Rehabilitation of gait after stroke: a review towards a top-down approach

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity

A Multi-Modal, Modified-Feedback and Self-Paced Brain-Computer Interface (BCI) to Control an Embodied Avatar's Gait

Brain-computer interfaces (BCI) have been used to control the gait of a virtual self-avatar with the aim of being used in gait rehabilitation. A BCI decodes the brain signals representing a desire to do something and transforms them into a control command for controlling external devices. The feelings described by the participants when they control a self-avatar in an immersive virtual environment (VE) demonstrate that humans can be embodied in the surrogate body of an avatar (ownership illusion). It has recently been shown that inducing the ownership illusion and then manipulating the movements of one’s self-avatar can lead to compensatory motor control strategies. In order to maximize this effect, there is a need for a method that measures and monitors embodiment levels of participants immersed in virtual reality (VR) to induce and maintain a strong ownership illusion. This is particularly true given that reaching a high level of both BCI performance and embodiment are inter-connected. To reach one of them, the second must be reached as well. Some limitations of many existing systems hinder their adoption for neurorehabilitation: 1- some use motor imagery (MI) of movements other than gait; 2- most systems allow the user to take single steps or to walk but do not allow both, which prevents users from progressing from steps to gait; 3- most of them function in a single BCI mode (cue-paced or self-paced), which prevents users from progressing from machine-dependent to machine-independent walking. Overcoming the aforementioned limitations can be done by combining different control modes and options in one single system. However, this would have a negative impact on BCI performance, therefore diminishing its usefulness as a potential rehabilitation tool. In this case, there will be a need to enhance BCI performance. For such purpose, many techniques have been used in the literature, such as providing modified feedback (whereby the presented feedback is not consistent with the user’s MI), sequential training (recalibrating the classifier as more data becomes available). This thesis was developed over 3 studies. The objective in study 1 was to investigate the possibility of measuring the level of embodiment of an immersive self-avatar, during the performing, observing and imagining of gait, using electroencephalogram (EEG) techniques, by presenting visual feedback that conflicts with the desired movement of embodied participants. The objective of study 2 was to develop and validate a BCI to control single steps and forward walking of an immersive virtual reality (VR) self-avatar, using mental imagery of these actions, in cue-paced and self-paced modes. Different performance enhancement strategies were implemented to increase BCI performance. The data of these two studies were then used in study 3 to construct a generic classifier that could eliminate offline calibration for future users and shorten training time. Twenty different healthy participants took part in studies 1 and 2. In study 1, participants wore an EEG cap and motion capture markers, with an avatar displayed in a head-mounted display (HMD) from a first-person perspective (1PP). They were cued to either perform, watch or imagine a single step forward or to initiate walking on a treadmill. For some of the trials, the avatar took a step with the contralateral limb or stopped walking before the participant stopped (modified feedback). In study 2, participants completed a 4-day sequential training to control the gait of an avatar in both BCI modes. In cue-paced mode, they were cued to imagine a single step forward, using their right or left foot, or to walk forward. In the self-paced mode, they were instructed to reach a target using the MI of multiple steps (switch control mode) or maintaining the MI of