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Item Brain-machine interfaces for rehabilitation in stroke: A review: A review(2018-07) López-Larraz, E.; Sarasola-Sanz, A.; Irastorza-Landa, N.; Birbaumer, N.; Ramos-Murguialday, A.; Medical TechnologiesBACKGROUND: Motor paralysis after stroke has devastating consequences for the patients, families and caregivers. Although therapies have improved in the recent years, traditional rehabilitation still fails in patients with severe paralysis. Brain-machine interfaces (BMI) have emerged as a promising tool to guide motor rehabilitation interventions as they can be applied to patients with no residual movement. OBJECTIVE: This paper reviews the efficiency of BMI technologies to facilitate neuroplasticity and motor recovery after stroke. METHODS: We provide an overview of the existing rehabilitation therapies for stroke, the rationale behind the use of BMIs for motor rehabilitation, the current state of the art and the results achieved so far with BMI-based interventions, as well as the future perspectives of neural-machine interfaces. RESULTS: Since the first pilot study by Buch and colleagues in 2008, several controlled clinical studies have been conducted, demonstrating the efficacy of BMIs to facilitate functional recovery in completely paralyzed stroke patients with noninvasive technologies such as the electroencephalogram (EEG). CONCLUSIONS: Despite encouraging results, motor rehabilitation based on BMIs is still in a preliminary stage, and further improvements are required to boost its efficacy. Invasive and hybrid approaches are promising and might set the stage for the next generation of stroke rehabilitation therapies.Item Chronic Stroke Sensorimotor Impairment Is Related to Smaller Hippocampal Volumes: An ENIGMA Analysis: An ENIGMA Analysis(2022-05-17) Zavaliangos‐Petropulu, Artemis; Lo, Bethany; Donnelly, Miranda R.; Schweighofer, Nicolas; Lohse, Keith; Jahanshad, Neda; Barisano, Giuseppe; Banaj, Nerisa; Borich, Michael R.; Boyd, Lara A.; Buetefisch, Cathrin M.; Byblow, Winston D.; Cassidy, Jessica M.; Charalambous, Charalambos C.; Conforto, Adriana B.; DiCarlo, Julie A.; Dula, Adrienne N.; Egorova‐Brumley, Natalia; Etherton, Mark R.; Feng, Wuwei; Fercho, Kelene A.; Geranmayeh, Fatemeh; Hanlon, Colleen A.; Hayward, Kathryn S.; Hordacre, Brenton; Kautz, Steven A.; Khlif, Mohamed Salah; Kim, Hosung; Kuceyeski, Amy; Lin, David J.; Liu, Jingchun; Lotze, Martin; MacIntosh, Bradley J.; Margetis, John L.; Mohamed, Feroze B.; Piras, Fabrizio; Ramos‐Murguialday, Ander; Revill, Kate P.; Roberts, Pamela S.; Robertson, Andrew D.; Schambra, Heidi M.; Seo, Na Jin; Shiroishi, Mark S.; Stinear, Cathy M.; Soekadar, Surjo R.; Spalletta, Gianfranco; Taga, Myriam; Tang, Wai Kwong; Thielman, Gregory T.; Vecchio, Daniela; Ward, Nick S.; Westlye, Lars T.; Werden, Emilio; Winstein, Carolee; Wittenberg, George F.; Wolf, Steven L.; Wong, Kristin A.; Yu, Chunshui; Brodtmann, Amy; Cramer, Steven C.; Thompson, Paul M.; Liew, Sook‐Lei; Zavaliangos-Petropulu, Artemis; Egorova-Brumley, Natalia; Ramos-Murguialday, Ander; Medical TechnologiesBackground. Persistent sensorimotor impairments after stroke can negatively impact quality of life. The hippocampus is vulnerable to poststroke secondary degeneration and is involved in sensorimotor behavior but has not been widely studied within the context of poststroke upper‐limb sensorimotor impairment. We investigated associations between non‐lesioned hippocampal volume and upper limb sensorimotor impairment in people with chronic stroke, hypothesizing that smaller ipsilesional hippocampal volumes would be associated with greater sensorimotor impairment. Methods and Results. Cross‐sectional T1‐weighted magnetic resonance images of the brain were pooled from 357 participants with chronic stroke from 18 research cohorts of the ENIGMA (Enhancing NeuoImaging Genetics through Meta‐Analysis) Stroke Recovery Working Group. Sensorimotor impairment was estimated from the FMA‐UE (Fugl‐Meyer Assessment of Upper Extremity). Robust mixed‐effects linear models were used to test associations between poststroke sensorimotor impairment and hippocampal volumes (ipsilesional and contralesional separately; Bonferroni‐corrected, P<0.025), controlling for age, sex, lesion volume, and lesioned hemisphere. In exploratory analyses, we tested for a sensorimotor impairment and sex interaction and