Online multi-class brain-computer interface for detection and classification of lower limb movement intentions and kinetics for stroke rehabilitation

Wearable Intelligent Machine Learning Rehabilitation Assessment for Stroke Patients Compared with Clinician Assessment

In order to solve the shortcomings of the current clinical scale assessment for stroke patients, such as excessive time consumption, strong subjectivity, and coarse grading, this study designed an intelligent rehabilitation assessment system based on wearable devices and a machine learning algorithm and explored the effectiveness of the system in assessing patients’ rehabilitation outcomes. The accuracy and effectiveness of the intelligent rehabilitation assessment system were verified by comparing the consistency and time between the designed intelligent rehabilitation assessment system scores and the clinical Fugl−Meyer assessment (FMA) scores. A total of 120 stroke patients from two hospitals participated as volunteers in the trial study, and statistical analyses of the two assessment methods were performed. The results showed that the R2 of the total score regression analysis for both methods was 0.9667, 95% CI 0.92−0.98, p < 0.001, and the mean of the deviation was 0.30, 95% CI 0.57−1.17. The percentages of deviations/relative deviations falling within the mean ± 1.96 SD of deviations/relative deviations were 92.50% and 95.83%, respectively. The mean time for system assessment was 35.00% less than that for clinician assessment, p < 0.05. Therefore, wearable intelligent machine learning rehabilitation assessment has a strong and significant correlation with clinician assessment, and the time spent is significantly reduced, which provides an accurate, objective, and effective solution for clinical rehabilitation assessment and remote rehabilitation without the presence of physicians.

Improving pre-movement pattern detection with filter bank selection

Objective. Pre-movement decoding plays an important role in detecting the onsets of actions using low-frequency electroencephalography (EEG) signals before the movement of an upper limb. In this work, a binary classification method is proposed between two different states.Approach. The proposed method, referred to as filter bank standard task-related component analysis (FBTRCA), is to incorporate filter bank selection into the standard task-related component analysis (STRCA) method. In FBTRCA, the EEG signals are first divided into multiple sub-bands which start at specific fixed frequencies and end frequencies that follow in an arithmetic sequence. The STRCA method is then applied to the EEG signals in these bands to extract CCPs. The minimum redundancy maximum relevance feature selection method is used to select essential features from these correlation patterns in all sub-bands. Finally, the selected features are classified using the binary support vector machine classifier. A convolutional neural network (CNN) is an alternative approach to select canonical correlation patterns.Main Results. Three methods were evaluated using EEG signals in the time window from 2 s before the movement onset to 1 s after the movement onset. In the binary classification between a movement state and the resting state, the FBTRCA achieved an average accuracy of 0.8968 ± 0.0847 while the accuracies of STRCA and CNN were 0.8228 ± 0.1149 and 0.8828 ± 0.0917, respectively. In the binary classification between two actions, the accuracies of STRCA, CNN, and FBTRCA were 0.6611 ± 0.1432, 0.6993 ± 0.1271, 0.7178 ± 0.1274, respectively. Feature selection using filter banks, as in FBTRCA, produces comparable results to STRCA.Significance. The proposed method provides a way to select filter banks in pre-movement decoding, and thus it improves the classification performance. The improved pre-movement decoding of single upper limb movements is expected to provide people with severe motor disabilities with a more natural, non-invasive control of their external devices.

Identification of Lower-Limb Motor Tasks via Brain–Computer Interfaces: A Topical Overview

Recent engineering and neuroscience applications have led to the development of brain–computer interface (BCI) systems that improve the quality of life of people with motor disabilities. In the same area, a significant number of studies have been conducted in identifying or classifying upper-limb movement intentions. On the contrary, few works have been concerned with movement intention identification for lower limbs. Notwithstanding, lower-limb neurorehabilitation is a major topic in medical settings, as some people suffer from mobility problems in their lower limbs, such as those diagnosed with neurodegenerative disorders, such as multiple sclerosis, and people with hemiplegia or quadriplegia. Particularly, the conventional pattern recognition (PR) systems are one of the most suitable computational tools for electroencephalography (EEG) signal analysis as the explicit knowledge of the features involved in the PR process itself is crucial for both improving signal classification performance and providing more interpretability. In this regard, there is a real need for outline and comparative studies gathering benchmark and state-of-art PR techniques that allow for a deeper understanding thereof and a proper selection of a specific technique. This study conducted a topical overview of specialized papers covering lower-limb motor task identification through PR-based BCI/EEG signal analysis systems. To do so, we first established search terms and inclusion and exclusion criteria to find the most relevant papers on the subject. As a result, we identified the 22 most relevant papers. Next, we reviewed their experimental methodologies for recording EEG signals during the execution of lower limb tasks. In addition, we review the algorithms used in the preprocessing, feature extraction, and classification stages. Finally, we compared all the algorithms and determined which of them are the most suitable in terms of accuracy.

