Hand eye coordination in surgery

The coordination of the hand in response to visual target selection has always been regarded as an essential quality in a range of professional activities. This quality has thus far been elusive to objective scientific measurements, and is usually engulfed in the overall performance of the individuals. Parallels can be drawn to surgery, especially Minimally Invasive Surgery (MIS), where the physical constraints imposed by the arrangements of the instruments and visualisation methods require certain coordination skills that are unprecedented. With the current paradigm shift towards early specialisation in surgical training and shortened focused training time, selection process should identify trainees with the highest potentials in certain specific skills. Although significant effort has been made in objective assessment of surgical skills, it is only currently possible to measure surgeons’ abilities at the time of assessment. It has been particularly difficult to quantify specific details of hand-eye coordination and assess innate ability of future skills development. The purpose of this thesis is to examine hand-eye coordination in laboratory-based simulations, with a particular emphasis on details that are important to MIS. In order to understand the challenges of visuomotor coordination, movement trajectory errors have been used to provide an insight into the innate coordinate mapping of the brain. In MIS, novel spatial transformations, due to a combination of distorted endoscopic image projections and the “fulcrum” effect of the instruments, accentuate movement generation errors. Obvious differences in the quality of movement trajectories have been observed between novices and experts in MIS, however, this is difficult to measure quantitatively. A Hidden Markov Model (HMM) is used in this thesis to reveal the underlying characteristic movement details of a particular MIS manoeuvre and how such features are exaggerated by the introduction of rotation in the endoscopic camera. The proposed method has demonstrated the feasibility of measuring movement trajectory quality by machine learning techniques without prior arbitrary classification of expertise. Experimental results have highlighted these changes in novice laparoscopic surgeons, even after a short period of training. The intricate relationship between the hands and the eyes changes when learning a skilled visuomotor task has been previously studied. Reactive eye movement, when visual input is used primarily as a feedback mechanism for error correction, implies difficulties in hand-eye coordination. As the brain learns to adapt to this new coordinate map, eye movements then become predictive of the action generated. The concept of measuring this spatiotemporal relationship is introduced as a measure of hand-eye coordination in MIS, by comparing the Target Distance Function (TDF) between the eye fixation and the instrument tip position on the laparoscopic screen. Further validation of this concept using high fidelity experimental tasks is presented, where higher cognitive influence and multiple target selection increase the complexity of the data analysis. To this end, Granger-causality is presented as a measure of the predictability of the instrument movement with the eye fixation pattern. Partial Directed Coherence (PDC), a frequency-domain variation of Granger-causality, is used for the first time to measure hand-eye coordination. Experimental results are used to establish the strengths and potential pitfalls of the technique. To further enhance the accuracy of this measurement, a modified Jensen-Shannon Divergence (JSD) measure has been developed for enhancing the signal matching algorithm and trajectory segmentations. The proposed framework incorporates high frequency noise filtering, which represents non-purposeful hand and eye movements. The accuracy of the technique has been demonstrated by quantitative measurement of multiple laparoscopic tasks by expert and novice surgeons. Experimental results supporting visual search behavioural theory are presented, as this underpins the target selection process immediately prior to visual motor action generation. The effects of specialisation and experience on visual search patterns are also examined. Finally, pilot results from functional brain imaging are presented, where the Posterior Parietal Cortical (PPC) activation is measured using optical spectroscopy techniques. PPC has been demonstrated to involve in the calculation of the coordinate transformations between the visual and motor systems, which establishes the possibilities of exciting future studies in hand-eye coordination

Sensorimotor learning under switching dynamics

Humans have a remarkable capacity to learn new motor behaviours without forgetting old ones. This capacity relies on the ability to acquire and express multiple motor memories without interference. Here we combine behavioural experiments and computational modelling to investigate how the sensorimotor system uses contextual information to create, update and recall motor memories. We first examine the role of muscle co-contraction in the learning of novel movement dynamics. We show that muscle co-contraction, as measured by surface electromyography, accelerates motor learning. We then explore the role of control points on objects in the formation of motor memories during object manipulation. We show that opposing dynamic perturbations, which interfere when controlling a single location on an object, can be learned when each is associated with a separate control point. To account for these results, we develop a parametric switching state-space model, in which the association between cues (control points) and contexts (dynamics) is learned from experience rather than fixed. We then extend this model to a Bayesian nonparametric switching state-space model, in which the number of contexts and cues are learned online rather than specified in advance. This model can instantiate new memories when novel perturbations are experienced and exhibits spontaneous recovery of a memory that has been ostensibly overwritten. To test the model, we perform an experiment in which we briefly present a previously experienced perturbation after behaviour has returned to baseline. As predicted, we observe a qualitatively distinct and more pronounced form of recovery, which we refer to as evoked recovery. Finally, we investigate Bayesian context estimation using single-trial learning. We show that people are able to learn novel associations between cues and contexts and that they use both contextual cues and state feedback to infer the current context and partition learning between memories. Taken together, these findings further the understanding of the behaviour and computational principles of sensorimotor learning under switching dynamics.Engineering and Physical Sciences Research Counci

