Virtual Reality Games for Motor Rehabilitation

This paper presents a fuzzy logic based method to track user satisfaction without the need for devices to monitor users physiological conditions. User satisfaction is the key to any product’s acceptance; computer applications and video games provide a unique opportunity to provide a tailored environment for each user to better suit their needs. We have implemented a non-adaptive fuzzy logic model of emotion, based on the emotional component of the Fuzzy Logic Adaptive Model of Emotion (FLAME) proposed by El-Nasr, to estimate player emotion in UnrealTournament 2004. In this paper we describe the implementation of this system and present the results of one of several play tests. Our research contradicts the current literature that suggests physiological measurements are needed. We show that it is possible to use a software only method to estimate user emotion

Motor learning induced neuroplasticity in minimally invasive surgery

Technical skills in surgery have become more complex and challenging to acquire since the introduction of technological aids, particularly in the arena of Minimally Invasive Surgery. Additional challenges posed by reforms to surgical careers and increased public scrutiny, have propelled identification of methods to assess and acquire MIS technical skills. Although validated objective assessments have been developed to assess motor skills requisite for MIS, they poorly understand the development of expertise. Motor skills learning, is indirectly observable, an internal process leading to relative permanent changes in the central nervous system. Advances in functional neuroimaging permit direct interrogation of evolving patterns of brain function associated with motor learning due to the property of neuroplasticity and has been used on surgeons to identify the neural correlates for technical skills acquisition and the impact of new technology. However significant gaps exist in understanding neuroplasticity underlying learning complex bimanual MIS skills. In this thesis the available evidence on applying functional neuroimaging towards assessment and enhancing operative performance in the field of surgery has been synthesized. The purpose of this thesis was to evaluate frontal lobe neuroplasticity associated with learning a complex bimanual MIS skill using functional near-infrared spectroscopy an indirect neuroimaging technique. Laparoscopic suturing and knot-tying a technically challenging bimanual skill is selected to demonstrate learning related reorganisation of cortical behaviour within the frontal lobe by shifts in activation from the prefrontal cortex (PFC) subserving attention to primary and secondary motor centres (premotor cortex, supplementary motor area and primary motor cortex) in which motor sequences are encoded and executed. In the cross-sectional study, participants of varying expertise demonstrate frontal lobe neuroplasticity commensurate with motor learning. The longitudinal study involves tracking evolution in cortical behaviour of novices in response to receipt of eight hours distributed training over a fortnight. Despite novices achieving expert like performance and stabilisation on the technical task, this study demonstrates that novices displayed persistent PFC activity. This study establishes for complex bimanual tasks, that improvements in technical performance do not accompany a reduced reliance in attention to support performance. Finally, least-squares support vector machine is used to classify expertise based on frontal lobe functional connectivity. Findings of this thesis demonstrate the value of interrogating cortical behaviour towards assessing MIS skills development and credentialing.Open Acces

Development of A Versatile Multichannel CWNIRS Instrument for Optical Brain-Computer Interface Applications

This thesis describes the design, development, and implementation of a versatile multichannel continuous-wave near-infrared spectroscopy (CWNIRS) instrument for brain-computer interface (BCI) applications. Specifically, it was of interest to assess what gains could be achieved by using a multichannel device compared to the single channel device implemented by Coyle in 2004. Moreover, the multichannel approach allows for the assessment of localisation of functional tasks in the cerebral cortex, and can identify lateralisation of haemodynamic responses to motor events. The approach taken to extend single channel to multichannel was based on a software-controlled interface. This interface allowed flexibility in the control of individual optodes including their synchronisation and modulation (AM, TDM, CDMA). Furthermore, an LED driver was developed for custom-made triple-wavelength LEDs. The system was commissioned using a series of experiments to verify the performance of individual components in the system. The system was then used to carry out a set of functional studies including motor imagery and cognitive tasks. The experimental protocols based on motor imagery and overt motor tasks were verified by comparison with fMRI. The multichannel approach identified stroke rehabilitation as a new application area for optical BCI. In addition, concentration changes in deoxyhaemoglobin were identified as being a more localised indicator of functional activity, which is important for effective BCI design. An assessment was made on the effect of the duration of the stimulus period on the haemodynamic signals. This demonstrated the possible benefits of using a shorter stimulus period to reduce the adverse affects of low blood pressure oscillations. i

Development of A Versatile Multichannel CWNIRS Instrument for Optical Brain-Computer Interface Applications

