Neuromechanical Biomarkers for Robotic Neurorehabilitation

: One of the current challenges for translational rehabilitation research is to develop the strategies to deliver accurate evaluation, prediction, patient selection, and decision-making in the clinical practice. In this regard, the robot-assisted interventions have gained popularity as they can provide the objective and quantifiable assessment of the motor performance by taking the kinematics parameters into the account. Neurophysiological parameters have also been proposed for this purpose due to the novel advances in the non-invasive signal processing techniques. In addition, other parameters linked to the motor learning and brain plasticity occurring during the rehabilitation have been explored, looking for a more holistic rehabilitation approach. However, the majority of the research done in this area is still exploratory. These parameters have shown the capability to become the "biomarkers" that are defined as the quantifiable indicators of the physiological/pathological processes and the responses to the therapeutical interventions. In this view, they could be finally used for enhancing the robot-assisted treatments. While the research on the biomarkers has been growing in the last years, there is a current need for a better comprehension and quantification of the neuromechanical processes involved in the rehabilitation. In particular, there is a lack of operationalization of the potential neuromechanical biomarkers into the clinical algorithms. In this scenario, a new framework called the "Rehabilomics" has been proposed to account for the rehabilitation research that exploits the biomarkers in its design. This study provides an overview of the state-of-the-art of the biomarkers related to the robotic neurorehabilitation, focusing on the translational studies, and underlying the need to create the comprehensive approaches that have the potential to take the research on the biomarkers into the clinical practice. We then summarize some promising biomarkers that are being under investigation in the current literature and provide some examples of their current and/or potential applications in the neurorehabilitation. Finally, we outline the main challenges and future directions in the field, briefly discussing their potential evolution and prospective

Performance Analysis of Vibrotactile and Slide-and-Squeeze Haptic Feedback Devices for Limbs Postural Adjustment

Recurrent or sustained awkward body postures are among the most frequently cited risk factors to the development of work-related musculoskeletal disorders (MSDs). To prevent workers from adopting harmful configurations but also to guide them toward more ergonomic ones, wearable haptic devices may be the ideal solution. In this paper, a vibrotactile unit, called ErgoTac, and a slide-and-squeeze unit, called CUFF, were evaluated in a limbs postural correction setting. Their capability of providing single-joint (shoulder or knee) and multi-joint (shoulder and knee at once) guidance was compared in twelve healthy subjects, using quantitative task-related metrics and subjective quantitative evaluation. An integrated environment was also built to ease communication and data sharing between the involved sensor and feedback systems. Results show good acceptability and intuitiveness for both devices. ErgoTac appeared as the suitable feedback device for the shoulder, while the CUFF may be the effective solution for the knee. This comparative study, although preliminary, was propaedeutic to the potential integration of the two devices for effective whole-body postural corrections, with the aim to develop a feedback and assistive apparatus to increase workers' awareness about risky working conditions and therefore to prevent MSDs

Human behavior understanding for worker-centered intelligent manufacturing

“In a worker-centered intelligent manufacturing system, sensing and understanding of the worker’s behavior are the primary tasks, which are essential for automatic performance evaluation & optimization, intelligent training & assistance, and human-robot collaboration. In this study, a worker-centered training & assistant system is proposed for intelligent manufacturing, which is featured with self-awareness and active-guidance. To understand the hand behavior, a method is proposed for complex hand gesture recognition using Convolutional Neural Networks (CNN) with multiview augmentation and inference fusion, from depth images captured by Microsoft Kinect. To sense and understand the worker in a more comprehensive way, a multi-modal approach is proposed for worker activity recognition using Inertial Measurement Unit (IMU) signals obtained from a Myo armband and videos from a visual camera. To automatically learn the importance of different sensors, a novel attention-based approach is proposed to human activity recognition using multiple IMU sensors worn at different body locations. To deploy the developed algorithms to the factory floor, a real-time assembly operation recognition system is proposed with fog computing and transfer learning. The proposed worker-centered training & assistant system has been validated and demonstrated the feasibility and great potential for applying to the manufacturing industry for frontline workers. Our developed approaches have been evaluated: 1) the multi-view approach outperforms the state-of-the-arts on two public benchmark datasets, 2) the multi-modal approach achieves an accuracy of 97% on a worker activity dataset including 6 activities and achieves the best performance on a public dataset, 3) the attention-based method outperforms the state-of-the-art methods on five publicly available datasets, and 4) the developed transfer learning model achieves a real-time recognition accuracy of 95% on a dataset including 10 worker operations”--Abstract, page iv