"Mine Works Better": Examining the Influence of Embodiment in Virtual Reality on the Sense of Agency During a Binary Motor Imagery Task With a Brain-Computer Interface

Motor imagery-based brain-computer interfaces (MI-BCI) have been proposed as a means for stroke rehabilitation, which combined with virtual reality allows for introducing game-based interactions into rehabilitation. However, the control of the MI-BCI may be difficult to obtain and users may face poor performance which frustrates them and potentially affects their motivation to use the technology. Decreases in motivation could be reduced by increasing the users' sense of agency over the system. The aim of this study was to understand whether embodiment (ownership) of a hand depicted in virtual reality can enhance the sense of agency to reduce frustration in an MI-BCI task. Twenty-two healthy participants participated in a within-subject study where their sense of agency was compared in two different embodiment experiences: 1) avatar hand (with body), or 2) abstract blocks. Both representations closed with a similar motion for spatial congruency and popped a balloon as a result. The hand/blocks were controlled through an online MI-BCI. Each condition consisted of 30 trials of MI-activation of the avatar hand/blocks. After each condition a questionnaire probed the participants' sense of agency, ownership, and frustration. Afterwards, a semi-structured interview was performed where the participants elaborated on their ratings. Both conditions supported similar levels of MI-BCI performance. A significant correlation between ownership and agency was observed (r = 0.47, p = 0.001). As intended, the avatar hand yielded much higher ownership than the blocks. When controlling for performance, ownership increased sense of agency. In conclusion, designers of BCI-based rehabilitation applications can draw on anthropomorphic avatars for the visual mapping of the trained limb to improve ownership. While not While not reducing frustration ownership can improve perceived agency given sufficient BCI performance. In future studies the findings should be validated in stroke patients since they may perceive agency and ownership differently than able-bodied users.

Electroencephalographic Recording of the Movement-Related Cortical Potential in Ecologically Valid Movements: A Scoping Review

The movement-related cortical potential (MRCP) is a brain signal that can be recorded using surface electroencephalography (EEG) and represents the cortical processes involved in movement preparation. The MRCP has been widely researched in simple, single-joint movements, however, these movements often lack ecological validity. Ecological validity refers to the generalizability of the findings to real-world situations, such as neurological rehabilitation. This scoping review aimed to synthesize the research evidence investigating the MRCP in ecologically valid movement tasks. A search of six electronic databases identified 102 studies that investigated the MRCP during multi-joint movements; 59 of these studies investigated ecologically valid movement tasks and were included in the review. The included studies investigated 15 different movement tasks that were applicable to everyday situations, but these were largely carried out in healthy populations. The synthesized findings suggest that the recording and analysis of MRCP signals is possible in ecologically valid movements, however the characteristics of the signal appear to vary across different movement tasks (i.e., those with greater complexity, increased cognitive load, or a secondary motor task) and different populations (i.e., expert performers, people with Parkinson’s Disease, and older adults). The scarcity of research in clinical populations highlights the need for further research in people with neurological and age-related conditions to progress our understanding of the MRCPs characteristics and to determine its potential as a measure of neurological recovery and intervention efficacy. MRCP-based neuromodulatory interventions applied during ecologically valid movements were only represented in one study in this review as these have been largely delivered during simple joint movements. No studies were identified that used ecologically valid movements to control BCI-driven external devices; this may reflect the technical challenges associated with accurately classifying functional movements from MRCPs. Future research investigating MRCP-based interventions should use movement tasks that are functionally relevant to everyday situations. This will facilitate the application of this knowledge into the rehabilitation setting.

