Brain-computer interface enhanced by virtual reality training for controlling a lower limb exoskeleton

Virtual Reality as a Therapeutic Tool in Spinal Cord Injury Rehabilitation: A Comprehensive Evaluation and Systematic Review

Introduction: The spinal rehabilitation process plays a crucial role in SCI patients' lives, and recent developments in VR have the potential to efficiently engage SCI patients in therapeutic activities and promote neuroplasticity. Objective: The primary objective of this study is to assess a complete review of the extended impacts of VR-assisted training on spine rehabilitation in SCI patients. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) through a single database search in PubMed/Medline between the dates 1 January 2010 and 1 February 2024. MESH terms and keywords were combined in the following search strategy: (Augmented Reality OR VR OR Virtual Reality) AND (Spine OR Spinal) AND Rehabilitation. Included articles were written in English, involved adults with SCI, included an intervention with VR, AR, or any mixed reality system, and assessed changes in outcomes after the intervention. Results: The search produced 257 articles, and 46 of them were allocated for data extraction to evaluate 652 patients. Both when VR training was analyzed and reviewed separately, and when compared to traditional training, the findings exhibited predominantly promising outcomes, reflecting a favorable trend in the study. VR technologies were used in different settings and customizations, and the medium total time of VR training among the studies was 60.46 h per patient. Conclusions: This auspicious outcome of the study further motivates the intervention of VR and AR in the rehabilitation of SCI patients along with ameliorating their overall holistic well-being.

Brain-computer interfaces: the innovative key to unlocking neurological conditions

Neurological disorders such as Parkinson's disease, stroke, and spinal cord injury can pose significant threats to human mortality, morbidity, and functional independence. Brain-Computer Interface (BCI) technology, which facilitates direct communication between the brain and external devices, emerges as an innovative key to unlocking neurological conditions, demonstrating significant promise in this context. This comprehensive review uniquely synthesizes the latest advancements in BCI research across multiple neurological disorders, offering an interdisciplinary perspective on both clinical applications and emerging technologies. We explore the progress in BCI research and its applications in addressing various neurological conditions, with a particular focus on recent clinical studies and prospective developments. Initially, the review provides an up-to-date overview of BCI technology, encompassing its classification, operational principles, and prevalent paradigms. It then critically examines specific BCI applications in movement disorders, disorders of consciousness, cognitive and mental disorders, as well as sensory disorders, highlighting novel approaches and their potential impact on patient care. This review reveals emerging trends in BCI applications, such as the integration of artificial intelligence and the development of closed-loop systems, which represent significant advancements over previous technologies. The review concludes by discussing the prospects and directions of BCI technology, underscoring the need for interdisciplinary collaboration and ethical considerations. It emphasizes the importance of prioritizing bidirectional and high-performance BCIs, areas that have been underexplored in previous reviews. Additionally, we identify crucial gaps in current research, particularly in long-term clinical efficacy and the need for standardized protocols. The role of neurosurgery in spearheading the clinical translation of BCI research is highlighted. Our comprehensive analysis presents BCI technology as an innovative key to unlocking neurological disorders, offering a transformative approach to diagnosing, treating, and rehabilitating neurological conditions, with substantial potential to enhance patients' quality of life and advance the field of neurotechnology.

[Virtual reality-brain computer interface hand function enhancement rehabilitation system incorporating multi-sensory stimulation]

Stroke is an acute cerebrovascular disease in which sudden interruption of blood supply to the brain or rupture of cerebral blood vessels cause damage to brain cells and consequently impair the patient's motor and cognitive abilities. A novel rehabilitation training model integrating brain-computer interface (BCI) and virtual reality (VR) not only promotes the functional activation of brain networks, but also provides immersive and interesting contextual feedback for patients. In this paper, we designed a hand rehabilitation training system integrating multi-sensory stimulation feedback, BCI and VR, which guides patients' motor imaginations through the tasks of the virtual scene, acquires patients' motor intentions, and then carries out human-computer interactions under the virtual scene. At the same time, haptic feedback is incorporated to further increase the patients' proprioceptive sensations, so as to realize the hand function rehabilitation training based on the multi-sensory stimulation feedback of vision, hearing, and haptic senses. In this study, we compared and analyzed the differences in power spectral density of different frequency bands within the EEG signal data before and after the incorporation of haptic feedback, and found that the motor brain area was significantly activated after the incorporation of haptic feedback, and the power spectral density of the motor brain area was significantly increased in the high gamma frequency band. The results of this study indicate that the rehabilitation training of patients with the VR-BCI hand function enhancement rehabilitation system incorporating multi-sensory stimulation can accelerate the two-way facilitation of sensory and motor conduction pathways, thus accelerating the rehabilitation process.