relationships between lesion volume, sensorimotor damage, and hippocampal volume. Greater sensorimotor impairment was significantly associated with ipsilesional (P=0.005; β=0.16) but not contralesional (P=0.96; β=0.003) hippocampal volume, independent of lesion volume and other covariates (P=0.001; β=0.26). Women showed progressively worsening sensorimotor impairment with smaller ipsilesional (P=0.008; β=−0.26) and contralesional (P=0.006; β=−0.27) hippocampal volumes compared with men. Hippocampal volume was associated with lesion size (P<0.001; β=−0.21) and extent of sensorimotor damage (P=0.003; β=−0.15). Conclusions. The present study identifies novel associations between chronic poststroke sensorimotor impairment and ipsilesional hippocampal volume that are not caused by lesion size and may be stronger in women.Item Consensus-Based Core Set of Outcome Measures for Clinical Motor Rehabilitation After Stroke—A Delphi Study(2020-09-02) Pohl, Johannes; Held, Jeremia Philipp Oskar; Verheyden, Geert; Alt Murphy, Margit; Engelter, Stefan; Flöel, Agnes; Keller, Thierry; Kwakkel, Gert; Nef, Tobias; Ward, Nick; Luft, Andreas Rüdiger; Veerbeek, Janne Marieke; Tecnalia Research & InnovationIntroduction: Outcome measures are key to tailor rehabilitation goals to the stroke patient’s individual needs and to monitor poststroke recovery. The large number of available outcome measures leads to high variability in clinical use. Currently, an internationally agreed core set of motor outcome measures for clinical application is lacking. Therefore, the goal was to develop such a set to serve as a quality standard in clinical motor rehabilitation poststroke. Methods: Outcome measures for the upper and lower extremities, and activities of daily living (ADL)/stroke-specific outcomes were identified and presented to stroke rehabilitation experts in an electronic Delphi study. In round 1, clinical feasibility and relevance of the outcome measures were rated on a 7-point Likert scale. In round 2, those rated at least as “relevant” and “feasible” were ranked within the body functions, activities, and participation domains of the International Classification of Functioning, Disability, and Health (ICF). Furthermore, measurement time points poststroke were indicated. In round 3, answers were reviewed in reference to overall results to reach final consensus.Item A decision support system for electrode shaping in multi-pad FES foot drop correction(2017-07-03) Malešević, Jovana; Dedijer Dujović, Suzana; Savić, Andrej M.; Konstantinović, Ljubica; Vidaković, Aleksandra; Bijelić, Goran; Malešević, Nebojša; Keller, Thierry; Tecnalia Research & Innovation; SG; MercadoBackground: Functional electrical stimulation (FES) can be applied as an assistive and therapeutic aid in the rehabilitation of foot drop. Transcutaneous multi-pad electrodes can increase the selectivity of stimulation; however, shaping the stimulation electrode becomes increasingly complex with an increasing number of possible stimulation sites. We described and tested a novel decision support system (DSS) to facilitate the process of multi-pad stimulation electrode shaping. The DSS is part of a system for drop foot treatment that comprises a customdesigned multi-pad electrode, an electrical stimulator, and an inertial measurement unit. Methods: The system was tested in ten stroke survivors (3-96 months post stroke) with foot drop over 20 daily sessions. The DSS output suggested stimulation pads and parameters based on muscle twitch responses to short stimulus trains. The DSS ranked combinations of pads and current amplitudes based on a novel measurement of the quality of the induced movement and classified them based on the movement direction (dorsiflexion, plantar flexion, eversion and inversion) of the paretic foot. The efficacy of the DSS in providing satisfactory pad-current amplitude choices for shaping the stimulation electrode was evaluated by trained clinicians. The range of paretic foot motion was used as a quality indicator for the chosen patterns. Results: The results suggest that the DSS output was highly effective in creating optimized FES patterns. The position and number of pads included showed pronounced inter-patient and inter-session variability; however, zones for inducing dorsiflexion and plantar flexion within the multi-pad electrode were clearly separated. The range of motion achieved with