Improving Real-Time Lower Limb Motor Imagery Detection Using tDCS and an Exoskeleton

Design of a brain-machine interface for reducing false activations of a lower-limb exoskeleton based on error related potential

BACKGROUND AND OBJECTIVE

Brain-Machine Interfaces (BMIs) based on a motor imagination paradigm provide an intuitive approach for the exoskeleton control during gait. However, their clinical applicability remains difficulted by accuracy limitations and sensitivity to false activations. A proposed improvement involves integrating the BMI with methods based on detecting Error Related Potentials (ErrP) to self-tune erroneous commands and enhance not only the system accuracy, but also its usability. The aim of the current research is to characterize the ErrP at the beginning of the gait with a lower limb exoskeleton to reduce the false starts in the BMI system. Furthermore, this study is valuable for determining which type of feedback, Tactile, Visual, or Visuo-Tactile, achieves the best performance in evoking and detecting the ErrP.

METHODS

The initial phase of the research concentrates on detecting ErrP at the beginning of gait to improve the efficiency of an asynchronous BMI based on motor imagery (BMI-MI) to control a lower limb exoskeleton. Initially, an experimental protocol is designed to evoke ErrP at the start of gait, employing three different stimuli: Tactile, Visual, and Visuo-Tactile. An iterative selection process is then utilized to characterize ErrP in both time and frequency domains and fine-tune various parameters, including electrode distribution, feature combinations, and classifiers. A generic classifier with 6 subjects is employed to configure an ensemble classification system for detecting ErrP and reducing the false starts.

RESULTS

The ensembled system configured with the selected parameters yields an average correction of false starts of 72.60 % ± 10.23, highlighting its corrective efficacy. Tactile feedback emerges as the most effective stimulus, outperforming Visual and Visuo-Tactile feedback in both training types.

CONCLUSIONS

The results suggest promising prospects for reducing the false starts when integrating ErrP with BMI-MI, employing Tactile feedback. Consequently, the security of the system is enhanced. Subsequent, further research efforts will focus on detecting error potential during movement for gait stop, in order to limit undesired stops.

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

This study explores the use of a brain-computer interface (BCI) based on motor imagery (MI) for the control of a lower limb exoskeleton to aid in motor recovery after a neural injury. The BCI was evaluated in ten able-bodied subjects and two patients with spinal cord injuries. Five able-bodied subjects underwent a virtual reality (VR) training session to accelerate training with the BCI. Results from this group were compared with a control group of five able-bodied subjects, and it was found that the employment of shorter training by VR did not reduce the effectiveness of the BCI and even improved it in some cases. Patients gave positive feedback about the system and were able to handle experimental sessions without reaching high levels of physical and mental exertion. These results are promising for the inclusion of BCI in rehabilitation programs, and future research should investigate the potential of the MI-based BCI system.

On closed-loop brain stimulation systems for improving the quality of life of patients with neurological disorders

Emerging brain technologies have significantly transformed human life in recent decades. For instance, the closed-loop brain-computer interface (BCI) is an advanced software-hardware system that interprets electrical signals from neurons, allowing communication with and control of the environment. The system then transmits these signals as controlled commands and provides feedback to the brain to execute specific tasks. This paper analyzes and presents the latest research on closed-loop BCI that utilizes electric/magnetic stimulation, optogenetic, and sonogenetic techniques. These techniques have demonstrated great potential in improving the quality of life for patients suffering from neurodegenerative or psychiatric diseases. We provide a comprehensive and systematic review of research on the modalities of closed-loop BCI in recent decades. To achieve this, the authors used a set of defined criteria to shortlist studies from well-known research databases into categories of brain stimulation techniques. These categories include deep brain stimulation, transcranial magnetic stimulation, transcranial direct-current stimulation, transcranial alternating-current stimulation, and optogenetics. These techniques have been useful in treating a wide range of disorders, such as Alzheimer's and Parkinson's disease, dementia, and depression. In total, 76 studies were shortlisted and analyzed to illustrate how closed-loop BCI can considerably improve, enhance, and restore specific brain functions. The analysis revealed that literature in the area has not adequately covered closed-loop BCI in the context of cognitive neural prosthetics and implanted neural devices. However, the authors demonstrate that the applications of closed-loop BCI are highly beneficial, and the technology is continually evolving to improve the lives of individuals with various ailments, including those with sensory-motor issues or cognitive deficiencies. By utilizing emerging techniques of stimulation, closed-loop BCI can safely improve patients' cognitive and affective skills, resulting in better healthcare outcomes.

