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

Enhancing Nervous System Recovery through Neurobiologics, Neural Interface Training, and Neurorehabilitation.

After an initial period of recovery, human neurological injury has long been thought to be static. In order to improve quality of life for those suffering from stroke, spinal cord injury, or traumatic brain injury, researchers have been working to restore the nervous system and reduce neurological deficits through a number of mechanisms. For example, neurobiologists have been identifying and manipulating components of the intra- and extracellular milieu to alter the regenerative potential of neurons, neuro-engineers have been producing brain-machine and neural interfaces that circumvent lesions to restore functionality, and neurorehabilitation experts have been developing new ways to revitalize the nervous system even in chronic disease. While each of these areas holds promise, their individual paths to clinical relevance remain difficult. Nonetheless, these methods are now able to synergistically enhance recovery of native motor function to levels which were previously believed to be impossible. Furthermore, such recovery can even persist after training, and for the first time there is evidence of functional axonal regrowth and rewiring in the central nervous system of animal models. To attain this type of regeneration, rehabilitation paradigms that pair cortically-based intent with activation of affected circuits and positive neurofeedback appear to be required-a phenomenon which raises new and far reaching questions about the underlying relationship between conscious action and neural repair. For this reason, we argue that multi-modal therapy will be necessary to facilitate a truly robust recovery, and that the success of investigational microscopic techniques may depend on their integration into macroscopic frameworks that include task-based neurorehabilitation. We further identify critical components of future neural repair strategies and explore the most updated knowledge, progress, and challenges in the fields of cellular neuronal repair, neural interfacing, and neurorehabilitation, all with the goal of better understanding neurological injury and how to improve recovery

User Intent Detection and Control of a Soft Poly-Limb

abstract: This work presents the integration of user intent detection and control in the development of the fluid-driven, wearable, and continuum, Soft Poly-Limb (SPL). The SPL utilizes the numerous traits of soft robotics to enable a novel approach to provide safe and compliant mobile manipulation assistance to healthy and impaired users. This wearable system equips the user with an additional limb made of soft materials that can be controlled to produce complex three-dimensional motion in space, like its biological counterparts with hydrostatic muscles. Similar to the elephant trunk, the SPL is able to manipulate objects using various end effectors, such as suction adhesion or a soft grasper, and can also wrap its entire length around objects for manipulation. User control of the limb is demonstrated using multiple user intent detection modalities. Further, the performance of the SPL studied by testing its capability to interact safely and closely around a user through a spatial mobility test. Finally, the limb’s ability to assist the user is explored through multitasking scenarios and pick and place tests with varying mounting locations of the arm around the user’s body. The results of these assessments demonstrate the SPL’s ability to safely interact with the user while exhibiting promising performance in assisting the user with a wide variety of tasks, in both work and general living scenarios.Dissertation/ThesisMasters Thesis Biomedical Engineering 201

Touch- and Walkable Virtual Reality to Support Blind and Visually Impaired Peoples‘ Building Exploration in the Context of Orientation and Mobility