Induction of Neural Plasticity Using a Low-Cost Open Source Brain-Computer Interface and a 3D-Printed Wrist Exoskeleton

Brain-computer interfaces (BCIs) have been proven to be useful for stroke rehabilitation, but there are a number of factors that impede the use of this technology in rehabilitation clinics and in home-use, the major factors including the usability and costs of the BCI system. The aims of this study were to develop a cheap 3D-printed wrist exoskeleton that can be controlled by a cheap open source BCI (OpenViBE), and to determine if training with such a setup could induce neural plasticity. Eleven healthy volunteers imagined wrist extensions, which were detected from single-trial electroencephalography (EEG), and in response to this, the wrist exoskeleton replicated the intended movement. Motor-evoked potentials (MEPs) elicited using transcranial magnetic stimulation were measured before, immediately after, and 30 min after BCI training with the exoskeleton. The BCI system had a true positive rate of 86 ± 12% with 1.20 ± 0.57 false detections per minute. Compared to the measurement before the BCI training, the MEPs increased by 35 ± 60% immediately after and 67 ± 60% 30 min after the BCI training. There was no association between the BCI performance and the induction of plasticity. In conclusion, it is possible to detect imaginary movements using an open-source BCI setup and control a cheap 3D-printed exoskeleton that when combined with the BCI can induce neural plasticity. These findings may promote the availability of BCI technology for rehabilitation clinics and home-use. However, the usability must be improved, and further tests are needed with stroke patients.

Evaluation of EEG Headset Mounting for Brain-Computer Interface-Based Stroke Rehabilitation by Patients, Therapists, and Relatives

Brain-computer interfaces (BCIs) have successfully been used for motor recovery training in stroke patients. However, the setup of BCI systems is complex and may be divided into (1) mounting the headset and (2) calibration of the BCI. One of the major problems is mounting the headset for recording brain activity in a stroke rehabilitation context, and usability testing of this is limited. In this study, the aim was to compare the translational aspects of mounting five different commercially available headsets from a user perspective and investigate the design considerations associated with technology transfer to rehabilitation clinics and home use. No EEG signals were recorded, so the effectiveness of the systems have not been evaluated. Three out of five headsets covered the motor cortex which is needed to pick up movement intentions of attempted movements. The other two were as control and reference for potential design considerations. As primary stakeholders, nine stroke patients, eight therapists and two relatives participated; the stroke patients mounted the headsets themselves. The setup time was recorded, and participants filled in questionnaires related to comfort, aesthetics, setup complexity, overall satisfaction, and general design considerations. The patients had difficulties in mounting all headsets except for a headband with a dry electrode located on the forehead (control). The therapists and relatives were able to mount all headsets. The fastest headset to mount was the headband, and the most preferred headsets were the headband and a behind-ear headset (control). The most preferred headset that covered the motor cortex used water-based electrodes. The patients reported that it was important that they could mount the headset themselves for them to use it every day at home. These results have implications for design considerations for the development of BCI systems to be used in rehabilitation clinics and in the patient’s home.

Decoding Movement-Related Cortical Potentials Based on Subject-Dependent and Section-Wise Spectral Filtering

An important challenge in developing a movement-related cortical potential (MRCP)-based brain-machine interface (BMI) is an accurate decoding of the user intention for real-world environments. However, the performance remains insufficient for real-time decoding owing to the endogenous signal characteristics compared to other BMI paradigms. This study aims to enhance the MRCP decoding performance from the perspective of preprocessing techniques (i.e., spectral filtering). To the best of our knowledge, existing MRCP studies have used spectral filters with a fixed frequency bandwidth for all subjects. Hence, we propose a subject-dependent and section-wise spectral filtering (SSSF) method that considers the subjects' individual MRCP characteristics for two different temporal sections. In this study, MRCP data were acquired under a powered exoskeleton environments in which the subjects conducted self-initiated walking. We evaluated our method using both our experimental data and a public dataset (BNCI Horizon 2020). The decoding performance using the SSSF was 0.86 (±0.09), and the performance on the public dataset was 0.73 (±0.06) across all subjects. The experimental results showed a statistically significant enhancement ( ) compared with the fixed frequency bands used in previous methods on both datasets. In addition, we presented successful decoding results from a pseudo-online analysis. Therefore, we demonstrated that the proposed SSSF method can involve more meaningful MRCP information than conventional methods.

