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 Table of Contents  
REVIEW ARTICLE
Year : 2017  |  Volume : 22  |  Issue : 2  |  Page : 83-87

Functional neuroimaging as a tool to supplement cognitive, affective and social functioning assessment and psychotherapy


1 Department of Psychology, North Campus, University of Delhi, New Delhi, India
2 Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
3 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
4 Department of Physiology, Teerthankar Mahaveer University, Moradabad, Uttar Pradesh, India

Date of Web Publication2-Apr-2018

Correspondence Address:
Kanwal Preet Kochhar
Department of Physiology, Cognitive Neurophysiology Laboratory, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_11_17

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  Abstract 


The most critical need in the field of clinical psychology is unifying the firmly grounded theoretical principles with the real-time clinical practice and modern day neuroimaging advances. The present paper purports at determining the applicability of functional near-infrared spectroscopy (fNIRS) as a tool to supplement the cognitive and affective assessment, social functioning, psychotherapy, and rehabilitation through a rigorous review of the literature. fNIRS is used to measure cortical activation by recording changes in oxygenated and deoxygenated hemoglobin. Given the advantages and wide applicability of neuroimaging techniques, fNIRS can be effectively employed to assess real-time affective, perceptual, visual, and motor and language functioning of adults as well as infants. Summarily, fNIRS is a potential measure for comprehensive assessment of both healthy and pathological cortical working.

Keywords: Affective, cognitive, functional near-infrared spectroscopy, psychotherapy, social functioning


How to cite this article:
Malik A, Kochhar KP, Sagar R, Patil A. Functional neuroimaging as a tool to supplement cognitive, affective and social functioning assessment and psychotherapy. J Mental Health Hum Behav 2017;22:83-7

How to cite this URL:
Malik A, Kochhar KP, Sagar R, Patil A. Functional neuroimaging as a tool to supplement cognitive, affective and social functioning assessment and psychotherapy. J Mental Health Hum Behav [serial online] 2017 [cited 2018 Jun 25];22:83-7. Available from: http://www.jmhhb.org/text.asp?2017/22/2/83/229098




  Introduction Top


Functional near-infrared spectroscopy (fNIRS) is a technique that uses light signals to study the brain activity. This technique uses the fact that the activity of neurons is closely related to changes in blood in that region of the brain, a phenomenon known as neurovascular coupling.[1] As the activity within the neurons increases, the blood flow to that region increases and it results in changes in hemoglobin (Hb) levels around that region. Second, the advantage of using near infrared rays is that it has the ability to be able to penetrate the skin and bone while getting absorbed by Hb within the neural tissue.[2] Using two different wavelengths in fNIRS provides the third advantage. The wavelength of 730 nm is absorbed more by oxyhemoglobin (HbO), whereas the wavelength of 850 nm is absorbed more by deoxyhemoglobin (HbR).[3] Thus, using fNIRS one can ascertain changes in HbO as well as HbR levels in response to neuronal activity. It is established that higher metabolic demands seen during increased brain activity leads to increased oxygen expenditure and thus, decrease in HbR levels initially.[4] This is closely followed by increased blood flow to that region resulting in increased HbO levels.[4] Thus, fNIRS successfully gives a fair idea regarding absorption of near infrared rays in the brain and hence, the brain activity.

The present review aims at putting forward an upcoming neuroimaging technique, fNIRS, which with its promising benefaction can promote bridging the gap between psychiatry and psychology.


  Functional Near-Infrared Spectroscopy Device and Recording Technique Top


The fNIRS device consists of a sensor band [Figure 1]a, which can be placed directly on the scalp, the region of interest (ROI). Most common fNIRS devices use a band, which can be placed on the forehead to record brain activity from the prefrontal region. The sensor band may consist of one or many source-detector combinations (one such combination is called an optode). The source in an optode is a light emitting device, which emits infrared light. This light passes through the skin and bone to reach the brain tissue and then it moves toward the detector. The path followed by the infrared light forms a “banana-shaped path” [Figure 1]b. As other tissues (except hemoglobin) do not absorb the infrared spectrum, it renders them invisible to this light. The amount of infrared light absorbed is directly proportional to the Hb amount. Hence, if we know the distance between the source and detector, we can calculate relative changes in Hb values using modified Beer–Lambert Law [Figure 1]c. As mentioned earlier using two different wavelengths we can even find relative changes in HbO and HbR levels.
Figure 1: (a) Shows the sensor band with multiple source-detector combinations (optode). (b). Depicts the banana-shaped path followed by the infrared light as it passes from the source to detector. (c) Shows the calculation for determining relative concentrations of oxyhemoglobin and deoxyhemoglobin using Modified Beer–Lambert Law. Where I: Intensity of light; α: Absorption coefficient; c: Concentration; L: Path length; DPF: Differential path length factor; d: Distance between source and detector; G: Constant attenuation factor

