Movement-Related Desynchronization in EEG-based Brain-Computer Interface applications for stroke motor rehabilitation

Neurological degenerative diseases like stroke, Alzheimer, Amyothrophic Lateral Sclerosis (ALS), Parkinson and many others are constantly increasing their incidence in the world health statistics as far as the mean age of the global population is getting higher and higher. This leads to a general need for effective, at-home and low-cost rehabilitative and health-daily-care tools. The latter should consist either of technological devices implemented for operating in a remote way, i.e. tele-medicine is quickly spreading around the world, or very-advanced computer-based and robotic systems to realize intense and repetitive trainings. This is the challenge in which Information and Communications Technology (ICT) is asked to play a major role in order to bring medicine to reach further advancements. Indeed, no way to cope with these issues is possible outside a strong and vivid cooperation among multi-disciplinary teams of clinicians, physicians, biologists, neuro-psychologists and engineers and without a resolute pushing towards a widespread inter-operability between Institutes, Hospitals and Universities all over the world, as recently highlighted during the main International conferences on ICT in healthcare. The establishment of well-defined standards for gathering and sharing data will then represent a key element to enhance the efficacy of the aforementioned collaborations. Among the others, stroke is one of the most common neurological pathologies being the second or third cause of mortality in the world; moreover, it causes more than sixty percent survivors remain with severe cognitive and motor impairments that impede them in living normal lives and require a twenty-four-hours daily care. As a consequence, on one side stroke survivors experience a frustrating condition of being completely dependent on other people even to perform simple daily actions like reach and grasp an object, hold a glass of water to drink it and so on. States, by their side, have to take into account additional costs to provide stroke patients and their families with appropriate cares and supports to cope with their needs. For this reason, more and more fundings are recently made available by means of grants, European and International projects, programs to exchange different expertise among various countries with the aim to study how to accelerate and make more effective the recovery process of chronic stroke patients. The global research about this topic is conducted on several parallel aspects: as regard as the basic knowledge of brain processes, neurophysiologists, biologists and engineers are particularly interested in an in-depth understanding of the so-called neuroplastic changes that brain daily operates in order to adapt individuals to life changes, experiences and to realize more extensively their own potentialities. Neuroplasticity is indeed the corner stone for most of the trainings nowadays adopted by the standard as well as the more innovative methods in the rehabilitative programs for post-stroke recovery. Specifically speaking, motor rehabilitation usually includes long term, repetitive and intense goal-directed exercises that promote neuroplastic mechanisms such as neural sprouting, synapto-genesis and dendritic branching. These processes are strictly related with motor improvements and their study could - one day - serve as prognostic measures of the recovery. Another aspect of this eld of neuroscience research is the number of applications that it makes feasible. One of the most exciting is to connect an injured brain to a computer or a robotic device in a Brain-Computer or Brain-Machine Interface (BCI or BMI) scheme aiming at bypassing the impairments of the patient and make him/her autonomously move again or train his/her motor abilities in a more effective way. This kind of research can already count an amount of literature that provides several proofs of concept that these heterogeneous systems constituted by humans and robots can work at the purpose. A particular application of BCI for restoring or enhancing, at least, the reaching abilities of chronic stroke survivors was implemented and is still currently being improved at I.R.C.C.S. San Camillo Hospital Foundation, an Institute for the rehabilitation from neurological diseases located in Lido of Venice and partially technically supported by the Department of Information Engineering of Padua in range of an agreement signed in 2009. This specific BCI platform allows patients to train and improve their reaching movements by means of a robotic arm that provides a force that helps patients in completing the training exercise, i.e. to hit a predetermined target. This force feedback is however subject to a strict condition: during the movement, the person has to produce the expected pattern of cerebral activity. Whenever this is accomplished, a force is delivered proportionally to the entity of the latter activity, otherwise the patient is obliged to operate without any help. In this way, this platform implements the so-called operant-learning, that is one of the most effective conditioning techniques to make a subject learn or re-learn a task. If, on one hand, the primary and explicit task is to improve a movement, on the other side the secondary but most important task is to deploy the perilesional part of the brain - still healthy - in becoming responsible for the control of the movement. It is a popular and widely-accepted opinion within the neuroscience community, indeed, that a healthy region of the sensorimotor area nearby the damaged one - which was previously in charge of performing the (reaching) movement - can optimally accomplish the impaired motor function substituting the original control area. Technically speaking, the main crucial feature that can ensure the effectiveness of the whole system is the precise and in real-time identification and quantification of the cerebral pattern associated with the movement, the worldwide named movement-related desynchronization (MRD). Starting from its original definition, passing through the most used techniques for its recognition, the thesis work presents a series of criticisms of the current signal processing method to detect the MRD and a complete analysis of the possible features that can better represent the movement condition and that can be more easily extracted during the on-line operations. Brain - it is well-known - learns by trials and errors and it needs a slightly-delayed (in the range of fraction of seconds) feedback of its performance to learn a task in the best way. This BCI application was born with the purpose to provide the above-mentioned feedback: however, this is only feasible if a computationally easy and contingent signal processing technique is available. This thesis work would like to cope with the lack of a well-planned real-time signal analysis in the current experimental protocol

