EMG-Based Real-Time Linear-Nonlinear Cascade Regression Decoding of Shoulder, Elbow, and Wrist Movements in Able-Bodied Persons and Stroke Survivors

Continuous Motion Intention Prediction Using sEMG for Upper-Limb Rehabilitation: A Systematic Review of Model-Based and Model-Free Approaches

Upper limb functional impairments persisting after stroke significantly affect patients' quality of life. Precise adjustment of robotic assistance levels based on patients' motion intentions using sEMG signals is crucial for active rehabilitation. This paper systematically reviews studies on continuous prediction of upper limb single joints and multi-joint combinations motion intention using Model-Based (MB) and Model-Free (MF) approaches over the past decade, based on 186 relevant studies screened from six major electronic databases. The findings indicate ongoing challenges in terms of subject composition, algorithm robustness and generalization, and algorithm feasibility for practical applications. Moreover, it suggests integrating the strengths of both MB and MF approaches to improve existing algorithms. Therefore, future research should further explore personalized MB-MF combination methods incorporating deep learning, attention mechanisms, muscle synergy features, motor unit features, and closed-loop feedback to achieve precise, real-time, and long-duration prediction of multi-joint complex movements, while further refining the transfer learning strategy for rapid algorithm deployment across days and subjects. Overall, this review summarizes the current research status, significant findings, and challenges, aiming to inspire future research on predicting upper limb motion intentions based on sEMG.

Wrist EMG Improves Gesture Classification for Stroke Patients

Electromyography (EMG) is a popular human-machine interface for hand gesture control of assistive and rehabilitative technology. EMG can be used to estimate motor intent even when an individual cannot physically move due to weakness or paralysis. EMG is traditionally recorded from the extrinsic hand muscles located in the forearm. However, the wrist has become an increasingly attractive recording location for commercial applications as EMG sensors can be integrated into wrist-worn wearables (e.g., watches, bracelets). Here we explored the impact that recording EMG from the wrist, instead of the forearm, has on stroke patients with upper-limb hemiparesis. We show that EMG signal-to-noise ratio is significantly worse at the paretic wrist relative to the paretic forearm and non-paretic wrist. Despite this, we also show that the ability to classify hand gestures from EMG was significantly better at the paretic wrist relative to the paretic forearm. Our results also provide guidance as to the ideal gestures for each recording location. Namely, single-digit gestures appeared easiest to classify from both forearm and wrist EMG on the paretic side. These results suggest commercialization of wrist-worn EMG would benefit stroke patients by providing more accurate EMG control in a more widely adopted wearable formfactor.

Elbow Joint Stiffness Functional Scales Based on Hill's Muscle Model and Genetic Optimization

The ultimate goal of rehabilitation engineering is to provide objective assessment tools for the level of injury and/or the degree of neurorehabilitation recovery based on a combination of different sensing technologies that enable the monitoring of relevant measurable variables, as well as the assessment of non-measurable variables (such as muscle effort/force and joint mechanical stiffness). This paper aims to present a feasibility study for a general assessment methodology for subject-specific non-measurable elbow model parameter prediction and elbow joint stiffness estimation. Ten participants without sensorimotor disorders performed a modified "Reach and retrieve" task of the Wolf Motor Function Test while electromyography (EMG) data of an antagonistic muscle pair (the triceps brachii long head and biceps brachii long head muscle) and elbow angle were simultaneously acquired. A complete list of the Hill's muscle model and passive joint structure model parameters was generated using a genetic algorithm (GA) on the acquired training dataset with a maximum deviation of 6.1% of the full elbow angle range values during the modified task 8 of the Wolf Motor Function Test, and it was also verified using two experimental test scenarios (a task tempo variation scenario and a load variation scenario with a maximum deviation of 8.1%). The recursive least square (RLS) algorithm was used to estimate elbow joint stiffness (Stiffness) based on the estimated joint torque and the estimated elbow angle. Finally, novel Stiffness scales (general patterns) for upper limb functional assessment in the two performed test scenarios were proposed. The stiffness scales showed an exponentially increasing trend with increasing movement tempo, as well as with increasing weights. The obtained general Stiffness patterns from the group of participants without sensorimotor disorders could significantly contribute to the further monitoring of motor recovery in patients with sensorimotor disorders.

