A brain-computer interface integrated with virtual reality and robotic exoskeletons for enhanced visual and kinaesthetic stimuli

Brain-computer interfaces (BCI) allow the direct control of robotic devices for neurorehabilitation and measure brain activity patterns following the user’s intent. In the past two decades, the use of non-invasive techniques such as electroencephalography and motor imagery in BCI has gained traction. However, many of the mechanisms that drive the proficiency of humans in eliciting discernible signals for BCI remains unestablished. The main objective of this thesis is to explore and assess what improvements can be made for an integrated BCI-robotic system for hand rehabilitation. Chapter 2 presents a systematic review of BCI-hand robot systems developed from 2010 to late 2019 in terms of their technical and clinical reports. Around 30 studies were identified as eligible for review and among these, 19 were still in their prototype or pre-clinical stages of development. A degree of inferiority was observed from these systems in providing the necessary visual and kinaesthetic stimuli during motor imagery BCI training. Chapter 3 discusses the theoretical background to arrive at a hypothesis that an enhanced visual and kinaesthetic stimulus, through a virtual reality (VR) game environment and a robotic hand exoskeleton, will improve motor imagery BCI performance in terms of online classification accuracy, class prediction probabilities, and electroencephalography signals. Chapters 4 and 5 focus on designing, developing, integrating, and testing a BCI-VR-robot prototype to address the research aims. Chapter 6 tests the hypothesis by performing a motor imagery BCI paradigm self-experiment with an enhanced visual and kinaesthetic stimulus against a control. A significant increase (p = 0.0422) in classification accuracies is reported among groups with enhanced visual stimulus through VR versus those without. Six out of eight sessions among the VR groups have a median of class probability values exceeding a pre-set threshold value of 0.6. Finally, the thesis concludes in Chapter 7 with a general discussion on how these findings could suggest the role of new and emerging technologies such as VR and robotics in advancing BCI-robotic systems and how the contributions of this work may help improve the usability and accessibility of such systems, not only in rehabilitation but also in skills learning and education

Methods toward improved lower extremity rehabilitation

Thesis (Ph. D. in Electrical and Medical Engineering)--Harvard-MIT Program in Health Sciences and Technology, 2012.Cataloged from PDF version of thesis.Includes bibliographical references.Ambulation is a very important part of everyday life and its absence has a detrimental effect on an individual's quality of life. While much is understood about the neurobiological systems involved in locomotion through detailed anatomical connectivity and lesion studies, it is not well understood how neurons across different regions of the nervous system share information and coordinate their firing activity to achieve ambulation. Moreover, while it is clear that understanding the processes involved in healthy ambulation are essential to understanding how diseases affect an individual's ability to walk, diseases such as stroke tend to "take out" large portions of the underlying system. Until technologies are developed to allow restoration of damaged neural tissue back to its original state, physical therapy (which aims to restore function by establishing new motor-cortical connections among the remaining neurons) remains the most viable option for patients. The aim of this thesis is to elucidate some of the underlying neurobiological mechanisms of walking and to develop tools for rehabilitation robotics that allow finer quantification of patient improvement. To elucidate the neural mechanisms of locomotion, we studied how task relevant information (e.g. positions, velocities, and forces) modulate single unit neural activity from hindlimb/trunk region of the rat motor cortex during adaptations to robot-applied elastic loads and closed-loop brain-machine-interface (BMI) control during treadmill locomotion. Using the Point Process-Generalized Linear Model (PP-GLM) statistical framework we systematically tested parametric and non-parametric point process models of increased complexity for 573 individual neurons recorded over multiple days in six animals. The developed statistical model captures within gait-cycle modulation, load-specific modulation, and intrinsic neural dynamics. Our proposed model accurately describes the firing statistics of 98.5% (563/573) of all the recorded units and allows characterization of the neural receptive fields associated with gait phase and loading force. Understanding how these receptive fields change during training and with experience will be central to developing rehabilitation strategies that optimize motor adaptations and motor learning. The methods utilized for this analysis were developed into an open source neural Spike Train Analysis Toolbox (nSTAT) for Matlab (Mathworks, Natick MA). Systematic analyses have demonstrated the effectiveness of physical therapy, but have been unable to determine which approaches tend to be most effective in restoring function. This is likely due to the multitude of approaches, diseases, and assessment scales used. To address this issue, we develop an extension of the Force Field Adaptation Paradigm, originally developed to quantitatively assess upper extremity motor adaptation, to the lower extremity. The algorithm is implemented on the Lokomat (Hocoma HG) lower extremity gait orthosis and is currently being utilized to assess short-term motor adaptation in 40 healthy adult subjects (ClinicalTrials.gov NCT01361867). Establishing an understanding of how healthy adults' motor systems adapt to external perturbations will be important to understanding how the adaptive mechanisms involved in gait integrate information and how this process is altered by disease.by Iahn Cajigas González.Ph.D.in Electrical and Medical Engineerin

