Effects of tDCS on Real-Time BCI Detection of Pedaling Motor Imagery

Evaluation of the separate and combined effects of anodal tDCS over the M1 and F3 regions on pain relief in patients with type-2 diabetes suffering from neuropathic pain

BACKGROUND

Neuropathic pain (NP) is a common complication of chronic diabetes that negatively affects the routine functioning and sleep of patients. The present study aimed to investigate the separate and combined effects of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) and left dorsolateral prefrontal cortex (F3) regions on pain relief in patients with type-2 diabetes suffering from NP.

METHODS

The statistical population of this double-blind randomized clinical trial consisted of all the members of the Bonab Diabetes Association in 2022 aged 45 to 65 years who were diagnosed with NP by a specialist. A total of 48 patients who met the inclusion criteria were selected as the sample through purposive sampling. The participants were then randomly assigned into 4 groups, each attending 12 sessions of a special intervention (three times a week). The Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2) was used for data collection. Data were statistically analyzed using SPANOVA, analysis of covariance, and the Bonferroni test.

RESULTS

The results showed that tDCS had the potential to induce pain relief in patients with type-2 diabetes suffering from NP (F = 11.48, P < 0.001). The mean perceived pain intensity in the posttest was lower in the M1 stimulation group than in the F3 stimulation group. Nevertheless, there was no significant difference between the two groups in terms of perceived pain intensity in the one-month and two-month follow-up stages.

CONCLUSIONS

The tDCS approach (over both M1 and F3) showed promising effects for pain management in patients with type-2 diabetes suffering from NP and may be an effective add-on treatment. However, more trials with larger sample sizes are necessary to define clinically relevant effects.

Unraveling Transformative Effects after tDCS and BCI Intervention in Chronic Post-Stroke Patient Rehabilitation-An Alternative Treatment Design Study

Stroke is a debilitating clinical condition resulting from a brain infarction or hemorrhage that poses significant challenges for motor function restoration. Previous studies have shown the potential of applying transcranial direct current stimulation (tDCS) to improve neuroplasticity in patients with neurological diseases or disorders. By modulating the cortical excitability, tDCS can enhance the effects of conventional therapies. While upper-limb recovery has been extensively studied, research on lower limbs is still limited, despite their important role in locomotion, independence, and good quality of life. As the life and social costs due to neuromuscular disability are significant, the relatively low cost, safety, and portability of tDCS devices, combined with low-cost robotic systems, can optimize therapy and reduce rehabilitation costs, increasing access to cutting-edge technologies for neuromuscular rehabilitation. This study explores a novel approach by utilizing the following processes in sequence: tDCS, a motor imagery (MI)-based brain-computer interface (BCI) with virtual reality (VR), and a motorized pedal end-effector. These are applied to enhance the brain plasticity and accelerate the motor recovery of post-stroke patients. The results are particularly relevant for post-stroke patients with severe lower-limb impairments, as the system proposed here provides motor training in a real-time closed-loop design, promoting cortical excitability around the foot area (Cz) while the patient directly commands with his/her brain signals the motorized pedal. This strategy has the potential to significantly improve rehabilitation outcomes. The study design follows an alternating treatment design (ATD), which involves a double-blind approach to measure improvements in both physical function and brain activity in post-stroke patients. The results indicate positive trends in the motor function, coordination, and speed of the affected limb, as well as sensory improvements. The analysis of event-related desynchronization (ERD) from EEG signals reveals significant modulations in Mu, low beta, and high beta rhythms. Although this study does not provide conclusive evidence for the superiority of adjuvant mental practice training over conventional therapy alone, it highlights the need for larger-scale investigations.

