A Systematic Review Establishing the Current State-of-the-Art, the Limitations, and the DESIRED Checklist in Studies of Direct Neural Interfacing With Robotic Gait Devices in Stroke Rehabilitation

Background: Stroke is a disease with a high associated disability burden. Robotic-assisted gait training offers an opportunity for the practice intensity levels associated with good functional walking outcomes in this population. Neural interfacing technology, electroencephalography (EEG), or electromyography (EMG) can offer new strategies for robotic gait re-education after a stroke by promoting more active engagement in movement intent and/or neurophysiological feedback. Objectives: This study identifies the current state-of-the-art and the limitations in direct neural interfacing with robotic gait devices in stroke rehabilitation. Methods: A pre-registered systematic review was conducted using standardized search operators that included the presence of stroke and robotic gait training and neural biosignals (EMG and/or EEG) and was not limited by study type. Results: From a total of 8,899 papers identified, 13 articles were considered for the final selection. Only five of the 13 studies received a strong or moderate quality rating as a clinical study. Three studies recorded EEG activity during robotic gait, two of which used EEG for BCI purposes. While demonstrating utility for decoding kinematic and EMG-related gait data, no EEG study has been identified to close the loop between robot and human. Twelve of the studies recorded EMG activity during or after robotic walking, primarily as an outcome measure. One study used multisource information fusion from EMG, joint angle, and force to modify robotic commands in real time, with higher error rates observed during active movement. A novel study identified used EMG data during robotic gait to derive the optimal, individualized robot-driven step trajectory. Conclusions: Wide heterogeneity in the reporting and the purpose of neurobiosignal use during robotic gait training after a stroke exists. Neural interfacing with robotic gait after a stroke demonstrates promise as a future field of study. However, as a nascent area, direct neural interfacing with robotic gait after a stroke would benefit from a more standardized protocol for biosignal collection and processing and for robotic deployment. Appropriate reporting for clinical studies of this nature is also required with respect to the study type and the participants' characteristics

Analysis of ANN and Fuzzy Logic Dynamic Modelling to Control the Wrist Exoskeleton

Human intention has long been a primary emphasis in the field of electromyography (EMG) research. This being considered, the movement of the exoskeleton hand can be accurately predicted based on the user's preferences. The EMG is a nonlinear signal formed by muscle contractions as the human hand moves and easily captured noise signal from its surroundings. Due to this fact, this study aims to estimate wrist desired velocity based on EMG signals using ANN and FL mapping methods. The output was derived using EMG signals and wrist position were directly proportional to control wrist desired velocity. Ten male subjects, ranging in age from 21 to 40, supplied EMG signal data set used for estimating the output in single and double muscles experiments. To validate the performance, a physical model of an exoskeleton hand was created using Sim-mechanics program tool. The ANN used Levenberg training method with 1 hidden layer and 10 neurons, while FL used a triangular membership function to represent muscles contraction signals amplitude at different MVC levels for each wrist position. As a result, PID was substituted to compensate fluctuation of mapping outputs, resulting in a smoother signal reading while improving the estimation of wrist desired velocity performance. As a conclusion, ANN compensates for complex nonlinear input to estimate output, but it works best with large data sets. FL allowed designers to design rules based on their knowledge, but the system will struggle due to the large number of inputs. Based on the results achieved, FL was able to show a distinct separation of wrist desired velocity hand movement when compared to ANN for similar testing datasets due to the decision making based on rules setting setup by the designer

A Biomechanical and Physiological Signal Monitoring System for Four Degrees of Upper Limb Movement