User Evaluation of a Shared Robot Control System Combining BCI and Eye Tracking in a Portable Augmented Reality User Interface

This study evaluates an innovative control approach to assistive robotics by integrating brain-computer interface (BCI) technology and eye tracking into a shared control system for a mobile augmented reality user interface. Aimed at enhancing the autonomy of individuals with physical disabilities, particularly those with impaired motor function due to conditions such as stroke, the system utilizes BCI to interpret user intentions from electroencephalography signals and eye tracking to identify the object of focus, thus refining control commands. This integration seeks to create a more intuitive and responsive assistive robot control strategy. The real-world usability was evaluated, demonstrating significant potential to improve autonomy for individuals with severe motor impairments. The control system was compared with an eye-tracking-based alternative to identify areas needing improvement. Although BCI achieved an acceptable success rate of 0.83 in the final phase, eye tracking was more effective with a perfect success rate and consistently lower completion times (p<0.001). The user experience responses favored eye tracking in 11 out of 26 questions, with no significant differences in the remaining questions, and subjective fatigue was higher with BCI use (p=0.04). While BCI performance lagged behind eye tracking, the user evaluation supports the validity of our control strategy, showing that it could be deployed in real-world conditions and suggesting a pathway for further advancements.

Decoding lower-limb kinematic parameters during pedaling tasks using deep learning approaches and EEG

Stroke is a neurological condition that usually results in the loss of voluntary control of body movements, making it difficult for individuals to perform activities of daily living (ADLs). Brain-computer interfaces (BCIs) integrated into robotic systems, such as motorized mini exercise bikes (MMEBs), have been demonstrated to be suitable for restoring gait-related functions. However, kinematic estimation of continuous motion in BCI systems based on electroencephalography (EEG) remains a challenge for the scientific community. This study proposes a comparative analysis to evaluate two artificial neural network (ANN)-based decoders to estimate three lower-limb kinematic parameters: x- and y-axis position of the ankle and knee joint angle during pedaling tasks. Long short-term memory (LSTM) was used as a recurrent neural network (RNN), which reached Pearson correlation coefficient (PCC) scores close to 0.58 by reconstructing kinematic parameters from the EEG features on the delta band using a time window of 250 ms. These estimates were evaluated through kinematic variance analysis, where our proposed algorithm showed promising results for identifying pedaling and rest periods, which could increase the usability of classification tasks. Additionally, negative linear correlations were found between pedaling speed and decoder performance, thereby indicating that kinematic parameters between slower speeds may be easier to estimate. The results allow concluding that the use of deep learning (DL)-based methods is feasible for the estimation of lower-limb kinematic parameters during pedaling tasks using EEG signals. This study opens new possibilities for implementing controllers most robust for MMEBs and BCIs based on continuous decoding, which may allow for maximizing the degrees of freedom and personalized rehabilitation.

Advancements in brain-computer interfaces for the rehabilitation of unilateral spatial neglect: a concise review

This short review examines recent advancements in neurotechnologies within the context of managing unilateral spatial neglect (USN), a common condition following stroke. Despite the success of brain-computer interfaces (BCIs) in restoring motor function, there is a notable absence of effective BCI devices for treating cerebral visual impairments, a prevalent consequence of brain lesions that significantly hinders rehabilitation. This review analyzes current non-invasive BCIs and technological solutions dedicated to cognitive rehabilitation, with a focus on visuo-attentional disorders. We emphasize the need for further research into the use of BCIs for managing cognitive impairments and propose a new potential solution for USN rehabilitation, by combining the clinical subtleties of this syndrome with the technological advancements made in the field of neurotechnologies.

Brain-machine interface based on deep learning to control asynchronously a lower-limb robotic exoskeleton: a case-of-study

BACKGROUND

This research focused on the development of a motor imagery (MI) based brain-machine interface (BMI) using deep learning algorithms to control a lower-limb robotic exoskeleton. The study aimed to overcome the limitations of traditional BMI approaches by leveraging the advantages of deep learning, such as automated feature extraction and transfer learning. The experimental protocol to evaluate the BMI was designed as asynchronous, allowing subjects to perform mental tasks at their own will.