FES was significantly greater than the corresponding active range of motion (p < 0.05) during the first three weeks of therapy. Conclusions: The proposed DSS in combination with a custom multi-pad electrode design covering the branches of peroneal and tibial nerves proved to be an effective tool for producing both the dorsiflexion and plantar flexion of a paretic foot. The results support the use of multi-pad electrode technology in combination with automatic electrode shaping algorithms for the rehabilitation of foot drop.Item The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain–behavior relationships after stroke: Big data neuroimaging to study brain–behavior relationships after stroke(2020) Liew, Sook‐Lei; Zavaliangos‐Petropulu, Artemis; Jahanshad, Neda; Lang, Catherine E.; Hayward, Kathryn S.; Lohse, Keith R.; Juliano, Julia M.; Assogna, Francesca; Baugh, Lee A.; Bhattacharya, Anup K.; Bigjahan, Bavrina; Borich, Michael R.; Boyd, Lara A.; Brodtmann, Amy; Buetefisch, Cathrin M.; Byblow, Winston D.; Cassidy, Jessica M.; Conforto, Adriana B.; Craddock, R. Cameron; Dimyan, Michael A.; Dula, Adrienne N.; Ermer, Elsa; Etherton, Mark R.; Fercho, Kelene A.; Gregory, Chris M.; Hadidchi, Shahram; Holguin, Jess A.; Hwang, Darryl H.; Jung, Simon; Kautz, Steven A.; Khlif, Mohamed Salah; Khoshab, Nima; Kim, Bokkyu; Kim, Hosung; Kuceyeski, Amy; Lotze, Martin; MacIntosh, Bradley J.; Margetis, John L.; Mohamed, Feroze B.; Piras, Fabrizio; Ramos‐Murguialday, Ander; Richard, Geneviève; Roberts, Pamela; Robertson, Andrew D.; Rondina, Jane M.; Rost, Natalia S.; Sanossian, Nerses; Schweighofer, Nicolas; Seo, Na Jin; Shiroishi, Mark S.; Soekadar, Surjo R.; Spalletta, Gianfranco; Stinear, Cathy M.; Suri, Anisha; Tang, Wai Kwong W.; Thielman, Gregory T.; Vecchio, Daniela; Villringer, Arno; Ward, Nick S.; Werden, Emilio; Westlye, Lars T.; Winstein, Carolee; Wittenberg, George F.; Wong, Kristin A.; Yu, Chunshui; Cramer, Steven C.; Thompson, Paul M.; Zavaliangos-Petropulu, Artemis; Ramos-Murguialday, Ander; Medical TechnologiesThe goal of the Enhancing Neuroimaging Genetics through Meta‐Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well‐powered meta‐ and mega‐analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world, comprising the largest multisite retrospective stroke data collaboration to date. This article outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multisite stroke brain magnetic resonance imaging, behavioral and demographics data. Specifically, the processes for scalable data intake and preprocessing, multisite data harmonization, and large‐scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided.Item European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus: data synthesis from systematic reviews, clinical practice guidelines and expert consensus(2021-12) Prange-Lasonder, Gerdienke B.; Alt Murphy, Margit; Lamers, Ilse; Hughes, Ann-Marie; Buurke, Jaap H.; Feys, Peter; Keller, Thierry; Klamroth-Marganska, Verena; Tarkka, Ina M.; Timmermans, Annick; Burridge, Jane H.; Tecnalia Research & InnovationBackground: Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN). Methods: Data from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set: strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set: strong evidence OR recommended by at least two sources and a supplementary set: some evidence OR recommended by at least one of the sources. Results: In total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week. Conclusions: The CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.Item Event-related desynchronization during movement attempt and execution in severely paralyzed stroke patients: An artifact removal relevance analysis: An artifact removal relevance analysis(2018) López-Larraz, Eduardo; Figueiredo, Thiago C.; Insausti-Delgado, Ainhoa; Ziemann, Ulf; Birbaumer, Niels; Ramos-Murguialday, Ander; Tecnalia Research & Innovation; Medical TechnologiesThe electroencephalogram (EEG) constitutes a relevant tool to study neural dynamics and to develop brain-machine interfaces (BMI) for rehabilitation of patients with paralysis due to stroke. However, the EEG is easily contaminated by artifacts of physiological origin, which can pollute the measured cortical activity and bias the interpretations of such data. This is especially relevant when recording EEG of stroke patients while they try to move their paretic limbs, since