Mapping Individual Motor Unit Activity to Continuous Three-DoF Wrist Torques: Perspectives for Myoelectric Control

The surface electromyography (EMG) decomposition techniques provide access to motor neuron activities and have been applied to myoelectric control schemes. However, the current decomposition-based myoelectric control mainly focuses on discrete gestures or single-DoF continuous movements. In this study, we aimed to map the motor unit discharges, which were identified from high-density surface EMG, to the three degrees of freedom (DoFs) wrist movements. The 3-DoF wrist torques and high-density surface EMG signals were recorded concurrently from eight non-disabled subjects. The experimental protocol included single-DoF movements and their various combinations. We decoded the motor unit discharges from the EMG signals using a segment-wise decomposition algorithm. Then the neural features were extracted from motor unit discharges and projected to wrist torques with a multiple linear regression model. We compared the performance of two neural features (twitch model and spike counting) and two training schemes (single-DoF and multi-DoF training). On average, 145 ± 33 motor units were identified from each subject, with a pulse-to-noise ratio of 30.8 ± 4.2 dB. Both neural features exhibited high estimation accuracy of 3-DoF wrist torques, with an average [Formula: see text] of 0.76 ± 0.12 and normalized root mean square error of 11.4 ± 3.1%. These results demonstrated the efficiency of the proposed method in continuous estimation of 3-DoF wrist torques, which has the potential to advance dexterous myoelectric control based on neural information.

Model-Based Mid-Level Regulation for Assist-As-Needed Hierarchical Control of Wearable Robots: A Computational Study of Human-Robot Adaptation

The closed-loop human–robot system requires developing an effective robotic controller that considers models of both the human and the robot, as well as human adaptation to the robot. This paper develops a mid-level controller providing assist-as-needed (AAN) policies in a hierarchical control setting using two novel methods: model-based and fuzzy logic rule. The goal of AAN is to provide the required extra torque because of the robot’s dynamics and external load compared to the human limb free movement. The human–robot adaptation is simulated using a nonlinear model predictive controller (NMPC) as the human central nervous system (CNS) for three conditions of initial (the initial session of wearing the robot, without any previous experience), short-term (the entire first session, e.g., 45 min), and long-term experiences. The results showed that the two methods (model-based and fuzzy logic) outperform the traditional proportional method in providing AAN by considering distinctive human and robot models. Additionally, the CNS actuator model has difficulty in the initial experience and activates both antagonist and agonist muscles to reduce movement oscillations. In the long-term experience, the simulation shows no oscillation when the CNS NMPC learns the robot model and modifies its weights to simulate realistic human behavior. We found that the desired strength of the robot should be increased gradually to ignore unexpected human–robot interactions (e.g., robot vibration, human spasticity). The proposed mid-level controllers can be used for wearable assistive devices, exoskeletons, and rehabilitation robots.

Compressed Sensing Image Reconstruction of Ultrasound Image for Treatment of Early Traumatic Myositis Ossificans of Elbow Joint by Electroacupuncture

This article conducts a retrospective analysis of 500 patients with posttraumatic elbow dysfunction admitted to our department from March 2019 to September 2020. The average time from injury to operation is 11 months (2–20 months). We adopt a personalized treatment method to completely remove the hyperplastic adhesion tissue and heterotopic ossification around the joint, remove part of the joint capsule and ligament, and release it to achieve maximum function. After the operation, an external fixator was used to stabilize the loosened elbow joint, and the patient was guided to perform rehabilitation exercises with the aid of a hinged external fixator, and celecoxib was used to prevent heterotopic ossification. Mayo functional scoring system was used to evaluate the curative effect before and after surgery. The rapid realization of ultrasound imaging under the framework of compressed sensing is studied. Under the premise of ensuring the quality of ultrasound imaging reconstruction, the theory of ultrasound imaging is improved, and a plane wave acoustic scattering ultrasound echo model is established. On this basis, the theory of compressed sensing is introduced, the mathematical model of compressed sensing reconstruction is established, and the fast iterative shrinkage thresholding algorithm (FISTA) of compressed sensing reconstruction is improved to reduce the computational complexity and the number of iterations. This article uses FISTA directly to reconstruct medical ultrasound images, and the reconstruction results are not ideal. Therefore, a simulation model of FISTA training and testing was established using the standard image library. By adding different intensities of noise to all images in the image library, the influence of noise intensity on the quality of FISTA reconstructed images is analyzed, and it is found that the FISTA model has requirements for the quality of the images to be reconstructed and the training set images. In this paper, Rob's blind deconvolution restoration algorithm is used to preprocess the original ultrasound image. The clarity of the texture details of the restored ultrasound image is significantly improved, and the image quality is improved, which meets the above requirements. This paper finally formed a reconstruction model suitable for ultrasound images. The reconstruction strategy verified by the ultrasound images provided by the Institute of Ultrasound Imaging of a medical university has achieved a significant improvement in the quality of ultrasound images.

