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

A Modular Mobile Robotic Platform to Assist People with Different Degrees of Disability

Robotics to support elderly people in living independently and to assist disabled people in carrying out the activities of daily living independently have demonstrated good results. Basically, there are two approaches: one of them is based on mobile robot assistants, such as Care-O-bot, PR2, and Tiago, among others; the other one is the use of an external robotic arm or a robotic exoskeleton fixed or mounted on a wheelchair. In this paper, a modular mobile robotic platform to assist moderately and severely impaired people based on an upper limb robotic exoskeleton mounted on a robotized wheel chair is presented. This mobile robotic platform can be customized for each user’s needs by exploiting its modularity. Finally, experimental results in a simulated home environment with a living room and a kitchen area, in order to simulate the interaction of the user with different elements of a home, are presented. In this experiment, a subject suffering from multiple sclerosis performed different activities of daily living (ADLs) using the platform in front of a group of clinicians composed of nurses, doctors, and occupational therapists. After that, the subject and the clinicians replied to a usability questionnaire. The results were quite good, but two key factors arose that need to be improved: the complexity and the cumbersome aspect of the platform.This work was supported by the AIDE project through Grant Agreement No. 645322 of the European Commission, by the Conselleria d’Educacio, Cultura i Esport of Generalitat Valenciana, by the European Social Fund—Investing in your future, through the grant ACIF 2018/214, and by the Promoción de empleo joven e implantación de garantía juvenil en I+D+I 2018 through the grant PEJ2018-002670-A

A Comparative Analysis of 2D and 3D Tasks for Virtual Reality Therapies Based on Robotic-Assisted Neurorehabilitation for Post-stroke Patients

Post-stroke neurorehabilitation based on virtual therapies are performed completing repetitive exercises shown in visual electronic devices, whose content represents imaginary or daily life tasks. Currently, there are two ways of visualization of these task. 3D virtual environments are used to get a three dimensional space that represents the real world with a high level of detail, whose realism is determinated by the resolucion and fidelity of the objects of the task. Furthermore, 2D virtual environments are used to represent the tasks with a low degree of realism using techniques of bidimensional graphics. However, the type of visualization can influence the quality of perception of the task, affecting the patient's sensorimotor performance. The purpose of this paper was to evaluate if there were differences in patterns of kinematic movements when post-stroke patients performed a reach task viewing a virtual therapeutic game with two different type of visualization of virtual environment: 2D and 3D. Nine post-stroke patients have participated in the study receiving a virtual therapy assisted by PUPArm rehabilitation robot. Horizontal movements of the upper limb were performed to complete the aim of the tasks, which consist in reaching peripheral or perspective targets depending on the virtual environment shown. Various parameter types such as the maximum speed, reaction time, path length, or initial movement are analyzed from the data acquired objectively by the robotic device to evaluate the influence of the task visualization. At the end of the study, a usability survey was provided to each patient to analysis his/her satisfaction level. For all patients, the movement trajectories were enhanced when they completed the therapy. This fact suggests that patient's motor recovery was increased. Despite of the similarity in majority of the kinematic parameters, differences in reaction time and path length were higher using the 3D task. Regarding the success rates were very similar. In conclusion, the using of 2D environments in virtual therapy may be a more appropriate and comfortable way to perform tasks for upper limb rehabilitation of post-stroke patients, in terms of accuracy in order to effectuate optimal kinematic trajectories

Synchronization of Slow Cortical Rhythms During Motor Imagery-Based Brain–Machine Interface Control

Modulation of sensorimotor rhythm (SMR) power, a rhythmic brain oscillation physiologically linked to motor imagery, is a popular Brain–Machine Interface (BMI) paradigm, but its interplay with slower cortical rhythms, also involved in movement preparation and cognitive processing, is not entirely understood. In this study, we evaluated the changes in phase and power of slow cortical activity in delta and theta bands, during a motor imagery task controlled by an SMR-based BMI system. In Experiment I, EEG of 20 right-handed healthy volunteers was recorded performing a motor-imagery task using an SMR-based BMI controlling a visual animation, and during task-free intervals. In Experiment II, 10 subjects were evaluated along five daily sessions, while BMI-controlling same visual animation, a buzzer, and a robotic hand exoskeleton. In both experiments, feedback received from the controlled device was proportional to SMR power (11–14 Hz) detected by a real-time EEG-based system. Synchronization of slow EEG frequencies along the trials was evaluated using inter-trial-phase coherence (ITPC). Results: cortical oscillations of EEG in delta and theta frequencies synchronized at the onset and at the end of both active and task-free trials; ITPC was significantly modulated by feedback sensory modality received during the tasks; and ITPC synchronization progressively increased along the training. These findings suggest that phase-locking of slow rhythms and resetting by sensory afferences might be a functionally relevant mechanism in cortical control of motor function. We propose that analysis of phase synchronization of slow cortical rhythms might also improve identification of temporal edges in BMI tasks and might help to develop physiological markers for identification of context task switching and practice-related changes in brain function, with potentially important implications for design and monitoring of motor imagery-based BMI systems, an emerging tool in neurorehabilitation of stro