EEG-Based BCIs on Motor Imagery Paradigm Using Wearable Technologies: A Systematic Review

In recent decades, the automatic recognition and interpretation of brain waves acquired by electroencephalographic (EEG) technologies have undergone remarkable growth, leading to a consequent rapid development of brain-computer interfaces (BCIs). EEG-based BCIs are non-invasive systems that allow communication between a human being and an external device interpreting brain activity directly. Thanks to the advances in neurotechnologies, and especially in the field of wearable devices, BCIs are now also employed outside medical and clinical applications. Within this context, this paper proposes a systematic review of EEG-based BCIs, focusing on one of the most promising paradigms based on motor imagery (MI) and limiting the analysis to applications that adopt wearable devices. This review aims to evaluate the maturity levels of these systems, both from the technological and computational points of view. The selection of papers has been performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), leading to 84 publications considered in the last ten years (from 2012 to 2022). Besides technological and computational aspects, this review also aims to systematically list experimental paradigms and available datasets in order to identify benchmarks and guidelines for the development of new applications and computational models.

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.

Effect of a Brain-Computer Interface Based on Pedaling Motor Imagery on Cortical Excitability and Connectivity

Recently, studies on cycling-based brain–computer interfaces (BCIs) have been standing out due to their potential for lower-limb recovery. In this scenario, the behaviors of the sensory motor rhythms and the brain connectivity present themselves as sources of information that can contribute to interpreting the cortical effect of these technologies. This study aims to analyze how sensory motor rhythms and cortical connectivity behave when volunteers command reactive motor imagery (MI) BCI that provides passive pedaling feedback. We studied 8 healthy subjects who performed pedaling MI to command an electroencephalography (EEG)-based BCI with a motorized pedal to receive passive movements as feedback. The EEG data were analyzed under the following four conditions: resting, MI calibration, MI online, and receiving passive pedaling (on-line phase). Most subjects produced, over the foot area, significant event-related desynchronization (ERD) patterns around Cz when performing MI and receiving passive pedaling. The sharpest decrease was found for the low beta band. The connectivity results revealed an exchange of information between the supplementary motor area (SMA) and parietal regions during MI and passive pedaling. Our findings point to the primary motor cortex activation for most participants and the connectivity between SMA and parietal regions during pedaling MI and passive pedaling.

Different Prevention and Treatment Strategies for Knee Osteoarthritis (KOA) with Various Lower Limb Exoskeletons – A Comprehensive Review

It was reported that about 10% of people suffer from painful knee arthritis, and a quarter of them were severely disabled. The core activities of daily living were severely limited by knee osteoarthritis (KOA). In order to reduce knee pain and prolong the life of the knee joint, there has been an increasing demand on the development of exoskeletons, for prevention and treatment. The course of KOA was closely related to the biomechanics of knee joint, and the pathogenesis was summarized based on the biomechanics of knee joint. For the prevention and clinical treatment, exoskeletons are classified into three categories: prevention, treatment, and rehabilitation after the operation. Furthermore, the design concepts, actuators, sensors, control strategies, and evaluation criteria were presented. Finally, the shortcomings and limitations were summarized. It is useful for researchers to develop suitable exoskeletons in the future.

Data Augmentation for Motor Imagery Signal Classification Based on a Hybrid Neural Network

As an important paradigm of spontaneous brain-computer interfaces (BCIs), motor imagery (MI) has been widely used in the fields of neurological rehabilitation and robot control. Recently, researchers have proposed various methods for feature extraction and classification based on MI signals. The decoding model based on deep neural networks (DNNs) has attracted significant attention in the field of MI signal processing. Due to the strict requirements for subjects and experimental environments, it is difficult to collect large-scale and high-quality electroencephalogram (EEG) data. However, the performance of a deep learning model depends directly on the size of the datasets. Therefore, the decoding of MI-EEG signals based on a DNN has proven highly challenging in practice. Based on this, we investigated the performance of different data augmentation (DA) methods for the classification of MI data using a DNN. First, we transformed the time series signals into spectrogram images using a short-time Fourier transform (STFT). Then, we evaluated and compared the performance of different DA methods for this spectrogram data. Next, we developed a convolutional neural network (CNN) to classify the MI signals and compared the classification performance of after DA. The Fréchet inception distance (FID) was used to evaluate the quality of the generated data (GD) and the classification accuracy, and mean kappa values were used to explore the best CNN-DA method. In addition, analysis of variance (ANOVA) and paired t-tests were used to assess the significance of the results. The results showed that the deep convolutional generative adversarial network (DCGAN) provided better augmentation performance than traditional DA methods: geometric transformation (GT), autoencoder (AE), and variational autoencoder (VAE) (p < 0.01). Public datasets of the BCI competition IV (datasets 1 and 2b) were used to verify the classification performance. Improvements in the classification accuracies of 17% and 21% (p < 0.01) were observed after DA for the two datasets. In addition, the hybrid network CNN-DCGAN outperformed the other classification methods, with average kappa values of 0.564 and 0.677 for the two datasets.

