Development of EEG-based technologies for the characterization and treatment of neurological diseases affecting the motor function

This thesis presents a set of studies applying signal processing and data mining techniques in real-time working systems to register, characterize and condition the movement-related cortical activity of healthy subjects and of patients with neurological disorders affecting the motor function. Patients with two of the most widespread neurological affections impairing the motor function are considered here: patients with essential tremor and patients who have suffered a cerebro-vascular accident. The different chapters in the presented thesis show results regarding the normal cortical activity associated with the planning and execution of motor actions with the upper-limb, and the pathological activity related to the patients' motor dysfunction (measurable with muscle electrodes or movement sensors). The initial chapters of the book present i) a revision of the basic concepts regarding the role of the cerebral cortex in the motor control and the way in which the electroencephalographic activity allows its analysis and conditioning, ii) a study on the cortico-muscular interaction at the tremor frequency in patients with essential tremor under the effects of a drug reducing their tremor, and finally iii) a study based on evolutionary algorithms that aims to identify cortical patterns related to the planning of a number of motor tasks performed with a single arm. In the second half of the thesis book, two brain-computer interface systems to be used in rehabilitation scenarios with essential tremor patients and with patients with a stroke are proposed. In the first system, the electroencephalographic activity is used to anticipate voluntary movement actions, and this information is integrated in a multimodal platform estimating and suppressing the pathological tremors. In the second case, a conditioning paradigm for stroke patients based on the identification of the motor intention with temporal precision is presented and tested with a cohort of four patients along a month during which the patients undergo eight intervention sessions. The presented thesis has yielded advances from both the technological and the scientific points of view in all studies proposed. The main contributions from the technological point of view are: ¿ The design of an integrated upper-limb platform working in real-time. The platform was designed to acquire information from different types of noninvasive sensors (EEG, EMG and gyroscopic sensors) characterizing the planning and execution of voluntary movements. The platform was also capable of processing online the acquired data and generating an electrical feedback. ¿ The development of signal processing and classifying techniques adapted to the kind of signal recorded in the two kinds of patients considered in this thesis (patients with essential tremor and patients with a stroke) and to the requirements of online processing and real-time single-trial function desired for BCI applications. Especially in this regard, an original methodology to detect onsets of voluntary movements using slow cortical potentials and cortical rhythms has been presented. ¿ The design and validation in real-time of asynchronous BCI systems using motor planning EEG segments to anticipate or detect when patients begin a voluntary movement with the upper-limb. ¿ The proof of concept of the advantages of an EEG system integrated in a multimodal human-robot interface architecture that constitutes the first multimodal interface using the combined acquisition of EEG, EMG and gyroscopic data, which allows the concurrent characterization of different parts of the body associated with the execution of a movement. The main scientific contributions of this thesis are: ¿ The study of the EEG-based anticipation of voluntary movements presented in Chapter 5 of the thesis was the first demonstration (to the author's knowledge) of the capacity of the EEG signal to provide reliable movement predictions based on single-trial classification of online data of healthy subjects and ET patients. This study also provides, for the first time, the results of a BCI system tested in ET patients and it represents an original approach to BCI applications for this group of patients. ¿ It has been presented the first neurophysiological study using EEG and EMG data to analyze the effects of a drug on cortical activity and tremors of patients with ET. In addition, the obtained results have shown for the first time that a significant correlation exists between the dynamics of specific cortical oscillations and pathological tremor manifestation as a consequence of the drug effects. ¿ It has been proposed for the first time an experiment to inspect whether the EEG signal carries enough information to classify up to seven different tasks performed with a single limb. Both the methodology applied and the validation procedure are also innovative in this sort of studies. ¿ It has been demonstrated for the first time the relevance of combining different cortical sources of information (such as BP and ERD) to estimate the initiation of voluntary movements with the upper-limb. In this line, special relevance may be given to the positive results achieved with stroke patients, improving the results presented by similar previous EEG-based studies by other research groups. It has also been proposed for the first time an upper-limb intervention protocol for stroke patients using BP and ERD patterns to provide proprioceptive feedback tightly associated with the patients' expectations of movement. The effects of the proposed intervention have been studied with a small group of patients