forward walking (continuous control mode). The avatar moved as a response to two calibrated regularized linear discriminant analysis (RLDA) classifiers that used the μ power spectral density (PSD) over the foot area of the motor cortex as features. The classifiers were retrained after every session. During the training, and for some of the trials, positive modified feedback was presented to half of the participants, where the avatar moved correctly regardless of the participant’s real performance. In both studies, the participants’ subjective experience was analyzed using a questionnaire. Results of study 1 show that subjective levels of embodiment correlate strongly with the power differences of the event-related synchronization (ERS) within the μ frequency band, and over the motor and pre-motor cortices between the modified and regular feedback trials. Results of study 2 show that all participants were able to operate the cued-paced BCI and the selfpaced BCI in both modes. For the cue-paced BCI, the average offline performance (classification rate) on day 1 was 67±6.1% and 86±6.1% on day 3, showing that the recalibration of the classifiers enhanced the offline performance of the BCI (p < 0.01). The average online performance was 85.9±8.4% for the modified feedback group (77-97%) versus 75% for the non-modified feedback group. For self-paced BCI, the average performance was 83% at switch control and 92% at continuous control mode, with a maximum of 12 seconds of control. Modified feedback enhanced BCI performances (p =0.001). Finally, results of study 3 show that the constructed generic models performed as well as models obtained from participant-specific offline data. The results show that there it is possible to design a participant-independent zero-training BCI.Les interfaces cerveau-ordinateur (ICO) ont été utilisées pour contrôler la marche d'un égo-avatar virtuel dans le but d'être utilisées dans la réadaptation de la marche. Une ICO décode les signaux du cerveau représentant un désir de faire produire un mouvement et les transforme en une commande de contrôle pour contrôler des appareils externes. Les sentiments décrits par les participants lorsqu'ils contrôlent un égo-avatar dans un environnement virtuel immersif démontrent que les humains peuvent être incarnés dans un corps d'un avatar (illusion de propriété). Il a été récemment démontré que provoquer l’illusion de propriété puis manipuler les mouvements de l’égo-avatar peut conduire à des stratégies de contrôle moteur compensatoire. Afin de maximiser cet effet, il existe un besoin d'une méthode qui mesure et surveille les niveaux d’incarnation des participants immergés dans la réalité virtuelle (RV) pour induire et maintenir une forte illusion de propriété. D'autre part, atteindre un niveau élevé de performances (taux de classification) ICO et d’incarnation est interconnecté. Pour atteindre l'un d'eux, le second doit également être atteint. Certaines limitations de plusieurs de ces systèmes entravent leur adoption pour la neuroréhabilitation: 1- certains utilisent l'imagerie motrice (IM) des mouvements autres que la marche; 2- la plupart des systèmes permettent à l'utilisateur de faire des pas simples ou de marcher mais pas les deux, ce qui ne permet pas à un utilisateur de passer des pas à la marche; 3- la plupart fonctionnent en un seul mode d’ICO, rythmé (cue-paced) ou auto-rythmé (self-paced). Surmonter les limitations susmentionnées peut être fait en combinant différents modes et options de commande dans un seul système. Cependant, cela aurait un impact négatif sur les performances de l’ICO, diminuant ainsi son utilité en tant qu'outil potentiel de réhabilitation. Dans ce cas, il sera nécessaire d'améliorer les performances des ICO. À cette fin, de nombreuses techniques ont été utilisées dans la littérature, telles que la rétroaction modifiée, le recalibrage du classificateur et l'utilisation d'un classificateur générique. Le projet de cette thèse a été réalisé en 3 études, avec objectif d'étudier dans l'étude 1, la possibilité de mesurer le niveau