Upper-limb Kinematic Analysis and Artificial Intelligent Techniques for Neurorehabilitation and Assistive Environments

Stroke, one of the leading causes of death and disability around the world, usually affects the motor cortex causing weakness or paralysis in the limbs of one side of the body. Research efforts in neurorehabilitation technology have focused on the development of robotic devices to restore motor and cognitive function in impaired individuals, having the potential to deliver high-intensity and motivating therapy. End-effector-based devices have become an usual tool in the upper- limb neurorehabilitation due to the ease of adapting to patients. However, they are unable to measure the joint movements during the exercise. Thus, the first part of this thesis is focused on the development of a kinematic reconstruction algorithm that can be used in a real rehabilitation environment, without disturbing the normal patient-clinician interaction. On the basis of the algorithm found in the literature that presents some instabilities, a new algorithm is developed. The proposed algorithm is the first one able to online estimate not only the upper-limb joints, but also the trunk compensation using only two non-invasive wearable devices, placed onto the shoulder and upper arm of the patient. This new tool will allow the therapist to perform a comprehensive assessment combining the range of movement with clinical assessment scales. Knowing that the intensity of the therapy improves the outcomes of neurorehabilitation, a ‘self-managed’ rehabilitation system can allow the patients to continue the rehabilitation at home. This thesis proposes a system to online measure a set of upper-limb rehabilitation gestures, and intelligently evaluates the quality of the exercise performed by the patients. The assessment is performed through the study of the performed movement as a whole as well as evaluating each joint independently. The first results are promising and suggest that this system can became a a new tool to complement the clinical therapy at home and improve the rehabilitation outcomes. Finally, severe motor condition can remain after rehabilitation process. Thus, a technology solution for these patients and people with severe motor disabilities is proposed. An intelligent environmental control interface is developed with the ability to adapt its scan control to the residual capabilities of the user. Furthermore, the system estimates the intention of the user from the environmental information and the behavior of the user, helping in the navigation through the interface, improving its independence at home.El accidente cerebrovascular o ictus es una de las causas principales de muerte y discapacidad a nivel mundial. Normalmente afecta a la corteza motora causando debilidad o parálisis en las articulaciones del mismo lado del cuerpo. Los esfuerzos de investigación dentro de la tecnología de neurorehabilitación se han centrado en el desarrollo de dispositivos robóticos para restaurar las funciones motoras y cognitivas en las personas con esta discapacidad, teniendo un gran potencial para ofrecer una terapia de alta intensidad y motivadora. Los dispositivos basados en efector final se han convertido en una herramienta habitual en la neurorehabilitación de miembro superior ya que es muy sencillo adaptarlo a los pacientes. Sin embargo, éstos no son capaces de medir los movimientos articulares durante la realización del ejercicio. Por tanto, la primera parte de esta tesis se centra en el desarrollo de un algoritmo de reconstrucción cinemática que pueda ser usado en un entorno de rehabilitación real, sin perjudicar a la interacción normal entre el paciente y el clínico. Partiendo de la base que propone el algoritmo encontrado en la literatura, el cual presenta algunas inestabilidades, se ha desarrollado un nuevo algoritmo. El algoritmo propuesto es el primero capaz de estimar en tiempo real no sólo las articulaciones del miembro superior, sino también la compensación del tronco usando solamente dos dispositivos no invasivos y portátiles, colocados sobre el hombro y el brazo del paciente. Esta nueva herramienta permite al terapeuta realizar una valoración más exhaustiva combinando el rango de movimiento con las escalas de valoración clínicas. Sabiendo que la intensidad de la terapia mejora los resultados de la recuperación del ictus, un sistema de rehabilitación ‘auto-gestionado’ permite a los pacientes continuar con la rehabilitación en casa. Esta tesis propone un sistema para medir en tiempo real un conjunto de gestos de miembro superior y evaluar de manera inteligente la calidad del ejercicio realizado por el paciente. La valoración se hace a través del estudio del movimiento ejecutado en su conjunto, así como evaluando cada articulación independientemente. Los primeros resultados son prometedores y apuntan a que este sistema puede convertirse en una nueva herramienta para complementar la terapia clínica en casa y mejorar los resultados de la rehabilitación. Finalmente, después del proceso de rehabilitación pueden quedar secuelas motoras graves. Por este motivo, se propone una solución tecnológica para estas personas y para personas con discapacidades motoras severas. Así, se ha desarrollado una interfaz de control de entorno inteligente capaz de adaptar su control a las capacidades residuales del usuario. Además, el sistema estima la intención del usuario a partir de la información del entorno y el comportamiento del usuario, ayudando en la navegación a través de la interfaz, mejorando su independencia en el hogar