Avances en el control mental de una mano robótica

Introduction: The present article is the product of the research "Advances in the mental control of a robotic hand", developed at the University of Pamplona in the year 2019. Problem: Currently one of the main problems presented by robotic hand prostheses is the way in which the user indicates the movements to be performed. Given this, the best results have been obtained using invasive systems. Objective: The main objective of the system is to allow a person to control the movements and / or gestures of a robotic hand using their thoughts, in such a way that the control is as natural and precise as possible. Methodology: Use is made of a non-invasive, low-cost brain-computer interface (BCI) for the generation of control system references. Results: The performance of the system is directly subject to the user's ability to recreate actions or movements in their mind; the more defined your thinking, the better the control response. Conclusion: Mind control represents a new challenge for users, but as it is used, it becomes a more natural and precise control method, offering great control possibilities to people who make daily use of robotic hand prostheses. Originality: Through this research, an alternative is formulated for the control of hand prostheses, which does not require invasive systems and has the advantage of being low cost. Limitations: Frustration, stress and external noise are factors that directly affect the performance of the system

Fusion of virtual reality and brain-machine interfaces for the assessment and rehabilitation of patients with spinal cord injury

La presente tesis está centrada en la utilización de nuevas tecnologías (Interfaces Cerebro-Máquina y Realidad Virtual). En la primera parte de la tesis se describe la definición y la aplicación de un conjunto de métricas para evaluar el estado funcional de los pacientes con lesión medular en el contexto de un sistema de realidad virtual para la rehabilitación de los miembros superiores. El objetivo de este primer estudio es demostrar que la realidad virtual puede utilizarse, en combinación con sensores inerciales para rehabilitar y evaluar simultáneamente. 15 pacientes con lesión medular llevaron a cabo 3 sesiones con el sistema de realidad virtual Toyra y se aplicó el conjunto definido de métricas a las grabaciones obtenidas con los sensores inerciales. Se encontraron correlaciones entre algunas de las métricas definidas y algunas de las escalas clínicas utilizadas con frecuencia en el contexto de la rehabilitación. En la segunda parte de la tesis se ha combinado una retroalimentación virtual con un estimulador eléctrico funcional (en adelante FES, por sus siglas en inglés Functional Electrical Stimulator), ambos controlados por un Interfaz Cerebro-Máquina (BMI por sus siglas en inglés Brain-Machine Interface), para desarrollar un nuevo tipo de enfoque terapéutico para los pacientes. El sistema ha sido utilizado por 4 pacientes con lesión medular que intentaron mover sus manos. Esta intención desencadenó simultáneamente el FES y la retroalimentación virtual, cerrando la mano de los pacientes y mostrándoles una fuente adicional de retroalimentación para complementar la terapia. Este trabajo es, de acuerdo al estado del arte revisado, el primero que integra BMI, FES y realidad virtual como terapia para pacientes con lesión medular. Se han obtenido resultados clínicos prometedores por 4 pacientes con lesión medular después de realizar 5 sesiones de terapia con el sistema, mostrando buenos niveles de precisión en las diferentes sesiones (79,13% en promedio). En la tercera parte de la tesis se ha definido una nueva métrica para estudiar los cambios de conectividad cerebral en los pacientes con lesión medular, que incluye información de las interacciones neuronales entre diferentes áreas. El objetivo de este estudio ha sido extraer información clínicamente relevante de la actividad del EEG cuando se realizan terapias basadas en BMI

Enhancement of Robot-Assisted Rehabilitation Outcomes of Post-Stroke Patients Using Movement-Related Cortical Potential

Post-stroke rehabilitation is essential for stroke survivors to help them regain independence and to improve their quality of life. Among various rehabilitation strategies, robot-assisted rehabilitation is an efficient method that is utilized more and more in clinical practice for motor recovery of post-stroke patients. However, excessive assistance from robotic devices during rehabilitation sessions can make patients perform motor training passively with minimal outcome. Towards the development of an efficient rehabilitation strategy, it is necessary to ensure the active participation of subjects during training sessions. This thesis uses the Electroencephalography (EEG) signal to extract the Movement-Related Cortical Potential (MRCP) pattern to be used as an indicator of the active engagement of stroke patients during rehabilitation training sessions. The MRCP pattern is also utilized in designing an adaptive rehabilitation training strategy that maximizes patients’ engagement. This project focuses on the hand motor recovery of post-stroke patients using the AMADEO rehabilitation device (Tyromotion GmbH, Austria). AMADEO is specifically developed for patients with fingers and hand motor deficits. The variations in brain activity are analyzed by extracting the MRCP pattern from the acquired EEG data during training sessions. Whereas, physical improvement in hand motor abilities is determined by two methods. One is clinical tests namely Fugl-Meyer Assessment (FMA) and Motor Assessment Scale (MAS) which include FMA-wrist, FMA-hand, MAS-hand movements, and MAS-advanced hand movements’ tests. The other method is the measurement of hand-kinematic parameters using the AMADEO assessment tool which contains hand strength measurements during flexion (force-flexion), and extension (force-extension), and Hand Range of Movement (HROM)