Research on AR-AKF Model Denoising of the EMG Signal

Electromyography (EMG) signals can be used for clinical diagnosis and biomedical applications. It is very important to reduce noise and to acquire accurate signals for the usage of the EMG signals in biomedical engineering. Since EMG signal noise has the time-varying and random characteristics, the present study proposes an adaptive Kalman filter (AKF) denoising method based on an autoregressive (AR) model. The AR model is built by applying the EMG signal, and the relevant parameters are integrated to find the state space model required to optimally estimate AKF, eliminate the noise in the EMG signal, and restore the damaged EMG signal. To be specific, AR autoregressive dynamic modeling and repair for distorted signals are affected by noise, and AKF adaptively can filter time-varying noise. The denoising method based on the self-learning mechanism of AKF exhibits certain capabilities to achieve signal tracking and adaptive filtering. It is capable of adaptively regulating the model parameters in the absence of any prior statistical knowledge regarding the signal and noise, which is aimed at achieving a stable denoising effect. By comparatively analyzing the denoising effects exerted by different methods, the EMG signal denoising method based on the AR-AKF model is demonstrated to exhibit obvious advantages.

Application Research on Optimization Algorithm of sEMG Gesture Recognition Based on Light CNN+LSTM Model

The deep learning gesture recognition based on surface electromyography plays an increasingly important role in human-computer interaction. In order to ensure the high accuracy of deep learning in multistate muscle action recognition and ensure that the training model can be applied in the embedded chip with small storage space, this paper presents a feature model construction and optimization method based on multichannel sEMG amplification unit. The feature model is established by using multidimensional sequential sEMG images by combining convolutional neural network and long-term memory network to solve the problem of multistate sEMG signal recognition. The experimental results show that under the same network structure, the sEMG signal with fast Fourier transform and root mean square as feature data processing has a good recognition rate, and the recognition accuracy of complex gestures is 91.40%, with the size of 1 MB. The model can still control the artificial hand accurately when the model is small and the precision is high.

Intra-Subject and Inter-Subject Movement Variability Quantified with Muscle Synergies in Upper-Limb Reaching Movements

Quantifying movement variability is a crucial aspect for clinical and laboratory investigations in several contexts. However, very few studies have assessed, in detail, the intra-subject variability across movements and the inter-subject variability. Muscle synergies are a valuable method that can be used to assess such variability. In this study, we assess, in detail, intra-subject and inter-subject variability in a scenario based on a comprehensive dataset, including multiple repetitions of multi-directional reaching movements. The results show that muscle synergies are a valuable tool for quantifying variability at the muscle level and reveal that intra-subject variability is lower than inter-subject variability in synergy modules and related temporal coefficients, and both intra-subject and inter-subject similarity are higher than random synergy matching, confirming shared underlying control structures. The study deepens the available knowledge on muscle synergy-based motor function assessment and rehabilitation applications, discussing their applicability to real scenarios.

Continuous Myoelectric Prediction of Future Ankle Angle and Moment Across Ambulation Conditions and Their Transitions