d'incarnation d'un égo-avatar immersif, lors de l'exécution, de l'observation et de l'imagination de la marche, à l'aide des techniques encéphalogramme (EEG), en présentant une rétroaction visuelle qui entre en conflit avec la commande du contrôle moteur des sujets incarnés. L'objectif de l'étude 2 était de développer un BCI pour contrôler les pas et la marche vers l’avant d'un égo-avatar dans la réalité virtuelle immersive, en utilisant l'imagerie motrice de ces actions, dans des modes rythmés et auto-rythmés. Différentes stratégies d'amélioration des performances ont été mises en œuvre pour augmenter la performance (taux de classification) de l’ICO. Les données de ces deux études ont ensuite été utilisées dans l'étude 3 pour construire des classificateurs génériques qui pourraient éliminer la calibration hors ligne pour les futurs utilisateurs et raccourcir le temps de formation. Vingt participants sains différents ont participé aux études 1 et 2. Dans l'étude 1, les participants portaient un casque EEG et des marqueurs de capture de mouvement, avec un avatar affiché dans un casque de RV du point de vue de la première personne (1PP). Ils ont été invités à performer, à regarder ou à imaginer un seul pas en avant ou la marche vers l’avant (pour quelques secondes) sur le tapis roulant. Pour certains essais, l'avatar a fait un pas avec le membre controlatéral ou a arrêté de marcher avant que le participant ne s'arrête (rétroaction modifiée). Dans l'étude 2, les participants ont participé à un entrainement séquentiel de 4 jours pour contrôler la marche d'un avatar dans les deux modes de l’ICO. En mode rythmé, ils ont imaginé un seul pas en avant, en utilisant leur pied droit ou gauche, ou la marche vers l’avant . En mode auto-rythmé, il leur a été demandé d'atteindre une cible en utilisant l'imagerie motrice (IM) de plusieurs pas (mode de contrôle intermittent) ou en maintenir l'IM de marche vers l’avant (mode de contrôle continu). L'avatar s'est déplacé en réponse à deux classificateurs ‘Regularized Linear Discriminant Analysis’ (RLDA) calibrés qui utilisaient comme caractéristiques la densité spectrale de puissance (Power Spectral Density; PSD) des bandes de fréquences µ (8-12 Hz) sur la zone du pied du cortex moteur. Les classificateurs ont été recalibrés après chaque session. Au cours de l’entrainement et pour certains des essais, une rétroaction modifiée positive a été présentée à la moitié des participants, où l'avatar s'est déplacé correctement quelle que soit la performance réelle du participant. Dans les deux études, l'expérience subjective des participants a été analysée à l'aide d'un questionnaire. Les résultats de l'étude 1 montrent que les niveaux subjectifs d’incarnation sont fortement corrélés à la différence de la puissance de la synchronisation liée à l’événement (Event-Related Synchronization; ERS) sur la bande de fréquence μ et sur le cortex moteur et prémoteur entre les essais de rétroaction modifiés et réguliers. L'étude 2 a montré que tous les participants étaient capables d’utiliser le BCI rythmé et auto-rythmé dans les deux modes. Pour le BCI rythmé, la performance hors ligne moyenne au jour 1 était de 67±6,1% et 86±6,1% au jour 3, ce qui montre que le recalibrage des classificateurs a amélioré la performance hors ligne du BCI (p <0,01). La performance en ligne moyenne était de 85,9±8,4% pour le groupe de rétroaction modifié (77-97%) contre 75% pour le groupe de rétroaction non modifié. Pour le BCI auto-rythmé, la performance moyenne était de 83% en commande de commutateur et de 92% en mode de commande continue, avec un maximum de 12 secondes de commande. Les performances de l’ICO ont été améliorées par la rétroaction modifiée (p = 0,001). Enfin, les résultats de l'étude 3 montrent que pour la classification des initialisations des pas et de la marche, il a été possible de construire des modèles génériques à partir de données hors ligne spécifiques aux participants. Les résultats montrent la possibilité de concevoir une ICO ne nécessitant aucun entraînement spécifique au participant

