Electroencephalography-guided upper-limb hybrid robotic platform to modulate cortical excitability

This study present an intervention combining an electroencephalography-based brain computer interface with a hybrid robotic system for the modulation of the cortical excitability (plasticity). Plasticity is intended to be elicited through the association of the voluntary motor-related cortical processes with the hybrid assistance during the execution of reaching movement. The cortical excitability was assessed before and after the intervention measuring the peak-to-peak amplitude of the Motor Evoked Potentials (MEPs) induced through transcranial magnetic stimulation pulses. Five healthy subjects participated in the experiments. Results showed an overall and distributed increase in the cortical excitability as a result of the proposed intervention

Development of a hybrid robotic system based on an adaptive and associative assistance for rehabilitation of reaching movement after stroke

Stroke causes irreversible neurological damage. Depending on the location and the size of this brain injury, different body functions could result affected. One of the most common consequences is motor impairments. The level of motor impairment affectation varies between post-stroke subjects, but often, it hampers the execution of most activities of daily living. Consequently, the quality of life of the stroke population is severely decreased. The rehabilitation of the upper-limb motor functions has gained special attention in the scientific community due the poor reported prognosis of post-stroke patients for recovering normal upper-extremity function after standard rehabilitation therapy. Driven by the advance of technology and the design of new rehabilitation methods, the use of robot devices, functional electrical stimulation and brain-computer interfaces as a neuromodulation system is proposed as a novel and promising rehabilitation tools. Although the uses of these technologies present potential benefits with respect to standard rehabilitation methods, there still are some milestones to be addressed for the consolidation of these methods and techniques in clinical settings. Mentioned evidences reflect the motivation for this dissertation. This thesis presents the development and validation of a hybrid robotic system based on an adaptive and associative assistance for rehabilitation of reaching movements in post-stroke subjects. The hybrid concept refers the combined use of robotic devices with functional electrical stimulation. Adaptive feature states a tailored assistance according to the users’ motor residual capabilities, while the associative term denotes a precise pairing between the users’ motor intent and the peripheral hybrid assistance. The development of the hybrid platform comprised the following tasks: 1. The identification of the current challenges for hybrid robotic system, considering twofold perspectives: technological and clinical. The hybrid systems submitted in literature were critically reviewed for such purpose. These identified features will lead the subsequent development and method framed in this work. 2. The development and validation of a hybrid robotic system, combining a mechanical exoskeleton with functional electrical stimulation to assist the execution of functional reaching movements. Several subsystems are integrated within the hybrid platform, which interact each other to cooperatively complement the rehabilitation task. Complementary, the implementation of a controller based on functional electrical stimulation to dynamically adjust the level of assistance is addressed. The controller is conceived to tackle one of the main limitations when using electrical stimulation, i.e. the highly nonlinear and time-varying muscle response. An experimental procedure was conducted with healthy and post-stroke patients to corroborate the technical feasibility and the usability evaluation of the system. 3. The implementation of an associative strategy within the hybrid platform. Three different strategies based on electroencephalography and electromyography signals were analytically compared. The main idea is to provide a precise temporal association between the hybrid assistance delivered at the periphery (arm muscles) and the users’ own intention to move and to configure a feasible clinical setup to be use in real rehabilitation scenarios. 4. Carry out a comprehensive pilot clinical intervention considering a small cohort of patient with post-stroke patients to evaluate the different proposed concepts and assess the feasibility of using the hybrid system in rehabilitation settings. In summary, the works here presented prove the feasibility of using the hybrid robotic system as a rehabilitative tool with post-stroke subjects. Moreover, it is demonstrated the adaptive controller is able to adjust the level of assistance to achieve successful tracking movement with the affected arm. Remarkably, the accurate association in time between motor cortex activation, represented through the motor-related cortical potential measured with electroencephalography, and the supplied hybrid assistance during the execution of functional (multidegree of freedom) reaching movement facilitate distributed cortical plasticity. These results encourage the validation of the overall hybrid concept in a large clinical trial including an increased number of patients with a control group, in order to achieve more robust clinical results and confirm the presented herein.Programa Oficial de Doctorado en Ingeniería Eléctrica, Electrónica y AutomáticaPresidente: Ramón Ceres Ruiz.- Secretario: Luis Enrique Moreno Lorente.- Vocal: Antonio Olivier

