Classification of electroencephalogram (EEG) for lower limb movement of post stroke patients using artificial neural network (ANN)

Nowadays, many neurological conditions happen suddenly, such as stroke or spinal cord injury. This can cause chronic gait function impairment due to functional deficits in motor control. Current physiotherapy techniques such as functional electrical stimulation (FES) can be used to reconstruct some skills needed for movements of daily life. However, FES system provides only a limited degree of motor function recovery and has no mechanism for reflecting a patient’s motor intentions, hence requires novel therapies. Brain-Computer Interfaces (BCI) provides the means to decode mental states and activate devices according to user intentions. However, conventional BCI cannot be used fully, due to the lack of accuracy, and need some improvement. In addition to that, the integration of BCI with lower extremity FES systems has received less attention compared to the BCI-FES systems with upper extremity. The discussion of this thesis was divided into two parts, which were the BCI part as input and the functional electrical stimulator (FES) controller part as the output for this system. For BCI part, the main processes involved are brainwave signals classification and mapping process. Here the signal has been classed will be applied to match the appropriate rehabilitation exercise. Whereas for the FES part, the signal from the mapping system will be controlled by the controller to ensure that the target knee angle is achieved to make the rehabilitation process more effective. As a conclusion, patients can be classified into two classes based on their alpha and beta signals status and these must undergone rehabilitation sessions according to their post-stroke level. So the results proved that the ANN model developed was able to classify the post-stroke severity. Also, the result had proven that the BCI fuzzy-based mapping system in this study was able to work perfectly into mapping the post-stroke patient with a suitable exercise according to their post-stroke level

Application of Micro-Electro-Mechanical Systems as Neural Interface

Micro-Electro-Mechanical Systems (MEMS) technology comprises of developing miniaturized mechanical and electro-mechanical elements such that the physical dimensions of these devices vary from micron to few millimeters in size.In various human disease disorders, the neural or body regulatory tissues are incapable of conveying commands directly to the target organ and unable to receive appropriate information from receptor mechanism to decide the future course of action. The MEMS based devices are playing important assistive role by becoming crucial interface in treating such disorders. These devices are increasingly being deployed inside the body at sub tissue levels to fulfill information receipt or command transmission gap, thereby enabling the governing tissue opportunity and environment to work effectively, leading to improvement in the neural signal recording and quality of life of the concerned individual. The aim of this paper is to review the present and future of MEMS based devices widely being employed as neural interface in penetrating probes, nerve regeneration, neuron culture and drug delivery devices depending on type of treatment provided to specific neural disorders. Further, they have been recently employed in developing advanced neuro-computer, nerve stimulators, wheel chair control based on head and hand movements and in medical robotics. Due to their stability, biocompatibility, usage and wider acceptability these MEMS based neural interface devices are providing future hope for their deployment in conquering various neurological disorders

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

A 12 month follow up of the re-education of arm and hand function following stroke (Reach) randomised controlled trial : a mixed methods study

Functional electrical stimulation (FES) has shown promise as a treatment for upper limb rehabilitation following stroke, although current devices are limited in functionality. To address this a new movement-triggered FES device was developed and trialled in people with chronic stroke in the REAcH study.Studies of long term effects of FES have been limited both in time (up to 9-months post intervention) and scope (focusing only on quantitative outcomes). Therefore, this mixed methods study followed up a sub-set of participants in the REAcH study at the Salford site at 12 months post intervention with the aims of: 1. Identifying whether changes in impairment, function and Quality of Life seen during REACH were maintained at 12 months. 2. Whether the changes in outcomes could be attributed to the nature of the intervention. 3. Exploring the experiences of the participants’ upper limb post stroke recovery during the REAcH study and over the 12 month follow up period.Measures taken during the REACH study were repeated 12 months following the end of the intervention period, and semi-structured interviews were carried out. Statistical and thematic analysis were used to present data.The nine participants recruited showed no statistically significant differences in all but two domains of the SIS, participation (p=0.03) and recovery (p = 0.006) at the end of intervention which were maintained at follow up. Some changes in study measures were seen at an individual level, which in cases were maintained, or showed continued improvement over the 12 month follow up. Thematic analysis identified long term positive outcomes from exercise and FES interventions in chronic stroke as well as non-physical issues which influence upper limb recovery. A degree of mismatch between quantitative and qualitative measures was noted, in line with recent research. Consideration of inclusion of both measures in future studies can assist to fully evaluate the effect of an intervention

Comprehending the Safety Paradox and Privacy Concerns with Medical Device Remote Patient Monitoring