Biomechanical Assessments of the Upper Limb for Determining Fatigue, Strain and Effort from the Laboratory to the Industrial Working Place: A Systematic Review

Recent human-centered developments in the industrial field (Industry 5.0) lead companies and stakeholders to ensure the wellbeing of their workers with assessments of upper limb performance in the workplace, with the aim of reducing work-related diseases and improving awareness of the physical status of workers, by assessing motor performance, fatigue, strain and effort. Such approaches are usually developed in laboratories and only at times they are translated to on-field applications; few studies summarized common practices for the assessments. Therefore, our aim is to review the current state-of-the-art approaches used for the assessment of fatigue, strain and effort in working scenarios and to analyze in detail the differences between studies that take place in the laboratory and in the workplace, in order to give insights on future trends and directions. A systematic review of the studies aimed at evaluating the motor performance, fatigue, strain and effort of the upper limb targeting working scenarios is presented. A total of 1375 articles were found in scientific databases and 288 were analyzed. About half of the scientific articles are focused on laboratory pilot studies investigating effort and fatigue in laboratories, while the other half are set in working places. Our results showed that assessing upper limb biomechanics is quite common in the field, but it is mostly performed with instrumental assessments in laboratory studies, while questionnaires and scales are preferred in working places. Future directions may be oriented towards multi-domain approaches able to exploit the potential of combined analyses, exploitation of instrumental approaches in workplace, targeting a wider range of people and implementing more structured trials to translate pilot studies to real practice

A wireless sEMG-based body-machine interface for assistive technology devices

Assistive technology (AT) tools and appliances are being more and more widely used and developed worldwide to improve the autonomy of people living with disabilities and ease the interaction with their environment. This paper describes an intuitive and wireless surface electromyography (sEMG) based body-machine interface for AT tools. Spinal cord injuries at C5-C8 levels affect patients' arms, forearms, hands, and fingers control. Thus, using classical AT control interfaces (keypads, joysticks, etc.) is often difficult or impossible. The proposed system reads the AT users' residual functional capacities through their sEMG activity, and converts them into appropriate commands using a threshold-based control algorithm. It has proven to be suitable as a control alternative for assistive devices and has been tested with the JACO arm, an articulated assistive device of which the vocation is to help people living with upper-body disabilities in their daily life activities. The wireless prototype, the architecture of which is based on a 3-channel sEMG measurement system and a 915-MHz wireless transceiver built around a low-power microcontroller, uses low-cost off-the-shelf commercial components. The embedded controller is compared with JACO's regular joystick-based interface, using combinations of forearm, pectoral, masseter, and trapeze muscles. The measured index of performance values is 0.88, 0.51, and 0.41 bits/s, respectively, for correlation coefficients with the Fitt's model of 0.75, 0.85, and 0.67. These results demonstrate that the proposed controller offers an attractive alternative to conventional interfaces, such as joystick devices, for upper-body disabled people using ATs such as JACO

Otimização muscle-in-the-loop em tempo real para reabilitação física com um exosqueleto ativo: uma mudança de paradigma