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

Applications of Brain Computer Interface in Present Healthcare Setting

Brain-computer interface (BCI) is an innovative method of integrating technology for healthcare. Utilizing BCI technology allows for direct communication and/or control between the brain and an external device, thereby displacing conventional neuromuscular pathways. The primary goal of BCI in healthcare is to repair or reinstate useful function to people who have impairments caused by neuromuscular disorders (e.g., stroke, amyotrophic lateral sclerosis, spinal cord injury, or cerebral palsy). BCI brings with it technical and usability flaws in addition to its benefits. We present an overview of BCI in this chapter, followed by its applications in the medical sector in diagnosis, rehabilitation, and assistive technology. We also discuss BCI’s strengths and limitations, as well as its future direction

Targeting the Brain in Brain-Computer Interfacing: The Effect of Transcranial Current Stimulation and Control of a Physical Effector on Performance and Electrophysiology Underlying Noninvasive Brain-Computer Interfaces

University of Minnesota Ph.D. dissertation. July 2017. Major: Biomedical Engineering. Advisor: Bin He. 1 computer file (PDF); vii, 123 pages.Brain-computer interfaces (BCIs) and neuromodulation technologies have recently begun to fulfill their promises of restoring function, improving rehabilitation, and enhancing abilities and learning. However, lengthy user training to achieve acceptable accuracy is a barrier to BCI acceptance and use by patients and the general population. Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technology whereby a low level of electrical current is injected into the brain to alter neural activity and has been found to improve motor learning and task performance. A barrier to optimizing behavioral effects of tDCS is that we do not yet understand how neural networks are affected by stimulation and how stimulation interacts with ongoing endogenous activity. The purpose of this dissertation was to elucidate strategies to improve BCI control by targeting the user through two approaches: 1. Subject control of a robotic arm to enhance user motivation and 2. tDCS application to improve behavioral outcomes and alter networks underlying sensorimotor rhythm-based BCI performance. The primary results illustrate that targeted tDCS of the motor network interacts with task specific neural activity to improve BCI performance and alter neural electrophysiology. This effect on neural activity extended across the task network, beyond the area of direct stimulation, and altered connectivity unilaterally and bilaterally between frontal and parietal cortical regions. These findings suggest targeted neuromodulation interacts with endogenous neural activity and can be used to improve motor-cognitive task performance

Human motor augmentation - spinal motor neurons control of redundant degrees-of-freedom

In 1963, Stan Lee introduced a new villain to the Spiderman Universe: Dr Octopus – a human equipped with multiple robotic arms that can be controlled seamlessly in coordination with his natural limbs. Throughout the last decades, turning such fiction into real-life applications gave rise to the research field of human motor augmentation, ultimately aiming to enable humans to perform motor tasks that are sheer impossible with our natural limbs alone. While a significant process was made in designing artificial supernumerary limbs, a central problem remains: identifying adequate bodily signals that allow moving supernumerary degrees-of-freedom together with our natural ones. So far, neural activity in the brain seems to hold the greatest potential for providing all the flexibility needed to ensure such coordination between natural and supernumerary degrees-of-freedom. However, accessing neural populations in the cortical regions is accompanied by an unacceptable risk for most users. A different group of neural cells can be found in the outmost layer of the motor pathway, driving the contraction of muscles and generation of force – spinal motor neurons. The development of novel neural interfaces has made it possible to study single motor neuron activity with minimal harm to the user. This allows a direct and non-invasive window into the neural activity orchestrating human movement. In this dissertation, I investigate whether these neurons innervating our muscles could provide supernumerary control signals. The results indicate, in essence, that features extracted non-invasively from motor neuron activity have the potential to overcome current limitations in supernumerary control and thus could significantly advance human motor augmentation.Open Acces

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

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)

Movement-Related Desynchronization in EEG-based Brain-Computer Interface applications for stroke motor rehabilitation