METHODS

A total of five healthy able-bodied subjects were enrolled in this study to participate in a series of experimental sessions. The brain signals from two of these sessions were used to develop a generic deep learning model through transfer learning. Subsequently, this model was fine-tuned during the remaining sessions and subjected to evaluation. Three distinct deep learning approaches were compared: one that did not undergo fine-tuning, another that fine-tuned all layers of the model, and a third one that fine-tuned only the last three layers. The evaluation phase involved the exclusive closed-loop control of the exoskeleton device by the participants' neural activity using the second deep learning approach for the decoding.

RESULTS

The three deep learning approaches were assessed in comparison to an approach based on spatial features that was trained for each subject and experimental session, demonstrating their superior performance. Interestingly, the deep learning approach without fine-tuning achieved comparable performance to the features-based approach, indicating that a generic model trained on data from different individuals and previous sessions can yield similar efficacy. Among the three deep learning approaches compared, fine-tuning all layer weights demonstrated the highest performance.

CONCLUSION

This research represents an initial stride toward future calibration-free methods. Despite the efforts to diminish calibration time by leveraging data from other subjects, complete elimination proved unattainable. The study's discoveries hold notable significance for advancing calibration-free approaches, offering the promise of minimizing the need for training trials. Furthermore, the experimental evaluation protocol employed in this study aimed to replicate real-life scenarios, granting participants a higher degree of autonomy in decision-making regarding actions such as walking or stopping gait.

Evaluation of temporal, spatial and spectral filtering in CSP-based methods for decoding pedaling-based motor tasks using EEG signals

Stroke is a neurological syndrome that usually causes a loss of voluntary control of lower/upper body movements, making it difficult for affected individuals to perform Activities of Daily Living (ADLs). Brain-Computer Interfaces (BCIs) combined with robotic systems, such as Motorized Mini Exercise Bikes (MMEB), have enabled the rehabilitation of people with disabilities by decoding their actions and executing a motor task. However, Electroencephalography (EEG)-based BCIs are affected by the presence of physiological and non-physiological artifacts. Thus, movement discrimination using EEG become challenging, even in pedaling tasks, which have not been well explored in the literature. In this study, Common Spatial Patterns (CSP)-based methods were proposed to classify pedaling motor tasks. To address this, Filter Bank Common Spatial Patterns (FBCSP) and Filter Bank Common Spatial-Spectral Patterns (FBCSSP) were implemented with different spatial filtering configurations by varying the time segment with different filter bank combinations for the three methods to decode pedaling tasks. An in-house EEG dataset during pedaling tasks was registered for 8 participants. As results, the best configuration corresponds to a filter bank with two filters (8-19 Hz and 19-30 Hz) using a time window between 1.5 and 2.5 s after the cue and implementing two spatial filters, which provide accuracy of approximately 0.81, False Positive Rates lower than 0.19, andKappaindex of 0.61. This work implies that EEG oscillatory patterns during pedaling can be accurately classified using machine learning. Therefore, our method can be applied in the rehabilitation context, such as MMEB-based BCIs, in the future.

Boosting lower-limb motor imagery performance through an ensemble method for gait rehabilitation

Lower-limb exoskeletons have been used extensively in many rehabilitation applications to assist disabled people with their therapies. Brain-machine interfaces (BMIs) further provide effective and natural control schemes. However, the limited performance of brain signal decoding from lower-limb kinematics restricts the broad growth of both BMI and rehabilitation industry. To address these challenges, we propose an ensemble method for lower-limb motor imagery (MI) classification. The proposed model employs multiple techniques to boost performance, including deep and shallow parts. Traditional wavelet transformation followed by filter-bank common spatial pattern (CSP) employs neurophysiologically reasonable patterns, while multi-head self-attention (MSA) followed by temporal convolutional network (TCN) extracts deeper encoded generalized patterns. Experimental results in a customized lower-limb exoskeleton on 8 subjects in 3 consecutive sessions showed that the proposed method achieved 60.27% and 64.20% for three (MI of left leg, MI of right leg, and rest) and two classes (lower-limb MI vs. rest), respectively. Besides, the proposed model achieves improvements of up to 4% and 2% accuracy for the subject-specific and subject-independent modes compared to the current state-of-the-art (SOTA) techniques, respectively. Finally, feature analysis was conducted to show discriminative brain patterns in each MI task and sessions with different feedback modalities. The proposed models integrated in the brain-actuated lower-limb exoskeleton established a potential BMI for gait training and neuroprosthesis.