Medical literature identifies a number of technology-driven improvements in disease management such as implantable medical devices (IMDs) that are a standard treatment for candidates with specific diseases. Among patients using implantable cardiac defibrillators (ICD), for example, problems and issues are being discovered faster compared to patients without monitoring, improving safety. What is not known is why patients report not feeling safer, creating a safety paradox, and why patients identify privacy concerns in ICD monitoring. There is a major gap in the literature regarding the factors that contribute to perceived safety and privacy in remote patient monitoring (RPM). To address this gap, the research goal of this study was to provide an interpretive account of the experience of RPM patients. This study investigated two research questions: 1) How did RPM recipients perceive safety concerns?, and 2) How did RPM recipients perceive privacy concerns? To address the research questions, in-depth, semi-structured interviews were conducted with six participants to explore individual perceptions in rich detail using interpretative phenomenological analysis (IPA). Four themes were identified and described based on the analysis of the interviews that include — comfort with perceived risk, control over information, education, and security — emerged from the iterative review and data analysis. Participants expressed comfort with perceived risk, however being scared and anxious were recurrent subordinate themes. The majority of participants expressed negative feelings as a result of an initial traumatic event related to their devices and lived in fear of being shocked in inopportune moments. Most of these concerns stem from lack of information and inadequate education. Uncertainties concerning treatment tends to be common, due to lack of feedback from ICD RPM status. Those who knew others with ICD RPM became worrisome after hearing about incidences of sudden cardiac death (SCD) when the device either failed or did not work adequately to save their friend’s life. Participants also expressed cybersecurity concerns that their ICD might be hacked, maladjusted, manipulated with magnets, or turned off. They believed ICD RPM security was in place but inadequate as well as reported feeling a lack of control over information. Participants expressed wanting the right to be left alone and in most cases wanted to limit others’ access to their information, which in turn, created conflict within families and loved ones. Geolocation was a contentious node in this study, with most of participants reporting they did not want to be tracked under any circumstances. This research was needed because few researchers have explored how people live and interact with these newer and more advanced devices. These findings have implications for practice relating to RPM safety and privacy such as identifying a gap between device companies, practitioners, and participants and provided directions for future research to discover better ways to live with ICD RPM and ICD shock

Investigation and Quantification of FES Exercise – Isometric Electromechanics and Perceptions of Its Usage as an Exercise Modality for Various Populations

Functional Electrical Stimulation (FES) is the triggering of muscle contraction by use of an electrical current. It can be used to give paralyzed individuals several health benefits, through allowing artificial movement and exercise. Although many FES devices exist, many aspects require innovation to increase usability and home translation. In addition, the effect of changing electrical parameters on limb biomechanics is not entirely understood; in particular with regards to stimulation duty cycle. This thesis has two distinct components. In the first (public health component), interview studies were conducted to understand several issues related to FES technology enhancement, implementation and home translation. In the second (computational biomechanics component), novel signal processing algorithms were designed that can be used to measure mechanical responses of muscles subjected to electrical stimulation. These experiments were performed by changing duty cycle and measuring its effect on quadriceps-generated knee torque. The studies of this thesis have presented several ideas, toolkits and results which have the potential to guide future FES biomechanics studies and the translatability of systems into regular usage for patients. The public health studies have provided conceptual frameworks upon which FES may be used in the home by patients. In addition, they have elucidated a range of issues that need to be addressed should FES technology reach its true potential as a therapy. The computational biomechanics studies have put forward novel data analysis techniques which may be used for understanding how muscle responds to electrical stimulation, as measured via torque. Furthermore, the effect of changing the electrical stimulation duty cycle on torque was successfully described, adding to an understanding of how electrical stimulation parameter modulation can influence joint biomechanics

The evaluation of and comparative evidence for two types of interventional devices for foot-drop of central neurological origin

Introduction This thesis focusses on ankle foot orthoses (AFO) and functional electrical stimulation (FES) for the correction of foot-drop. It consists of two parts linked through identification of three gaps in the knowledge base: 1) limitations in device design, 2) limitations in device evaluation and 3) a lack of clear clinical guidance surrounding which of the two devices to use. Methods and Results PART 1 reports on the design and evaluation of an AFO alternative (dorsiflex sock) and an alternative to conventional FES systems (ShefStim®). Article 1 reports the evaluation of the researcher/user co-design approach used in the development of both devices, finding that lay-advisory involvement guided aspects such as where to locate the stimulator and informed the revision of the evaluation studies. Article 2 used a single case experimental design with 2 stroke participants to preliminarily explore the efficacy and user views of the dorsiflex sock. It found no clear evidence to demonstrate that the dorsiflex sock with its current design was effective, despite user views to the contrary. Article 3 reported on the feasibility of ShefStim®. Seven current foot-drop FES users used ShefStim® unsupervised for two weeks at home, alongside gait laboratory testing of foot-clearance and kinematics at initial contact. Number of heel rises in day-day use was logged, as well as user satisfaction, donning/setup times and diary data. This data demonstrated that ShefStim® could be used in the community. Lab-based testing suggested that ShefStim® was comparable to conventional FES systems with regards kinematics at initial contact and foot-clearance. User satisfaction was comparable for both devices. However, further product refinement around setup and the electrode array-skin interface is necessary to make ShefStim® commercially viable. Article 4 reports on the design, development and evaluation of ShefStim®. PART 2 comprises two meta-analyses focussing on orthotic (Article 5) and therapeutic (Article 6) effects. Article 5 revealed statistically comparable positive orthotic effects on walking speed, exercise capacity and the stroke impact scale. Article 6 found comparable therapeutic speed increases, but both reviews highlighted the lack of high quality evidence on use of each device outside of the laboratory. It was not possible draw any conclusions about the mechanisms-of-action underlying these findings. Conclusion and future study The dorsiflex sock and ShefStim® are both feasible devices and the novel approaches taken to their evaluation merit wider use in the field. Further work is necessary to improve the design of both devices before definitive clinical trials are carried out. Despite AFO and FES showing similar levels of efficacy there is very little published work on the real world evaluation of either type of device or foot-drop specific mechanistic evaluations that might help to guide clinical choice. Therefore, this thesis highlights the need for further comparative randomised controlled trials, focussing on biomechanical and real world measures, informed by potential end-users