Automatic Setting Procedure for Exoskeleton-Assisted Overground Gait: Proof of Concept on Stroke Population

Stroke-related locomotor impairments are often associated with abnormal timing and intensity of recruitment of the affected and non-affected lower limb muscles. Restoring the proper lower limbs muscles activation is a key factor to facilitate recovery of gait capacity and performance, and to reduce maladaptive plasticity. Ekso is a wearable powered exoskeleton robot able to support over-ground gait training. The user controls the exoskeleton by triggering each single step during the gait cycle. The fine-tuning of the exoskeleton control system is crucial-it is set according to the residual functional abilities of the patient, and it needs to ensure lower limbs powered gait to be the most physiological as possible. This work focuses on the definition of an automatic calibration procedure able to detect the best Ekso setting for each patient. EMG activity has been recorded from Tibialis Anterior, Soleus, Rectus Femoris, and Semitendinosus muscles in a group of 7 healthy controls and 13 neurological patients. EMG signals have been processed so to obtain muscles activation patterns. The mean muscular activation pattern derived from the controls cohort has been set as reference. The developed automatic calibration procedure requires the patient to perform overground walking trials supported by the exoskeleton while changing parameters setting. The Gait Metric index is calculated for each trial, where the closer the performance is to the normative muscular activation pattern, in terms of both relative amplitude and timing, the higher the Gait Metric index is. The trial with the best Gait Metric index corresponds to the best parameters set. It has to be noted that the automatic computational calibration procedure is based on the same number of overground walking trials, and the same experimental set-up as in the current manual calibration procedure. The proposed approach allows supporting the rehabilitation team in the setting procedure. It has been demonstrated to be robust, and to be in agreement with the current gold standard (i.e., manual calibration performed by an expert engineer). The use of a graphical user interface is a promising tool for the effective use of an automatic procedure in a clinical context

Ergonomic Analysis of Mobile Cart–Assisted Stocking Activities Using Electromyography

Workers in grocery stores are exposed to numerous musculoskeletal risks that can be reduced using assistive devices while performing stocking tasks. A regional grocery store has recently deployed a mobile cart without comprehension of its ergonomic impact on workers, which this article investigates using normalized electromyography data (%MVC). This article studies not only ergonomic impact based on %MVC values but also work performance represented by a muscle force metric (MFM). The results from this study showed highest muscle groups in %MVC and MFM were the erector spinae and triceps. Interestingly, muscle activations on erector spinae were reduced when mobile cart is used. %MVC and MFM distribution for value-added- and non-value-added subtasks were slightly different, with larger differences observed for non-value-added tasks. Video recordings revealed higher work performance when the mobile cart is used. In future research, the number of participants will be increased to further validate the results from this study

A Comparison of ICA versus genetic algorithm optimized ICA for use in non-invasive muscle tissue EMG

Includes bibliographical references.The patent developed by Dr. L. John [1] allows for the the detection of deep muscle activation through the combination of specially positioned monopolar surface Electromyography (sEMG) electrodes and a Blind Source Separation algorithm. This concept was then proved by Morowasi and John [2] in a 12 electrode prototype system around the bicep. This proof of concept showed that it was possible to extract the deep tissue activity of the brachialis muscle in the upper arm, however, the effect of surface electrode positioning and effectual number of electrodes on signal quality is still unclear. The hope of this research is to extend this work. In this research, a genetic algorithm (GA) is implemented on top of the Fast Independent Component Analysis (FastICA) algorithm to reduce the number of electrodes needed to isolate the activity from all muscles in the upper arm, including deep tissue. The GA selects electrodes based on the amount of significant information they contribute to the ICA solution and by doing so, a reduced electrode set is generated and alternative electrode positions are identified. This allows a near optimal electrode configuration to be produced for each user. The benefits of this approach are: 1.The generalized electrode array and this algorithm can select the near optimal electrode arrangement with very minimal understanding of the underlying anatomy. 2. It can correct for small anatomical differences between test subjects and act as a calibration phase for individuals. As with any design there are also disadvantages, such as each user needs to have the electrode placement specifically customised for him or her and this process needs to be conducted using a higher number of electrodes to begin with

Implementing physiologically-based approaches to improve Brain-Computer Interfaces usability in post-stroke motor rehabilitation

