Visual error augmentation enhances learning in three dimensions

Because recent preliminary evidence points to the use of Error augmentation (EA) for motor learning enhancements, we visually enhanced deviations from a straight line path while subjects practiced a sensorimotor reversal task, similar to laparoscopic surgery. Our study asked 10 healthy subjects in two groups to perform targeted reaching in a simulated virtual reality environment, where the transformation of the hand position matrix was a complete reversal--rotated 180 degrees about an arbitrary axis (hence 2 of the 3 coordinates are reversed). Our data showed that after 500 practice trials, error-augmented-trained subjects reached the desired targets more quickly and with lower error (differences of 0.4 seconds and 0.5 cm Maximum Perpendicular Trajectory deviation) when compared to the control group. Furthermore, the manner in which subjects practiced was influenced by the error augmentation, resulting in more continuous motions for this group and smaller errors. Even with the extreme sensory discordance of a reversal, these data further support that distorted reality can promote more complete adaptation/learning when compared to regular training. Lastly, upon removing the flip all subjects quickly returned to baseline rapidly within 6 trials

Hybrid brain/neural interface and autonomous vision-guided whole-arm exoskeleton control to perform activities of daily living (ADLs)

[EN] Background The aging of the population and the progressive increase of life expectancy in developed countries is leading to a high incidence of age-related cerebrovascular diseases, which affect people's motor and cognitive capabilities and might result in the loss of arm and hand functions. Such conditions have a detrimental impact on people's quality of life. Assistive robots have been developed to help people with motor or cognitive disabilities to perform activities of daily living (ADLs) independently. Most of the robotic systems for assisting on ADLs proposed in the state of the art are mainly external manipulators and exoskeletal devices. The main objective of this study is to compare the performance of an hybrid EEG/EOG interface to perform ADLs when the user is controlling an exoskeleton rather than using an external manipulator. Methods Ten impaired participants (5 males and 5 females, mean age 52 +/- 16 years) were instructed to use both systems to perform a drinking task and a pouring task comprising multiple subtasks. For each device, two modes of operation were studied: synchronous mode (the user received a visual cue indicating the sub-tasks to be performed at each time) and asynchronous mode (the user started and finished each of the sub-tasks independently). Fluent control was assumed when the time for successful initializations ranged below 3 s and a reliable control in case it remained below 5 s. NASA-TLX questionnaire was used to evaluate the task workload. For the trials involving the use of the exoskeleton, a custom Likert-Scale questionnaire was used to evaluate the user's experience in terms of perceived comfort, safety, and reliability. Results All participants were able to control both systems fluently and reliably. However, results suggest better performances of the exoskeleton over the external manipulator (75% successful initializations remain below 3 s in case of the exoskeleton and bellow 5s in case of the external manipulator). Conclusions Although the results of our study in terms of fluency and reliability of EEG control suggest better performances of the exoskeleton over the external manipulator, such results cannot be considered conclusive, due to the heterogeneity of the population under test and the relatively limited number of participants.This study was funded by the European Commission under the project AIDE (G.A. no: 645322), Spanish Ministry of Science and Innovation, through the projects PID2019-108310RB-I00 and PLEC2022-009424 and by the Ministry of Universities and European Union, "fnanced by European Union-Next Generation EU" through Margarita Salas grant for the training of young doctors.Catalán, JM.; Trigili, E.; Nann, M.; Blanco-Ivorra, A.; Lauretti, C.; Cordella, F.; Ivorra, E.... (2023). Hybrid brain/neural interface and autonomous vision-guided whole-arm exoskeleton control to perform activities of daily living (ADLs). Journal of NeuroEngineering and Rehabilitation. 20(1):1-16. https://doi.org/10.1186/s12984-023-01185-w11620

The feasibility of measuring rehabilitation-induced changes in upper limb movement and cognition using robotic kinematics in chronic stroke

Background: Robotic measurement of kinematics is a potential method to detect precise rehabilitation-induced changes in upper limb movement and cognition post-stroke. To what degree robot-derived data aligns with other gold-standard upper limb measurement tools has yet to be described. Such comparisons would be important for translating such tools to research and clinical practice. Methods: Using the Kinesiological Instrument for Normal and Altered Reaching Movement (Kinarm), we compared the relationship between robot-derived values and gold-standard clinical tests of upper limb performance and cognitive function before and after a rehabilitation intervention in patients with chronic stroke. The intervention involved 10 sessions of pairing aerobic exercise with skilled motor and cognitive practice. Participants underwent motor performance and cognitive function assessments using the Kinarm endpoint robot and standardized measurement scales at baseline, after the 10 intervention sessions and 30 days later. Results: Ten participants with chronic upper limb impairment due to stroke (69.4 ± 12.9 years old: 7 males, 3 females) completed the intervention sessions. There were no significant improvements in upper limb recovery when measured using the clinical gold-standard tests. However, robotic kinematics variables showed significant changes in motor performance at follow-up. There were no significant changes in cognitive measures pre- and post-rehabilitation intervention. Conclusion: Rehabilitation-induced changes in upper limb performance and cognitive changes may be effectively detected and quantified using robotic kinematics measures