Investigating the Effects of Custom Made Orthotics on Brain Forms: A Pilot Study

OBJECTIVES: To determine (1) the feasibility of this novel approach and technique of recording brain activity, wirelessly and continuously, during human gait, and (2) if custom made orthotics will alter the brain activity patterns recorded. METHODS: Gait trials were performed on 16 participants walking with and without orthotic devices in their shoes while simultaneously collecting EEG data through the Emotiv wireless neuroheadset. RESULTS: The Emotiv neuroheadset was capable of detecting changes in brain activity between the two gait trials. The differences in brain activity identified between conditions were not statistically significant. CONCLUSION: The findings suggest the Emotiv EEG device is sensitive enough to detect changes in brain activation patterns during human gait. Further research is required before definite conclusions can be made about this novel device, or about what effects, if any, orthotics have on brain activation patterns during gait

Novel Neural Interfaces For Upper-Limb Motor Rehabilitation After Stroke

Stroke is the third most common cause of death and the main cause of acquired adult disability in developed countries. The most common consequence of stroke is motor impairment, which becomes chronic in 56% of stroke survivors. However, reorganization of brain networks can occur in response to sensory input, expe- rience and learning. Although several post-stroke neurorehabilitation techniques have been investigated, there is no standardized therapy for severely impaired chronic stroke patients except for brain-machine interfaces (BMIs), which have shown positive results but still fail to elicit full motor function restoration. This work presents novel neural interfaces that aim to improve the existing rehabilita- tion therapies and to offer an alternative treatment to severely paralyzed stroke patients. First, we propose a novel myoelectric interface (MI) that is calibrated with electromyographic (EMG) data from the healthy limb, mirrored and used as a reference model for the paretic arm in order to reshape the pathological muscle synergy organization of stroke patients. A 4-session motor training with this mir- ror MI sufficed to induce motor learning in 10 healthy participants, suggesting that it might be a potential tool for the correction of maladaptive muscle activations and by extension, for the subsequent motor rehabilitation after stroke. Second, although significant positive results have been achieved with non-invasive BMIs based on electroencephalographic (EEG) activity, the functional motor recovery induced by such therapies still remains modest mainly due to poor decoding per- formance. Here, we explored the possibility of using novel algorithms to increase the performance of multi-class EEG-decoding of movements from the same limb, showing encouraging but still limited results. Finally, we propose integrating the novel mirror MI into a cortico-muscular hybrid BMI that combines brain and resid- ual muscle activity to increase decoding accuracy and hence, allow a more natural and dexterous control of the interface, facilitating neuroplasticity and motor re- covery. The system was validated in a healthy participant and a stroke patient, setting the premise for its application in a clinical setup

ECoG correlates of visuomotor transformation, neural plasticity, and application to a force-based brain computer interface

Electrocorticography: ECoG) has gained increased notoriety over the past decade as a possible recording modality for Brain-Computer Interface: BCI) applications that offers a balance of minimal invasiveness to the patient in addition to robust spectral information over time. More recently, the scale of ECoG devices has begun to shrink to the order of micrometer diameter contacts and millimeter spacings with the intent of extracting more independent signals for BCI control within less cortical real-estate. However, most control signals to date, whether within the field of ECoG or any of the more seasoned recording techniques, have translated their control signals to kinematic control parameters: i.e. position or velocity of an object) which may not be practical for certain BCI applications such as functional neuromuscular stimulation: FNS). Thus, the purpose of this dissertation was to present a novel application of ECoG signals to a force-based control algorithm and address its feasibility for such a BCI system. Micro-ECoG arrays constructed from thin-film polyimide were implanted epidurally over areas spanning premotor, primary motor, and parietal cortical areas of two monkeys: three hemispheres, three arrays). Monkeys first learned to perform a classic center-out task using a brain signal-to-velocity mapping for control of a computer cursor. The BCI algorithm utilized day-to-day adaptation of the decoding model to match the task intention of the monkeys with no need for pre-screeening of movement-related ECoG signals. Using this strategy, subjects showed notable 2-D task profiency and increased task-related modulation of ECoG features within five training sessions. After fixing the last model trained for velocity control of the cursor, the monkeys then utilized this decoding model to control the acceleration of the cursor in the same center-out task. Cursor movement profiles under this mapping paralleled those demonstrated using velocity control, and neural control signal profiles revealed the monkeys actively accelerated and decelerated the cursor within a limited time window: 1-1.5 seconds). The fixed BCI decoding model was recast once again to control the force on a virtual cursor in a novel mass-grab task. This task required targets not only to reach to peripheral targets but also account for an additional virtual mass as they grabbed each target and moved it to a second target location in the presence of the external force of gravity. Examination of the ensemble control signals showed neural adaptation to variations in the perceived mass of the target as well as the presence or absence of gravity. Finally, short rest periods were interleaved within blocks of each task type to elucidate differences between active BCI intention and rest. Using a post-hoc state-decoder model, periods of active BCI task control could be distinguished from periods of rest with a very high degree of accuracy: ~99%). Taken together, the results from these experiments present a first step toward the design of a dynamics-based BCI system suitable for FNS applications as well as a framework for implementation of an asyncrhonous ECoG BCI