Tele-Rehabilitation Versus Local Rehabilitation Therapies Assisted by Robotic Devices: A Pilot Study with Patients

The present study aims to evaluate the advantages of a master-slave robotic rehabilitation therapy in which the patient is assisted in real-time by a therapist. We have also explored if this type of strategy is applicable in a tele-rehabilitation environment. A pilot study has been carried out involving 10 patients who have performed a point-to-point rehabilitation exercise supported by three assistance modalities: fixed assistance (without therapist interaction), local therapist assistance, and remote therapist assistance in a simulated tele-rehabiliation scenario. The rehabilitation exercise will be performed using an upper-limb rehabilitation robotic device that assists the patients through force fields. The results suggest that the assistance provided by the therapist is better adapted to patient needs than fixed assistance mode. Therefore, it maximizes the patient’s level of effort, which is an important aspect to improve the rehabilitation outcomes. We have also seen that in a tele-rehabilitation environment it is more difficult to assess when to assist the patient than locally. However, the assistance suits patients better than the fixed assistance mode.This work was funded by the Conselleria d’Educacio, Cultura i Esport of Generalitat Valenciana by the European Social Fund—Investing in your Future, through the grant ACIF 2018/214, PEJ2018-002684-A and PEJ2018-002670-A, and by the Spanish Ministry of Science and Innovation through the project PID2019-108310RB-I00

Predicción de actividades de la vida diaria en entornos inteligentes para personas con movilidad reducida

[Resumen] Las Actividades de la Vida Diaria (AVD) son aquellas actividades orientas al cuidado, productividad y ocio. Las tareas básicas de una persona, que consisten en el cuidado personal, se pueden ver afectadas por una enfermedad degenerativa o el sufrimiento de un accidente cerebrovascular. Por este motivo, el proyecto "Adaptive Multimodal Interfaces to Assist Disabled People in Daily Activities(AIDE)" pretende realizar un sistema multimodal capaz de extraer información relevante del comportamiento e intención del usuario, extraer información de las capacidades motoras residuales y del análisis del entorno con el objetivo de mejorar la independencia de estas personas. Para ello se ha realizado el estudio de dos técnicas de aprendizaje automático: campos aleatorios condicionales (CRF) y redes neuronales temporales (TDNN), para predecir la actividad que el usuario desea realizar estudiando también la adaptación de los métodos a la rutina del usuario. De este modo, y usando un entorno virtual, se ha adquirido la información necesaria de un usuario durante cinco días bajo las condiciones del proyecto AIDE obteniendo una tasa de acierto de más del 90% en ambos m etodos, llegando al 100% de precisión en algunas actividades usando CRF. Por lo tanto, mediante esta técnica seremos capaces de ayudar a estas personas actuando sobre el hogar, adaptándonos a sus necesidades y rutinas.Ministerio de Economía y Competitividad; DPI2015-70415-C2-2-

Estudio comparativo de efectos tDCS y rehabilitación combinado con rehabilitación con dispositivo robótico

