Feasibility and safety of shared EEG/EOG and vision-guided autonomous whole-arm exoskeleton control to perform activities of daily living

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Abstract

Arm and finger paralysis, e.g. due to brain stem stroke, often results in the inability to perform activities of daily living (ADLs) such as eating and drinking. Recently, it was shown that a hybrid electroencephalography/electrooculography (EEG/EOG) brain/neural hand exoskeleton can restore hand function to quadriplegics, but it was unknown whether such control paradigm can be also used for fluent, reliable and safe operation of a semi-autonomous whole-arm exoskeleton restoring ADLs. To test this, seven abled-bodied participants (seven right-handed males, mean age 30 ± 8 years) were instructed to use an EEG/EOG-controlled whole-arm exoskeleton attached to their right arm to perform a drinking task comprising multiple sub-tasks (reaching, grasping, drinking, moving back and releasing a cup). Fluent and reliable control was defined as average ‘time to initialize’ (TTI) execution of each sub-task below 3 s with successful initializations of at least 75% of sub-tasks within 5 s. During use of the system, no undesired side effects were reported. All participants were able to fluently and reliably control the vision-guided autonomous whole-arm exoskeleton (average TTI 2.12 ± 0.78 s across modalities with 75% successful initializations reached at 1.9 s for EOG and 4.1 s for EEG control) paving the way for restoring ADLs in severe arm and hand paralysis.

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Brain-machine interface in chronic stroke rehabilitation: a controlled study.

Ander Ramos-Murguialday, Doris Broetz, Massimiliano Rea … (2013)

Chronic stroke patients with severe hand weakness respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain-machine interface (BMI) training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double-blind sham-controlled design proof of concept study. Thirty-two chronic stroke patients with severe hand weakness were randomly assigned to 2 matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms with contingent online movements of hand and arm orthoses (experimental group, n = 16). In the control group (sham group, n = 16), movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo-expectancy effects, and functional magnetic resonance imaging (fMRI) blood oxygenation level-dependent activity were assessed before and after intervention. A significant group × time interaction in upper limb (combined hand and modified arm) Fugl-Meyer assessment (cFMA) motor scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41 ± 0.563-point difference, p = 0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in fMRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups. The addition of BMI training to behaviorally oriented physiotherapy can be used to induce functional improvements in motor function in chronic stroke patients without residual finger movements and may open a new door in stroke neurorehabilitation. Copyright © 2013 American Neurological Association.

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Restoration of reaching and grasping in a person with tetraplegia through brain-controlled muscle stimulation: a proof-of-concept demonstration

Abidemi Ajiboye, Francis Willett, Daniel Young … (2017)

SUMMARY Background People with chronic tetraplegia due to high cervical spinal cord injury (SCI) can regain limb movements through coordinated electrical stimulation of peripheral muscles and nerves, known as Functional Electrical Stimulation (FES). Users typically command FES systems through other preserved, but limited and unrelated, volitional movements (e.g. facial muscle activity, head movements). We demonstrate an individual with traumatic high cervical SCI performing coordinated reaching and grasping movements using his own paralyzed arm and hand, reanimated through FES, and commanded using his own cortical signals through an intracortical brain-computer-interface (iBCI). Methods The study participant (53 years old, C4, ASIA A) received two intracortical microelectrode arrays in the hand area of motor cortex, and 36 percutaneous electrodes for electrically stimulating hand, elbow, and shoulder muscles. The participant used a motorized mobile arm support for gravitational assistance and to provide humeral ab/adduction under cortical control. We assessed the participant’s ability to cortically command his paralyzed arm to perform simple single-joint arm/hand movements and functionally meaningful multi-joint movements. We compared iBCI control of his paralyzed arm to that of a virtual 3D arm. This study is registered with ClinicalTrials.gov, NCT00912041. Findings The participant successfully cortically commanded single-joint and coordinated multi-joint arm movements for point-to-point target acquisitions (80% – 100% accuracy) using first a virtual arm, and second his own arm animated by FES. Using his paralyzed arm, the participant volitionally performed self-paced reaches to drink a mug of coffee (successfully completing 11 of 12 attempts within a single session) and feed himself. Interpretation This is the first demonstration of a combined FES+iBCI neuroprosthesis for both reaching and grasping for people with SCI resulting in chronic tetraplegia, and represents a major advance, with a clear translational path, for clinically viable neuroprostheses for restoring reaching and grasping post-paralysis.