they generate more artifacts due to compensatory activity. In this paper, we study how physiological artifacts (i.e., eye movements, motion artifacts, muscle artifacts and compensatory movements with the other limb) can affect EEG activity of stroke patients. Data from 31 severely paralyzed stroke patients performing/attempting grasping movements with their healthy/paralyzed hand were analyzed offline. We estimated the cortical activation as the event-related desynchronization (ERD) of sensorimotor rhythms and used it to detect the movements with a pseudo-online simulated BMI. Automated state-of-the-art methods (linear regression to remove ocular contaminations and statistical thresholding to reject the other types of artifacts) were used to minimize the influence of artifacts. The effect of artifact reduction was quantified in terms of ERD and BMI performance. The results reveal a significant contamination affecting the EEG, being involuntary muscle activity the main source of artifacts. Artifact reduction helped extracting the oscillatory signatures of motor tasks, isolating relevant information from noise and revealing a more prominent ERD activity. Lower BMI performances were obtained when artifacts were eliminated from the training datasets. This suggests that artifacts produce an optimistic bias that improves theoretical accuracy but may result in a poor link between task-related oscillatory activity and BMI peripheral feedback. With a clinically relevant dataset of stroke patients, we evidence the need of appropriate methodologies to remove artifacts from EEG datasets to obtain accurate estimations of the motor brain activity.Item A foot drop compensation device based on surface multi-field functional electrical stimulation—Usability study in a clinical environment(2019) Imatz-Ojanguren, Eukene; Sánchez-Márquez, Gema; Asiain-Aristu, Jose Ramón; Cueto-Mendo, Joxean; Jaunarena-Goicoechea, Edurne; Zabaleta, Haritz; Keller, Thierry; Tecnalia Research & InnovationFunctional electrical stimulation applies electrical pulses to the peripheral nerves to artificially achieve a sensory/motor function. When applied for the compensation of foot drop it provides both assistive and therapeutic effects. Multi-field electrodes have shown great potential but may increase the complexity of these systems. Usability aspects should be checked to ensure their success in clinical environments. We developed the Fesia Walk device, based on a surface multi-field electrode and an automatic calibration algorithm, and carried out a usability study to check the feasibility of integrating this device in therapeutic programs in clinical environments. The study included 4 therapists and 10 acquired brain injury subjects (8 stroke and 2 traumatic brain injury).Item Functional synergy recruitment index as a reliable biomarker of motor function and recovery in chronic stroke patients(2021-05-18) Irastorza-Landa, Nerea; García-Cossio, Eliana; Sarasola-Sanz, Andrea; Brötz, Doris; Birbaumer, Niels; Ramos-Murguialday, Ander; Tecnalia Research & Innovation; Medical TechnologiesObjective. Stroke affects the expression of muscle synergies underlying motor control, most notably in patients with poorer motor function. The majority of studies on muscle synergies have conventionally approached this analysis by assuming alterations in the inner structures of synergies after stroke. Although different synergy-based features based on this assumption have to some extent described pathological mechanisms in post-stroke neuromuscular control, a biomarker that reliably reflects motor function and recovery is still missing. Approach. Based on the theory of muscle synergies, we alternatively hypothesize that functional synergy structures are physically preserved and measure the temporal correlation between the recruitment profiles of healthy modules by paretic and healthy muscles, a feature hereafter reported as the FSRI. We measured clinical scores and extracted the muscle synergies of both ULs of 18 chronic stroke survivors from the electromyographic activity of 8 muscles during bilateral movements before and after 4 weeks of non-invasive BMI controlled robot therapy and physiotherapy. We computed the FSRI as well as features quantifying inter-limb structural differences and evaluated the correlation of these synergy-based measures with clinical scores. Main results. Correlation