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The main advantage of fNIRS is that recording can be done while the participant is sitting, supine or even ambulatory. The sensor band is placed so as to cover the ROI, making sure that the sensor band is in firm contact with the scalp. The standard procedure of cleaning with spirited cotton to remove dust/oil can increase sensitivity and prevent infections. However, there is no single standard protocol for positioning the band. Nevertheless, most commonly standard 10–20 international system electrode sites are noted while placing the band for inter-individual comparison. Alternatively, three-dimensional digital simulator or magnetic resonance imaging (MRI) coordinates can also be used for the same. Baseline recording is taken with the participant at rest, followed by recording during the task to find a relative increase in the brain activity. Similarly, multiple contrasts can be made by breaking the task into subtasks, to find differential brain activation using subtraction technique. Use of multiple optodes provides fairly good spatial resolution, which can be used to compare the left and right halves of the ROI. Oxygenation of ROI is calculated as the difference between concentrations of HbO and HbR, whereas total blood flow to the ROI can be calculated by adding the HbO and HbR values.


  Applications in Psychology Top


The fNIRS technique can nearly be put to use in every domain of psychology as can be viewed in [Figure 2]. It can be used to study the areas activated during cognitive tasks as depicted in [Table 1] in healthy participants and in people with psychiatric diseases. This information would help in proving or disproving age-old theories on human cognitive psychology. fNIRS can be used to study the defects in the brain activation in cases of social phobia or antisocial behavior. Thus, psychotherapy and medications can be individualized according to the defect noted in fNIRS. Rehabilitation exercises or tasks can be used to activate the defective pathway.
Figure 2: Major domains of psychology where functional near-infrared spectroscopy is been used

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Table 1: Various psychological tasks used with functional near-infrared spectroscopy

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  Cognitive Domain Top


Recently, fNIRS has been used to demonstrate decreased oxygenation in the dorsolateral prefrontal cortex (DLPFC)[5] and bilateral parietal area [6] on a verbal fluency task in patients with Alzheimer's disease as compared to healthy age-matched controls. Reduced levels of oxygenated Hb and impaired hemispheric lateralization were found out during verbal fluency task in Alzheimer's Dementia patients.[7]

Various fNIRS studies using verbal fluency task [7],[8],[9],[10] and working memory [8],[9] in patients with unipolar depression found out reduced oxygenation in frontotemporal region.

In individuals scoring high on schizotypal personality scores altered frontal lateralization was found during various cognitive tasks.[10],[11] Similar results were obtained on a Go/No-Go task in patients with schizophrenia.[12] Findings indicating an abnormality in brain activation, especially prefrontal cortex during tasks such as Stroop task, Tower of Hanoi, Random number generation, and verbal fluency in schizophrenic patients have been reported.[13],[14],[15]

Decreased activity of the left prefrontal cortex during cognitive activation [16] (and in anxiety and affective content material) was reported in a fNIRS study in panic disorder patients.[17] A fNIRS study related to attention and concentration deficits in verbal fluency test in patients with PTSD found out reduced activation of the prefrontal cortex.[18]

Hemodynamic changes in the frontal lobes while doing mental tasks such as mathematical problems, calculation, or picture observation were detected in healthy participants.[19],[20],[21],[22],[23]


  Affective and Social Top


One of the studies examined contrasting alterations in the degrees of oxygenation as a reaction to “emotions” provoking impetus in both left and right prefrontal cortex. The stimuli utilized were in the form of image set appropriated by the International Affective Picture System. The study revealed heightened oxygenation during a task involving facial recognition in the left hemispheric section compared to precedent levels.[24] Effect on emotion in terms of arousal and valence was assessed through prefrontal cortical activation while listening to music with some emotional content was assessed using fNIRS.[25]

During working memory and verbal fluency task with healthy participants, an inverse relationship was reported between prefrontal cortical activity and depressed mood using fNIRS.[26] A fNIRS study with bipolar disorder patients indicated increased prefrontal cortical activity when shown social exclusion pictures.[27] On the other hand, decreased oxygenated Hb activity when shown sad pictures.[28] A study examined prefrontal cortical activation in patients with late-onset depression and reported reduced activity during cognitive tasks in front temporal areas. Furthermore, a correlation was found between poor social functioning and front polar cortex.[29],[30]