Subject-specific EEG channel selection using non-negative matrix factorization for lower-limb motor imagery recognition

OBJECTIVE

This study aims to propose and validate a subject-specific approach to recognize two different cognitive neural states (relax and pedaling motor imagery (MI)) by selecting the relevant electroencephalogram (EEG) channels. The main aims of the proposed work are: (i) to reduce the computational complexity of the BCI systems during MI detection by selecting the relevant EEG channels, (ii) to reduce the amount of data overfitting that may arise due to unnecessary channels and redundant features, and (iii) to reduce the classification time for real-time BCI applications.

APPROACH

The proposed method selects subject-specific EEG channels and features based on their MI. In this work, we make use of non-negative matrix factorization to extract the weight of the EEG channels based on their contribution to MI detection. Further, the neighborhood component analysis is used for subject-specific feature selection.

MAIN RESULTS

We executed the experiments using EEG signals recorded for MI where ten healthy subjects performed MI movement of the lower limb to generate motor commands. An average accuracy of 96.66%, average true positive rate (TPR) of 97.77%, average false positives rate of 4.44%, and average Kappa of 93.33% were obtained. The proposed subject-specific EEG channel selection based MI recognition system provides 13.20% improvement in detection accuracy, and 27% improvement in Kappa value with less number of EEG channels compared to the results obtained using all EEG channels.

SIGNIFICANCE

The proposed subject-specific BCI system has been found significantly advantageous compared to the typical approach of using a fixed channel configuration. This work shows that fewer EEG channels not only reduce computational complexity and processing time (two times faster) but also improve the MI detection performance. The proposed method selects EEG locations related to the foot movement, which may be relevant for neuro-rehabilitation using lower-limb movements that may provide a real-time and more natural interface between patient and robotic device.

A Low-Cost Lower-Limb Brain-Machine Interface Triggered by Pedaling Motor Imagery for Post-Stroke Patients Rehabilitation

A low-cost Brain-Machine Interface (BMI) based on electroencephalography for lower-limb motor recovery of post-stroke patients is proposed here, which provides passive pedaling as feedback, when patients trigger a Mini-Motorized Exercise Bike (MMEB) by executing pedaling motor imagery (MI). This system was validated in an On-line phase by eight healthy subjects and two post-stroke patients, which felt a closed-loop commanding the MMEB due to the fast response of our BMI. It was developed using methods of low-computational cost, such as Riemannian geometry for feature extraction, Pair-Wise Feature Proximity (PWFP) for feature selection, and Linear Discriminant Analysis (LDA) for pedaling imagery recognition. The On-line phase was composed of two sessions, where each participant completed a total of 12 trials per session executing pedaling MI for triggering the MMEB. As a result, the MMEB was successfully triggered by healthy subjects for almost all trials (ACC up to 100%), while the two post-stroke patients, PS1 and PS2, achieved their best performance (ACC of 41.67% and 91.67%, respectively) in Session #2. These patients improved their latency (2.03 ± 0.42 s and 1.99 ± 0.35 s, respectively) when triggering the MMEB, and their performance suggests the hypothesis that our system may be used with chronic stroke patients for lower-limb recovery, providing neural relearning and enhancing neuroplasticity.

Assistance Robotics and Biosensors

This Special Issue is focused on breakthrough developments in the field of biosensors and current scientific progress in biomedical signal processing. The papers address innovative solutions in assistance robotics based on bioelectrical signals, including: Affordable biosensor technology, affordable assistive-robotics devices, new techniques in myoelectric control and advances in brain–machine interfacing.