A hallmark of human locomotion is that it continuously adapts to changes in the environment and predictively adjusts to changes in the terrain, both of which are major challenges to lower limb amputees due to the limitations in prostheses and control algorithms. Here, the ability of a single-network nonlinear autoregressive model to continuously predict future ankle kinematics and kinetics simultaneously across ambulation conditions using lower limb surface electromyography (EMG) signals was examined. Ankle plantarflexor and dorsiflexor EMG from ten healthy young adults were mapped to normal ranges of ankle angle and ankle moment during level overground walking, stair ascent, and stair descent, including transitions between terrains (i.e., transitions to/from staircase). Prediction performance was characterized as a function of the time between current EMG/angle/moment inputs and future angle/moment model predictions (prediction interval), the number of past EMG/angle/moment input values over time (sampling window), and the number of units in the network hidden layer that minimized error between experimentally measured values (targets) and model predictions of ankle angle and moment. Ankle angle and moment predictions were robust across ambulation conditions with root mean squared errors less than 1° and 0.04 Nm/kg, respectively, and cross-correlations (R²) greater than 0.99 for prediction intervals of 58 ms. Model predictions at critical points of trip-related fall risk fell within the variability of the ankle angle and moment targets (Benjamini-Hochberg adjusted p > 0.065). EMG contribution to ankle angle and moment predictions occurred consistently across ambulation conditions and model outputs. EMG signals had the greatest impact on noncyclic regions of gait such as double limb support, transitions between terrains, and around plantarflexion and moment peaks. The use of natural muscle activation patterns to continuously predict variations in normal gait and the model's predictive capabilities to counteract electromechanical inherent delays suggest that this approach could provide robust and intuitive user-driven real-time control of a wide variety of lower limb robotic devices, including active powered ankle-foot prostheses.

Simplified Optimal Estimation of Time-Varying Electromyogram Standard Deviation (EMGσ): Evaluation on Two Datasets

To facilitate the broader use of EMG signal whitening, we studied four whitening procedures of various complexities, as well as the roles of sampling rate and noise correction. We separately analyzed force-varying and constant-force contractions from 64 subjects who completed constant-posture tasks about the elbow over a range of forces from 0% to 50% maximum voluntary contraction (MVC). From the constant-force tasks, we found that noise correction via the root difference of squares (RDS) method consistently reduced EMG recording noise, often by a factor of 5-10. All other primary results were from the force-varying contractions. Sampling at 4096 Hz provided small and statistically significant improvements over sampling at 2048 Hz (~3%), which, in turn, provided small improvements over sampling at 1024 Hz (~4%). In comparing equivalent processing variants at a sampling rate of 4096 Hz, whitening filters calibrated to the EMG spectrum of each subject generally performed best (4.74% MVC EMG-force error), followed by one universal whitening filter for all subjects (4.83% MVC error), followed by a high-pass filter whitening method (4.89% MVC error) and then a first difference whitening filter (4.91% MVC error)-but none of these statistically differed. Each did significantly improve from EMG-force error without whitening (5.55% MVC). The first difference is an excellent whitening option over this range of contraction forces since no calibration or algorithm decisions are required.

A 4-DOF Upper Limb Exoskeleton for Physical Assistance: Design, Modeling, Control and Performance Evaluation

Wheelchair mounted upper limb exoskeletons offer an alternative way to support disabled individuals in their activities of daily living (ADL). Key challenges in exoskeleton technology include innovative mechanical design and implementation of a control method that can assure a safe and comfortable interaction between the human upper limb and exoskeleton. In this article, we present a mechanical design of a four degrees of freedom (DOF) wheelchair mounted upper limb exoskeleton. The design takes advantage of non-backdrivable mechanism that can hold the output position without energy consumption and provide assistance to the completely paralyzed users. Moreover, a PD-based trajectory tracking control is implemented to enhance the performance of human exoskeleton system for two different tasks. Preliminary results are provided to show the effectiveness and reliability of using the proposed design for physically disabled people.

Inter-Subject Domain Adaptation for CNN-Based Wrist Kinematics Estimation Using sEMG

Recently, convolutional neural network (CNN) has been widely investigated to decode human intentions using surface Electromyography (sEMG) signals. However, a pre-trained CNN model usually suffers from severe degradation when testing on a new individual, and this is mainly due to domain shift where characteristics of training and testing sEMG data differ substantially. To enhance inter-subject performances of CNN in the wrist kinematics estimation, we propose a novel regression scheme for supervised domain adaptation (SDA), based on which domain shift effects can be effectively reduced. Specifically, a two-stream CNN with shared weights is established to exploit source and target sEMG data simultaneously, such that domain-invariant features can be extracted. To tune CNN weights, both regression losses and a domain discrepancy loss are employed, where the former enable supervised learning and the latter minimizes distribution divergences between two domains. In this study, eight healthy subjects were recruited to perform wrist flexion-extension movements. Experiment results illustrated that the proposed regression SDA outperformed fine-tuning, a state-of-the-art transfer learning method, in both single-single and multiple-single scenarios of kinematics estimation. Unlike fine-tuning which suffers from catastrophic forgetting, regression SDA can maintain much better performances in original domains, which boosts the model reusability among multiple subjects.