Kinematics and Robot Design II (KaRD2019) and III (KaRD2020)

This volume collects papers published in two Special Issues “Kinematics and Robot Design II, KaRD2019” (https://www.mdpi.com/journal/robotics/special_issues/KRD2019) and “Kinematics and Robot Design III, KaRD2020” (https://www.mdpi.com/journal/robotics/special_issues/KaRD2020), which are the second and third issues of the KaRD Special Issue series hosted by the open access journal robotics.The KaRD series is an open environment where researchers present their works and discuss all topics focused on the many aspects that involve kinematics in the design of robotic/automatic systems. It aims at being an established reference for researchers in the field as other serial international conferences/publications are. Even though the KaRD series publishes one Special Issue per year, all the received papers are peer-reviewed as soon as they are submitted and, if accepted, they are immediately published in MDPI Robotics. Kinematics is so intimately related to the design of robotic/automatic systems that the admitted topics of the KaRD series practically cover all the subjects normally present in well-established international conferences on “mechanisms and robotics”.KaRD2019 together with KaRD2020 received 22 papers and, after the peer-review process, accepted only 17 papers. The accepted papers cover problems related to theoretical/computational kinematics, to biomedical engineering and to other design/applicative aspects

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

Advanced Applications of Rapid Prototyping Technology in Modern Engineering

Rapid prototyping (RP) technology has been widely known and appreciated due to its flexible and customized manufacturing capabilities. The widely studied RP techniques include stereolithography apparatus (SLA), selective laser sintering (SLS), three-dimensional printing (3DP), fused deposition modeling (FDM), 3D plotting, solid ground curing (SGC), multiphase jet solidification (MJS), laminated object manufacturing (LOM). Different techniques are associated with different materials and/or processing principles and thus are devoted to specific applications. RP technology has no longer been only for prototype building rather has been extended for real industrial manufacturing solutions. Today, the RP technology has contributed to almost all engineering areas that include mechanical, materials, industrial, aerospace, electrical and most recently biomedical engineering. This book aims to present the advanced development of RP technologies in various engineering areas as the solutions to the real world engineering problems

Evaluating footwear “in the wild”: Examining wrap and lace trail shoe closures during trail running

Trail running participation has grown over the last two decades. As a result, there have been an increasing number of studies examining the sport. Despite these increases, there is a lack of understanding regarding the effects of footwear on trail running biomechanics in ecologically valid conditions. The purpose of our study was to evaluate how a Wrap vs. Lace closure (on the same shoe) impacts running biomechanics on a trail. Thirty subjects ran a trail loop in each shoe while wearing a global positioning system (GPS) watch, heart rate monitor, inertial measurement units (IMUs), and plantar pressure insoles. The Wrap closure reduced peak foot eversion velocity (measured via IMU), which has been associated with fit. The Wrap closure also increased heel contact area, which is also associated with fit. This increase may be associated with the subjective preference for the Wrap. Lastly, runners had a small but significant increase in running speed in the Wrap shoe with no differences in heart rate nor subjective exertion. In total, the Wrap closure fit better than the Lace closure on a variety of terrain. This study demonstrates the feasibility of detecting meaningful biomechanical differences between footwear features in the wild using statistical tools and study design. Evaluating footwear in ecologically valid environments often creates additional variance in the data. This variance should not be treated as noise; instead, it is critical to capture this additional variance and challenges of ecologically valid terrain if we hope to use biomechanics to impact the development of new products