Visual error amplification showed no benefit for non-naïve subjects in trunk-arm rowing

Motor learning is assumed to be a partly error driven process. Motor learning studies on simple movements have shown that skilled subjects benefit from training with error amplification. Findings of studies with simple movements do not necessarily transfer to complex sport movements. The goal of this work was to determine the benefit of visual error amplification for non-naïve subjects in learning a fast rowing movement.We conducted a study comparing non-naïve subjects receiving a fading, visual feedback with visual error amplification against a control group receiving the same visual feedback without error amplification. Separate outcome metrics were applied for the domains of spatial and velocity magnitude errors. Besides error metrics, variability metrics were evaluated for both domains, such that they could be interpreted in quantitative relation to each other.The implemented error amplification did not cause group differences in any variable. Subjects with or without error amplification reached similar absolute levels in error and variability. Possible reasons remain speculative. For implementing error amplification to the training of complex movements design decisions must be made for which an informative basis is missing, e.g. the error amplification gains

Development of a hybrid robotic system based on an adaptive and associative assistance for rehabilitation of reaching movement after stroke

Stroke causes irreversible neurological damage. Depending on the location and the size of this brain injury, different body functions could result affected. One of the most common consequences is motor impairments. The level of motor impairment affectation varies between post-stroke subjects, but often, it hampers the execution of most activities of daily living. Consequently, the quality of life of the stroke population is severely decreased. The rehabilitation of the upper-limb motor functions has gained special attention in the scientific community due the poor reported prognosis of post-stroke patients for recovering normal upper-extremity function after standard rehabilitation therapy. Driven by the advance of technology and the design of new rehabilitation methods, the use of robot devices, functional electrical stimulation and brain-computer interfaces as a neuromodulation system is proposed as a novel and promising rehabilitation tools. Although the uses of these technologies present potential benefits with respect to standard rehabilitation methods, there still are some milestones to be addressed for the consolidation of these methods and techniques in clinical settings. Mentioned evidences reflect the motivation for this dissertation. This thesis presents the development and validation of a hybrid robotic system based on an adaptive and associative assistance for rehabilitation of reaching movements in post-stroke subjects. The hybrid concept refers the combined use of robotic devices with functional electrical stimulation. Adaptive feature states a tailored assistance according to the users’ motor residual capabilities, while the associative term denotes a precise pairing between the users’ motor intent and the peripheral hybrid assistance. The development of the hybrid platform comprised the following tasks: 1. The identification of the current challenges for hybrid robotic system, considering twofold perspectives: technological and clinical. The hybrid systems submitted in literature were critically reviewed for such purpose. These identified features will lead the subsequent development and method framed in this work. 2. The development and validation of a hybrid robotic system, combining a mechanical exoskeleton with functional electrical stimulation to assist the execution of functional reaching movements. Several subsystems are integrated within the hybrid platform, which interact each other to cooperatively complement the rehabilitation task. Complementary, the implementation of a controller based on functional electrical stimulation to dynamically adjust the level of assistance is addressed. The controller is conceived to tackle one of the main limitations when using electrical stimulation, i.e. the highly nonlinear and time-varying muscle response. An experimental procedure was conducted with healthy and post-stroke patients to corroborate the technical feasibility and the usability evaluation of the system. 3. The implementation of an associative strategy within the hybrid platform. Three different strategies based on electroencephalography and electromyography signals were analytically compared. The main idea is to provide a precise temporal association between the hybrid assistance delivered at the periphery (arm muscles) and the users’ own intention to move and to configure a feasible clinical setup to be use in real rehabilitation scenarios. 4. Carry out a comprehensive pilot clinical intervention considering a small cohort of patient with post-stroke patients to evaluate the different proposed concepts and assess the feasibility of using the hybrid system in rehabilitation settings. In summary, the works here presented prove the feasibility of using the hybrid robotic system as a rehabilitative tool with post-stroke subjects. Moreover, it is demonstrated the adaptive controller is able to adjust the level of assistance to achieve successful tracking movement with the affected arm. Remarkably, the accurate association in time between motor cortex activation, represented through the motor-related cortical potential measured with electroencephalography, and the supplied hybrid assistance during the execution of functional (multidegree of freedom) reaching movement facilitate distributed cortical plasticity. These results encourage the validation of the overall hybrid concept in a large clinical trial including an increased number of patients with a control group, in order to achieve more robust clinical results and confirm the presented herein.Programa Oficial de Doctorado en Ingeniería Eléctrica, Electrónica y AutomáticaPresidente: Ramón Ceres Ruiz.- Secretario: Luis Enrique Moreno Lorente.- Vocal: Antonio Olivier