analysis revealed weak relationships between conventional features describing inter-limb synergy structural differences and motor function. In contrast, FSRI values during specific or combined movement data significantly correlated with UL motor function and recovery scores. Additionally, we observed that BMI-based training with contingent positive proprioceptive feedback led to improved FSRI values during the specific trained finger extension movement. Significance. We demonstrated that FSRI can be used as a reliable physiological biomarker of motor function and recovery in stroke, which can be targeted via BMI-based proprioceptive therapies and adjuvant physiotherapy to boost effective rehabilitation.Item HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke: telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke(2021-03) Rozevink, Samantha G.; van der Sluis, Corry K.; Garzo, Ainara; Keller, Thierry; Hijmans, Juha M.; Tecnalia Research & Innovation; Medical TechnologiesHoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke). Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation.Item Minimizing endpoint variability through reinforcement learning during reaching movements involving shoulder, elbow and wrist(2017-07-18) Mehler, David Marc Anton; Reichenbach, Alexandra; Klein, Julius; Diedrichsen, Jörn; Tecnalia Research & InnovationReaching movements are comprised of the coordinated action across multiple joints. The human skeleton is redundant for this task because different joint configurations can lead to the same endpoint in space. How do people learn to use combinations of joints that maximize success in goal-directed motor tasks? To answer this question, we used a 3-degreeof-freedom manipulandum to measure shoulder, elbow and wrist joint movements during reaching in a plane. We tested whether a shift in the relative contribution of the wrist and elbow joints to a reaching movement could be learned by an implicit reinforcement regime. Unknown to the participants, we decreased the task success for certain joint configurations (wrist flexion or extension, respectively) by adding random variability to the endpoint feedback. In return, the opposite wrist postures were rewarded in the two experimental groups (flexion and extension group). We found that the joint configuration slowly shifted towards movements that provided more control over the endpoint and hence higher task success. While the overall learning was significant, only the group that was guided to extend the wrist joint more during the movement showed substantial learning. Importantly, all changes in movement pattern occurred independent of conscious awareness of the experimental manipulation. These findings suggest that the motor system is generally sensitive to its output variability and can optimize joint-space solutions that minimize task-relevant output variability. We discuss biomechanical biases (e.g. joint's range of movement) that could impose hurdles to the learning process.Item On the design of EEG-based movement decoders for completely paralyzed stroke patients(2018-11-20) Spüler, Martin; López-Larraz, Eduardo; Ramos-Murguialday, Ander; Tecnalia Research & Innovation; Medical TechnologiesBackground: Brain machine interface (BMI) technology has demonstrated its efficacy for rehabilitation of paralyzed chronic stroke patients. The critical component in BMI-training consists of the associative connection (contingency) between the intention and the feedback provided. However, the relationship between the BMI design and its performance in stroke patients is still an open question. Methods: In this study we compare different methodologies to design a BMI for rehabilitation and evaluate their effects on movement intention decoding performance. We analyze the data of 37 chronic stroke patients who underwent 4 weeks of BMI intervention with different types of association between their brain activity and the proprioceptive feedback. We simulate the pseudo-online performance that a BMI would have under different conditions, varying: (1) the cortical source of activity (i.e., ipsilesional, contralesional, bihemispheric), (2) the type of spatial filter applied, (3) the EEG frequency band, (4) the type of classifier; and also evaluated the use of residual EMG activity to decode the movement intentions. Results: We observed a significant influence of the different BMI designs