Der Zugang zu digitalen Inhalten und Informationen wird immer wichtiger für eine erfolgreiche Teilnahme an der heutigen, zunehmend digitalisierten Zivilgesellschaft. Solche Informationen werden meist visuell präsentiert, was den Zugang für blinde und sehbehinderte Menschen einschränkt. Die grundlegendste Barriere ist oft die elementare Orientierung und Mobilität (und folglich die soziale Mobilität), einschließlich der Erlangung von Kenntnissen über unbekannte Gebäude vor deren Besuch. Um solche Barrieren zu überbrücken, sollten technische Hilfsmittel entwickelt und eingesetzt werden. Es ist ein Kompromiss zwischen technologisch niedrigschwellig zugänglichen und verbreitbaren Hilfsmitteln und interaktiv-adaptiven, aber komplexen Systemen erforderlich. Die Anpassung der Technologie der virtuellen Realität (VR) umfasst ein breites Spektrum an Entwicklungs- und Entscheidungsoptionen. Die Hauptvorteile der VR-Technologie sind die erhöhte Interaktivität, die Aktualisierbarkeit und die Möglichkeit, virtuelle Räume und Modelle als Abbilder von realen Räumen zu erkunden, ohne dass reale Gefahren und die begrenzte Verfügbarkeit von sehenden Helfern auftreten. Virtuelle Objekte und Umgebungen haben jedoch keine physische Beschaffenheit. Ziel dieser Arbeit ist es daher zu erforschen, welche VR-Interaktionsformen sinnvoll sind (d.h. ein angemessenes Verbreitungspotenzial bieten), um virtuelle Repräsentationen realer Gebäude im Kontext von Orientierung und Mobilität berührbar oder begehbar zu machen. Obwohl es bereits inhaltlich und technisch disjunkte Entwicklungen und Evaluationen zur VR-Technologie gibt, fehlt es an empirischer Evidenz. Zusätzlich bietet diese Arbeit einen Überblick über die verschiedenen Interaktionen. Nach einer Betrachtung der menschlichen Physiologie, Hilfsmittel (z.B. taktile Karten) und technologischen Eigenschaften wird der aktuelle Stand der Technik von VR vorgestellt und die Anwendung für blinde und sehbehinderte Nutzer und der Weg dorthin durch die Einführung einer neuartigen Taxonomie diskutiert. Neben der Interaktion selbst werden Merkmale des Nutzers und des Geräts, der Anwendungskontext oder die nutzerzentrierte Entwicklung bzw. Evaluation als Klassifikatoren herangezogen. Begründet und motiviert werden die folgenden Kapitel durch explorative Ansätze, d.h. im Bereich 'small scale' (mit sogenannten Datenhandschuhen) und im Bereich 'large scale' (mit einer avatargesteuerten VR-Fortbewegung). Die folgenden Kapitel führen empirische Studien mit blinden und sehbehinderten Nutzern durch und geben einen formativen Einblick, wie virtuelle Objekte in Reichweite der Hände mit haptischem Feedback erfasst werden können und wie verschiedene Arten der VR-Fortbewegung zur Erkundung virtueller Umgebungen eingesetzt werden können. Daraus werden geräteunabhängige technologische Möglichkeiten und auch Herausforderungen für weitere Verbesserungen abgeleitet. Auf der Grundlage dieser Erkenntnisse kann sich die weitere Forschung auf Aspekte wie die spezifische Gestaltung interaktiver Elemente, zeitlich und räumlich kollaborative Anwendungsszenarien und die Evaluation eines gesamten Anwendungsworkflows (d.h. Scannen der realen Umgebung und virtuelle Erkundung zu Trainingszwecken sowie die Gestaltung der gesamten Anwendung in einer langfristig barrierefreien Weise) konzentrieren.Access to digital content and information is becoming increasingly important for successful participation in today's increasingly digitized civil society. Such information is mostly presented visually, which restricts access for blind and visually impaired people. The most fundamental barrier is often basic orientation and mobility (and consequently, social mobility), including gaining knowledge about unknown buildings before visiting them. To bridge such barriers, technological aids should be developed and deployed. A trade-off is needed between technologically low-threshold accessible and disseminable aids and interactive-adaptive but complex systems. The adaptation of virtual reality (VR) technology spans a wide range of development and decision options. The main benefits of VR technology are increased interactivity, updatability, and the possibility to explore virtual spaces as proxies of real ones without real-world hazards and the limited availability of sighted assistants. However, virtual objects and environments have no physicality. Therefore, this thesis aims to research which VR interaction forms are reasonable (i.e., offering a reasonable dissemination potential) to make virtual representations of real buildings touchable or walkable in the context of orientation and mobility. Although there are already content and technology disjunctive developments and evaluations on VR technology, there is a lack of empirical evidence. Additionally, this thesis provides a survey between different interactions. Having considered the human physiology, assistive media (e.g., tactile maps), and technological characteristics, the current state of the art of VR is introduced, and the application for blind and visually impaired users and the way to get there is discussed by introducing a novel taxonomy. In addition to the interaction itself, characteristics of the user and the device, the application context, or the user-centered development respectively evaluation are used as classifiers. Thus, the following chapters are justified and motivated by explorative approaches, i.e., in the group of 'small scale' (using so-called data gloves) and in the scale of 'large scale' (using an avatar-controlled VR locomotion) approaches. The following chapters conduct empirical studies with blind and visually impaired users and give formative insight into how virtual objects within hands' reach can be grasped using haptic feedback and how different kinds of VR locomotion implementation can be applied to explore virtual environments. Thus, device-independent technological possibilities and also challenges for further improvements are derived. On the basis of this knowledge, subsequent research can be focused on aspects such as the specific design of interactive elements, temporally and spatially collaborative application scenarios, and the evaluation of an entire application workflow (i.e., scanning the real environment and exploring it virtually for training purposes, as well as designing the entire application in a long-term accessible manner)