This thesis describes the design, development, and implementation of a versatile multichannel continuous-wave near-infrared spectroscopy (CWNIRS) instrument for brain-computer interface (BCI) applications. Specifically, it was of interest to assess what gains could be achieved by using a multichannel device compared to the single channel device implemented by Coyle in 2004. Moreover, the multichannel approach allows for the assessment of localisation of functional tasks in the cerebral cortex, and can identify lateralisation of haemodynamic responses to motor events. The approach taken to extend single channel to multichannel was based on a software-controlled interface. This interface allowed flexibility in the control of individual optodes including their synchronisation and modulation (AM, TDM, CDMA). Furthermore, an LED driver was developed for custom-made triple-wavelength LEDs. The system was commissioned using a series of experiments to verify the performance of individual components in the system. The system was then used to carry out a set of functional studies including motor imagery and cognitive tasks. The experimental protocols based on motor imagery and overt motor tasks were verified by comparison with fMRI. The multichannel approach identified stroke rehabilitation as a new application area for optical BCI. In addition, concentration changes in deoxyhaemoglobin were identified as being a more localised indicator of functional activity, which is important for effective BCI design. An assessment was made on the effect of the duration of the stimulus period on the haemodynamic signals. This demonstrated the possible benefits of using a shorter stimulus period to reduce the adverse affects of low blood pressure oscillations. i

Rehabilitation Engineering

Population ageing has major consequences and implications in all areas of our daily life as well as other important aspects, such as economic growth, savings, investment and consumption, labour markets, pensions, property and care from one generation to another. Additionally, health and related care, family composition and life-style, housing and migration are also affected. Given the rapid increase in the aging of the population and the further increase that is expected in the coming years, an important problem that has to be faced is the corresponding increase in chronic illness, disabilities, and loss of functional independence endemic to the elderly (WHO 2008). For this reason, novel methods of rehabilitation and care management are urgently needed. This book covers many rehabilitation support systems and robots developed for upper limbs, lower limbs as well as visually impaired condition. Other than upper limbs, the lower limb research works are also discussed like motorized foot rest for electric powered wheelchair and standing assistance device

Speech-brain synchronization: a possible cause for developmental dyslexia

152 p.Dyslexia is a neurological learning disability characterized by the difficulty in an individual¿s ability to read despite adequate intelligence and normal opportunities. The majority of dyslexic readers present phonological difficulties. The phonological difficulty most often associated with dyslexia is a deficit in phonological awareness, that is, the ability to hear and manipulate the sound structure of language. Some appealing theories of dyslexia attribute a causal role to auditory atypical oscillatory neural activity, suggesting it generates some of the phonological problems in dyslexia. These theories propose that auditory cortical oscillations of dyslexic individuals entrain less accurately to the spectral properties of auditory stimuli at distinct frequency bands (delta, theta and gamma) that are important for speech processing. Nevertheless, there are diverging hypotheses concerning the specific bands that would be disrupted in dyslexia, and which are the consequences of such difficulties on speech processing. The goal of the present PhD thesis was to portray the neural oscillatory basis underlying phonological difficulties in developmental dyslexia. We evaluated whether phonological deficits in developmental dyslexia are associated with impaired auditory entrainment to a specific frequency band. In that aim, we measured auditory neural synchronization to linguistic and non-linguistic auditory signals at different frequencies corresponding to key phonological units of speech (prosodic, syllabic and phonemic information). We found that dyslexic readers presented atypical neural entrainment to delta, theta and gamma frequency bands. Importantly, we showed that atypical entrainment to theta and gamma modulations in dyslexia could compromise perceptual computations during speech processing, while reduced delta entrainment in dyslexia could affect perceptual and attentional operations during speech processing. In addition, we characterized the links between the anatomy of the auditory cortex and its oscillatory responses, taking into account previous studies which have observed structural alterations in dyslexia. We observed that the cortical pruning in auditory regions was linked to a stronger sensitivity to gamma oscillation in skilled readers, but to stronger theta band sensitivity in dyslexic readers. Thus, we concluded that the left auditory regions might be specialized for processing phonological information at different time scales (phoneme vs. syllable) in skilled and dyslexic readers. Lastly, by assessing both children and adults on similar tasks, we provided the first evaluation of developmental modulations of typical and atypical auditory sampling (and their structural underpinnings). We found that atypical neural entrainment to delta, theta and gamma are present in dyslexia throughout the lifespan and is not modulated by reading experience