Neuroimaging of human motor control in real world scenarios: from lab to urban environment

The main goal of this research programme was to explore the neurophysiological correlates of human motor control in real-world scenarios and define mechanism-specific markers that could eventually be employed as targets of novel neurorehabilitation practice. As a result of recent developments in mobile technologies it is now possible to observe subjects' behaviour and monitor neurophysiological activity whilst they perform natural activities freely. Investigations in real-world scenarios would shed new light on mechanisms of human motor control previously not observed in laboratory settings and how they could be exploited to improve rehabilitative interventions for the neurologically impaired. This research programme was focussed on identifying cortical mechanisms involved in both upper- (i.e. reaching) and lower-limb (i.e. locomotion) motor control. Complementary results were obtained by the simultaneous recordings of kinematic, electromyographic and electrocorticographic signals. To study motor control of the upper-limb, a lab­based setup was developed, and the reaching movement of healthy young individuals was observed in both stable and unstable (i.e. external perturbation) situations. Robot-mediated force-field adaptation has the potential to be employed in rehabilitation practice to promote new skills learning and motor recovery. The muscular (i.e. intermuscular couplings) and neural (i.e. spontaneous oscillations and cortico­muscular couplings) indicators of the undergoing adaptation process were all symbolic of adaptive strategies employed during early stages of adaptation. The medial frontal, premotor and supplementary motor regions appeared to be the principal cortical regions promoting adaptive control and force modulation. To study locomotion control, a mobile setup was developed and daily life human activities (i.e. walking while conversing, walking while texting with a smartphone) were investigated outside the lab. Walking in hazardous environments or when simultaneously performing a secondary task has been demonstrated to be challenging for the neurologically impaired. Healthy young adults showed a reduced motor performance when walking in multitasking conditions, during which whole-brain and task-specific neural correlates were observed. Interestingly, the activity of the left posterior parietal cortex was predictive of the level of gait stability across individuals, suggesting a crucial role of this area in gait control and determination of subject specific motor capabilities. In summary, this research programme provided evidence on different cortical mechanisms operative during two specific scenarios for "real­world" motor behaviour in and outside the laboratory-setting in healthy subjects. The results suggested that identification of neuro-muscular indicators of specific motor control mechanisms could be exploited in future "real-world" rehabilitative practice

Analysis of sensorimotor rhythms based on lower-limbs motor imagery for brain-computer interface