Neurological degenerative diseases like stroke, Alzheimer, Amyothrophic Lateral Sclerosis (ALS), Parkinson and many others are constantly increasing their incidence in the world health statistics as far as the mean age of the global population is getting higher and higher. This leads to a general need for effective, at-home and low-cost rehabilitative and health-daily-care tools. The latter should consist either of technological devices implemented for operating in a remote way, i.e. tele-medicine is quickly spreading around the world, or very-advanced computer-based and robotic systems to realize intense and repetitive trainings. This is the challenge in which Information and Communications Technology (ICT) is asked to play a major role in order to bring medicine to reach further advancements. Indeed, no way to cope with these issues is possible outside a strong and vivid cooperation among multi-disciplinary teams of clinicians, physicians, biologists, neuro-psychologists and engineers and without a resolute pushing towards a widespread inter-operability between Institutes, Hospitals and Universities all over the world, as recently highlighted during the main International conferences on ICT in healthcare. The establishment of well-defined standards for gathering and sharing data will then represent a key element to enhance the efficacy of the aforementioned collaborations. Among the others, stroke is one of the most common neurological pathologies being the second or third cause of mortality in the world; moreover, it causes more than sixty percent survivors remain with severe cognitive and motor impairments that impede them in living normal lives and require a twenty-four-hours daily care. As a consequence, on one side stroke survivors experience a frustrating condition of being completely dependent on other people even to perform simple daily actions like reach and grasp an object, hold a glass of water to drink it and so on. States, by their side, have to take into account additional costs to provide stroke patients and their families with appropriate cares and supports to cope with their needs. For this reason, more and more fundings are recently made available by means of grants, European and International projects, programs to exchange different expertise among various countries with the aim to study how to accelerate and make more effective the recovery process of chronic stroke patients. The global research about this topic is conducted on several parallel aspects: as regard as the basic knowledge of brain processes, neurophysiologists, biologists and engineers are particularly interested in an in-depth understanding of the so-called neuroplastic changes that brain daily operates in order to adapt individuals to life changes, experiences and to realize more extensively their own potentialities. Neuroplasticity is indeed the corner stone for most of the trainings nowadays adopted by the standard as well as the more innovative methods in the rehabilitative programs for post-stroke recovery. Specifically speaking, motor rehabilitation usually includes long term, repetitive and intense goal-directed exercises that promote neuroplastic mechanisms such as neural sprouting, synapto-genesis and dendritic branching. These processes are strictly related with motor improvements and their study could - one day - serve as prognostic measures of the recovery. Another aspect of this eld of neuroscience research is the number of applications that it makes feasible. One of the most exciting is to connect an injured brain to a computer or a robotic device in a Brain-Computer or Brain-Machine Interface (BCI or BMI) scheme aiming at bypassing the impairments of the patient and make him/her autonomously move again or train his/her motor abilities in a more effective way. This kind of research can already count an amount of literature that provides several proofs of concept that these heterogeneous systems constituted by humans and robots can work at the purpose. A particular application of BCI for restoring or enhancing, at least, the reaching abilities of chronic stroke survivors was implemented and is still currently being improved at I.R.C.C.S. San Camillo Hospital Foundation, an Institute for the rehabilitation from neurological diseases located in Lido of Venice and partially technically supported by the Department of Information Engineering of Padua in range of an agreement signed in 2009. This specific BCI platform allows patients to train and improve their reaching movements by means of a robotic arm that provides a force that helps patients in completing the training exercise, i.e. to hit a predetermined target. This force feedback is however subject to a strict condition: during the movement, the person has to produce the expected pattern of cerebral activity. Whenever this is accomplished, a force is delivered proportionally to the entity of the latter activity, otherwise the patient is obliged to operate without any help. In this way, this platform implements the so-called operant-learning, that is one of the most effective conditioning techniques to make a subject learn or re-learn a task. If, on one hand, the primary and explicit task is to improve a movement, on the other side the secondary but most important task is to deploy the perilesional part of the brain - still healthy - in becoming responsible for the control of the movement. It is a popular and widely-accepted opinion within the neuroscience community, indeed, that a healthy region of the sensorimotor area nearby the damaged one - which was previously in charge of performing the (reaching) movement - can optimally accomplish the impaired motor function substituting the original control area. Technically speaking, the main crucial feature that can ensure the effectiveness of the whole system is the precise and in real-time identification and quantification of the cerebral pattern associated with the movement, the worldwide named movement-related desynchronization (MRD). Starting from its original definition, passing through the most used techniques for its recognition, the thesis work presents a series of criticisms of the current signal processing method to detect the MRD and a complete analysis of the possible features that can better represent the movement condition and that can be more easily extracted during the on-line operations. Brain - it is well-known - learns by trials and errors and it needs a slightly-delayed (in the range of fraction of seconds) feedback of its performance to learn a task in the best way. This BCI application was born with the purpose to provide the above-mentioned feedback: however, this is only feasible if a computationally easy and contingent signal processing technique is available. This thesis work would like to cope with the lack of a well-planned real-time signal analysis in the current experimental protocol