Upper limb complex movements decoding from pre-movement EEG signals using wavelet common spatial patterns

BACKGROUND AND OBJECTIVE

Decoding functional movements from electroencephalographic (EEG) activity for motor disability rehabilitation is essential to develop home-use brain-computer interface systems. In this paper, the classification of five complex functional upper limb movements is studied by using only the pre-movement planning and preparation recordings of EEG data.

METHODS

Nine healthy volunteers performed five different upper limb movements. Different frequency bands of the EEG signal are extracted by the stationary wavelet transform. Common spatial patterns are used as spatial filters to enhance separation of the five movements in each frequency band. In order to increase the efficiency of the system, a mutual information-based feature selection algorithm is applied. The selected features are classified using the k-nearest neighbor, support vector machine, and linear discriminant analysis methods.

RESULTS

K-nearest neighbor method outperformed the other classifiers and resulted in an average classification accuracy of 94.0 ± 2.7% for five classes of movements across subjects. Further analysis of each frequency band's contribution in the optimal feature set, showed that the gamma and beta frequency bands had the most contribution in the classification. To reduce the complexity of the EEG recording system setup, we selected a subset of the 10 most effective EEG channels from 64 channels, by which we could reach an accuracy of 70%. Those EEG channels were mostly distributed over the prefrontal and frontal areas.

CONCLUSIONS

Overall, the results indicate that it is possible to classify complex movements before the movement onset by using spatially selected EEG data.

EMG- Versus EEG-Triggered Electrical Stimulation for Inducing Corticospinal Plasticity

Brain-computer interfaces have been proposed for stroke rehabilitation. Motor cortical activity derived from the electroencephalography (EEG) can trigger external devices that provide congruent sensory feedback. However, many stroke patients regain residual muscle (EMG: electromyography) control due to spontaneous recovery and rehabilitation; therefore, EEG may not be necessary as a control signal. In this paper, a direct comparison was made between the induction of corticospinal plasticity using either EEG- or EMG-controlled electrical nerve stimulation. Twenty healthy participants participated in two intervention sessions consisting of EEG- and EMG-controlled electrical stimulation. The sessions consisted of 50 pairings between foot dorsiflexion movements (decoded through either EEG or EMG) and electrical stimulation of the common peroneal nerve. Before, immediately after and 30 minutes after the intervention, 15 motor evoked potentials (MEPs) were elicited in tibialis anterior through transcranial magnetic stimulation. Increased MEPs were observed immediately after (62 ± 26%, 73 ± 27% for EEG- and EMG-triggered electrical stimulation, respectively) and 30 minutes after each of the two interventions (79 ± 26% and 72 ± 27%) compared to the pre-intervention measurement. There was no difference between the interventions. Both EEG- and EMG-controlled electrical stimulation can induce corticospinal plasticity which suggests that stroke patients with residual EMG can use that modality instead of EEG to trigger stimulation.

Self-Paced Online vs. Cue-Based Offline Brain-Computer Interfaces for Inducing Neural Plasticity

: Brain-computer interfaces (BCIs), operated in a cue-based (offline) or self-paced (online) mode, can be used for inducing cortical plasticity for stroke rehabilitation by the pairing of movement-related brain activity with peripheral electrical stimulation. The aim of this study was to compare the difference in cortical plasticity induced by the two BCI modes. Fifteen healthy participants participated in two experimental sessions: cue-based BCI and self-paced BCI. In both sessions, imagined dorsiflexions were extracted from continuous electroencephalogram (EEG) and paired 50 times with the electrical stimulation of the common peroneal nerve. Before, immediately after, and 30 minutes after each intervention, the cortical excitability was measured through the motor-evoked potentials (MEPs) of tibialis anterior elicited through transcranial magnetic stimulation. Linear mixed regression models showed that the MEP amplitudes increased significantly (p < 0.05) from pre- to post- and 30-minutes post-intervention in terms of both the absolute and relative units, regardless of the intervention type. Compared to pre-interventions, the absolute MEP size increased by 79% in post- and 68% in 30-minutes post-intervention in the self-paced mode (with a true positive rate of ~75%), and by 37% in post- and 55% in 30-minutes post-intervention in the cue-based mode. The two modes were significantly different (p = 0.03) at post-intervention (relative units) but were similar at both post timepoints (absolute units). These findings suggest that immediate changes in cortical excitability may have implications for stroke rehabilitation, where it could be used as a priming protocol in conjunction with another intervention; however, the findings need to be validated in studies involving stroke patients.