A lack of adherence to prescribed physical therapy regimens in improper healing results in poor outcomes for those affected by musculoskeletal disorders (MSDs) of the upper limb. Societal and psychological barriers to proper adherence can be addressed through the system presented in this work consisting of the following components: an ambulatory biosignal acquisition sleeve, an electromyography (EMG) based motion repetition detection algorithm, and the design of a compatible capacitive EMG acquisition module. The biosignal acquisition sleeve was untethered, unobtrusive to motion, contained only modular components, and collected biomechanical and physiological sensor data to form full motion profiles of the following four degrees of freedom: elbow flexion—extension, forearm pronation—supination, wrist flexion—extension, and ulnar--radial deviation. The piloted sleeve simultaneously collected data from four inertial sensors, two electromyography (EMG) sensors and a flex-bend sensor. A visualization application was developed to present the information in a manner meaningful to the user. As well, an EMG based motion repetition detector was developed for use within the system. It was validated using an existing database of 23 subjects with varying musculoskeletal health, achieving a success rate of 95.43%. This algorithm was modified for use with the sleeve, resulting in a 95% success rate. An electrode and analog front end module was proposed, relying on unique material structures and low-noise, precision sensing techniques. The system prototype presented a resource-conscious tool for multi-modality tracking of elbow, forearm, and wrist motion, which could eventually be integrated into upper limb MSD rehabilitation

Enhancing brain/neural-machine interfaces for upper limb motor restoration in chronic stroke and cervical spinal cord injury

Operation of assistive exoskeletons based on voluntary control of sensorimotor rhythms (SMR, 8-12 Hz) enables intuitive control of finger or arm movements in severe paralysis after chronic stroke or cervical spinal cord injury (SCI). To improve reliability of such systems outside the laboratory, in particular when brain activity is recorded non-invasively with scalp electroencephalography (EEG), a hybrid EEG/electrooculography (EOG) brain/neural-machine interface (B/NMI) was recently introduced. Besides providing assistance, recent studies indicate that repeated use of such systems can trigger neural recovery. However, important prerequisites have to achieved before broader use in clinical settings or everyday life environments is feasible. Current B/NMI systems predominantly restore hand function, but do not allow simultaneous control of more proximal joints for whole-arm motor coordination as required for most stroke survivors suffering from paralysis in the entire upper limb. Besides paralysis, cognitive impairments including post-stroke fatigue due to the brain lesion reduce the capacity to maintain effortful B/NMI control over a longer period of time. This impedes the applicability in daily life assistance and might even limits the efficacy of neurorehabilitation training. In contrast to stroke survivors, tetraplegics due to cervical SCI lack motor function in both hands. Given that most activities of daily living (ADL) involve bimanual manipulation, e.g., to open the lid of a bottle, bilateral exoskeleton control is required but was not shown yet in tetraplegics. To further enhance B/NMI systems, we first investigated whether B/NMI whole-arm exoskeleton control in hemiplegia after chronic stroke is feasible and safe. In contrast to simple grasping, control of more complex tasks involving the entire upper limb was not feasible with established B/NMIs because high- dimensionality of such multiple joint systems exceeds the bandwidth of these interfaces. Thus, we blended B/NMI control with vision-guidance to receive a semiautonomous whole-arm exoskeleton control. Such setup allowed to divide ADL tasks into a sequence of EEG/EOG-triggered sub-tasks reducing complexity for the user. While, for instance, a drinking task was resolved into EOG-induced reaching, lifting and placing back the cup, grasping and releasing movements were based on intuitive SMR control. Feasibility of such shared vision-guided B/NMI control was assumed when executions were initialized within 3 s (fluent control) and a minimum of 75 % of subtasks were executed within that time (reliable control). We showed feasibility in healthy subjects as well as stroke survivors without report of any side effects documenting safe use. Similarly, feasibility and safety of bilateral B/NMI control after cervical SCI was evaluated. To enable bilateral B/NMI control, established EEG-based grasping and EOG-based releasing or stop commands were complemented with a novel EOG command allowing to switch laterality by performing prolonged horizontal eye movements (>1 s) to the left or to the right. Study results with healthy subjects and tetraplegics document fluent initialization of grasping motions below 3 s as well as safe use as unintended grasping could be stopped before a full motion was conducted. Superiority of novel bilateral control was documented by a higher accuracy of up to 22 % in tetraplegics compared to a bilateral control without prolonged EOG command. Lastly, as reliable B/NMI control is cognitively demanding, e.g., by imagining or attempting the desired movements, we investigated whether heart rate variability (HRV) can be used as biomarker to predict declining control performance, which is often reported in stroke survivors due to their cognitive impairments. Referring to the close brain-heart connection, we showed in healthy subjects that a decline in HRV is specific as well as predictive to a decline in B/NMI control performance within a single training session. The predictive link was revealed by a Granger-causality analysis. In conclusion, we could demonstrate important enhancements in B/NMI control paradigms including complex whole-arm exoskeleton control as well as individual performance monitoring within a training session based on HRV. Both achievements contribute to broaden the use as a standard therapy in stroke neurorehabilitation. Especially the predictive characteristic of HRV paves the way for adaptive B/NMI control paradigms to account for individual differences among impaired stroke survivors. Moreover, we also showed feasibility and safety of a novel implementation for bilateral B/NMI control, which is necessary for reliable operation of two hand-exoskeletons for bimanual ADLs after SCI