[Resumen] El Accidente Cerebrovascular (ACV), representa uno de los principales problemas en la salud pública en todo el mundo. Una nueva herramienta empleada en rehabilitación es la estimulación transcraneal por corriente directa (tDCS) no invasiva. Se trata de técnica segura, ya que no se realiza ningún tipo de punción o perforación sobre el paciente. Esta técnica modula la excitabilidad o inhibición neuronal en áreas corticales específicas. En este estudio han participado 2 pacientes con ACV y sintomatología espástica e hipotónica (1:1) que recibieron un total de 10 sesiones de estimulación tDCS y terapia con dispositivo robótico. Se emplearon evaluaciones funcionales al inicio y final del tratamiento tales como, valoración del Índice Motor, escala STREAM y valoración Frenchay, además se registraron datos electromiográficos durante todas las sesiones. Tras la realización del tratamiento se analizaron todos los datos obtenidos tanto en las valoraciones funcionales como en las señales registradas obteniendo resultados positivos en referencia al control motor voluntario, disminuyendo o aumentando el tono muscular con el que partían de inicio los pacientes. Concluyendo este estudio en que la estimulación tDCS puede emplearse como una herramienta más al alcance del personal rehabilitador, la cual, puede combinarse con terapias alternativas como las generadas por un dispositivo robótico.Esta investigación ha sido financiada por el Ministerio de Economía y Competitividad a través del proyecto DPI2015-70415-C2-2-Rhttps://doi.org/10.17979/spudc.978849749808

Efectos sobre la ERD en tareas de control de exoesqueleto de mano empleando BCI

[Resumen] Los estudios con interfaces cerebro-máquina basados en electroencefalografía (EEG) en el campo de la rehabilitación y ayuda a personas con movilidad reducida, típicamente basados la modulación de los ritmos sensoriomotores (SMR), han aumentado notablemente en estos últimos diez años. Unidos a la aparición de nuevas herramientas en rehabilitación, como son los exoesqueletos, prometen ser una poderosa alternativa terapéutica y rehabilitadora para la recuperación motora de las lesiones distales de los miembros superiores. Diez sujetos sanos han participado en este estudio, en el cual se cuantificó en tiempo real las modulaciones de los ritmos SMR en la banda alpha (8-12 Hz) durante una actividad de de imaginería motora (IM) (cierre de mano/relax) utilizando diferentes modalidades sensoriales como feedback: propioceptivo (utilizando un exoesqueleto de mano), auditivo y visual. Los resultados obtenidos muestran una incremento en la intensidad y la duración de la desincronizaci on (ERD) en la banda alpha durante la IM utilizando el exoesqueleto.Ministerio de Economía y Competitividad; DPI2015-70415-C2-2-

Arquitectura de control multimodal para robótica asistencial

[Resumen] Este documento presenta una arquitectura de control multimodal para robótica de asistencia, la cual trata de tener en cuenta las decisiones del usuario para mejorar en el desempeño de las tareas al mismo tiempo que se implementa un método para minimizar posibles errores en el manejo del robot mediante un control visual. A través de la información proporcionada por el sistema de eyetracking, el usuario será capaz de interactuar con el sistema para seleccionar el objeto deseado, indicar la intención de cogerlo o incluso abortar la ejecución. El sistema incorpora un sistema de tracking 3D para conocer la ubicación de los objetos con respecto al manipulador robótico. Este sistema nos sirve tanto para definir la posición que debe alcanzar el robot, como para corregir las posibles desviaciones durante la ejecución de la trayectoria.Este trabajo ha sido financiado por la Comisión Europea a través del proyecto AIDE: Adaptive Multimodal Interfaces to AssistDisabled People in Daily Activities (Grant agreementno: 645322) y por el Ministerio de Economía y Competitividad a través del proyecto DPI2015-70415-C2-2-Rhttps://doi.org/10.17979/spudc.978849749808

Tele-rehabilitation versus local rehabilitation therapies assisted by robotic devices: a pilot study with patients

The present study aims to evaluate the advantages of a master-slave robotic rehabilitation therapy in which the patient is assisted in real-time by a therapist. We have also explored if this type of strategy is applicable in a tele-rehabilitation environment. A pilot study has been carried out involving 10 patients who have performed a point-to-point rehabilitation exercise supported by three assistance modalities: fixed assistance (without therapist interaction), local therapist assistance, and remote therapist assistance in a simulated tele-rehabiliation scenario. The rehabilitation exercise will be performed using an upper-limb rehabilitation robotic device that assists the patients through force fields. The results suggest that the assistance provided by the therapist is better adapted to patient needs than fixed assistance mode. Therefore, it maximizes the patient's level of effort, which is an important aspect to improve the rehabilitation outcomes. We have also seen that in a tele-rehabilitation environment it is more difficult to assess when to assist the patient than locally. However, the assistance suits patients better than the fixed assistance mode