Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation

Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and functional restoration

JNER at 15 years: analysis of the state of neuroengineering and rehabilitation.

On JNER's 15th anniversary, this editorial analyzes the state of the field of neuroengineering and rehabilitation. I first discuss some ways that the nature of neurorehabilitation research has evolved in the past 15 years based on my perspective as editor-in-chief of JNER and a researcher in the field. I highlight increasing reliance on advanced technologies, improved rigor and openness of research, and three, related, new paradigms - wearable devices, the Cybathlon competition, and human augmentation studies - indicators that neurorehabilitation is squarely in the age of wearability. Then, I briefly speculate on how the field might make progress going forward, highlighting the need for new models of training and learning driven by big data, better personalization and targeting, and an increase in the quantity and quality of usability and uptake studies to improve translation

Optimal dimensional synthesis of force feedback lower arm exoskeletons

This paper presents multi-criteria design optimization of parallel mechanism based force feedback exoskeletons for human forearm and wrist. The optimized devices are aimed to be employed as a high fidelity haptic interfaces. Multiple design objectives are discussed and classified for the devices and the optimization problem to study the trade-offs between these criteria is formulated. Dimensional syntheses are performed for optimal global kinematic and dynamic performance, utilizing a Pareto front based framework, for two spherical parallel mechanisms that satisfy the ergonomic necessities of a human forearm and wrist. Two optimized mechanisms are compared and discussed in the light of multiple design criteria. Finally, kinematic structure and dimensions of an optimal exoskeleton are decided

Comfort-Centered Design of a Lightweight and Backdrivable Knee Exoskeleton

This paper presents design principles for comfort-centered wearable robots and their application in a lightweight and backdrivable knee exoskeleton. The mitigation of discomfort is treated as mechanical design and control issues and three solutions are proposed in this paper: 1) a new wearable structure optimizes the strap attachment configuration and suit layout to ameliorate excessive shear forces of conventional wearable structure design; 2) rolling knee joint and double-hinge mechanisms reduce the misalignment in the sagittal and frontal plane, without increasing the mechanical complexity and inertia, respectively; 3) a low impedance mechanical transmission reduces the reflected inertia and damping of the actuator to human, thus the exoskeleton is highly-backdrivable. Kinematic simulations demonstrate that misalignment between the robot joint and knee joint can be reduced by 74% at maximum knee flexion. In experiments, the exoskeleton in the unpowered mode exhibits 1.03 Nm root mean square (RMS) low resistive torque. The torque control experiments demonstrate 0.31 Nm RMS torque tracking error in three human subjects.Comment: 8 pages, 16figures, Journa

Feature Analysis for Classification of Physical Actions using surface EMG Data

Based on recent health statistics, there are several thousands of people with limb disability and gait disorders that require a medical assistance. A robot assisted rehabilitation therapy can help them recover and return to a normal life. In this scenario, a successful methodology is to use the EMG signal based information to control the support robotics. For this mechanism to function properly, the EMG signal from the muscles has to be sensed and then the biological motor intention has to be decoded and finally the resulting information has to be communicated to the controller of the robot. An accurate detection of the motor intention requires a pattern recognition based categorical identification. Hence in this paper, we propose an improved classification framework by identification of the relevant features that drive the pattern recognition algorithm. Major contributions include a set of modified spectral moment based features and another relevant inter-channel correlation feature that contribute to an improved classification performance. Next, we conducted a sensitivity analysis of the classification algorithm to different EMG channels. Finally, the classifier performance is compared to that of the other state-of the art algorithm

Incorporating Feedback from Multiple Sensory Modalities Enhances Brain–Machine Interface Control

The brain typically uses a rich supply of feedback from multiple sensory modalities to control movement in healthy individuals. In many individuals, these afferent pathways, as well as their efferent counterparts, are compromised by disease or injury resulting in significant impairments and reduced quality of life. Brain–machine interfaces (BMIs) offer the promise of recovered functionality to these individuals by allowing them to control a device using their thoughts. Most current BMI implementations use visual feedback for closed-loop control; however, it has been suggested that the inclusion of additional feedback modalities may lead to improvements in control. We demonstrate for the first time that kinesthetic feedback can be used together with vision to significantly improve control of a cursor driven by neural activity of the primary motor cortex (MI). Using an exoskeletal robot, the monkey\u27s arm was moved to passively follow a cortically controlled visual cursor, thereby providing the monkey with kinesthetic information about the motion of the cursor. When visual and proprioceptive feedback were congruent, both the time to successfully reach a target decreased and the cursor paths became straighter, compared with incongruent feedback conditions. This enhanced performance was accompanied by a significant increase in the amount of movement-related information contained in the spiking activity of neurons in MI. These findings suggest that BMI control can be significantly improved in paralyzed patients with residual kinesthetic sense and provide the groundwork for augmenting cortically controlled BMIs with multiple forms of natural or surrogate sensory feedback

Exploiting Multiple Sensory Modalities in Brain-Machine Interfaces

Recent improvements in cortically-controlled brain-machine interfaces (BMIs) have raised hopes that such technologies may improve the quality of life of severely motor-disabled patients. However, current generation BMIs do not perform up to their potential due to the neglect of the full range of sensory feedback in their strategies for training and control. Here we confirm that neurons in the primary motor cortex (MI) encode sensory information and demonstrate a significant heterogeneity in their responses with respect to the type of sensory modality available to the subject about a reaching task. We further show using mutual information and directional tuning analyses that the presence of multi-sensory feedback (i.e. vision and proprioception) during replay of movements evokes neural responses in MI that are almost indistinguishable from those responses measured during overt movement. Finally, we suggest how these playback-evoked responses may be used to improve BMI performance

Comfort of two shoulder actuation mechanisms for arm therapy exoskeletons: a comparative study in healthy subjects

Robotic exoskeletons can be used to study and treat patients with neurological impairments. They can guide and support the human limb over a large range of motion, which requires that the movement trajectory of the exoskeleton coincide with the one of the human arm. This is straightforward to achieve for rather simple joints like the elbow, but very challenging for complex joints like the human shoulder, which is comprised by several bones and can exhibit a movement with multiple rotational and translational degrees of freedom. Thus, several research groups have developed different shoulder actuation mechanism. However, there are no experimental studies that directly compare the comfort of two different shoulder actuation mechanisms. In this study, the comfort and the naturalness of the new shoulder actuation mechanism of the ARMin III exoskeleton are compared to a ball-and-socket-type shoulder actuation. The study was conducted in 20 healthy subjects using questionnaires and 3D-motion records to assess comfort and naturalness. The results indicate that the new shoulder actuation is slightly better than a ball-and-socket-type actuation. However, the differences are small, and under the tested conditions, the comfort and the naturalness of the two tested shoulder actuations do not differ a lo