Evaluation of a Soft Robotic Knee Exosuit for Assistance in Stair Ascent

abstract: Muscular weakness is a common manifestation for Stroke survivors and for patients with Anterior Cruciate Ligament reconstruction leading to reduced functional independence, especially mobility. Several rigid orthotic devices are being designed to assist mobility. However, limitations in majority of these devices are: 1) that they are constrained only to level walking applications, 2) are mostly bulky and rigid lacking user comfort. For these reasons, rehabilitation using soft-robotics can serve as a powerful modality in gait assistance and potentially accelerate functional recovery. The characteristics of soft robotic exosuit is that it’s more flexible, delivers high power to weight ratio, and conforms with the user’s body structure making it a suitable choice. This work explores the implementation of an existing soft robotic exosuit in assisting knee joint mechanism during stair ascent for patients with muscular weakness. The exosuit assists by compensating the lack of joint moment and minimizing the load on the affected limb. It consists of two I-cross-section soft pneumatic actuators encased within a sleeve along with insole sensor shoes and control electronics. The exosuit actuators were mechanically characterized at different angles, in accordance to knee flexion in stair gait, to enable the generation of the desired joint moments. A linear relation between the actuator stiffness and internal pressure as a function of the knee angle was obtained. Results from this characterization along with the insole sensor outputs were used to provide assistance to the knee joint. Analysis of stair gait with and without the exosuit ‘active’ was performed, using surface electromyography (sEMG) sensors, for two healthy participants at a slow walking speed. Preliminary user testing with the exosuit presented a promising 16% reduction in average muscular activity of Vastus Lateralis muscle and a 3.6% reduction on Gluteus Maximus muscle during the stance phase and unrestrained motion during the swing phase of ascent thereby demonstrating the applicability of the soft-inflatable exosuit in rehabilitation.Dissertation/ThesisMasters Thesis Biomedical Engineering 201

Haptics Rendering and Applications

There has been significant progress in haptic technologies but the incorporation of haptics into virtual environments is still in its infancy. A wide range of the new society's human activities including communication, education, art, entertainment, commerce and science would forever change if we learned how to capture, manipulate and reproduce haptic sensory stimuli that are nearly indistinguishable from reality. For the field to move forward, many commercial and technological barriers need to be overcome. By rendering how objects feel through haptic technology, we communicate information that might reflect a desire to speak a physically- based language that has never been explored before. Due to constant improvement in haptics technology and increasing levels of research into and development of haptics-related algorithms, protocols and devices, there is a belief that haptics technology has a promising future