Stroke is one of the leading causes of long-term motor disability and, as such, directly impacts on daily living activities. Identifying new strategies to recover motor function is a central goal of clinical research. In the last years the approach to the post-stroke function restore has moved from the physical rehabilitation to the evidence-based neurological rehabilitation. Brain-Computer Interface (BCI) technology offers the possibility to detect, monitor and eventually modulate brain activity. The potential of guiding altered brain activity back to a physiological condition through BCI and the assumption that this recovery of brain activity leads to the restoration of behaviour is the key element for the use of BCI systems for therapeutic purposes. To bridge the gap between research-oriented methodology in BCI design and the usability of a system in the clinical realm requires efforts towards BCI signal processing procedures that would optimize the balance between system accuracy and usability. The thesis focused on this issue and aimed to propose new algorithms and signal processing procedures that, by combining physiological and engineering approaches, would provide the basis for designing more usable BCI systems to support post-stroke motor recovery. Results showed that introduce new physiologically-driven approaches to the pre-processing of BCI data, methods to support professional end-users in the BCI control parameter selection according to evidence-based rehabilitation principles and algorithms for the parameter adaptation in time make the BCI technology more affordable, more efficient, and more usable and, therefore, transferable to the clinical realm

Concept of an exoskeleton for industrial applications with modulated impedance based on Electromyographic signal recorded from the operator

The introduction of an active exoskeleton that enhances the operator power in the manufacturing field was demonstrated in literature to lead to beneficial effects in terms of reducing fatiguing and the occurrence of musculo-skeletal diseases. However, a large number of manufacturing operations would not benefit from power increases because it rather requires the modulation of the operator stiffness. However, in literature, considerably less attention was given to those robotic devices that regulate their stiffness based on the operator stiffness, even if their introduction in the line would aid the operator during different manipulations respect with the exoskeletons with variable power. In this thesis the description of the command logic of an exoskeleton for manufacturing applications, whose stiffness is modulated based on the operator stiffness, is described. Since the operator stiffness cannot be mechanically measured without deflecting the limb, an estimation based on the superficial Electromyographic signal is required. A model composed of 1 joint and 2 antagonist muscles was developed to approximate the elbow and the wrist joints. Each muscle was approximated as the Hill model and the analysis of the joint stiffness, at different joint angle and muscle activations, was performed. The same Hill muscle model was then implemented in a 2 joint and 6 muscles (2J6M) model which approximated the elbow-shoulder system. Since the estimation of the exerted stiffness with a 2J6M model would be quite onerous in terms of processing time, the estimation of the operator end-point stiffness in realtime would therefore be questionable. Then, a linear relation between the end-point stiffness and the component of muscle activation that does not generate any end-point force, is proposed. Once the stiffness the operator exerts was estimated, three command logics that identifies the stiffness the exoskeleton is required to exert are proposed. These proposed command logics are: Proportional, Integral 1 s, and Integral 2 s. The stiffening exerted by a device in which a Proportional logic is implemented is proportional, sample by sample, to the estimated stiffness exerted by the operator. The stiffening exerted by the exoskeleton in which an Integral logic is implemented is proportional to the stiffness exerted by the operator, averaged along the previous 1 second (Integral 1 s) or 2 seconds (Integral 2 s). The most effective command logic, among the proposed ones, was identified with empirical tests conducted on subjects using a wrist haptic device (the Hi5, developed by the Bioengineering group of the Imperial College of London). The experimental protocol consisted in a wrist flexion/extension tracking task with an external perturbation, alternated with isometric force exertion for the estimation of the occurrence of the fatigue. The fatigue perceived by the subject, the tracking error, defined as the RMS of the difference between wrist and target angles, and the energy consumption, defined as the sum of the squared signals recorded from two antagonist muscles, indicated the Integral 1 s logic to be the most effective for controlling the exoskeleton. A logistic relation between the stiffness exerted by the subject and the stiffness exerted by the robotic devices was selected, because it assured a smooth transition between the maximum and the minimum stiffness the device is required to exert. However, the logistic relation parameters are subject-specific, therefore an experimental estimation is required. An example was provided. Finally, the literature about variable stiffness actuators was analyzed to identify the most suitable device for exoskeleton stiffness modulation. This actuator is intended to be integrated on an existing exoskeleton that already enhances the operator power based on the operator Electromyographic signal. The identified variable stiffness actuator is the DLR FSJ, which controls its stiffness modulating the preload of a single spring

Assist-as-needed EMG-based control strategy for wearable powered assistive devices