EEG and ECoG features for Brain Computer Interface in Stroke Rehabilitation

The ability of non-invasive Brain-Computer Interface (BCI) to control an exoskeleton was used for motor rehabilitation in stroke patients or as an assistive device for the paralyzed. However, there is still a need to create a more reliable BCI that could be used to control several degrees of Freedom (DoFs) that could improve rehabilitation results. Decoding different movements from the same limb, high accuracy and reliability are some of the main difficulties when using conventional EEG-based BCIs and the challenges we tackled in this thesis. In this PhD thesis, we investigated that the classification of several functional hand reaching movements from the same limb using EEG is possible with acceptable accuracy. Moreover, we investigated how the recalibration could affect the classification results. For this reason, we tested the recalibration in each multi-class decoding for within session, recalibrated between-sessions, and between sessions. It was shown the great influence of recalibrating the generated classifier with data from the current session to improve stability and reliability of the decoding. Moreover, we used a multiclass extension of the Filter Bank Common Spatial Patterns (FBCSP) to improve the decoding accuracy based on features and compared it to our previous study using CSP. Sensorimotor-rhythm-based BCI systems have been used within the same frequency ranges as a way to influence brain plasticity or controlling external devices. However, neural oscillations have shown to synchronize activity according to motor and cognitive functions. For this reason, the existence of cross-frequency interactions produces oscillations with different frequencies in neural networks. In this PhD, we investigated for the first time the existence of cross-frequency coupling during rest and movement using ECoG in chronic stroke patients. We found that there is an exaggerated phase-amplitude coupling between the phase of alpha frequency and the amplitude of gamma frequency, which can be used as feature or target for neurofeedback interventions using BCIs. This coupling has been also reported in another neurological disorder affecting motor function (Parkinson and dystonia) but, to date, it has not been investigated in stroke patients. This finding might change the future design of assistive or therapeuthic BCI systems for motor restoration in stroke patients

Control of an ambulatory exoskeleton with a brain-machine interface for spinal cord injury gait rehabilitation

The closed-loop control of rehabilitative technologies by neural commands has shown a great potential to improve motor recovery in patients suffering from paralysis. Brain-machine interfaces (BMI) can be used as a natural control method for such technologies. BMI provides a continuous association between the brain activity and peripheral stimulation, with the potential to induce plastic changes in the nervous system. Paraplegic patients, and especially the ones with incomplete injuries, constitute a potential target population to be rehabilitated with brain-controlled robotic systems, as they may improve their gait function after the reinforcement of their spared intact neural pathways. This paper proposes a closed-loop BMI system to control an ambulatory exoskeleton-without any weight or balance support-for gait rehabilitation of incomplete spinal cord injury (SCI) patients. The integrated system was validated with three healthy subjects, and its viability in a clinical scenario was tested with four SCI patients. Using a cue-guided paradigm, the electroencephalographic signals of the subjects were used to decode their gait intention and to trigger the movements of the exoskeleton. We designed a protocol with a special emphasis on safety, as patients with poor balance were required to stand and walk. We continuously monitored their fatigue and exertion level, and conducted usability and user-satisfaction tests after the experiments. The results show that, for the three healthy subjects, 84.44 ± 14.56% of the trials were correctly decoded. Three out of four patients performed at least one successful BMI session, with an average performance of 77.6 1 ± 14.72%. The shared control strategy implemented (i.e., the exoskeleton could only move during specific periods of time) was effective in preventing unexpected movements during periods in which patients were asked to relax. On average, 55.22 ± 16.69% and 40.45 ± 16.98% of the trials (for healthy subjects and patients, respectively) would have suffered from unexpected activations (i.e., false positives) without the proposed control strategy. All the patients showed low exertion and fatigue levels during the performance of the experiments. This paper constitutes a proof-of-concept study to validate the feasibility of a BMI to control an ambulatory exoskeleton by patients with incomplete paraplegia (i.e., patients with good prognosis for gait rehabilitation)

