bowstring is released when audible impetus is received from a device called &ldquo / clicker&rdquo / . As the fall of the clicker is an acoustic stimulus, it may evoke a sequence of potentials that can be recorded from the scalp of an archer. Auditory Evoked Potentials (AEPs) occur at different latencies and with various relations to the auditory stimuli. Therefore, the present study aims at investigating the Long-latency Auditory Evoked Potentials in Recurve Archery. Research questions can be stated briefly as follows: (1) What kind of Brain Potentials are Evoked by the Event (Fall of Clicker) during Archery Shooting? (2) Is there any significant difference between the characteristics of the potentials measured in laboratory conditions and during archery shooting? (3) Is there any significant difference between the successful and unsuccessful shots in terms of Auditory Evoked Brain Potentials? (4) Does Archery Shooting session have any effect on Auditory Evoked Brain Potentials? The subjects of the present study were 10 non-archers (N=6 males / N=4 females) for control trials and 15 archers (N=9 males / N=6 females) for archery shooting experiments. All subjects reported normal hearing, had medical histories free of significant neurological problems, and were not taking medication known to affect brain activity. Six different control paradigms have been created. Archery shootings were performed from 18 m that is official competition distance with target face.AEBPs were recorded 200 ms before and 800 ms after the trigger (fall of the clicker) over the vertex during the shots of each subject. Paradigm 1 and 5 was conducted just before and after the archery shooting to test the effect of archery shooting on AEBPs. The hit-area is defined as the rectangle between (x1, y1), (x1, y2), (x2, y1), (x2, y2) and the miss-area is the outer part of the hit-area on the target face. The preliminary analysis has shown that fall of the clicker evokes long latency auditory brain potentials with the latency of 100 msec and 200 msec. These responses are called as N1-P2 components. The means and standard deviations of both N100 and P200 amplitudes were as follows: N100 = 27,73 &plusmn / 16,82, P200 = -21,89 &plusmn / 20,46. The latencies of given brain responses were also summarized as: N100 = 141,93 &plusmn / 41,46 / P200 = 211,8 &plusmn / 43,97. N1 amplitude was significantly different in archery shooting than that of control conditions (p&lt / 0.05) except for trial 3, N1 latency was significantly different than that of trial 2 &ndash / 5 (p&lt / 0.05). P2 amplitude is significantly different in archery shooting than that of trial 6 (p&lt / 0.05). However, there was no significant difference in terms of P2 latency between archery shooting and control conditions (p&gt / 0.05). There was no significant difference between successful and unsuccessful shots in terms of N1-P2 components (p&gt / 0.05). An archery shooting session did not create any difference between these components recorded before and after the shot (p&gt / 0.05). Having higher N1 amplitudes during archery shooting can be explained by the known multi-component structure of this wave. Different lobes and regions of the brain can be active during the time of the scalp-recorded N1 and simultaneous involvement of several of these areas may be contributing to the electrical field recorded at scalp in the archery shooting paradigm.