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)Robotic-based gait rehabilitation and assistance using Wearable Powered Assistive Devices (WPADs), such as orthosis and exoskeletons, has been growing in the rehabilitation area to recover and augment the motor function of neurologically impaired subjects. These WPADs should provide a personalized assistance, since physical condition and muscular fatigue modify from patient to patient. In this field, electromyography (EMG) signals have been used to control WPADs given their ability to infer the user’s motion intention. However, in cases of motor disability conditions, EMG signals present lower magnitudes when compared to EMG signals under healthy conditions. Thus, the use of WPADs managed by EMG signals may not have potential to provide the assistance that the patient requires. The main goal of this dissertation aims the development of an Assisted-As-Needed (AAN) EMG-based control strategy for a future insertion in a Smart Active Orthotic System (SmartOs). To achieve this goal, the following elements were developed and validated: (i) an EMG system to acquire muscle activity signals from the most relevant muscles during the motion of the ankle joint; (ii) machine learning-based tool for ankle joint torque estimation to serve as reference in the AAN EMG-based control strategy; and (iii) a tool for real EMG-based torque estimation using Tibialis Anterior (TA) and Gastrocnemius Lateralis (GASL) muscles and real ankle joint angles. EMG system showed satisfactory pattern correlations with a commercial system. The reference ankle joint torque was generated based on predicted reference ankle joint kinematics, walking speed information (from 1 to 4 km/h) and anthropometric data (body height from 1.51 m to 1.83 m and body mass from 52.0 kg to 83.7 kg), using five machine learning algorithms: Support Vector Regression (SVR), Random Forest (RF), Multilayer Perceptron (MLP), Long-Short Term Memory (LSTM) and Convolutional Neural Network (CNN). CNN provided the best performance, predicting the reference ankle joint torque with fitting curves ranging from 74.7 to 89.8 % and Normalized Root Mean Square Errors (NRMSEs) between 3.16 and 8.02 %. EMG-based torque estimation beneficiates of a higher number of muscles, since EMG data from TA and GASL are not enough to estimate the real ankle joint torque.A assistência e reabilitação robótica usando dispositivos de assistência ativos vestíveis (WPADs), como ortóteses e exosqueletos, tem crescido na área da reabilitação com o fim de recuperar e aumentar a função motora de sujeitos com alterações neurológicas. Estes dispositivos devem fornecer uma assistência personalizada, uma vez que a condição física e a fadiga muscular variam de paciente para paciente. Nesta área, sinais de eletromiografia (EMG) têm sido usados para controlar WPADs, dada a sua capacidade de inferir a intenção de movimento do utilizador. Contudo, em casos de deficiência motora, os sinais de EMG apresentam menor amplitude quando comparados com sinais de EMG em condições saudáveis e, portanto, o uso de WPADs geridos por sinais de EMG pode não oferecer a assistência que o paciente necessita. O principal objetivo desta dissertação visa o desenvolvimento de uma estratégia de controlo baseada em EMG capaz de fornecer assistência quando necessário, para futura integração num sistema ortótico ativo e inteligente (SmartOs). Para atingir este objetivo foram desenvolvidos e validados os seguintes elementos: (i) sistema de EMG para adquirir sinais de atividade muscular dos músculos mais relevantes no movimento da articulação do tornozelo; (ii) ferramenta de machine learning para estimação do binário da articulação do tornozelo para servir como referência na estratégia de controlo; e (iii) ferramenta de estimação do binário real do tornozelo considerando sinais de EMG dos músculos Tibialis Anterior (TA) e Gastrocnemius Lateralis (GASL) e ângulo real do tornozelo. O sistema de EMG apresentou correlações satisfatórias com um sistema comercial. O binário de referência para o tornozelo foi gerado com base no ângulo de referência da mesma articulação, velocidade de marcha (de 1 até 4 km/h) e dados antropométricos (alturas de 1.51 m até 1.83 e massas de 52.0 kg até 83.7 kg), usando cinco algoritmos de machine learning: Support Vector Machine, Random Forest, Multilayer Perceptron, Long-Short Term Memory e Convolutional Neural Network. CNN apresentou a melhor performance, prevendo binários de referência do tornozelo com um fit entre 74.7 e 89.8 % e Normalized Root Mean Square Errors (NRMSE) entre 3.16 e 8.02 %. A estimativa do torque com base em sinais de EMG requer a inclusão de um maior número de músculos, uma vez que sinais de EMG dos músculos TA e GASL não foram suficientes

Mechanical Redesign and Implementation of Intuitive User Input Methods for a Hand Exoskeleton Informed by User Studies on Individuals with Chronic Upper Limb Impairments