Event-related desynchronization during movement attempt and execution in severely paralyzed stroke patients: An artifact removal relevance analysis

The electroencephalogram (EEG) constitutes a relevant tool to study neural dynamics and to develop brain-machine interfaces (BMI) for rehabilitation of patients with paralysis due to stroke. However, the EEG is easily contaminated by artifacts of physiological origin, which can pollute the measured cortical activity and bias the interpretations of such data. This is especially relevant when recording EEG of stroke patients while they try to move their paretic limbs, since they generate more artifacts due to compensatory activity. In this paper, we study how physiological artifacts (i.e., eye movements, motion artifacts, muscle artifacts and compensatory movements with the other limb) can affect EEG activity of stroke patients. Data from 31 severely paralyzed stroke patients performing/attempting grasping movements with their healthy/paralyzed hand were analyzed offline. We estimated the cortical activation as the event-related desynchronization (ERD) of sensorimotor rhythms and used it to detect the movements with a pseudo-online simulated BMI. Automated state-of-the-art methods (linear regression to remove ocular contaminations and statistical thresholding to reject the other types of artifacts) were used to minimize the influence of artifacts. The effect of artifact reduction was quantified in terms of ERD and BMI performance. The results reveal a significant contamination affecting the EEG, being involuntary muscle activity the main source of artifacts. Artifact reduction helped extracting the oscillatory signatures of motor tasks, isolating relevant information from noise and revealing a more prominent ERD activity. Lower BMI performances were obtained when artifacts were eliminated from the training datasets. This suggests that artifacts produce an optimistic bias that improves theoretical accuracy but may result in a poor link between task-related oscillatory activity and BMI peripheral feedback. With a clinically relevant dataset of stroke patients, we evidence the need of appropriate methodologies to remove artifacts from EEG datasets to obtain accurate estimations of the motor brain activity.This study was funded by the fortüne-Program of the University of Tübingen (2422-0-1 and 2452-0-0), the Bundesministerium für Bildung und Forschung BMBF MOTORBIC (FKZ 13GW0053) and AMORSA (FKZ 16SV7754), the Deutsche Forschungsgemeinschaft (DFG), the Basque Government Science Program (EXOTEK: KK 2016/00083). The work of A. Insausti-Delgado was supported by the Basque Government's scholarship for predoctoral students

EEG-EMG Analysis Method in Hybrid Brain Computer Interface for Hand Rehabilitation Training

Brain-computer interfaces (BCIs) have demonstrated immense potential in aiding stroke patients during their physical rehabilitation journey. By reshaping the neural circuits connecting the patient’s brain and limbs, these interfaces contribute to the restoration of motor functions, ultimately leading to a significant improvement in the patient’s overall quality of life. However, the current BCI primarily relies on Electroencephalogram (EEG) motor imagery (MI), which has relatively coarse recognition granularity and struggles to accurately recognize specific hand movements. To address this limitation, this paper proposes a hybrid BCI framework based on Electroencephalogram and Electromyography (EEG-EMG). The framework utilizes a combination of techniques: decoding EEG by using Graph Convolutional LSTM Networks (GCN-LSTM) to recognize the subject’s motion intention, and decoding EMG by using a convolutional neural network (CNN) to accurately identify hand movements. In EEG decoding, the correlation between channels is calculated using Standardized Permutation Mutual Information (SPMI), and the decoding process is further explained by analyzing the correlation matrix. In EMG decoding, experiments are conducted on two task paradigms, both achieving promising results. The proposed framework is validated using the publicly available WAL-EEG-GAL (Wearable interfaces for hand function recovery Electroencephalography Grasp-And-Lift) dataset, where the average classification accuracies of EEG and EMG are 0.892 and 0.954, respectively. This research aims to establish an efficient and user-friendly EEG-EMG hybrid BCI, thereby facilitating the hand rehabilitation training of stroke patients