De animais a máquinas : humanos tecnicamente melhores nos imaginários de futuro da convergência tecnológica

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Sociais, Departamento de Sociologia, 2020.O tema desta investigação é discutir os imaginários sociais de ciência e tecnologia que emergem a partir da área da neuroengenharia, em sua relação com a Convergência Tecnológica de quatro disciplinas: Nanotecnologia, Biotecnologia, tecnologias da Informação e tecnologias Cognitivas - neurociências- (CT-NBIC). Estas áreas desenvolvem-se e são articuladas por meio de discursos que ressaltam o aprimoramento das capacidades físicas e cognitivas dos seres humanos, com o intuito de construir uma sociedade melhor por meio do progresso científico e tecnológico, nos limites das agendas de pesquisa e desenvolvimento (P&D). Objetivos: Os objetivos nesse cenário, são discutir as implicações éticas, econômicas, políticas e sociais deste modelo de sistema sociotécnico. Nos referimos, tanto as aplicações tecnológicas, quanto as consequências das mesmas na formação dos imaginários sociais, que tipo de relações se estabelecem e como são criadas dentro desse contexto. Conclusão: Concluímos na busca por refletir criticamente sobre as propostas de aprimoramento humano mediado pela tecnologia, que surgem enquanto parte da agenda da Convergência Tecnológica NBIC. No entanto, as propostas de melhoramento humano vão muito além de uma agenda de investigação. Há todo um quadro de referências filosóficas e políticas que defendem o aprimoramento da espécie, vertentes estas que se aliam a movimentos trans-humanistas e pós- humanistas, posições que são ao mesmo tempo éticas, políticas e econômicas. A partir de nossa análise, entendemos que ciência, tecnologia e política estão articuladas, em coprodução, em relação às expectativas de futuros que são esperados ou desejados. Ainda assim, acreditamos que há um espaço de diálogo possível, a partir do qual buscamos abrir propostas para o debate público sobre questões de ciência e tecnologia relacionadas ao aprimoramento da espécie humana.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The subject of this research is to discuss the social imaginaries of science and technology that emerge from the area of neuroengineering in relation with the Technological Convergence of four disciplines: Nanotechnology, Biotechnology, Information technologies and Cognitive technologies -neurosciences- (CT-NBIC). These areas are developed and articulated through discourses that emphasize the enhancement of human physical and cognitive capacities, the intuition it is to build a better society, through the scientific and technological progress, at the limits of the research and development (R&D) agendas. Objectives: The objective in this scenery, is to discuss the ethic, economic, politic and social implications of this model of sociotechnical system. We refer about the technological applications and the consequences of them in the formation of social imaginaries as well as the kind of social relations that are created and established in this context. Conclusion: We conclude looking for critical reflections about the proposals of human enhancement mediated by the technology. That appear as a part of the NBIC technologies agenda. Even so, the proposals of human enhancement go beyond boundaries that an investigation agenda. There is a frame of philosophical and political references that defend the enhancement of the human beings. These currents that ally to the transhumanism and posthumanism movements, positions that are ethic, politic and economic at the same time. From our analysis, we understand that science, technology and politics are articulated, are in co-production, regarding the expected and desired futures. Even so, we believe that there is a space of possible dialog, from which we look to open proposals for the public discussion on questions of science and technology related to enhancement of human beings