EEG and ECoG features for Brain Computer Interface in Stroke Rehabilitation

The ability of non-invasive Brain-Computer Interface (BCI) to control an exoskeleton was used for motor rehabilitation in stroke patients or as an assistive device for the paralyzed. However, there is still a need to create a more reliable BCI that could be used to control several degrees of Freedom (DoFs) that could improve rehabilitation results. Decoding different movements from the same limb, high accuracy and reliability are some of the main difficulties when using conventional EEG-based BCIs and the challenges we tackled in this thesis. In this PhD thesis, we investigated that the classification of several functional hand reaching movements from the same limb using EEG is possible with acceptable accuracy. Moreover, we investigated how the recalibration could affect the classification results. For this reason, we tested the recalibration in each multi-class decoding for within session, recalibrated between-sessions, and between sessions. It was shown the great influence of recalibrating the generated classifier with data from the current session to improve stability and reliability of the decoding. Moreover, we used a multiclass extension of the Filter Bank Common Spatial Patterns (FBCSP) to improve the decoding accuracy based on features and compared it to our previous study using CSP. Sensorimotor-rhythm-based BCI systems have been used within the same frequency ranges as a way to influence brain plasticity or controlling external devices. However, neural oscillations have shown to synchronize activity according to motor and cognitive functions. For this reason, the existence of cross-frequency interactions produces oscillations with different frequencies in neural networks. In this PhD, we investigated for the first time the existence of cross-frequency coupling during rest and movement using ECoG in chronic stroke patients. We found that there is an exaggerated phase-amplitude coupling between the phase of alpha frequency and the amplitude of gamma frequency, which can be used as feature or target for neurofeedback interventions using BCIs. This coupling has been also reported in another neurological disorder affecting motor function (Parkinson and dystonia) but, to date, it has not been investigated in stroke patients. This finding might change the future design of assistive or therapeuthic BCI systems for motor restoration in stroke patients

Down-Conditioning of Soleus Reflex Activity using Mechanical Stimuli and EMG Biofeedback

Spasticity is a common syndrome caused by various brain and neural injuries, which can severely impair walking ability and functional independence. To improve functional independence, conditioning protocols are available aimed at reducing spasticity by facilitating spinal neuroplasticity. This down-conditioning can be performed using different types of stimuli, electrical or mechanical, and reflex activity measures, EMG or impedance, used as biofeedback variable. Still, current results on effectiveness of these conditioning protocols are incomplete, making comparisons difficult. We aimed to show the within-session task- dependent and across-session long-term adaptation of a conditioning protocol based on mechanical stimuli and EMG biofeedback. However, in contrast to literature, preliminary results show that subjects were unable to successfully obtain task-dependent modulation of their soleus short-latency stretch reflex magnitude

Principles of human movement augmentation and the challenges in making it a reality

Augmenting the body with artificial limbs controlled concurrently to one's natural limbs has long appeared in science fiction, but recent technological and neuroscientific advances have begun to make this possible. By allowing individuals to achieve otherwise impossible actions, movement augmentation could revolutionize medical and industrial applications and profoundly change the way humans interact with the environment. Here, we construct a movement augmentation taxonomy through what is augmented and how it is achieved. With this framework, we analyze augmentation that extends the number of degrees-of-freedom, discuss critical features of effective augmentation such as physiological control signals, sensory feedback and learning as well as application scenarios, and propose a vision for the field

De animais a máquinas : humanos tecnicamente melhores nos imaginários de futuro da convergência tecnológica

