Multimodal brain-controlled system for rehabilitation training: Combining asynchronous online brain-computer interface and exoskeleton

BACKGROUND

Traditional therapist-based rehabilitation training for patients with movement impairment is laborious and expensive. In order to reduce the cost and improve the treatment effect of rehabilitation, many methods based on human-computer interaction (HCI) technology have been proposed, such as robot-assisted therapy and functional electrical stimulation (FES). However, due to the lack of active participation of brain, these methods have limited effects on the promotion of damaged nerve remodeling.

NEW METHOD

Based on the neurofeedback training provided by the combination of brain-computer interface (BCI) and exoskeleton, this paper proposes a multimodal brain-controlled active rehabilitation system to help improve limb function. The joint control mode of steady-state visual evoked potential (SSVEP) and motor imagery (MI) is adopted to achieve self-paced control and thus maximize the degree of brain involvement, and a requirement selection function based on SSVEP design is added to facilitate communication with aphasia patients.

COMPARISON WITH EXISTING METHODS

In addition, the Transformer is introduced as the MI decoder in the asynchronous online BCI to improve the global perception of electroencephalogram (EEG) signals and maintain the sensitivity and efficiency of the system.

RESULTS

In two multi-task online experiments for left hand, right hand, foot and idle states, subject achieves 91.25% and 92.50% best accuracy, respectively.

CONCLUSION

Compared with previous studies, this paper aims to establish a high-performance and low-latency brain-controlled rehabilitation system, and provide an independent and autonomous control mode of the brain, so as to improve the effect of neural remodeling. The performance of the proposed method is evaluated through offline and online experiments.

Effectiveness of Spinal Stabilization Exercises on Dynamic Balance in Adults with Chronic Low Back Pain

Background

Dynamic balance is a vital aspect of everyday life. It is important to incorporate an exercise program that is useful for maintaining and improving balance in patients with chronic low back pain (CLBP). However, there is a lack of evidence supporting the effectiveness of spinal stabilization exercises (SSEs) on improving dynamic balance.

Purpose

To determine the effectiveness of SSEs on dynamic balance in adults with CLBP.

Study Design

A double-blind randomized clinical trial.

Methods

Forty participants with CLBP were assigned randomly into either an SSE group or a general exercise (GE) group, which consisted of flexibility and range-of-motion exercises. Participants attended a total of four to eight supervised physical therapy (PT) sessions and performed their assigned exercises at home in the first four weeks of the eight-week intervention. In the last four weeks, the participants performed their exercises at home with no supervised PT sessions. Participants' dynamic balance was measured using the Y-Balance Test (YBT) and the normalized composite scores, Numeric Pain Rating Scale and Modified Oswestry Low Back Pain Disability Questionnaire scores were collected at baseline, two weeks, four weeks, and eight weeks.

Results

A significant difference between groups from two weeks to four weeks (p = 0.002) was found, with the SSE group demonstrating higher YBT composite scores than the GE group. However, there were no significant between-group differences from baseline to two weeks (p =0.098), and from four weeks to eight weeks (p = 0.413).

Conclusions

Supervised SSEs were superior to GEs in improving dynamic balance for the first four weeks after initiating intervention in adults with CLBP. However, GEs appeared to have an effect equivalent to that of SSEs after 8-week intervention.

Levels of Evidence

1b.

Examination and physical therapy management of a young gymnast with bilateral wrist pain: A case report

BACKGROUND

Wrist pain associated with weight-bearing gymnastic activities may be linked to musculoskeletal impairments, faulty movement patterns, and poor training techniques. Inadequate proximal control may adversely impact the loading mechanics throughout the upper extremities and contribute to a gymnast's complaint of wrist pain. The purpose of this case report is to describe the management of a young gymnast with primary complaint of bilateral wrist pain associated with upper extremity weight-bearing activities.

CASE DESCRIPTION

A 10 year-old male gymnast presented with a 6-month history of bilateral wrist pain aggravated by weight-bearing gymnastic activities. Based on the findings from a physical therapy examination, a 3-stage progressive rehabilitation program was designed using an impairment-based, multi-modal approach to treat key musculoskeletal impairments and movement deficiencies. Consistent with the principle of activity simulation, treatment targeted areas of weakness considered key to activity performance and included a progression of exercises and techniques that simulated activities reported by the gymnast to be painful.

OUTCOMES

The gymnast was treated for 11 visits over 8 weeks. He demonstrated improved strength, motor control, and self-reported outcome scores that allowed pain-free return to all gymnastic activities.

Reliability and Validity of Standing Back Extension Test for Detecting Motor Control Impairment in Subjects with Low Back Pain

INTRODUCTION

Low back pain is a chronic health problem with high socioeconomic impact. Specific diagnosis or treatment approach has not yet effectively established to treat chronic low back pain. Standing Back Extension Test is one of the clinical measures to detect the passive extension subgroup of Motor Control Impairment (MCI); which could have an impact on spinal stability leading to recurrent chronic low back pain. Reliability and validity of this test is not fully established.

AIM

To determine the intra-rater and inter-rater reliability and concurrent validity of the Standing Back Extension Test for detecting MCI of the lumbar spine.

MATERIALS AND METHODS

A total of 50 subjects were included in the study, 25 patients with Non Specific Low Back Pain (NSLBP) (12 men, 13 women) and 25 healthy controls (12 men, 13 women) were recruited into the study. All subjects performed the test movement. Two raters blinded to the subjects rated the test performance as either 'Positive' or 'Negative' based on the predetermined rating protocol. The thickness of Transverse Abdominis (TrA) muscle was assessed using Rehabilitative Ultrasound Imaging (RUSI).

STATISTICAL TEST USED

For reliability, the kappa coefficient with percent agreement was calculated and for assessing the validity Receiver Operator Characteristic (ROC) curves and Area under the Curve (AUC) were constructed.

RESULTS

The standing back extension test showed very good intra-rater (k=0.87 with an agreement of 96%) and good inter-rater (k=0.78 with an agreement of 94%) reliability and high AUC for TrA muscle.

CONCLUSION

The standing back extension test was found to be a reliable and a valid measure to detect passive extension subgroup for MCI in subjects with low back pain.