Evidence Synthesis of Shoulder Pain Among Canadian Firefighters

Injury or degeneration of rotator cuff tendon leads to rotator cuff disease (subacromial impingement syndrome and rotator cuff tears). Shoulder pain – pain in the upper arm close to the deltoid muscle insertion has been reported as the most common symptom for subacromial impingement syndrome and rotator cuff tears. However, the current state of evidence on treatment effectiveness of rotator cuff disease is indeterminate. The shoulder function is essential for many of the physically demanding tasks that firefighters perform on the fire ground. For fire services and firefighters, the preservation of active duty is critical for their continued service to their communities. However, the prevalence of shoulder pain among Canadian firefighters has not been synthesized. Further, high quality randomized clinical trials (RCTs) provide the highest level of evidence and assist in clinical decision making. The International Committee of Medical Journal Editors (ICMJE) recommendation of RCT trial registration in public trials registry has been made to improve the reporting, transparency, rigor and reproducibility in RCTs. However, there is a paucity of evidence on the proportion of RCTs with proper trial registrations in the field of rehabilitation therapy. Therefore, the purposes of this thesis were 1) to assess the effects of arthroscopic versus mini-open rotator cuff repair surgery on function, pain and range of motion at in patients with rotator cuff tears; 2) to quantify the effects of surgical vs conservative interventions on clinical outcomes of pain and function in patients with subacromial impingement syndrome; 3) to assess the prevalence of musculoskeletal disorders (MSDs) among Canadian firefighters, 4) to examine the proportion of RCTs that were reported to have been prospectively, retrospectively registered or not registered in the field of rehabilitation therapy, and 5) to use the synthesized evidence to inform the design of a single center (fire-station), investigator-blinded, randomized, 12-month, parallel-group, superiority trial for the evaluation of the efficacy of a shoulder exercises on clinical outcomes in firefighters with shoulder pain. From the existing literature, we found evidence that both arthroscopic and mini-open techniques to rotator cuff repairs with post-operative rehabilitation exercises were effective in improving clinical outcomes of function, pain and shoulder range of motion in patients with rotator cuff tears. However, the between-group differences in outcomes were too small to be clinically important. The effects of surgery plus physiotherapy (exercises) vs physiotherapy (exercises) alone on pain and function were too small to be clinically important at 3-, 6-months, 1-, 2-, 5- and ≥ 10-years follow up. This further highlighted that rehabilitation exercises be considered as the first treatment approach in patients with shoulder pain. We also identified high point-prevalence estimates (1 in 4 firefighters) of shoulder-, back-, and knee-related MSDs among Canadian firefighters (shoulder pain was 23%). Our review study indicated that fifteen years after the introduction of standards for RCT registration by ICMJE, only one-third of the RCTs in the field of rehabilitation therapy were prospectively registered. Subsequently, the emergence of further evidence (observational studies in firefighters and RCTs in active-duty military personnel) indicating the clinical effectiveness of occupation-specific rehabilitation exercises along with our evidence syntheses provided the rationale for the design and conduct of an RCT to assess the effectiveness of firefighter-specific rehabilitation exercises among Canadian firefighter with shoulder pain

Augmentation of Brain Function: Facts, Fiction and Controversy. Volume III: From Clinical Applications to Ethical Issues and Futuristic Ideas