Review of tDCS Configurations for Stimulation of the Lower-Limb Area of Motor Cortex and Cerebellum

This article presents an exhaustive analysis of the works present in the literature pertaining to transcranial direct current stimulation(tDCS) applications. The aim of this work is to analyze the specific characteristics of lower-limb stimulation, identifying the strengths and weaknesses of these works and framing them with the current knowledge of tDCS. The ultimate goal of this work is to propose areas of improvement to create more effective stimulation therapies with less variability.

Detecting the Speed Change Intention from EEG Signals: From the Offline and Pseudo-Online Analysis to an Online Closed-Loop Validation

Control of assistive devices by voluntary user intention is an underdeveloped topic in the Brain–Machine Interfaces (BMI) literature. In this work, a preliminary real-time BMI for the speed control of an exoskeleton is presented. First, an offline analysis for the selection of the intention patterns based on the optimum features and electrodes is proposed. This is carried out comparing three different classification models: monotonous walk vs. increasing and decreasing change speed intentions, monotonous walk vs. only increasing intention, and monotonous walk vs. only decreasing intention. The results indicate that, among the features tested, the most suitable parameter to represent these models are the Hjorth statistics in alpha and beta frequency bands. The average offline classification accuracy for the offline cross-validation of the three models obtained is 68 ± 11%. This selection is also tested following a pseudo-online analysis, simulating a real-time detection of the subject’s intentions to change speed. The average results indices of the three models during this pseudoanalysis are of a 42% true positive ratio and a false positive rate per minute of 9. Finally, in order to check the viability of the approach with an exoskeleton, a case of study is presented. During the experimental session, the pros and cons of the implementation of a closed-loop control of speed change for the H3 exoskeleton through EEG analysis are commented.

BCI-Based Control for Ankle Exoskeleton T-FLEX: Comparison of Visual and Haptic Stimuli with Stroke Survivors

Brain–computer interface (BCI) remains an emerging tool that seeks to improve the patient interaction with the therapeutic mechanisms and to generate neuroplasticity progressively through neuromotor abilities. Motor imagery (MI) analysis is the most used paradigm based on the motor cortex’s electrical activity to detect movement intention. It has been shown that motor imagery mental practice with movement-associated stimuli may offer an effective strategy to facilitate motor recovery in brain injury patients. In this sense, this study aims to present the BCI associated with visual and haptic stimuli to facilitate MI generation and control the T-FLEX ankle exoskeleton. To achieve this, five post-stroke patients (55–63 years) were subjected to three different strategies using T-FLEX: stationary therapy (ST) without motor imagination, motor imagination with visual stimulation (MIV), and motor imagination with visual-haptic inducement (MIVH). The quantitative characterization of both BCI stimuli strategies was made through the motor imagery accuracy rate, the electroencephalographic (EEG) analysis during the MI active periods, the statistical analysis, and a subjective patient’s perception. The preliminary results demonstrated the viability of the BCI-controlled ankle exoskeleton system with the beta rebound, in terms of patient’s performance during MI active periods and satisfaction outcomes. Accuracy differences employing haptic stimulus were detected with an average of 68% compared with the 50.7% over only visual stimulus. However, the power spectral density (PSD) did not present changes in prominent activation of the MI band but presented significant variations in terms of laterality. In this way, visual and haptic stimuli improved the subject’s MI accuracy but did not generate differential brain activity over the affected hemisphere. Hence, long-term sessions with a more extensive sample and a more robust algorithm should be carried out to evaluate the impact of the proposed system on neuronal and motor evolution after stroke.