Analysis of Human Gait Using Hybrid EEG-fNIRS-Based BCI System: A Review

Human gait is a complex activity that requires high coordination between the central nervous system, the limb, and the musculoskeletal system. More research is needed to understand the latter coordination\u27s complexity in designing better and more effective rehabilitation strategies for gait disorders. Electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) are among the most used technologies for monitoring brain activities due to portability, non-invasiveness, and relatively low cost compared to others. Fusing EEG and fNIRS is a well-known and established methodology proven to enhance brain–computer interface (BCI) performance in terms of classification accuracy, number of control commands, and response time. Although there has been significant research exploring hybrid BCI (hBCI) involving both EEG and fNIRS for different types of tasks and human activities, human gait remains still underinvestigated. In this article, we aim to shed light on the recent development in the analysis of human gait using a hybrid EEG-fNIRS-based BCI system. The current review has followed guidelines of preferred reporting items for systematic reviews and meta-Analyses (PRISMA) during the data collection and selection phase. In this review, we put a particular focus on the commonly used signal processing and machine learning algorithms, as well as survey the potential applications of gait analysis. We distill some of the critical findings of this survey as follows. First, hardware specifications and experimental paradigms should be carefully considered because of their direct impact on the quality of gait assessment. Second, since both modalities, EEG and fNIRS, are sensitive to motion artifacts, instrumental, and physiological noises, there is a quest for more robust and sophisticated signal processing algorithms. Third, hybrid temporal and spatial features, obtained by virtue of fusing EEG and fNIRS and associated with cortical activation, can help better identify the correlation between brain activation and gait. In conclusion, hBCI (EEG + fNIRS) system is not yet much explored for the lower limb due to its complexity compared to the higher limb. Existing BCI systems for gait monitoring tend to only focus on one modality. We foresee a vast potential in adopting hBCI in gait analysis. Imminent technical breakthroughs are expected using hybrid EEG-fNIRS-based BCI for gait to control assistive devices and Monitor neuro-plasticity in neuro-rehabilitation. However, although those hybrid systems perform well in a controlled experimental environment when it comes to adopting them as a certified medical device in real-life clinical applications, there is still a long way to go

Enhancement of Robot-Assisted Rehabilitation Outcomes of Post-Stroke Patients Using Movement-Related Cortical Potential

Post-stroke rehabilitation is essential for stroke survivors to help them regain independence and to improve their quality of life. Among various rehabilitation strategies, robot-assisted rehabilitation is an efficient method that is utilized more and more in clinical practice for motor recovery of post-stroke patients. However, excessive assistance from robotic devices during rehabilitation sessions can make patients perform motor training passively with minimal outcome. Towards the development of an efficient rehabilitation strategy, it is necessary to ensure the active participation of subjects during training sessions. This thesis uses the Electroencephalography (EEG) signal to extract the Movement-Related Cortical Potential (MRCP) pattern to be used as an indicator of the active engagement of stroke patients during rehabilitation training sessions. The MRCP pattern is also utilized in designing an adaptive rehabilitation training strategy that maximizes patients’ engagement. This project focuses on the hand motor recovery of post-stroke patients using the AMADEO rehabilitation device (Tyromotion GmbH, Austria). AMADEO is specifically developed for patients with fingers and hand motor deficits. The variations in brain activity are analyzed by extracting the MRCP pattern from the acquired EEG data during training sessions. Whereas, physical improvement in hand motor abilities is determined by two methods. One is clinical tests namely Fugl-Meyer Assessment (FMA) and Motor Assessment Scale (MAS) which include FMA-wrist, FMA-hand, MAS-hand movements, and MAS-advanced hand movements’ tests. The other method is the measurement of hand-kinematic parameters using the AMADEO assessment tool which contains hand strength measurements during flexion (force-flexion), and extension (force-extension), and Hand Range of Movement (HROM)

