Enhancing brain/neural-machine interfaces for upper limb motor restoration in chronic stroke and cervical spinal cord injury

Operation of assistive exoskeletons based on voluntary control of sensorimotor rhythms (SMR, 8-12 Hz) enables intuitive control of finger or arm movements in severe paralysis after chronic stroke or cervical spinal cord injury (SCI). To improve reliability of such systems outside the laboratory, in particular when brain activity is recorded non-invasively with scalp electroencephalography (EEG), a hybrid EEG/electrooculography (EOG) brain/neural-machine interface (B/NMI) was recently introduced. Besides providing assistance, recent studies indicate that repeated use of such systems can trigger neural recovery. However, important prerequisites have to achieved before broader use in clinical settings or everyday life environments is feasible. Current B/NMI systems predominantly restore hand function, but do not allow simultaneous control of more proximal joints for whole-arm motor coordination as required for most stroke survivors suffering from paralysis in the entire upper limb. Besides paralysis, cognitive impairments including post-stroke fatigue due to the brain lesion reduce the capacity to maintain effortful B/NMI control over a longer period of time. This impedes the applicability in daily life assistance and might even limits the efficacy of neurorehabilitation training. In contrast to stroke survivors, tetraplegics due to cervical SCI lack motor function in both hands. Given that most activities of daily living (ADL) involve bimanual manipulation, e.g., to open the lid of a bottle, bilateral exoskeleton control is required but was not shown yet in tetraplegics. To further enhance B/NMI systems, we first investigated whether B/NMI whole-arm exoskeleton control in hemiplegia after chronic stroke is feasible and safe. In contrast to simple grasping, control of more complex tasks involving the entire upper limb was not feasible with established B/NMIs because high- dimensionality of such multiple joint systems exceeds the bandwidth of these interfaces. Thus, we blended B/NMI control with vision-guidance to receive a semiautonomous whole-arm exoskeleton control. Such setup allowed to divide ADL tasks into a sequence of EEG/EOG-triggered sub-tasks reducing complexity for the user. While, for instance, a drinking task was resolved into EOG-induced reaching, lifting and placing back the cup, grasping and releasing movements were based on intuitive SMR control. Feasibility of such shared vision-guided B/NMI control was assumed when executions were initialized within 3 s (fluent control) and a minimum of 75 % of subtasks were executed within that time (reliable control). We showed feasibility in healthy subjects as well as stroke survivors without report of any side effects documenting safe use. Similarly, feasibility and safety of bilateral B/NMI control after cervical SCI was evaluated. To enable bilateral B/NMI control, established EEG-based grasping and EOG-based releasing or stop commands were complemented with a novel EOG command allowing to switch laterality by performing prolonged horizontal eye movements (>1 s) to the left or to the right. Study results with healthy subjects and tetraplegics document fluent initialization of grasping motions below 3 s as well as safe use as unintended grasping could be stopped before a full motion was conducted. Superiority of novel bilateral control was documented by a higher accuracy of up to 22 % in tetraplegics compared to a bilateral control without prolonged EOG command. Lastly, as reliable B/NMI control is cognitively demanding, e.g., by imagining or attempting the desired movements, we investigated whether heart rate variability (HRV) can be used as biomarker to predict declining control performance, which is often reported in stroke survivors due to their cognitive impairments. Referring to the close brain-heart connection, we showed in healthy subjects that a decline in HRV is specific as well as predictive to a decline in B/NMI control performance within a single training session. The predictive link was revealed by a Granger-causality analysis. In conclusion, we could demonstrate important enhancements in B/NMI control paradigms including complex whole-arm exoskeleton control as well as individual performance monitoring within a training session based on HRV. Both achievements contribute to broaden the use as a standard therapy in stroke neurorehabilitation. Especially the predictive characteristic of HRV paves the way for adaptive B/NMI control paradigms to account for individual differences among impaired stroke survivors. Moreover, we also showed feasibility and safety of a novel implementation for bilateral B/NMI control, which is necessary for reliable operation of two hand-exoskeletons for bimanual ADLs after SCI

