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      A Single-Session Preliminary Evaluation of an Affordable BCI-Controlled Arm Exoskeleton and Motor-Proprioception Platform

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          Abstract

          Traditional, hospital-based stroke rehabilitation can be labor-intensive and expensive. Furthermore, outcomes from rehabilitation are inconsistent across individuals and recovery is hard to predict. Given these uncertainties, numerous technological approaches have been tested in an effort to improve rehabilitation outcomes and reduce the cost of stroke rehabilitation. These techniques include brain–computer interface (BCI), robotic exoskeletons, functional electrical stimulation (FES), and proprioceptive feedback. However, to the best of our knowledge, no studies have combined all these approaches into a rehabilitation platform that facilitates goal-directed motor movements. Therefore, in this paper, we combined all these technologies to test the feasibility of using a BCI-driven exoskeleton with FES (robotic training device) to facilitate motor task completion among individuals with stroke. The robotic training device operated to assist a pre-defined goal-directed motor task. Because it is hard to predict who can utilize this type of technology, we considered whether the ability to adapt skilled movements with proprioceptive feedback would predict who could learn to control a BCI-driven robotic device. To accomplish this aim, we developed a motor task that requires proprioception for completion to assess motor-proprioception ability. Next, we tested the feasibility of robotic training system in individuals with chronic stroke ( n = 9) and found that the training device was well tolerated by all the participants. Ability on the motor-proprioception task did not predict the time to completion of the BCI-driven task. Both participants who could accurately target ( n = 6) and those who could not ( n = 3), were able to learn to control the BCI device, with each BCI trial lasting on average 2.47 min. Our results showed that the participants’ ability to use proprioception to control motor output did not affect their ability to use the BCI-driven exoskeleton with FES. Based on our preliminary results, we show that our robotic training device has potential for use as therapy for a broad range of individuals with stroke.

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          Most cited references38

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          Modulation of brain plasticity in stroke: a novel model for neurorehabilitation.

          Noninvasive brain stimulation (NIBS) techniques can be used to monitor and modulate the excitability of intracortical neuronal circuits. Long periods of cortical stimulation can produce lasting effects on brain function, paving the way for therapeutic applications of NIBS in chronic neurological disease. The potential of NIBS in stroke rehabilitation has been of particular interest, because stroke is the main cause of permanent disability in industrial nations, and treatment outcomes often fail to meet the expectations of patients. Despite promising reports from many clinical trials on NIBS for stroke recovery, the number of studies reporting a null effect remains a concern. One possible explanation is that the interhemispheric competition model--which posits that suppressing the excitability of the hemisphere not affected by stroke will enhance recovery by reducing interhemispheric inhibition of the stroke hemisphere, and forms the rationale for many studies--is oversimplified or even incorrect. Here, we critically review the proposed mechanisms of synaptic and functional reorganization after stroke, and suggest a bimodal balance-recovery model that links interhemispheric balancing and functional recovery to the structural reserve spared by the lesion. The proposed model could enable NIBS to be tailored to the needs of individual patients.
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            Brain-computer interfaces in neurological rehabilitation.

            Recent advances in analysis of brain signals, training patients to control these signals, and improved computing capabilities have enabled people with severe motor disabilities to use their brain signals for communication and control of objects in their environment, thereby bypassing their impaired neuromuscular system. Non-invasive, electroencephalogram (EEG)-based brain-computer interface (BCI) technologies can be used to control a computer cursor or a limb orthosis, for word processing and accessing the internet, and for other functions such as environmental control or entertainment. By re-establishing some independence, BCI technologies can substantially improve the lives of people with devastating neurological disorders such as advanced amyotrophic lateral sclerosis. BCI technology might also restore more effective motor control to people after stroke or other traumatic brain disorders by helping to guide activity-dependent brain plasticity by use of EEG brain signals to indicate to the patient the current state of brain activity and to enable the user to subsequently lower abnormal activity. Alternatively, by use of brain signals to supplement impaired muscle control, BCIs might increase the efficacy of a rehabilitation protocol and thus improve muscle control for the patient.
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              EEGLAB, SIFT, NFT, BCILAB, and ERICA: New Tools for Advanced EEG Processing

              We describe a set of complementary EEG data collection and processing tools recently developed at the Swartz Center for Computational Neuroscience (SCCN) that connect to and extend the EEGLAB software environment, a freely available and readily extensible processing environment running under Matlab. The new tools include (1) a new and flexible EEGLAB STUDY design facility for framing and performing statistical analyses on data from multiple subjects; (2) a neuroelectromagnetic forward head modeling toolbox (NFT) for building realistic electrical head models from available data; (3) a source information flow toolbox (SIFT) for modeling ongoing or event-related effective connectivity between cortical areas; (4) a BCILAB toolbox for building online brain-computer interface (BCI) models from available data, and (5) an experimental real-time interactive control and analysis (ERICA) environment for real-time production and coordination of interactive, multimodal experiments.
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                Author and article information

                Contributors
                Journal
                Front Hum Neurosci
                Front Hum Neurosci
                Front. Hum. Neurosci.
                Frontiers in Human Neuroscience
                Frontiers Media S.A.
                1662-5161
                30 March 2015
                2015
                : 9
                : 168
                Affiliations
                [1] 1MENRVA Research Group, School of Engineering Science, Simon Fraser University , Burnaby, BC, Canada
                [2] 2Brain Behaviour Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia , Vancouver, BC, Canada
                Author notes

                Edited by: Lorenzo Masia, Nanyang Technological University, Singapore

                Reviewed by: Giovanni Mirabella, Sapienza University of Rome, Italy; Arturo Forner-Cordero, University of São Paulo, Brazil

                *Correspondence: Carlo Menon, MENRVA Laboratory, School of Engineering Science, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada e-mail: cmenon@ 123456sfu.ca

                This article was submitted to the journal Frontiers in Human Neuroscience.

                Article
                10.3389/fnhum.2015.00168
                4378300
                a1642c23-bb8e-4a1a-aac6-495a67d4ab3f
                Copyright © 2015 Elnady, Zhang, Xiao, Yong, Randhawa, Boyd and Menon.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 25 August 2014
                : 11 March 2015
                Page count
                Figures: 7, Tables: 6, Equations: 0, References: 54, Pages: 14, Words: 10196
                Funding
                Funded by: Natural Sciences and Engineering Research Council of Canada
                Funded by: Canadian Institutes of Health Research
                Funded by: Michael Smith Foundation for Health Research
                Categories
                Neuroscience
                Original Research

                Neurosciences
                stroke,exoskeleton,bci,electric stimulation,proprioception
                Neurosciences
                stroke, exoskeleton, bci, electric stimulation, proprioception

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