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Sociais, Departamento de Sociologia, 2020.O tema desta investigação é discutir os imaginários sociais de ciência e tecnologia que emergem a partir da área da neuroengenharia, em sua relação com a Convergência Tecnológica de quatro disciplinas: Nanotecnologia, Biotecnologia, tecnologias da Informação e tecnologias Cognitivas - neurociências- (CT-NBIC). Estas áreas desenvolvem-se e são articuladas por meio de discursos que ressaltam o aprimoramento das capacidades físicas e cognitivas dos seres humanos, com o intuito de construir uma sociedade melhor por meio do progresso científico e tecnológico, nos limites das agendas de pesquisa e desenvolvimento (P&D). Objetivos: Os objetivos nesse cenário, são discutir as implicações éticas, econômicas, políticas e sociais deste modelo de sistema sociotécnico. Nos referimos, tanto as aplicações tecnológicas, quanto as consequências das mesmas na formação dos imaginários sociais, que tipo de relações se estabelecem e como são criadas dentro desse contexto. Conclusão: Concluímos na busca por refletir criticamente sobre as propostas de aprimoramento humano mediado pela tecnologia, que surgem enquanto parte da agenda da Convergência Tecnológica NBIC. No entanto, as propostas de melhoramento humano vão muito além de uma agenda de investigação. Há todo um quadro de referências filosóficas e políticas que defendem o aprimoramento da espécie, vertentes estas que se aliam a movimentos trans-humanistas e pós- humanistas, posições que são ao mesmo tempo éticas, políticas e econômicas. A partir de nossa análise, entendemos que ciência, tecnologia e política estão articuladas, em coprodução, em relação às expectativas de futuros que são esperados ou desejados. Ainda assim, acreditamos que há um espaço de diálogo possível, a partir do qual buscamos abrir propostas para o debate público sobre questões de ciência e tecnologia relacionadas ao aprimoramento da espécie humana.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The subject of this research is to discuss the social imaginaries of science and technology that emerge from the area of neuroengineering in relation with the Technological Convergence of four disciplines: Nanotechnology, Biotechnology, Information technologies and Cognitive technologies -neurosciences- (CT-NBIC). These areas are developed and articulated through discourses that emphasize the enhancement of human physical and cognitive capacities, the intuition it is to build a better society, through the scientific and technological progress, at the limits of the research and development (R&D) agendas. Objectives: The objective in this scenery, is to discuss the ethic, economic, politic and social implications of this model of sociotechnical system. We refer about the technological applications and the consequences of them in the formation of social imaginaries as well as the kind of social relations that are created and established in this context. Conclusion: We conclude looking for critical reflections about the proposals of human enhancement mediated by the technology. That appear as a part of the NBIC technologies agenda. Even so, the proposals of human enhancement go beyond boundaries that an investigation agenda. There is a frame of philosophical and political references that defend the enhancement of the human beings. These currents that ally to the transhumanism and posthumanism movements, positions that are ethic, politic and economic at the same time. From our analysis, we understand that science, technology and politics are articulated, are in co-production, regarding the expected and desired futures. Even so, we believe that there is a space of possible dialog, from which we look to open proposals for the public discussion on questions of science and technology related to enhancement of human beings

VALIDATION OF A MODEL OF SENSORIMOTOR INTEGRATION WITH CLINICAL BENEFITS

Healthy sensorimotor integration – or how our touch influences our movements – is critical to efficiently interact with our environment. Yet, many aspects of this process are still poorly understood. Importantly, several movement disorders are often considered as originating from purely motor impairments, while a sensory origin could also lead to a similar set of symptoms. To alleviate these issues, we hereby propose a novel biologically-based model of the sensorimotor loop, known as the SMILE model. After describing both the functional, and the corresponding neuroanatomical versions of the SMILE, we tested several aspects of its motor component through functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS). Both experimental studies resulted in coherent outcomes with respect to the SMILE predictions, but they also provided novel scientific outcomes about such broad topics as the sub-phases of motor imagery, the neural processing of bodily representations, or the extend of the role of the extrastriate body area. In the final sections of this manuscript, we describe some potential clinical application of the SMILE. The first one presents the identification of plausible neuroanatomical origins for focal hand dystonia, a yet poorly understood sensorimotor disorder. The last chapter then covers possible improvements on brain-machine interfaces, driven by a better understanding of the sensorimotor system. -- La façon dont votre sens du toucher et vos mouvements interagissent est connue sous le nom d’intégration sensorimotrice. Ce procédé est essentiel pour une interaction normale avec tout ce qui nous entoure. Cependant, plusieurs aspects de ce processus sont encore méconnus. Plus important encore, l’origine de certaines déficiences motrices encore trop peu comprises sont parfois considérées comme purement motrice, alors qu’une origine sensorielle pourrait mener à un même ensemble de symptômes. Afin d’améliorer cette situation, nous proposons ici un nouveau modèle d’intégration sensorimotrice, dénommé « SMILE », basé sur les connaissances de neurobiologie actuelles. Dans ce manuscrit, nous commençons par décrire les caractéristiques fonctionnelles et neuroanatomiques du SMILE. Plusieurs expériences sont ensuite effectuées, via l’imagerie par résonance magnétique fonctionnelle (IRMf), et la stimulation magnétique transcranienne (SMT), afin de tester différents aspects de la composante motrice du SMILE. Si les résultats de ces expériences corroborent les prédictions du SMILE, elles ont aussi mis en évidences d’autres résultats scientifiques intéressants et novateurs, dans des domaines aussi divers que les sous-phases de l’imagination motrice, les processus cérébraux liés aux représentations corporelles, ou encore l’extension du rôle de l’extrastriate body area. Dans les dernières parties de ce manuscrit, nous dévoilons quelques applications cliniques potentielles de notre modèle. Nous utilisons le SMILE afin de proposer deux origines cérébrales plausibles de la dystonie focale de la main. Le dernier chapitre présente comment certaines technologies existantes, telles que les interfaces cerveaux-machines, pourraient bénéficier d’une meilleure compréhension du système sensorimoteur