Noninvasive Electroencephalography Equipment for Assistive, Adaptive, and Rehabilitative Brain-Computer Interfaces: A Systematic Literature Review

Humans interact with computers through various devices. Such interactions may not require any physical movement, thus aiding people with severe motor disabilities in communicating with external devices. The brain-computer interface (BCI) has turned into a field involving new elements for assistive and rehabilitative technologies. This systematic literature review (SLR) aims to help BCI investigator and investors to decide which devices to select or which studies to support based on the current market examination. This examination of noninvasive EEG devices is based on published BCI studies in different research areas. In this SLR, the research area of noninvasive BCIs using electroencephalography (EEG) was analyzed by examining the types of equipment used for assistive, adaptive, and rehabilitative BCIs. For this SLR, candidate studies were selected from the IEEE digital library, PubMed, Scopus, and ScienceDirect. The inclusion criteria (IC) were limited to studies focusing on applications and devices of the BCI technology. The data used herein were selected using IC and exclusion criteria to ensure quality assessment. The selected articles were divided into four main research areas: education, engineering, entertainment, and medicine. Overall, 238 papers were selected based on IC. Moreover, 28 companies were identified that developed wired and wireless equipment as means of BCI assistive technology. The findings of this review indicate that the implications of using BCIs for assistive, adaptive, and rehabilitative technologies are encouraging for people with severe motor disabilities and healthy people. With an increasing number of healthy people using BCIs, other research areas, such as the motivation of players when participating in games or the security of soldiers when observing certain areas, can be studied and collaborated using the BCI technology. However, such BCI systems must be simple (wearable), convenient (sensor fabrics and self-adjusting abilities), and inexpensive.

A BMI Based on Motor Imagery and Attention for Commanding a Lower-Limb Robotic Exoskeleton: A Case Study

Lower-limb robotic exoskeletons are wearable devices that can be beneficial for people with lower-extremity motor impairment because they can be valuable in rehabilitation or assistance. These devices can be controlled mentally by means of brain–machine interfaces (BMI). The aim of the present study was the design of a BMI based on motor imagery (MI) to control the gait of a lower-limb exoskeleton. The evaluation is carried out with able-bodied subjects as a preliminary study since potential users are people with motor limitations. The proposed control works as a state machine, i.e., the decoding algorithm is different to start (standing still) and to stop (walking). The BMI combines two different paradigms for reducing the false triggering rate (when the BMI identifies irrelevant brain tasks as MI), one based on motor imagery and another one based on the attention to the gait of the user. Research was divided into two parts. First, during the training phase, results showed an average accuracy of 68.44 ± 8.46% for the MI paradigm and 65.45 ± 5.53% for the attention paradigm. Then, during the test phase, the exoskeleton was controlled by the BMI and the average performance was 64.50 ± 10.66%, with very few false positives. Participants completed various sessions and there was a significant improvement over time. These results indicate that, after several sessions, the developed system may be employed for controlling a lower-limb exoskeleton, which could benefit people with motor impairment as an assistance device and/or as a therapeutic approach with very limited false activations.

Detection of the Intention of Direction Changes During Gait Through EEG Signals

Brain-Computer Interfaces (BCIs) are becoming an important technological tool for the rehabilitation process of patients with locomotor problems, due to their ability to recover the connection between brain and limbs by promoting neural plasticity. They can be used as assistive devices to improve the mobility of handicapped people. For this reason, current BCIs have to be improved to allow an accurate and natural use of external devices. This work proposes a novel methodology for the detection of the intention to change the direction during gait based on event-related desynchronization (ERD). Frequency and temporal features of the electroencephalographic (EEG) signals are characterized. Then, a selection of the most influential features and electrodes to differentiate the direction change intention from the walking is carried out. Best results are obtained when combining frequency and temporal features with an average accuracy of [Formula: see text]%, which are promising to be applied for future BCIs.