A fNIRS study involved showing preschoolers a cartoon with emotional as well as neutral scenes to pinpoint the hemodynamic responses associated with pleasant and unpleasant emotions and anticipation. The results revealed that a rise in cerebral blood flow was observed in anticipation responses as compared to neutral stimuli. Furthermore, a decline in cerebral blood flow was noted when viewing unpleasant scenes.[31] It was reported that when shown video clips related to trauma, increased levels of oxygenated Hb and its direct relationship with changes in heart rate were noted.[32]

fNIRS has also been used in establishing the relationship between hemodynamics of prefrontal area and tasks relating to processing of self-others. Differential activation of the prefrontal area during self-face processing and empathy in schizotypal personality was observed.[33]


  Assessment and Psychotherapy Top


Research on personality using fNIRS have demonstrated correlation between changes in hemodynamics and personality traits such as neuroticism [26] and agreeableness.[34]

Galantamine effects of word frequency on dementia patients were assessed using fNIRS. The results indicated that the treatment had no effect on levels of brain oxygenation although differential DLPFC activity was evident in dementia patients as compared to elderly.[35] Word generation tasks using written or spoken language [36] can be used to investigate speech perception. fNIRS can also be used as a primary screening tool for Alzheimer's disease by detecting significant changes in morphology, which is evident before the onset of the disease.[37]

fNIRS has been used to evaluate the activation of sensorimotor cortex in infants during passive elbow and knee movements.[38] A fNIRS study of newborn infants using stroboscopic light as a stimulus while sleeping reported increased oxygenated Hb in prefrontal cortices as well as in occipital lobe.[39]

In recent times, fNIRS has been applied as a neurofeedback technique during motor imagery to produce therapeutic effects.[40]


  Advantages and Disadvantages of Functional Near Infrared Spectroscopy Top


Advantages

There are potential merits of fNIRS technique over other neuroimaging techniques [Figure 3]. The fact that fNIRS is noninvasive gives this technique cutting edge over other techniques, making it suitable for a wider range of populations including children. In functional MRI (fMRI), the participant has to be in supine motionless position. Such a position is not akin to real-life situation. This can be overcome by the use of fNIRS, as recording can be done in sitting, supine, or standing, and to some extent even during ambulatory state. Such an advantage allows the researchers to include tasks, which were not possible in fMRI settings. In addition, there is no enclosed chamber with magnet sounds in fNIRS technique and hence can be used in claustrophobic and child participants too. Finally, fNIRS is cheaper than as other techniques including fMRI and PET scan. The results obtained from fNIRS studies have long been compared with fMRI findings, and researchers have reported high consistency between the two tools. This offers an added advantage and the possibility of combing fNIRS with other neuroimaging techniques for a more comprehensive assessment such as with fMRI,[41] EEG potentials,[42] and PET scans.[41] Furthermore, there is ever increasing technical advancement in the fNIRS system. Increasing the spatial resolution from 4 channels to 256 channel system and availability of wireless device has surely contributed to its wider scope and applicability.[7],[43] Relatedly, it allows representing complicated analysis in the forms of brain map images. Specifically, it is very useful method concerning psychological research aiding its ecological validity. In addition, it can be clubbed with psychological tests such as working memory task, verbal fluency task, and sustained attention tasks and so on. Finally, fNIRS makes functional real-time testing possible and simple.
Figure 3: Advantages of functional near-infrared spectroscopy

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Disadvantages

One underlying limitation [Figure 4] of this technique centers around its dependability on the number of channels for increased accuracy of results by investigating related brain regions. Second, the spatial resolution of fNIRS lacks the precision of that of other neuroimaging techniques. Individual participant vary in the head sizes, and hence, inter-individual comparison lacks true spatial registration. In fMRI technique, the analysis is far more advanced which allows standardizing results on same brain template for inter-individual comparison. Nevertheless, new spatial registration softwares are been developed to plot data on the same template in a fNIRS technique akin to fMRI thus increasing its precision.[44] Though such analysis is far from the well-developed fMRI technique. In addition, currently fNIRS technique aids in examination of the major cerebral cortex as it fails to reach the depths of the brain, whereas other established techniques such as fMRI give an opportunity to the investigator for whole-brain examination. However, various new fNIRS devices are advancing toward better models to detect brain activity even in deeper parts of the brain.
Figure 4: Disadvantages of functional near-infrared spectroscopy

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  Conclusion Top


This review is directed at exhibiting various applications of fNIRS which on one hand help to see through the gap between clinical psychiatry and applied psychology. On the other hand, it integrates the two diverse but related fields. Thus, the widely cited literature on fNIRS makes it a suitable tool for the diagnosis and plausible one for psychotherapy as well.

Acknowledgment

We would like to extend gratitude to Prof. Nandita Babu, Head of the Department, and Dr. Dinesh Chhabra, Assistant Professor, Department of Psychology, University of Delhi, for their support during the course of this review.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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