Motion Artifact Processing Techniques for Physiological Signals

The combination of reducing birth rate and increasing life expectancy continues to drive the demographic shift toward an ageing population and this is placing an ever-increasing burden on our healthcare systems. The urgent need to address this so called healthcare \time bomb" has led to a rapid growth in research into ubiquitous, pervasive and distributed healthcare technologies where recent advances in signal acquisition, data storage and communication are helping such systems become a reality. However, similar to recordings performed in the hospital environment, artifacts continue to be a major issue for these systems. The magnitude and frequency of artifacts can vary signicantly depending on the recording environment with one of the major contributions due to the motion of the subject or the recording transducer. As such, this thesis addresses the challenges of the removal of this motion artifact removal from various physiological signals. The preliminary investigations focus on artifact identication and the tagging of physiological signals streams with measures of signal quality. A new method for quantifying signal quality is developed based on the use of inexpensive accelerometers which facilitates the appropriate use of artifact processing methods as needed. These artifact processing methods are thoroughly examined as part of a comprehensive review of the most commonly applicable methods. This review forms the basis for the comparative studies subsequently presented. Then, a simple but novel experimental methodology for the comparison of artifact processing techniques is proposed, designed and tested for algorithm evaluation. The method is demonstrated to be highly eective for the type of artifact challenges common in a connected health setting, particularly those concerned with brain activity monitoring. This research primarily focuses on applying the techniques to functional near infrared spectroscopy (fNIRS) and electroencephalography (EEG) data due to their high susceptibility to contamination by subject motion related artifact. Using the novel experimental methodology, complemented with simulated data, a comprehensive comparison of a range of artifact processing methods is conducted, allowing the identication of the set of the best performing methods. A novel artifact removal technique is also developed, namely ensemble empirical mode decomposition with canonical correlation analysis (EEMD-CCA), which provides the best results when applied on fNIRS data under particular conditions. Four of the best performing techniques were then tested on real ambulatory EEG data contaminated with movement artifacts comparable to those observed during in-home monitoring. It was determined that when analysing EEG data, the Wiener lter is consistently the best performing artifact removal technique. However, when employing the fNIRS data, the best technique depends on a number of factors including: 1) the availability of a reference signal and 2) whether or not the form of the artifact is known. It is envisaged that the use of physiological signal monitoring for patient healthcare will grow signicantly over the next number of decades and it is hoped that this thesis will aid in the progression and development of artifact removal techniques capable of supporting this growth

Novel Bidirectional Body - Machine Interface to Control Upper Limb Prosthesis

Objective. The journey of a bionic prosthetic user is characterized by the opportunities and limitations involved in adopting a device (the prosthesis) that should enable activities of daily living (ADL). Within this context, experiencing a bionic hand as a functional (and, possibly, embodied) limb constitutes the premise for mitigating the risk of its abandonment through the continuous use of the device. To achieve such a result, different aspects must be considered for making the artificial limb an effective support for carrying out ADLs. Among them, intuitive and robust control is fundamental to improving amputees’ quality of life using upper limb prostheses. Still, as artificial proprioception is essential to perceive the prosthesis movement without constant visual attention, a good control framework may not be enough to restore practical functionality to the limb. To overcome this, bidirectional communication between the user and the prosthesis has been recently introduced and is a requirement of utmost importance in developing prosthetic hands. Indeed, closing the control loop between the user and a prosthesis by providing artificial sensory feedback is a fundamental step towards the complete restoration of the lost sensory-motor functions. Within my PhD work, I proposed the development of a more controllable and sensitive human-like hand prosthesis, i.e., the Hannes prosthetic hand, to improve its usability and effectiveness. Approach. To achieve the objectives of this thesis work, I developed a modular and scalable software and firmware architecture to control the Hannes prosthetic multi-Degree of Freedom (DoF) system and to fit all users’ needs (hand aperture, wrist rotation, and wrist flexion in different combinations). On top of this, I developed several Pattern Recognition (PR) algorithms to translate electromyographic (EMG) activity into complex movements. However, stability and repeatability were still unmet requirements in multi-DoF upper limb systems; hence, I started by investigating different strategies to produce a more robust control. To do this, EMG signals were collected from trans-radial amputees using an array of up to six sensors placed over the skin. Secondly, I developed a vibrotactile system to implement haptic feedback to restore proprioception and create a bidirectional connection between the user and the prosthesis. Similarly, I implemented an object stiffness detection to restore tactile sensation able to connect the user with the external word. This closed-loop control between EMG and vibration feedback is essential to implementing a Bidirectional Body - Machine Interface to impact amputees’ daily life strongly. For each of these three activities: (i) implementation of robust pattern recognition control algorithms, (ii) restoration of proprioception, and (iii) restoration of the feeling of the grasped object's stiffness, I performed a study where data from healthy subjects and amputees was collected, in order to demonstrate the efficacy and usability of my implementations. In each study, I evaluated both the algorithms and the subjects’ ability to use the prosthesis by means of the F1Score parameter (offline) and the Target Achievement Control test-TAC (online). With this test, I analyzed the error rate, path efficiency, and time efficiency in completing different tasks. Main results. Among the several tested methods for Pattern Recognition, the Non-Linear Logistic Regression (NLR) resulted to be the best algorithm in terms of F1Score (99%, robustness), whereas the minimum number of electrodes needed for its functioning was determined to be 4 in the conducted offline analyses. Further, I demonstrated that its low computational burden allowed its implementation and integration on a microcontroller running at a sampling frequency of 300Hz (efficiency). Finally, the online implementation allowed the subject to simultaneously control the Hannes prosthesis DoFs, in a bioinspired and human-like way. In addition, I performed further tests with the same NLR-based control by endowing it with closed-loop proprioceptive feedback. In this scenario, the results achieved during the TAC test obtained an error rate of 15% and a path efficiency of 60% in experiments where no sources of information were available (no visual and no audio feedback). Such results demonstrated an improvement in the controllability of the system with an impact on user experience. Significance. The obtained results confirmed the hypothesis of improving robustness and efficiency of a prosthetic control thanks to of the implemented closed-loop approach. The bidirectional communication between the user and the prosthesis is capable to restore the loss of sensory functionality, with promising implications on direct translation in the clinical practice