The final volume in this tripartite series on Brain Augmentation is entitled “From Clinical Applications to Ethical Issues and Futuristic Ideas”. Many of the articles within this volume deal with translational efforts taking the results of experiments on laboratory animals and applying them to humans. In many cases, these interventions are intended to help people with disabilities in such a way so as to either restore or extend brain function. Traditionally, therapies in brain augmentation have included electrical and pharmacological techniques. In contrast, some of the techniques discussed in this volume add specificity by targeting select neural populations. This approach opens the door to where and how to promote the best interventions. Along the way, results have empowered the medical profession by expanding their understanding of brain function. Articles in this volume relate novel clinical solutions for a host of neurological and psychiatric conditions such as stroke, Parkinson’s disease, Huntington’s disease, epilepsy, dementia, Alzheimer’s disease, autism spectrum disorders (ASD), traumatic brain injury, and disorders of consciousness. In disease, symptoms and signs denote a departure from normal function. Brain augmentation has now been used to target both the core symptoms that provide specificity in the diagnosis of a disease, as well as other constitutional symptoms that may greatly handicap the individual. The volume provides a report on the use of repetitive transcranial magnetic stimulation (rTMS) in ASD with reported improvements of core deficits (i.e., executive functions). TMS in this regard departs from the present-day trend towards symptomatic treatment that leaves unaltered the root cause of the condition. In diseases, such as schizophrenia, brain augmentation approaches hold promise to avoid lengthy pharmacological interventions that are usually riddled with side effects or those with limiting returns as in the case of Parkinson’s disease. Brain stimulation can also be used to treat auditory verbal hallucination, visuospatial (hemispatial) neglect, and pain in patients suffering from multiple sclerosis. The brain acts as a telecommunication transceiver wherein different bandwidth of frequencies (brainwave oscillations) transmit information. Their baseline levels correlate with certain behavioral states. The proper integration of brain oscillations provides for the phenomenon of binding and central coherence. Brain augmentation may foster the normalization of brain oscillations in nervous system disorders. These techniques hold the promise of being applied remotely (under the supervision of medical personnel), thus overcoming the obstacle of travel in order to obtain healthcare. At present, traditional thinking would argue the possibility of synergism among different modalities of brain augmentation as a way of increasing their overall effectiveness and improving therapeutic selectivity. Thinking outside of the box would also provide for the implementation of brain-to-brain interfaces where techniques, proper to artificial intelligence, could allow us to surpass the limits of natural selection or enable communications between several individual brains sharing memories, or even a global brain capable of self-organization. Not all brains are created equal. Brain stimulation studies suggest large individual variability in response that may affect overall recovery/treatment, or modify desired effects of a given intervention. The subject’s age, gender, hormonal levels may affect an individual’s cortical excitability. In addition, this volume discusses the role of social interactions in the operations of augmenting technologies. Finally, augmenting methods could be applied to modulate consciousness, even though its neural mechanisms are poorly understood. Finally, this volume should be taken as a debate on social, moral and ethical issues on neurotechnologies. Brain enhancement may transform the individual into someone or something else. These techniques bypass the usual routes of accommodation to environmental exigencies that exalted our personal fortitude: learning, exercising, and diet. This will allow humans to preselect desired characteristics and realize consequent rewards without having to overcome adversity through more laborious means. The concern is that humans may be playing God, and the possibility of an expanding gap in social equity where brain enhancements may be selectively available to the wealthier individuals. These issues are discussed by a number of articles in this volume. Also discussed are the relationship between the diminishment and enhancement following the application of brain-augmenting technologies, the problem of “mind control” with BMI technologies, free will the duty to use cognitive enhancers in high-responsibility professions, determining the population of people in need of brain enhancement, informed public policy, cognitive biases, and the hype caused by the development of brain- augmenting approaches

Manipulador aéreo con brazos antropomórficos de articulaciones flexibles

[Resumen] Este artículo presenta el primer robot manipulador aéreo con dos brazos antropomórficos diseñado para aplicarse en tareas de inspección y mantenimiento en entornos industriales de difícil acceso para operarios humanos. El robot consiste en una plataforma aérea multirrotor equipada con dos brazos antropomórficos ultraligeros, así como el sistema de control integrado de la plataforma y los brazos. Una de las principales características del manipulador es la flexibilidad mecánica proporcionada en todas las articulaciones, lo que aumenta la seguridad en las interacciones físicas con el entorno y la protección del propio robot. Para ello se ha introducido un compacto y simple mecanismo de transmisión por muelle entre el eje del servo y el enlace de salida. La estructura en aluminio de los brazos ha sido cuidadosamente diseñada de forma que los actuadores estén aislados frente a cargas radiales y axiales que los puedan dañar. El manipulador desarrollado ha sido validado a través de experimentos en base fija y en pruebas de vuelo en exteriores.Ministerio de Economía y Competitividad; DPI2014-5983-C2-1-