Over recent years significant advancements in the field of assistive technologies have been observed. One of the paramount needs for the development and advancement that urged researchers to contribute in the field other than congenital or diagnosed chronic disorders, is the rising number of affectees from accidents, natural calamity (due to climate change), or warfare, worldwide resulting in spinal cord injuries (SCI), neural disorder, or amputation (interception) of limbs, that impede a human to live a normal life. In addition to this, more than ten million people in the world are living with some form of handicap due to the central nervous system (CNS) disorder, which is precarious. Biomedical devices for rehabilitation are the center of research focus for many years. For people with lost motor control, or amputation, but unscathed sensory control, instigation of control signals from the source, i.e. electrophysiological signals, is vital for seamless control of assistive biomedical devices. Control signals, i.e. motion intentions, arouse&amp;nbsp;&amp;nbsp;&amp;nbsp; in the sensorimotor cortex of the brain that can be detected using invasive or non-invasive modality. With non-invasive modality, the electroencephalography (EEG) is used to record these motion intentions encoded in electrical activity of the cortex, and are deciphered to recognize user intent for locomotion. They are further transferred to the actuator, or end effector of the assistive device for control purposes. This can be executed via the brain-computer interface (BCI) technology. BCI is an emerging research field that establishes a real-time bidirectional connection between the human brain and a computer/output device. Amongst its diverse applications, neurorehabilitation to deliver sensory feedback and brain controlled biomedical devices for rehabilitation are most popular. While substantial literature on control of upper-limb assistive technologies controlled via BCI is there, less is known about the lower-limb (LL) control of biomedical devices for navigation or gait assistance via BCI. The types&amp;nbsp; of EEG signals compatible with an independent BCI are the oscillatory/sensorimotor rhythms (SMR) and event-related potential (ERP). These signals have successfully been used in BCIs for navigation control of assistive devices. However, ERP paradigm accounts for a voluminous setup for stimulus presentation to the user during operation of BCI assistive device. Contrary to this, the SMR does not require large setup for activation of cortical activity; it instead depends on the motor imagery (MI) that is produced synchronously or asynchronously by the user. MI is a covert cognitive process also termed kinaesthetic motor imagery (KMI) and elicits clearly after rigorous training trials, in form of event-related desynchronization (ERD) or synchronization (ERS), depending on imagery activity or resting period. It usually comprises of limb movement tasks, but is not limited to it in a BCI paradigm. In order to produce detectable features that correlate to the user&amp;iquest;s intent, selection of cognitive task is an important aspect to improve the performance of a BCI. MI used in BCI predominantly remains associated with the upper- limbs, particularly hands, due to the somatotopic organization of the motor cortex. The hand representation area is substantially large, in contrast to the anatomical location of the LL representation areas in the human sensorimotor cortex. The LL area is located within the interhemispheric fissure, i.e. between the mesial walls of both hemispheres of the cortex. This makes it arduous to detect EEG features prompted upon imagination of LL. Detailed investigation of the ERD/ERS in the mu and beta oscillatory rhythms during left and right LL KMI tasks is required, as the user&amp;iquest;s intent to walk is of paramount importance associated to everyday activity. This is an important area of research, followed by the improvisation of the already existing rehabilitation system that serves the LL affectees. Though challenging, solution to these issues is also imperative for the development of robust controllers that follow the asynchronous BCI paradigms to operate LL assistive devices seamlessly. This thesis focusses on the investigation of cortical lateralization of ERD/ERS in the SMR, based on foot dorsiflexion KMI and knee extension KMI separately. This research infers the possibility to deploy these features in real-time BCI by finding maximum possible classification accuracy from the machine learning (ML) models. EEG signal is non-stationary, as it is characterized by individual-to-individual and trial-to-trial variability, and a low signal-to-noise ratio (SNR), which is challenging. They are high in dimension with relatively low number of samples available for fitting ML models to the data. These factors account for ML methods that were developed into the tool of choice&amp;nbsp; to analyse single-trial EEG data. Hence, the selection of appropriate ML model for true detection of class label with no tradeoff of overfitting is crucial. The feature extraction part of the thesis constituted of testing the band-power (BP) and the common spatial pattern (CSP) methods individually. The study focused on the synchronous BCI paradigm. This was to ensure the exhibition of SMR for the possibility of a practically viable control system in a BCI. For the left vs. right foot KMI, the objective was to distinguish the bilateral tasks, in order to use them as unilateral commands in a 2-class BCI for controlling/navigating a robotic/prosthetic