Feasibility and Safety of Bilateral Hybrid EEG/EOG Brain/Neural–Machine Interaction

Cervical spinal cord injuries (SCIs) often lead to loss of motor function in both hands and legs, limiting autonomy and quality of life. While it was shown that unilateral hand function can be restored after SCI using a hybrid electroencephalography/electrooculography (EEG/EOG) brain/neural hand exoskeleton (B/NHE), it remained unclear whether such hybrid paradigm also could be used for operating two hand exoskeletons, e.g., in the context of bimanual tasks such as eating with fork and knife. To test whether EEG/EOG signals allow for fluent and reliable as well as safe and user-friendly bilateral B/NHE control, eight healthy participants (six females, mean age 24.1 +/- 3.2 years) as well as four chronic tetraplegics (four males, mean age 51.8 +/- 15.2 years) performed a complex sequence of EEG-controlled bilateral grasping and EOG-controlled releasing motions of two exoskeletons visually presented on a screen. A novel EOG command performed by prolonged horizontal eye movements (>1 s) to the left or right was introduced as a reliable switch to activate either the left or right exoskeleton. Fluent EEG control was defined as average "time to initialize" (TTI) grasping motions below 3 s. Reliable EEG control was assumed when classification accuracy exceeded 80%. Safety was defined as "time to stop" (TTS) all unintended grasping motions within 2 s. After the experiment, tetraplegics were asked to rate the user-friendliness of bilateral B/NHE control using Likert scales. Average TTI and accuracy of EEG-controlled operations ranged at 2.14 +/- 0.66 s and 85.89 +/- 15.81% across healthy participants and at 1.90 +/- 0.97 s and 81.25 +/- 16.99% across tetraplegics. Except for one tetraplegic, all participants met the safety requirements. With 88 +/- 11% of the maximum achievable score, tetraplegics rated the control paradigm as user-friendly and reliable. These results suggest that hybrid EEG/EOG B/NHE control of two assistive devices is feasible and safe, paving the way to test this paradigm in larger clinical trials performing bimanual tasks in everyday life environments

Restoration of Gait using Personalized Brain/Neural-Controlled Exoskeletons

The development of brain/neural-controlled exoskeletons allow for restoration of movements in paralysis. By translating brain activity associated with the intention to move, such systems enabled, e.g., quadriplegic patients with complete finger paralysis to eat and drink in an outside restaurant. However, noninvasive means to record brain activity often lack sufficient signal quality for reliable and safe operation, particularly in noisy, uncontrolled environments or presence of muscle artifacts due to whole body movements. Thus, hybrid control paradigms were developed that merge different biosignals to increase reliability of exoskeleton control. Here, we introduce such control paradigm for restoration of gait using a personalized exoskeleton based on electroencephalographic and electrooculographic (EEG/EOG) signals. While exoskeleton movements were initiated by event-related desynchronization (ERD) of sensorimotor rhythms (SMR) associated with the intention to walk, the exoskeleton was stopped by a specific EOG signal. Using such paradigm does not only provide intuitive control, but may also trigger neural recovery when used repeatedly over a longer period of time. Further validation of this approach in a larger clinical study on gait assistance and rehabilitation will be needed

LIFEDATA - a framework for traceable active learning projects

Active Learning has become a popular method for iteratively improving data-intensive Artificial Intelligence models. However, it often presents a significant challenge when dealing with large volumes of volatile data in projects, as with an Active Learning loop. This paper introduces LIFEDATA, a Python- based framework designed to assist developers in implementing Active Learning projects focusing on traceability. It supports seamless tracking of all artifacts, from data selection and labeling to model interpretation, thus promoting transparency throughout the entire model learning process and enhancing error debugging efficiency while ensuring experiment reproducibility. To showcase its applicability, we present two life science use cases. Moreover, the paper proposes an algorithm that combines query strategies to demonstrate LIFEDATA’s ability to reduce data labeling effort