3D Multimodal Interaction with Physically-based Virtual Environments

The virtual has become a huge field of exploration for researchers: it could assist the surgeon, help the prototyping of industrial objects, simulate natural phenomena, be a fantastic time machine or entertain users through games or movies. Far beyond the only visual rendering of the virtual environment, the Virtual Reality aims at -literally- immersing the user in the virtual world. VR technologies simulate digital environments with which users can interact and, as a result, perceive through different modalities the effects of their actions in real time. The challenges are huge: the user's motions need to be perceived and to have an immediate impact on the virtual world by modifying the objects in real-time. In addition, the targeted immersion of the user is not only visual: auditory or haptic feedback needs to be taken into account, merging all the sensory modalities of the user into a multimodal answer. The global objective of my research activities is to improve 3D interaction with complex virtual environments by proposing novel approaches for physically-based and multimodal interaction. I have laid the foundations of my work on designing the interactions with complex virtual worlds, referring to a higher demand in the characteristics of the virtual environments. My research could be described within three main research axes inherent to the 3D interaction loop: (1) the physically-based modeling of the virtual world to take into account the complexity of the virtual object behavior, their topology modifications as well as their interactions, (2) the multimodal feedback for combining the sensory modalities into a global answer from the virtual world to the user and (3) the design of body-based 3D interaction techniques and devices for establishing the interfaces between the user and the virtual world. All these contributions could be gathered in a general framework within the 3D interaction loop. By improving all the components of this framework, I aim at proposing approaches that could be used in future virtual reality applications but also more generally in other areas such as medical simulation, gesture training, robotics, virtual prototyping for the industry or web contents.Le virtuel est devenu un vaste champ d'exploration pour la recherche et offre de nos jours de nombreuses possibilités : assister le chirurgien, réaliser des prototypes de pièces industrielles, simuler des phénomènes naturels, remonter dans le temps ou proposer des applications ludiques aux utilisateurs au travers de jeux ou de films. Bien plus que le rendu purement visuel d'environnement virtuel, la réalité virtuelle aspire à -littéralement- immerger l'utilisateur dans le monde virtuel. L'utilisateur peut ainsi interagir avec le contenu numérique et percevoir les effets de ses actions au travers de différents retours sensoriels. Permettre une véritable immersion de l'utilisateur dans des environnements virtuels de plus en plus complexes confronte la recherche en réalité virtuelle à des défis importants: les gestes de l'utilisateur doivent être capturés puis directement transmis au monde virtuel afin de le modifier en temps-réel. Les retours sensoriels ne sont pas uniquement visuels mais doivent être combinés avec les retours auditifs ou haptiques dans une réponse globale multimodale. L'objectif principal de mes activités de recherche consiste à améliorer l'interaction 3D avec des environnements virtuels complexes en proposant de nouvelles approches utilisant la simulation physique et exploitant au mieux les différentes modalités sensorielles. Dans mes travaux, je m'intéresse tout particulièrement à concevoir des interactions avec des mondes virtuels complexes. Mon approche peut être décrite au travers de trois axes principaux de recherche: (1) la modélisation dans les mondes virtuels d'environnements physiques plausibles où les objets réagissent de manière naturelle, même lorsque leur topologie est modifiée ou lorsqu'ils sont en interaction avec d'autres objets, (2) la mise en place de retours sensoriels multimodaux vers l'utilisateur intégrant des composantes visuelles, haptiques et/ou sonores, (3) la prise en compte de l'interaction physique de l'utilisateur avec le monde virtuel dans toute sa richesse : mouvements de la tête, des deux mains, des doigts, des jambes, voire de tout le corps, en concevant de nouveaux dispositifs ou de nouvelles techniques d'interactions 3D. Les différentes contributions que j'ai proposées dans chacun de ces trois axes peuvent être regroupées au sein d'un cadre plus général englobant toute la boucle d'interaction 3D avec les environnements virtuels. Elles ouvrent des perspectives pour de futures applications en réalité virtuelle mais également plus généralement dans d'autres domaines tels que la simulation médicale, l'apprentissage de gestes, la robotique, le prototypage virtuel pour l'industrie ou bien les contenus web