LL for rehabilitation. Similar was the approach for left-right knee KMI. The research was based on four main experimental studies. In addition to the four studies, the research is also inclusive of the comparison of intra-cognitive tasks within the same limb, i.e. left foot vs. left knee and right foot vs. right knee tasks, respectively (Chapter 4). This added to another novel contribution towards the findings based on comparison of different tasks within the same LL. It provides basis to increase the dimensionality of control signals within one BCI paradigm, such as a BCI-controlled LL assistive device with multiple degrees of freedom (DOF) for restoration of locomotion function. This study was based on analysis of statistically significant mu ERD feature using BP feature extraction method. The first stage of this research comprised of the left vs. right foot KMI tasks, wherein the ERD/ERS that elicited in the mu-beta rhythms were analysed using BP feature extraction method (Chapter 5). Three individual features, i.e. mu ERD, beta ERD, and beta ERS were investigated on EEG topography and time-frequency (TF) maps, and average time course of power percentage, using the common average reference and bipolar reference methods. A comparative study was drawn for both references to infer the optimal method. This was followed by ML, i.e. classification of the three feature vectors (mu ERD, beta ERD, and beta ERS), using linear discriminant analysis (LDA), support vector machine (SVM), and k-nearest neighbour (KNN) algorithms, separately. Finally, the multiple correction statistical tests were done, in order to predict maximum possible classification accuracy amongst all paradigms for the most significant feature. All classifier models were supported with the statistical techniques of k-fold cross validation and evaluation of area under receiver-operator characteristic curves (AUC-ROC) for prediction of the true class label. The highest classification accuracy of 83.4% &amp;plusmn; 6.72 was obtained with KNN model for beta ERS feature. The next study was based on enhancing the classification accuracy obtained from previous study. It was based on using similar cognitive tasks as study in Chapter 5, however deploying different methodology for feature extraction and classification procedure. In the second study, ERD/ERS from mu and beta rhythms were extracted using CSP and filter bank common spatial pattern (FBCSP) algorithms, to optimize the individual spatial patterns (Chapter 6). This was followed by ML process, for which the supervised logistic regression (Logreg) and LDA were deployed separately. Maximum classification accuracy resulted in 77.5% &amp;plusmn; 4.23 with FBCSP feature vector and LDA model, with a maximum kappa coefficient of 0.55 that is in the moderate range of agreement between the two classes. The left vs. right foot discrimination results were nearly same, however the BP feature vector performed better than CSP. The third stage was based on the deployment of novel cognitive task of left vs. right knee extension KMI. Analysis of the ERD/ERS in the mu-beta rhythms was done for verification of cortical lateralization via BP feature vector (Chapter 7). Similar to Chapter 5, in this study the analysis of ERD/ERS features was done on the EEG topography and TF maps, followed by the determination of average time course and peak latency of feature occurrence. However, for this study, only mu ERD and beta ERS features were taken into consideration and the EEG recording method only comprised of common average reference. This was due to the established results from the foot study earlier, in Chapter 5, where beta ERD features showed less average amplitude. The LDA and KNN classification algorithms were employed. Unexpectedly, the left vs. right knee KMI reflected the highest accuracy of 81.04% &amp;plusmn; 7.5 and an AUC-ROC = 0.84, strong enough to be used in a real-time BCI as two independent control features. This was using KNN model for beta ERS feature. The final study of this research followed the same paradigm as used in Chapter 6, but for left vs. right knee KMI cognitive task (Chapter 8). Primarily this study aimed at enhancing the resulting accuracy from Chapter 7, using CSP and FBCSP methods with Logreg and LDA models respectively. Results were in accordance with those of the already established foot KMI study, i.e. BP feature vector performed better than the CSP. Highest classification accuracy of 70.00% &amp;plusmn; 2.85 with kappa score of 0.40 was obtained with Logreg using FBCSP feature vector. Results stipulated the utilization of ERD/ERS in mu and beta bands, as independent control features for discrimination of bilateral foot or the novel bilateral knee KMI tasks. Resulting classification accuracies implicate that any 2-class BCI, employing unilateral foot, or knee KMI, is suitable for real-time implementation. In conclusion, this thesis demonstrates the possible EEG pre-processing, feature extraction and classification methods to instigate a real-time BCI from the conducted studies. Following this, the critical aspects of latency in information transfer rate, SNR, and tradeoff between dimensionality and overfitting needs to be taken care of, during design of real-time BCI controller. It also highlights that there is a need for consensus over the development of standardized methods of cognitive tasks for MI based BCI. Finally, the application of wireless EEG for portable assistance is essential as it will contribute to lay the foundations of the development of independent asynchronous BCI based on SMR