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A survey on robotic devices for upper limb rehabilitation

Paweł Maciejasz, Jörg Eschweiler, Kurt Gerlach-Hahn … (2014)

The existing shortage of therapists and caregivers assisting physically disabled individuals at home is expected to increase and become serious problem in the near future. The patient population needing physical rehabilitation of the upper extremity is also constantly increasing. Robotic devices have the potential to address this problem as noted by the results of recent research studies. However, the availability of these devices in clinical settings is limited, leaving plenty of room for improvement. The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing solutions and facilitate the development of new and improved devices. In particular the following issues are discussed: application field, target group, type of assistance, mechanical design, control strategy and clinical evaluation. This paper also includes a comprehensive, tabulated comparison of technical solutions implemented in various systems.

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Author and article information

Contributors

Simona Crea: simona.crea@santannapisa.it

Surjo R. Soekadar: surjo.soekadar@uni-tuebingen.de

Journal

Journal ID (nlm-ta): Sci Rep

Journal ID (iso-abbrev): Sci Rep

Title: Scientific Reports

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2045-2322

Publication date (Electronic): 17 July 2018

Publication date PMC-release: 17 July 2018

Publication date Collection: 2018

Volume: 8

Electronic Location Identifier: 10823

Affiliations

[1 ]ISNI 0000 0004 1762 600X, GRID grid.263145.7, The BioRobotics Institute, , Scuola Superiore Sant’Anna, ; Pisa, Italy

[2 ]ISNI 0000 0001 1090 9021, GRID grid.418563.d, Fondazione Don Carlo Gnocchi, ; Milan, Italy

[3 ]ISNI 0000 0001 0196 8249, GRID grid.411544.1, Applied Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, , University Hospital of Tübingen, ; Tübingen, Germany

[4 ]ISNI 0000 0004 1757 5329, GRID grid.9657.d, Unit of Biomedical Robotics and Biomicrosystems, , University Campus Bio-Medico of Rome, ; Rome, Italy

[5 ]ISNI 0000000103580096, GRID grid.7759.c, Applied Robotics, Departamento de Ingeniería en Automática, , Electrónica, Arquitectura y Redes de Computadores, Universidad de Cádiz, ; Cádiz, Spain

[6 ]ISNI 0000 0001 0586 4893, GRID grid.26811.3c, Biomedical Neuroengineering, Departamento de Ingenieria de Sistemas y Automática, , Universidad Miguel Hernandez de Elche, ; Elche, Spain

[7 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Clinical Neurotechnology Laboratory, Neuroscience Research Center (NWFZ) & Department of Psychiatry and Psychotherapy, , Charité – University Medicine Berlin, ; Berlin, Germany

Author information

Emilio Trigili http://orcid.org/0000-0002-3725-5694

Nicolas Garcia Aracil http://orcid.org/0000-0002-2510-3829

Article

Publisher ID: 29091

DOI: 10.1038/s41598-018-29091-5

PMC ID: 6050229

PubMed ID: 30018334

SO-VID: 81d41900-130e-4039-bd74-97b323e4c688

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 4 January 2018

Date accepted : 3 July 2018

Funding

Funded by: FundRef https://doi.org/10.13039/501100007601, EC | Horizon 2020 (European Union Framework Programme for Research and Innovation);

Award ID: 645322

Award Recipient : Simona Crea Marius Nann Emilio Trigili Francesca Cordella Andrea Baldoni Francisco Javier Badesa Loredana Zollo Nicola Vitiello Nicolas Garcia Aracil Surjo R. Soekadar

Funded by: FundRef https://doi.org/10.13039/501100000781, EC | European Research Council (ERC);

Award ID: 759370

Award Recipient : Surjo R. Soekadar

Funded by: SRS received special support by the Brain & Behavior Research Foundation as 2017 NARSAD Young Investigator Grant recipient and P&S Fund Investigator.

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