Analysis of Human Gait Using Hybrid EEG-fNIRS-Based BCI System: A Review

Human gait is a complex activity that requires high coordination between the central nervous system, the limb, and the musculoskeletal system. More research is needed to understand the latter coordination's complexity in designing better and more effective rehabilitation strategies for gait disorders. Electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) are among the most used technologies for monitoring brain activities due to portability, non-invasiveness, and relatively low cost compared to others. Fusing EEG and fNIRS is a well-known and established methodology proven to enhance brain-computer interface (BCI) performance in terms of classification accuracy, number of control commands, and response time. Although there has been significant research exploring hybrid BCI (hBCI) involving both EEG and fNIRS for different types of tasks and human activities, human gait remains still underinvestigated. In this article, we aim to shed light on the recent development in the analysis of human gait using a hybrid EEG-fNIRS-based BCI system. The current review has followed guidelines of preferred reporting items for systematic reviews and meta-Analyses (PRISMA) during the data collection and selection phase. In this review, we put a particular focus on the commonly used signal processing and machine learning algorithms, as well as survey the potential applications of gait analysis. We distill some of the critical findings of this survey as follows. First, hardware specifications and experimental paradigms should be carefully considered because of their direct impact on the quality of gait assessment. Second, since both modalities, EEG and fNIRS, are sensitive to motion artifacts, instrumental, and physiological noises, there is a quest for more robust and sophisticated signal processing algorithms. Third, hybrid temporal and spatial features, obtained by virtue of fusing EEG and fNIRS and associated with cortical activation, can help better identify the correlation between brain activation and gait. In conclusion, hBCI (EEG + fNIRS) system is not yet much explored for the lower limb due to its complexity compared to the higher limb. Existing BCI systems for gait monitoring tend to only focus on one modality. We foresee a vast potential in adopting hBCI in gait analysis. Imminent technical breakthroughs are expected using hybrid EEG-fNIRS-based BCI for gait to control assistive devices and Monitor neuro-plasticity in neuro-rehabilitation. However, although those hybrid systems perform well in a controlled experimental environment when it comes to adopting them as a certified medical device in real-life clinical applications, there is still a long way to go.

Usability and acceptance of using a lower-limb exoskeleton controlled by a BMI in incomplete spinal cord injury patients: a case study

Spinal cord injury (SCI) limits life expectancy and causes a restriction of patient's daily activities. In the last years, robotics exoskeletons have appeared as a promising rehabilitation and assistance tool for patients with motor limitations, as people that have suffered a SCI. The usability and clinical relevance of these robotics systems could be further enhanced by brain-machine interfaces (BMIs), as they can be used to foster patients' neuroplasticity. However, there are not many studies showing the use of BMIs to control exoskeletons with patients. In this work we show a case study where one SCI patient has used a BMI based on motor imagery (MI) in order to control a lower limb exoskeleton that assists their gait.

Study of the Functional Brain Connectivity and Lower-Limb Motor Imagery Performance After Transcranial Direct Current Stimulation

The use of transcranial direct current stimulation (tDCS) has been related to the improvement of motor and learning tasks. The current research studies the effects of an asymmetric tDCS setup over brain connectivity, when the subject is performing a motor imagery (MI) task during five consecutive days. A brain–computer interface (BCI) based on electroencephalography is simulated in offline analysis to study the effect that tDCS has over different electrode configurations for the BCI. This way, the BCI performance is used as a validation index of the effect of the tDCS setup by the analysis of the classifier accuracy of the experimental sessions. In addition, the relationship between the brain connectivity and the BCI accuracy performance is analyzed. Results indicate that tDCS group, in comparison to the placebo sham group, shows a higher significant number of connectivity interactions in the motor electrodes during MI tasks and an increasing BCI accuracy over the days. However, the asymmetric tDCS setup does not improve the BCI performance of the electrodes in the intended hemisphere.