Individuals with upper limb motor deficits due to neurological conditions, such as stroke and traumatic brain injury, may exhibit hypertonia and spasticity, which makes it difficult for these individuals to open their hand. The Hand Orthosis with Powered Extension (HOPE) Hand was created in 2018. The performance of the HOPE Hand was evaluated by conducting a Box and Blocks test with an impaired subject. Improvements were identified and the HOPE Hand was mechanically redesigned to increase the functionality in performing grasps. The original motor configuration was reorganized to include active thumb flexion and extension, as well as thumb abduction/adduction. An Electromyography (EMG) study was conducted on 19 individuals (10 healthy, 9 impaired) to evaluate the viability of EMG device control for the specified user group. EMG control, voice control, and manual control were implemented with the HOPE Hand 2.0 and the exoskeleton system was tested for usability during a second Box and Blocks test

Advancing Medical Technology for Motor Impairment Rehabilitation: Tools, Protocols, and Devices

Excellent motor control skills are necessary to live a high-quality life. Activities such as walking, getting dressed, and feeding yourself may seem mundane, but injuries to the neuromuscular system can render these tasks difficult or even impossible to accomplish without assistance. Statistics indicate that well over 100 million people are affected by diseases or injuries, such as stroke, Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, peripheral nerve injury, spinal cord injury, and amputation, that negatively impact their motor abilities. This wide array of injuries presents a challenge to the medical field as optimal treatment paradigms are often difficult to implement due to a lack of availability of appropriate assessment tools, the inability for people to access the appropriate medical centers for treatment, or altogether gaps in technology for treating the underlying impairments causing the disability. Addressing each of these challenges will improve the treatment of movement impairments, provide more customized and continuous treatment to a larger number of patients, and advance rehabilitative and assistive device technology. In my research, the key approach was to develop tools to assess and treat upper extremity movement impairment. In Chapter 2.1, I challenged a common biomechanical[GV1] modeling technique of the forearm. Comparing joint torque values through inverse dynamics simulation between two modeling platforms, I discovered that representing the forearm as a single cylindrical body was unable to capture the inertial parameters of a physiological forearm which is made up of two segments, the radius and ulna. I split the forearm segment into a proximal and distal segment, with the rationale being that the inertial parameters of the proximal segment could be tuned to those of the ulna and the inertial parameters of the distal segment could be tuned to those of the radius. Results showed a marked increase in joint torque calculation accuracy for those degrees of freedom that are affected by the inertial parameters of the radius and ulna. In Chapter 2.2, an inverse kinematic upper extremity model was developed for joint angle calculations from experimental motion capture data, with the rationale being that this would create an easy-to-use tool for clinicians and researchers to process their data. The results show accurate angle calculations when compared to algebraic solutions. Together, these chapters provide easy-to-use models and tools for processing movement assessment data. In Chapter 3.1, I developed a protocol to collect high-quality movement data in a virtual reality task that is used to assess hand function as part of a Box and Block Test. The goal of this chapter is to suggest a method to not only collect quality data in a research setting but can also be adapted for telehealth and at home movement assessment and rehabilitation. Results indicate that the data collected in this protocol are good and the virtual nature of this approach can make it a useful tool for continuous, data driven care in clinic or at home. In Chapter 3.2 I developed a high-density electromyography device for collecting motor unit action potentials of the arm. Traditional surface electromyography is limited by its ability to obtain signals from deep muscles and can also be time consuming to selectively place over appropriate muscles. With this high-density approach, muscle coverage is increased, placement time is decreased, and deep muscle activity can potentially be collected due to the high-density nature of the device[GV2] . Furthermore, the high-density electromyography device is built as a precursor to a high-density electromyography-electrical stimulation device for functional electrical stimulation. The customizable nature of the prototype in Chapter 3.2 allows for the implementation both recording and stimulating electrodes. Furthermore, signal results show that the electromyography data obtained from the device are of high quality and are correlated with gold standard surface electromyography sensors. One key factor in a device that can record and then stimulate based on the information from the recorded signals is an accurate movement intent decoder. High-quality movement decoders have been designed by closed-loop device controllers in the past, but they still struggle when the user interacts with objects of varying weight due to underlying alterations in muscle signals. In Chapter 4, I investigate this phenomenon by administering an experiment where participants perform a Box and Block Task with objects of 3 different weights, 0 kg, 0.02 kg, and 0.1 kg. Electromyography signals of the participants right arm were collected and co-contraction levels between antagonistic muscles were analyzed to uncover alterations in muscle forces and joint dynamics. Results indicated contraction differences between the conditions and also between movement stages (contraction levels before grabbing the block vs after touching the block) for each condition. This work builds a foundation for incorporating object weight estimates into closed-loop electromyography device movement decoders. Overall, we believe the chapters in this thesis provide a basis for increasing availability to movement assessment tools, increasing access to effective movement assessment and rehabilitation, and advance the medical device and technology field