Assisting human locomotion with a wearable robotic orthosis is still quite challenging, largely due to the complexity of the neuromusculoskeletal system, the time-varying dynamics that accompany motor adaptation, and the uniqueness of every individual’s response to the assistance given by the robot. To this day, these devices have not met their well-known promise yet, mostly due to the fact that they are not perfectly suitable for the rehabilitation of neuropathologic patients. One of the main challenges hampering this goal still relies on the interface and co-dependency between the human and the machine. Nowadays, most commercial exoskeletons replay pre-defined gait patterns, whereas research exoskeletons are switching to controllers based on optimized torque profiles. In most cases, the dynamics of the human musculoskeletal system are still ignored and do not take into account the optimal conditions for inducing a positive modulation of neuromuscular activity. This is because both rehabilitation strategies are still emphasized on the macro level of the whole joint instead of focusing on the muscles’ dynamics and activity, which are the actual anatomical elements that may need to be rehabilitated. Strategies to keep the human in the loop of the exoskeleton’s control laws in real-time may help to overcome these challenges. The main purpose of the present dissertation is to make a paradigm shift in the approach on how the assistance that is given to a subject by an exoskeleton is modelled and controlled during physical rehabilitation. Therefore, in the scope of the present work, it was intended to design, concede, implement, and validate a real-time muscle-in-the-loop optimization model to find the best assistive support ratio that would induce optimal rehabilitation conditions to a specific group of impaired muscles while having a minimum impact on the other healthy muscles. The developed optimization model was implemented in the form of a plugin and was integrated on a neuromechanical model-based interface for driving a bilateral ankle exoskeleton. Experimental pilot tests evaluated the feasibility and effectiveness of the model. Results of the most significant pilots achieved EMG reductions up to 61 ± 3 % in Soleus and 41 ± 10 % in Gastrocnemius Lateralis. Moreover, results also demonstrated the efficiency of the optimization’s specific reduction on rehabilitation by looking into the muscular fatigue after each experiment. Finally, two parallel preliminary studies emerged from the pilots, which looked at muscle adaptation, after a new assistive condition had been applied, over time and at the effect of the lateral positioning of the exoskeleton’s actuators on the leg muscles.Auxiliar a locomoção humana com uma ortose robótica ainda é bastante desafiante, em grande parte devido à complexidade do sistema neuromusculoesquelético, à dinâmica variável no tempo que acompanha a adaptação motora e à singularidade da resposta de cada indivíduo à assistência dada pelo robô. Até hoje, está por cumprir a promessa inicial destes dispositivos, principalmente devido ao facto de não serem perfeitamente adequados para a reabilitação de pacientes neuropatológicos. Um dos principais desafios que dificultam esse objetivo foca-se ainda na interface e na co-dependência entre o ser humano e a máquina. Hoje em dia, a maioria dos exoesqueletos comerciais reproduz padrões de marcha predefinidos, enquanto que os exoesqueletos em investigação estão só agora a mudar para controladores com base em perfis de binário otimizados. Na maioria dos casos, a dinâmica do sistema musculoesquelético humano ainda é ignorada e não tem em consideração as condições ideais para induzir uma modulação positiva da atividade neuromuscular. Isso ocorre porque ambas as estratégias de reabilitação ainda são enfatizadas no nível macro de toda a articulação, em vez de se concentrar na dinâmica e atividade dos músculos, que são os elementos anatómicos que realmente precisam de ser reabilitados. Estratégias para manter o ser humano em loop nos comandos que controlam o exoesqueleto em tempo real podem ajudar a superar estes desafios. O principal objetivo desta dissertação é fazer uma mudança de paradigma na abordagem em como a assistência que é dada a um sujeito por um exosqueleto é modelada e controlada durante a reabilitação física. Portanto, no contexto do presente trabalho, pretendeu-se projetar, conceder, implementar e validar um modelo de otimização muscle-in-the-loop em tempo real para encontrar a melhor relação de suporte capaz de induzir as condições ideais de reabilitação para um grupo específico de músculos fragilizados, tendo um impacto mínimo nos outros músculos saudáveis. O modelo de otimização desenvolvido foi implementado na forma de um plugin e foi integrado numa interface baseada num modelo neuromecânico para o controlo de um exoesqueleto bilateral de tornozelo. Testes experimentais piloto avaliaram a viabilidade e a eficácia do modelo. Os resultados dos testes mais significativos demonstraram reduções de EMG de até 61 ± 3 % no Soleus e 41 ± 10 % no Gastrocnemius Lateral. Adicionalmente, os resultados demonstraram também a eficiência em reabilitação da redução específica no EMG devido à otimização tendo em conta a fadiga muscular após cada teste. Finalmente, dois estudos preliminares paralelos emergiram dos testes piloto, que analisaram a adaptação muscular após uma nova condição assistiva ter sido definida ao longo do tempo e o efeito do posicionamento lateral dos atuadores do exoesqueleto nos músculos da perna.Mestrado em Engenharia Biomédic