Robotic arm dynamics modelling and robust control based on model recognition method

This paper analyzes the dynamics modelling and robust control of the robotic arm by using a model-based defines method. Firstly, the motion coupling relationship between the front and rear joints of the robotic arm is analyzed, and two kinds of motion decoupling modules based on planetary gear and pulley system are proposed, and the decoupling principle of the motion decoupling module is analyzed to realize the mechanical decoupling of the joint motion of the robotic arm. After that, a comprehensive test bench of two-degree-of-freedom robotic arm joint motion is constructed, and the factors influencing the decoupling effect of the mechanical decoupling module are analyzed through experiments to verify the effectiveness of the motion decoupling module. At the same time, the analysis also shows that: with the increase of the number of robotic arm joints, the number and volume of required decoupling modules increase, and the application of decoupling modules will significantly increase the volume, weight, and torque loss of the robotic arm, thus leading to the robotic arm’s large load to weight ratio which is not an advantage, therefore, mechanical decoupling is not suitable for robotic arms with more than 3 degrees of freedom. The design of a fuzzy incremental controller based on the model dialectic method is proposed for application in parallel robot control; it has universal approximation characteristics and can self-organize the velocity and position information of the parallel robot legs, and dynamically adjust the output of the controller by the designed affiliation function and control rules.

Human Motion Intent Description Based on Bumpless Switching Mechanism for Rehabilitation Robot

This paper aims to improve the performance of an electromyography (EMG) decoder based on a switching mechanism in controlling a rehabilitation robot for assisting human-robot cooperation arm movements. For a complex arm movement, the major difficulty of the EMG decoder modeling is to decode EMG signals with high accuracy in real-time. Our recent study presented a switching mechanism for carving up a complex task into simple subtasks and trained different submodels with low nonlinearity. However, it was observed that a "bump" behavior of decoder output (i.e., the discontinuity) occurred during the switching between two submodels. The bumps might cause unexpected impacts on the affected limb and thus potentially injure patients. To improve this undesired transient behavior on decoder outputs, we attempt to maintain the continuity of the outputs during the switching between multiple submodels. A bumpless switching mechanism is proposed by parameterizing submodels with all shared states and applied in the construction of the EMG decoder. Numerical simulation and real-time experiments demonstrated that the bumpless decoder shows high estimation accuracy in both offline and online EMG decoding. Furthermore, the outputs achieved by the proposed bumpless decoder in both testing and verification phases are significantly smoother than the ones obtained by a multimodel decoder without a bumpless switching mechanism. Therefore, the bumpless switching approach can be used to provide a smooth and accurate motion intent prediction from multi-channel EMG signals. Indeed, the method can actually prevent participants from being exposed to the risk of unpredictable loads.

EMG-Based 3D Hand Motor Intention Prediction for Information Transfer from Human to Robot

(1) Background: Three-dimensional (3-D) hand position is one of the kinematic parameters that can be inferred from Electromyography (EMG) signals. The inferred parameter is used as a communication channel in human–robot collaboration applications. Although its application from the perspective of rehabilitation and assistive technologies are widely studied, there are few papers on its application involving healthy subjects such as intelligent manufacturing and skill transfer. In this regard, for tasks associated with complex hand trajectories without the consideration of the degree of freedom (DOF), the prediction of 3-D hand position from EMG signal alone has not been addressed. (2) Objective: The primary aim of this study is to propose a model to predict human motor intention that can be used as information from human to robot. Therefore, the prediction of a 3-D hand position directly from the EMG signal for complex trajectories of hand movement, without the direct consideration of joint movements, is studied. In addition, the effects of slow and fast motions on the accuracy of the prediction model are analyzed. (3) Methods: This study used the EMG signal that is collected from the upper limb of healthy subjects, and the position signal of the hand while the subjects manipulate complex trajectories. We considered and analyzed two types of tasks with complex trajectories, each with quick and slow motions. A recurrent fuzzy neural network (RFNN) model was constructed to predict the 3-D position of the hand from the features of EMG signals alone. We used the Pearson correlation coefficient (CC) and normalized root mean square error (NRMSE) as performance metrics. (4) Results: We found that 3-D hand positions of the complex movement can be predicted with the mean performance of CC = 0.85 and NRMSE = 0.105. The 3-D hand position can be predicted well within a future time of 250 ms, from the EMG signal alone. Even though tasks performed under quick motion had a better prediction performance; the statistical difference in the accuracy of prediction between quick and slow motion was insignificant. Concerning the prediction model, we found that RFNN has a good performance in decoding for the time-varying system. (5) Conclusions: In this paper, irrespective of the speed of the motion, the 3-D hand position is predicted from the EMG signal alone. The proposed approach can be used in human–robot collaboration applications to enhance the natural interaction between a human and a robot.