Brain-Computer Interface Robotics for Hand Rehabilitation After Stroke: A Systematic Review

Background Hand rehabilitation is core to helping stroke survivors regain activities of daily living. Recent studies have suggested that the use of electroencephalography-based brain-computer interfaces (BCI) can promote this process. Here, we report the first systematic examination of the literature on the use of BCI-robot systems for the rehabilitation of fine motor skills associated with hand movement and profile these systems from a technical and clinical perspective. Methods A search for January 2010–October 2019 articles using Ovid MEDLINE, Embase, PEDro, PsycINFO, IEEE Xplore and Cochrane Library databases was performed. The selection criteria included BCI-hand robotic systems for rehabilitation at different stages of development involving tests on healthy participants or people who have had a stroke. Data fields include those related to study design, participant characteristics, technical specifications of the system, and clinical outcome measures. Results 30 studies were identified as eligible for qualitative review and among these, 11 studies involved testing a BCI-hand robot on chronic and subacute stroke patients. Statistically significant improvements in motor assessment scores relative to controls were observed for three BCI-hand robot interventions. The degree of robot control for the majority of studies was limited to triggering the device to perform grasping or pinching movements using motor imagery. Most employed a combination of kinaesthetic and visual response via the robotic device and display screen, respectively, to match feedback to motor imagery. Conclusion 19 out of 30 studies on BCI-robotic systems for hand rehabilitation report systems at prototype or pre-clinical stages of development. We identified large heterogeneity in reporting and emphasise the need to develop a standard protocol for assessing technical and clinical outcomes so that the necessary evidence base on efficiency and efficacy can be developed

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

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    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  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¿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¿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  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% ± 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% ± 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% ± 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% ± 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

Down-Conditioning of Soleus Reflex Activity using Mechanical Stimuli and EMG Biofeedback

Spasticity is a common syndrome caused by various brain and neural injuries, which can severely impair walking ability and functional independence. To improve functional independence, conditioning protocols are available aimed at reducing spasticity by facilitating spinal neuroplasticity. This down-conditioning can be performed using different types of stimuli, electrical or mechanical, and reflex activity measures, EMG or impedance, used as biofeedback variable. Still, current results on effectiveness of these conditioning protocols are incomplete, making comparisons difficult. We aimed to show the within-session task- dependent and across-session long-term adaptation of a conditioning protocol based on mechanical stimuli and EMG biofeedback. However, in contrast to literature, preliminary results show that subjects were unable to successfully obtain task-dependent modulation of their soleus short-latency stretch reflex magnitude

Modelling and EMG based Control of Upper Limb Exoskeletons for Hand Impairments

Functional losses associated with hand impairments have led to the growing development of hand exoskeletons. The main challenges are to develop the exoskeletons that work according to the user’s motion intention, which can be done by utilizing the electromyogram signals generated by forearm muscles contributed from the movement and/or grasping abilities of the hand. In this research, modelling and EMG based control of hand exoskeletons with the aim to assist stroke survivors in regaining their hand strength and functionality, and improve their quality of life is presented

Wearable Movement Sensors for Rehabilitation: From Technology to Clinical Practice

This Special Issue shows a range of potential opportunities for the application of wearable movement sensors in motor rehabilitation. However, the papers surely do not cover the whole field of physical behavior monitoring in motor rehabilitation. Most studies in this Special Issue focused on the technical validation of wearable sensors and the development of algorithms. Clinical validation studies, studies applying wearable sensors for the monitoring of physical behavior in daily life conditions, and papers about the implementation of wearable sensors in motor rehabilitation are under-represented in this Special Issue. Studies investigating the usability and feasibility of wearable movement sensors in clinical populations were lacking. We encourage researchers to investigate the usability, acceptance, feasibility, reliability, and clinical validity of wearable sensors in clinical populations to facilitate the application of wearable movement sensors in motor rehabilitation

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