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

Physiological Responses During Hybrid BNCI Control of an Upper-Limb Exoskeleton

When combined with assistive robotic devices, such as wearable robotics, brain/neural-computer interfaces (BNCI) have the potential to restore the capabilities of handicapped people to carry out activities of daily living. To improve applicability of such systems, workload and stress should be reduced to a minimal level. Here, we investigated the user’s physiological reactions during the exhaustive use of the interfaces of a hybrid control interface. Eleven BNCI-naive healthy volunteers participated in the experiments. All participants sat in a comfortable chair in front of a desk and wore a whole-arm exoskeleton as well as wearable devices for monitoring physiological, electroencephalographic (EEG) and electrooculographic (EoG) signals. The experimental protocol consisted of three phases: (i) Set-up, calibration and BNCI training; (ii) Familiarization phase ; and (iii) Experimental phase during which each subject had to perform EEG and EoG tasks. After completing each task, the NASA-TLX questionnaire and self-assessment manikin (SAM) were completed by the user. We found significant differences (p-value < 0.05) in heart rate variability (HRV) and skin conductance level (SCL) between participants during the use of the two different biosignal modalities (EEG, EoG) of the BNCI. This indicates that EEG control is associated with a higher level of stress (associated with a decrease in HRV) and mental work load (associated with a higher level of SCL) when compared to EoG control. In addition, HRV and SCL modulations correlated with the subject’s workload perception and emotional responses assessed through NASA-TLX questionnaires and SAM

Hybrid brain/neural interface and autonomous vision-guided whole-arm exoskeleton control to perform activities of daily living (ADLs)

[EN] Background The aging of the population and the progressive increase of life expectancy in developed countries is leading to a high incidence of age-related cerebrovascular diseases, which affect people's motor and cognitive capabilities and might result in the loss of arm and hand functions. Such conditions have a detrimental impact on people's quality of life. Assistive robots have been developed to help people with motor or cognitive disabilities to perform activities of daily living (ADLs) independently. Most of the robotic systems for assisting on ADLs proposed in the state of the art are mainly external manipulators and exoskeletal devices. The main objective of this study is to compare the performance of an hybrid EEG/EOG interface to perform ADLs when the user is controlling an exoskeleton rather than using an external manipulator. Methods Ten impaired participants (5 males and 5 females, mean age 52 +/- 16 years) were instructed to use both systems to perform a drinking task and a pouring task comprising multiple subtasks. For each device, two modes of operation were studied: synchronous mode (the user received a visual cue indicating the sub-tasks to be performed at each time) and asynchronous mode (the user started and finished each of the sub-tasks independently). Fluent control was assumed when the time for successful initializations ranged below 3 s and a reliable control in case it remained below 5 s. NASA-TLX questionnaire was used to evaluate the task workload. For the trials involving the use of the exoskeleton, a custom Likert-Scale questionnaire was used to evaluate the user's experience in terms of perceived comfort, safety, and reliability. Results All participants were able to control both systems fluently and reliably. However, results suggest better performances of the exoskeleton over the external manipulator (75% successful initializations remain below 3 s in case of the exoskeleton and bellow 5s in case of the external manipulator). Conclusions Although the results of our study in terms of fluency and reliability of EEG control suggest better performances of the exoskeleton over the external manipulator, such results cannot be considered conclusive, due to the heterogeneity of the population under test and the relatively limited number of participants.This study was funded by the European Commission under the project AIDE (G.A. no: 645322), Spanish Ministry of Science and Innovation, through the projects PID2019-108310RB-I00 and PLEC2022-009424 and by the Ministry of Universities and European Union, "fnanced by European Union-Next Generation EU" through Margarita Salas grant for the training of young doctors.Catalán, JM.; Trigili, E.; Nann, M.; Blanco-Ivorra, A.; Lauretti, C.; Cordella, F.; Ivorra, E.... (2023). Hybrid brain/neural interface and autonomous vision-guided whole-arm exoskeleton control to perform activities of daily living (ADLs). Journal of NeuroEngineering and Rehabilitation. 20(1):1-16. https://doi.org/10.1186/s12984-023-01185-w11620