The effects of chiropractic spinal manipulation on central processing of tonic pain - a pilot study using standardized low-resolution brain electromagnetic tomography (sLORETA)

The objectives of the study were to investigate changes in pain perception and neural activity during tonic pain due to altered sensory input from the spine following chiropractic spinal adjustments. Fifteen participants with subclinical pain (recurrent spinal dysfunction such as mild pain, ache or stiffness but with no pain on the day of the experiment) participated in this randomized cross-over study involving a chiropractic spinal adjustment and a sham session, separated by 4.0 ± 4.2 days. Before and after each intervention, 61-channel electroencephalography (EEG) was recorded at rest and during 80 seconds of tonic pain evoked by the cold-pressor test (left hand immersed in 2 °C water). Participants rated the pain and unpleasantness to the cold-pressor test on two separate numerical rating scales. To study brain sources, sLORETA was performed on four EEG frequency bands: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz) and beta (12–32 Hz). The pain scores decreased by 9% after the sham intervention (p < 0.05), whereas the unpleasantness scores decreased by 7% after both interventions (p < 0.05). sLORETA showed decreased brain activity following tonic pain in all frequency bands after the sham intervention, whereas no change in activity was seen after the chiropractic spinal adjustment session. This study showed habituation to pain following the sham intervention, with no habituation occurring following the chiropractic intervention. This suggests that the chiropractic spinal adjustments may alter central processing of pain and unpleasantness.

Feature domain-specific movement intention detection for stroke rehabilitation with brain-computer interfaces

Brain-computer interface (BCI) driven electrical stimulation has been proposed for neuromodulation for stroke rehabilitation by pairing intentions to move with somatosensory feedback from electrical stimulation. Movement intentions have been detected in several studies using different techniques, with temporal and spectral features being the most common. A few studies have compared temporal and spectral features, but conflicting results have been reported. In this study, the aim was to investigate if complexity measures can be used for movement intention detection and to compare the detection performance based on features extracted from three different domains (time, frequency and complexity) from single-trial EEG. Two data sets were used where four different isometric palmar grasps or dorsiflexions were performed while continuous EEG was recorded. 39 healthy subjects performed or imagined these movements and 11 stroke patients attempted to perform the movements. The EEG was pre-processed and divided into two epoch classes: Background EEG (2 s) and movement intention (2 s). To obtain an estimated detection performance, temporal, spectral and complexity features were extracted and classified (linear discriminant analysis) after the feature vector was reduced using sequential forward selection. The results show that accuracies between 82-87% and 74-80% are obtained for foot and hand movements, respectively. The temporal feature domain was the most dominant for foot movement intention detection, while the spectral features contributed more to the hand movement detection. The complexity features could be used to detect movement intentions, but the performance was much lower compared to temporal and spectral features.

Pairing Voluntary Movement and Muscle-Located Electrical Stimulation Increases Cortical Excitability

Learning new motor skills has been correlated with increased cortical excitability. In this study, different location of electrical stimulation (ES), nerve, or muscle, was paired with voluntary movement to investigate if ES paired with voluntary movement (a) would increase the excitability of cortical projections to tibialis anterior and (b) if stimulation location mattered. Cortical excitability changes were quantified using motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) at varying intensities during four conditions. Twelve healthy subjects performed 50 dorsiflexions at the ankle during nerve or muscle ES at motor threshold (MTh). ES alone was delivered 50 times and the movement was performed 50 times. A significant increase in the excitability from pre- to post-intervention (P = 0.0061) and pre- to 30 min post-intervention (P = 0.017) measurements was observed when voluntary movement was paired with muscle ES located at tibialis anterior. An increase of 50 ± 57 and 28 ± 54% in the maximum MEPs was obtained for voluntary movement paired with muscle-located and nerve-located ES, respectively. The maximum MEPs for voluntary movement alone and muscle-located ES alone were −5 ± 28 and 2 ± 42%, respectively. Pairing voluntary movement with muscle-located ES increases excitability of corticospinal projections of tibialis anterior in healthy participants. This finding suggests that active participation during muscle-located ES protocols increases cortical excitability to a greater extent than stimulation alone. The next stage of this research is to investigate the effect in people with stroke. The results may have implications for motor recovery in patients with motor impairments following neurological injury.