Hybrid Impedance-Admittance Control for Upper Limb Exoskeleton Using Electromyography

Exoskeletons are wearable mobile robots that combine various technologies to enable limb movement with greater strength and endurance, being used in several application areas, such as industry and medicine. In this context, this paper presents the development of a hybrid control method for exoskeletons, combining admission and impedance control based on electromyographic input signals. A proof of concept of a robotic arm with two degrees of freedom, mimicking the functions of a human’s upper limb, was built to evaluate the proposed control system. Through tests that measured the discrepancy between the angles of the human joint and the joint of the exoskeleton, it was possible to determine that the system remained within an acceptable error range. The average error is lower than 4.3%, and the robotic arm manages to mimic the movements of the upper limbs of a human in real-time.

Current Trends and Confounding Factors in Myoelectric Control: Limb Position and Contraction Intensity

This manuscript presents a hybrid study of a comprehensive review and a systematic(research) analysis. Myoelectric control is the cornerstone ofmany assistive technologies used in clinicalpractice, such as prosthetics and orthoses, and human-computer interaction, such as virtual reality control.Although the classification accuracy of such devices exceeds 90% in a controlled laboratory setting,myoelectric devices still face challenges in robustness to variability of daily living conditions.The intrinsic physiological mechanisms limiting practical implementations of myoelectric deviceswere explored: the limb position effect and the contraction intensity effect. The degradationof electromyography (EMG) pattern recognition in the presence of these factors was demonstratedon six datasets, where classification performance was 13% and 20% lower than the controlledsetting for the limb position and contraction intensity effect, respectively. The experimental designsof limb position and contraction intensity literature were surveyed. Current state-of-the-art trainingstrategies and robust algorithms for both effects were compiled and presented. Recommendationsfor future limb position effect studies include: the collection protocol providing exemplars of at least 6positions (four limb positions and three forearm orientations), three-dimensional space experimentaldesigns, transfer learning approaches, and multi-modal sensor configurations. Recommendationsfor future contraction intensity effect studies include: the collection of dynamic contractions, nonlinearcomplexity features, and proportional control.

Real-Time EMG Based Pattern Recognition Control for Hand Prostheses: A Review on Existing Methods, Challenges and Future Implementation

Upper limb amputation is a condition that significantly restricts the amputees from performing their daily activities. The myoelectric prosthesis, using signals from residual stump muscles, is aimed at restoring the function of such lost limbs seamlessly. Unfortunately, the acquisition and use of such myosignals are cumbersome and complicated. Furthermore, once acquired, it usually requires heavy computational power to turn it into a user control signal. Its transition to a practical prosthesis solution is still being challenged by various factors particularly those related to the fact that each amputee has different mobility, muscle contraction forces, limb positional variations and electrode placements. Thus, a solution that can adapt or otherwise tailor itself to each individual is required for maximum utility across amputees. Modified machine learning schemes for pattern recognition have the potential to significantly reduce the factors (movement of users and contraction of the muscle) affecting the traditional electromyography (EMG)-pattern recognition methods. Although recent developments of intelligent pattern recognition techniques could discriminate multiple degrees of freedom with high-level accuracy, their efficiency level was less accessible and revealed in real-world (amputee) applications. This review paper examined the suitability of upper limb prosthesis (ULP) inventions in the healthcare sector from their technical control perspective. More focus was given to the review of real-world applications and the use of pattern recognition control on amputees. We first reviewed the overall structure of pattern recognition schemes for myo-control prosthetic systems and then discussed their real-time use on amputee upper limbs. Finally, we concluded the paper with a discussion of the existing challenges and future research recommendations.