Remembering Forward: Neural Correlates of Memory and Prediction in Human Motor Adaptation

We used functional MR imaging (FMRI), a robotic manipulandum and systems identification techniques to examine neural correlates of predictive compensation for spring-like loads during goal-directed wrist movements in neurologically-intact humans. Although load changed unpredictably from one trial to the next, subjects nevertheless used sensorimotor memories from recent movements to predict and compensate upcoming loads. Prediction enabled subjects to adapt performance so that the task was accomplished with minimum effort. Population analyses of functional images revealed a distributed, bilateral network of cortical and subcortical activity supporting predictive load compensation during visual target capture. Cortical regions – including prefrontal, parietal and hippocampal cortices – exhibited trial-by-trial fluctuations in BOLD signal consistent with the storage and recall of sensorimotor memories or “states” important for spatial working memory. Bilateral activations in associative regions of the striatum demonstrated temporal correlation with the magnitude of kinematic performance error (a signal that could drive reward-optimizing reinforcement learning and the prospective scaling of previously learned motor programs). BOLD signal correlations with load prediction were observed in the cerebellar cortex and red nuclei (consistent with the idea that these structures generate adaptive fusimotor signals facilitating cancelation of expected proprioceptive feedback, as required for conditional feedback adjustments to ongoing motor commands and feedback error learning). Analysis of single subject images revealed that predictive activity was at least as likely to be observed in more than one of these neural systems as in just one. We conclude therefore that motor adaptation is mediated by predictive compensations supported by multiple, distributed, cortical and subcortical structures