Support vector machines to detect physiological patterns for EEG and EMG-based human-computer interaction:a review

Support vector machines (SVMs) are widely used classifiers for detecting physiological patterns in human-computer interaction (HCI). Their success is due to their versatility, robustness and large availability of free dedicated toolboxes. Frequently in the literature, insufficient details about the SVM implementation and/or parameters selection are reported, making it impossible to reproduce study analysis and results. In order to perform an optimized classification and report a proper description of the results, it is necessary to have a comprehensive critical overview of the applications of SVM. The aim of this paper is to provide a review of the usage of SVM in the determination of brain and muscle patterns for HCI, by focusing on electroencephalography (EEG) and electromyography (EMG) techniques. In particular, an overview of the basic principles of SVM theory is outlined, together with a description of several relevant literature implementations. Furthermore, details concerning reviewed papers are listed in tables and statistics of SVM use in the literature are presented. Suitability of SVM for HCI is discussed and critical comparisons with other classifiers are reported

Robotic Platforms for Assistance to People with Disabilities

People with congenital and/or acquired disabilities constitute a great number of dependents today. Robotic platforms to help people with disabilities are being developed with the aim of providing both rehabilitation treatment and assistance to improve their quality of life. A high demand for robotic platforms that provide assistance during rehabilitation is expected because of the health status of the world due to the COVID-19 pandemic. The pandemic has resulted in countries facing major challenges to ensure the health and autonomy of their disabled population. Robotic platforms are necessary to ensure assistance and rehabilitation for disabled people in the current global situation. The capacity of robotic platforms in this area must be continuously improved to benefit the healthcare sector in terms of chronic disease prevention, assistance, and autonomy. For this reason, research about human–robot interaction in these robotic assistance environments must grow and advance because this topic demands sensitive and intelligent robotic platforms that are equipped with complex sensory systems, high handling functionalities, safe control strategies, and intelligent computer vision algorithms. This Special Issue has published eight papers covering recent advances in the field of robotic platforms to assist disabled people in daily or clinical environments. The papers address innovative solutions in this field, including affordable assistive robotics devices, new techniques in computer vision for intelligent and safe human–robot interaction, and advances in mobile manipulators for assistive tasks

Surface Electromyography and Artificial Intelligence for Human Activity Recognition - A Systematic Review on Methods, Emerging Trends Applications, Challenges, and Future Implementation

Human activity recognition (HAR) has become increasingly popular in recent years due to its potential to meet the growing needs of various industries. Electromyography (EMG) is essential in various clinical and biological settings. It is a metric that helps doctors diagnose conditions that affect muscle activation patterns and monitor patients’ progress in rehabilitation, disease diagnosis, motion intention recognition, etc. This review summarizes the various research papers based on HAR with EMG. Over recent years, the integration of Artificial Intelligence (AI) has catalyzed remarkable advancements in the classification of biomedical signals, with a particular focus on EMG data. Firstly, this review meticulously curates a wide array of research papers that have contributed significantly to the evolution of EMG-based activity recognition. By surveying the existing literature, we provide an insightful overview of the key findings and innovations that have propelled this field forward. It explore the various approaches utilized for preprocessing EMG signals, including noise reduction, baseline correction, filtering, and normalization, ensure that the EMG data is suitably prepared for subsequent analysis. In addition, we unravel the multitude of techniques employed to extract meaningful features from raw EMG data, encompassing both time-domain and frequency-domain features. These techniques are fundamental to achieving a comprehensive characterization of muscle activity patterns. Furthermore, we provide an extensive overview of both Machine Learning (ML) and Deep Learning (DL) classification methods, showcasing their respective strengths, limitations, and real-world applications in recognizing diverse human activities from EMG signals. In examining the hardware infrastructure for HAR with EMG, the synergy between hardware and software is underscored as paramount for enabling real-time monitoring. Finally, we also discovered open issues and future research direction that may point to new lines of inquiry for ongoing research toward EMG-based detection.publishedVersio