Classification of movements of the rat based on intra-cortical signals using artificial neural network and support vector machine

A BCI aims at creating a communication pathway between the brain and an external device. This is possible by decoding signals from the primary motor cortex and translating them into commands for a prosthetic device. The experimental design was developed starting from intra-cortical signal recorded in the rat brain. The data pre-processing included denoising with wavelet technique, spike detection, and feature extraction. Artificial neural network and support vector machine were applied to classify the rat movements into two possible classes, Hit or No Hit. The misclassification error rates from denoised and not denoised data were statistically different (p<0.05), proving the efficiency of the denoising technique. ANN and SVM gave comparable classification result

Motor system plasticity induced by non-invasive stimuli

MD ThesisPrecisely timed paired stimulation protocols can change cortical and subcortical excitability. In the first study, induction of plastic changes in the long-latency stretch reflex (LLSR) by pairing non-invasive stimuli was attempted, at timings predicted to cause spiketiming dependent plasticity (STDP) in the brainstem. LLSR in human elbow muscles depends on multiple pathways; one possible contributor is the reticulospinal tract. The stimuli used are known to activate reticulospinal pathways. In healthy human subjects, reflex responses in flexor muscles were recorded following extension perturbations at the elbow. Subjects were then fitted with a portable device which delivered auditory click stimuli, and electrical stimuli to biceps muscle. The LLSR was significantly enhanced or suppressed in the biceps muscle depending on the intervention protocol. No changes were observed in the unstimulated brachioradialis muscle. Although contributions from the spinal or cortical pathways cannot be excluded, the results were consistent with STDP in reticulospinal circuits. In the second study, baseline TMS responses were recorded from two intrinsic hand muscles, flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC). In the first phase, paired associative stimulation (PAS) was delivered by pairing motor point stimulation of FDS or EDC with TMS. Responses were then remeasured. Increases were greatest in the hand muscles, smaller in FDS, and non-significant in EDC. In the second phase, intermittent theta-burst rapid-rate TMS was applied instead of PAS. In this case, all muscles showed similar increases in TMS responses. This study showed that potential plasticity in motor cortical output has a gradient: hand muscles > flexors > extensors. However, this was only seen in a protocol which requires integration of sensory input (PAS), and not when plasticity was induced purely by cortical stimulation (rapid rate TMS). In the third study, motor imagery was paired with TMS in healthy human subjects. They were asked to imagine wrist flexion or extension movement, while TMS was delivered to the motor cortex. Six different protocols were tested, but only flexor imagination with TMS and extensor imagination with TMS showed significant facilitation following the test. Flexor imagination with TMS increased motor evoked potential (MEP) in all four Abstract 2 muscles with maximum changes towards flexor, whereas extensor imagination with TMS increased MEP only in extensor. Above changes in the cortical or subcortical excitability evoked by non-invasive stimulation protocols were consistent with long term potentiation and long-term depression mediated plastic change

A Review of Control Strategies in Closed-Loop Neuroprosthetic Systems

It has been widely recognized that closed-loop neuroprosthetic systems achieve more favourable outcomes for users then equivalent open-loop devices. Improved performance of tasks, better usability and greater embodiment have all been reported in systems utilizing some form of feedback. However the interdisciplinary work on neuroprosthetic systems can lead to miscommunication due to similarities in well established nomenclature in different fields. Here we present a review of control strategies in existing experimental, investigational and clinical neuroprosthetic systems in order to establish a baseline and promote a common understanding of different feedback modes and closed loop controllers. The first section provides a brief discussion of feedback control and control theory. The second section reviews the control strategies of recent Brain Machine Interfaces, neuromodulatory implants, neuroprosthetic systems and assistive neurorobotic devices. The final section examines the different approaches to feedback in current neuroprosthetic and neurorobotic systems