Phase Dynamics in Human Visuomotor Control - Health & Disease

In this thesis, comprised of four publications, I investigated phase dynamics of visuomotor control in humans during upright stance in response to an oscillatory visual drive. For this purpose, I applied different versions of a ‘moving room’ paradigm in virtual reality while stimulating human participants with anterior-posterior motion of their visual surround and analyzed their bodily responses. Human balance control constitutes a complex interplay of interdependent processes. The main sensory contributors include vision, vestibular input, and proprioception, with a dominant role attributed to vision. The purpose of the balance control system is to keep the body’s center of mass (COM) within a certain spatial range around the current base of support. Ever-changing environmental circumstances along with sensory noise cause the body to permanently sway around its point of equilibrium. Considering this sway, the human body can be modelled as a (multi-link) inverted pendulum. To maintain balance while being exposed to perturbations of the visual environment, humans adjust their sway to counteract the perceived motion of their bodies. Neurodegenerative diseases like Parkinson’s impair balance control and thus are likely to affect these mechanisms. Hence, investigation of bodily responses to a visual drive gives insight into visuomotor control in health and disease. In my first study, I introduced inter-trial phase coherence (ITPC) as a novel method to investigate postural responses to periodical visual stimulation. I found that human participants phase-locked the motion of their center of pressure (COP) to a 3-D dot cloud which oscillated in the anterior-posterior direction. This effect was equally strong for a low frequency of visual stimulation at 0.2 Hz and a high frequency of 1.5 Hz, the latter exceeding the previously assumed frequency range associated with coherent postural sway responses to periodical oscillations of the visual environment (moving room). Moreover, I was able to show that ITPC reliably captured responses in almost all participants, thereby addressing the common problem of inter-subject variability in body sway research. Based on the results of my first study, I concluded phase locking to be an essential feature in human postural control. For the second study, I introduced a mobile and cost-effective setup to apply a visual paradigm consisting of a virtual tunnel which stretched in the anterior-posterior direction and oscillated back and forth at three distinct frequencies (0.2 Hz, 0.8 Hz, and 1.2 Hz). Because tracking of the COP alone neglects crucial information about how COM shifts are arranged across the body, I included additional full-body motion tracking here to evaluate sway of individual body segments. Using a modified measure of phase locking, the phase locking value (PLV), allowed me to find participants phase-locking not only their COP, but also additional segments of their body to the visual drive. While their COP exhibited a strong phase locking to all frequencies of visual stimulation, distribution of phase locking across the body underwent a shift as the frequency of the visual stimulation increased. For the lowest frequency of 0.2 Hz, participants phase-locked almost their entire body to the stimulus. At higher frequencies, this phase locking shifted towards the lower torso and hip, with subjects almost exclusively phase-locking their hip to the visual drive at the highest frequency of 1.2 Hz. Having introduced a novel and reliable measurement along with a mobile setup, these results allowed me to empirically confirm shifts in postural strategies previously proposed in the literature. In the third study, a collaboration with the neurology department of the Universitätsklinikum Gießen und Marburg (UKGM), I used the same setup and paradigm as in the previous study and additionally derived the trajectory of the COM from a weighted combination of certain body segments. The aim was to investigate phase locking of body sway in a group of patients suffering from Parkinson’s disease (PD) to find potential means for an early diagnosis of the illness. For this purpose, I recruited a group of PD patients, an age-matched control group, and a group of young healthy adults. Even though the sway amplitude of PD patients was significantly larger than that of both other groups, they phase-locked their COP and COM in a similar manner as the control groups. However, considering individual body segments, the shift in PLV distribution differed between groups. While young healthy adults, analogous to the participants in the second study, exhibited a shift towards exclusive phase locking of their hips as frequency of the stimulation increased, both PD patients and age-matched controls maintained a rather homogeneous phase locking across their body. This suggested increased body stiffness, although being an effect of age rather than disease. Overall, I concluded that patients of early-to-mid stage PD exhibit impaired motor control, reflected in their increased sway amplitude, but intact visuomotor processing, indicated by their ability to phase-lock the motion of their body to a visual drive. The fourth study, to which I contributed as second author, used experimental data collected from an additional visual condition in the course of the third study. This condition consisted of unpredictable back and forward motion of the simulated tunnel. Here, we investigated the velocity profiles of the COP and COM in response to the unpredictable visual motion and a baseline condition at which the tunnel remained static. We found PD patients to exhibit larger velocities of their COP and COM under both conditions when compared to the control groups. When examining the net increase that unpredictable motion had on the velocity of both parameters, we found a significantly higher increase in COP velocity for both PD patients and age-matched controls, but no increase in COM velocity in any of the groups. These results suggested that all groups successfully maintained their balance under unpredictable visual perturbations, but that PD patients and older adults required more effort to accomplish this task, as reflected by the increased velocity of their COP. Again, these results indicated an effect of age rather than disease on the observed postural responses. In summary, using innovative phase-locking techniques and simultaneously tracking multiple body sway parameters, I was able to provide novel insight into visuomotor control in humans. First, I overcame previous issues of inconsistent sway parameters in groups of participants; Second, I found phase-locking to be an essential feature of visuomotor processing, which also allowed me to empirically confirm previously established theories of postural control; Third, through studies in collaboration with the neurology department of the UKGM, I was able to uncover new aspects of visuomotor processing in Parkinson’s, contributing to a better understanding of the sensorimotor aspects of the disease

A survey on policy search algorithms for learning robot controllers in a handful of trials

Most policy search algorithms require thousands of training episodes to find an effective policy, which is often infeasible with a physical robot. This survey article focuses on the extreme other end of the spectrum: how can a robot adapt with only a handful of trials (a dozen) and a few minutes? By analogy with the word "big-data", we refer to this challenge as "micro-data reinforcement learning". We show that a first strategy is to leverage prior knowledge on the policy structure (e.g., dynamic movement primitives), on the policy parameters (e.g., demonstrations), or on the dynamics (e.g., simulators). A second strategy is to create data-driven surrogate models of the expected reward (e.g., Bayesian optimization) or the dynamical model (e.g., model-based policy search), so that the policy optimizer queries the model instead of the real system. Overall, all successful micro-data algorithms combine these two strategies by varying the kind of model and prior knowledge. The current scientific challenges essentially revolve around scaling up to complex robots (e.g., humanoids), designing generic priors, and optimizing the computing time.Comment: 21 pages, 3 figures, 4 algorithms, accepted at IEEE Transactions on Robotic