A brain-machine interface for assistive robotic control

Brain-machine interfaces (BMIs) are the only currently viable means of communication for many individuals suffering from locked-in syndrome (LIS) – profound paralysis that results in severely limited or total loss of voluntary motor control. By inferring user intent from task-modulated neurological signals and then translating those intentions into actions, BMIs can enable LIS patients increased autonomy. Significant effort has been devoted to developing BMIs over the last three decades, but only recently have the combined advances in hardware, software, and methodology provided a setting to realize the translation of this research from the lab into practical, real-world applications. Non-invasive methods, such as those based on the electroencephalogram (EEG), offer the only feasible solution for practical use at the moment, but suffer from limited communication rates and susceptibility to environmental noise. Maximization of the efficacy of each decoded intention, therefore, is critical. This thesis addresses the challenge of implementing a BMI intended for practical use with a focus on an autonomous assistive robot application. First an adaptive EEG- based BMI strategy is developed that relies upon code-modulated visual evoked potentials (c-VEPs) to infer user intent. As voluntary gaze control is typically not available to LIS patients, c-VEP decoding methods under both gaze-dependent and gaze- independent scenarios are explored. Adaptive decoding strategies in both offline and online task conditions are evaluated, and a novel approach to assess ongoing online BMI performance is introduced. Next, an adaptive neural network-based system for assistive robot control is presented that employs exploratory learning to achieve the coordinated motor planning needed to navigate toward, reach for, and grasp distant objects. Exploratory learning, or “learning by doing,” is an unsupervised method in which the robot is able to build an internal model for motor planning and coordination based on real-time sensory inputs received during exploration. Finally, a software platform intended for practical BMI application use is developed and evaluated. Using online c-VEP methods, users control a simple 2D cursor control game, a basic augmentative and alternative communication tool, and an assistive robot, both manually and via high-level goal-oriented commands

The interplay between movement and perception: how interaction can influence sensorimotor performance and neuromotor recovery

openMovement and perception interact continuously in daily activities. Motor output changes the outside world and affect perceptual representations. Similarly, perception has consequences on movement. Nevertheless, how movement and perception influence each other and share information is still an open question. Mappings from movement to perceptual outcome and vice versa change continuously throughout life. For example, a cerebrovascular accident (stroke) elicits in the nervous system a complex series of reorganization processes at various levels and with different temporal scales. Functional recovery after a stroke seems to be mediated by use-dependent reorganization of the preserved neural circuitry. The goal of this thesis is to discuss how interaction with the environment can influence the progress of both sensorimotor performance and neuromotor recovery. I investigate how individuals develop an implicit knowledge of the ways motor outputs regularly correlate with changes in sensory inputs, by interacting with the environment and experiencing the perceptual consequences of self-generated movements. Further, I applied this paradigm to model the exercise-based neurorehabilitation in stroke survivors, which aims at gradually improving both perceptual and motor performance through repeated exercise. The scientific findings of this thesis indicate that motor learning resolve visual perceptual uncertainty and contributes to persistent changes in visual and somatosensory perception. Moreover, computational neurorehabilitation may help to identify the underlying mechanisms of both motor and perceptual recovery, and may lead to more personalized therapies.openXXXII CICLO - BIOINGEGNERIA E ROBOTICA - BIOENGINEERING AND ROBOTICS - Bioengineering and bioelectronicsSedda, Giuli

Assessment of movement quality in robot- assisted upper limb rehabilitation after stroke: a review

Studies of stroke patients undergoing robot-assisted rehabilitation have revealed various kinematic parameters describing movement quality of the upper limb. However, due to the different level of stroke impairment and different assessment criteria and interventions, the evaluation of the effectiveness of rehabilitation program is undermined. This paper presents a systematic review of kinematic assessments of movement quality of the upper limb and identifies the suitable parameters describing impairments in stroke patients. A total of 41 different clinical and pilot studies on different phases of stroke recovery utilizing kinematic parameters are evaluated. Kinematic parameters describing movement accuracy are mostly reported for chronic patients with statistically significant outcomes and correlate strongly with clinical assessments. Meanwhile, parameters describing feed-forward sensorimotor control are the most frequently reported in studies on sub-acute patients with significant outcomes albeit without correlation to any clinical assessments. However, lack of measures in coordinated movement and proximal component of upper limb enunciate the difficulties to distinguish the exploitation of joint redundancies exhibited by stroke patients in completing the movement. A further study on overall measures of coordinated movement is recommended

Technology assisted screening and balance training systems for stroke patients

by Deepesh KumarPh.D