on the obtained performances. Our results revealed that using bihemispheric beta activity with a common average reference and an adaptive support vector machine led to the best classification results. Furthermore, the decoding results based on brain activity were significantly higher than those based on muscle activity. Conclusions: This paper underscores the relevance of the different parameters used to decode movement, using EEG in severely paralyzed stroke patients. We demonstrated significant differences in performance for the different designs, which supports further research that should elucidate if those approaches leading to higher accuracies also induce higher motor recovery in paralyzed stroke patients.Item Real-Time Control of a Multi-Degree-of-Freedom Mirror Myoelectric Interface During Functional Task Training(2022-03-11) Sarasola-Sanz, Andrea; López-Larraz, Eduardo; Irastorza-Landa, Nerea; Rossi, Giulia; Figueiredo, Thiago; McIntyre, Joseph; Ramos-Murguialday, Ander; Tecnalia Research & Innovation; Medical Technologies; Robótica MédicaMotor learning mediated by motor training has in the past been explored for rehabilitation. Myoelectric interfaces together with exoskeletons allow patients to receive real-time feedback about their muscle activity. However, the number of degrees of freedom that can be simultaneously controlled is limited, which hinders the training of functional tasks and the effectiveness of the rehabilitation therapy. The objective of this study was to develop a myoelectric interface that would allow multi-degree-of-freedom control of an exoskeleton involving arm, wrist and hand joints, with an eye toward rehabilitation. We tested the effectiveness of a myoelectric decoder trained with data from one upper limb and mirrored to control a multi-degree-of-freedom exoskeleton with the opposite upper limb (i.e., mirror myoelectric interface) in 10 healthy participants. We demonstrated successful simultaneous control of multiple upper-limb joints by all participants. We showed evidence that subjects learned the mirror myoelectric model within the span of a five-session experiment, as reflected by a significant decrease in the time to execute trials and in the number of failed trials. These results are the necessary precursor to evaluating if a decoder trained with EMG from the healthy limb could foster learning of natural EMG patterns and lead to motor rehabilitation in stroke patients.Item Smart Protocols for Physical Therapy of Foot Drop Based on Functional Electrical Stimulation: A Case Study: A case study(2021-04-26) Malešević, Jovana; Konstantinović, Ljubica; Bijelić, Goran; Malešević, Nebojša; SG; MercadoFunctional electrical stimulation (FES) is used for treating foot drop by delivering electrical pulses to the anterior tibialis muscle during the swing phase of gait. This treatment requires that a patient can walk, which is mostly possible in the later phases of rehabilitation. In the early phase of recovery, the therapy conventionally consists of stretching exercises, and less commonly of FES delivered cyclically. Nevertheless, both approaches minimize patient engagement, which is inconsistent with recent findings that the full rehabilitation potential could be achieved by an active psycho-physical engagement of the patient during physical therapy. Following this notion, we proposed smart protocols whereby the patient sits and ankle movements are FES-induced by self-control. In six smart protocols, movements of the paretic ankle were governed by the non-paretic ankle with different control strategies, while in the seventh voluntary movements of the paretic ankle were used for stimulation triggering. One stroke survivor in the acute phase of recovery participated in the study. During the therapy, the patient’s voluntary ankle range of motion increased and reached the value of normal gait after 15 sessions. Statistical analysis did not reveal the differences between the protocols in FES-induced movements.Item A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting(2021-02) Guillén-Climent, Silvia; Garzo, Ainara; Muñoz-Alcaraz, María Nieves; Casado-Adam, Pablo; Arcas-Ruiz-Ruano, Javier; Mejías-Ruiz, Manuela; Mayordomo-Riera, Fernando Jesús; Tecnalia Research & Innovation; Medical TechnologiesNeuroscience and neurotechnology are transforming stroke rehabilitation. Robotic devices, in addition to telerehabilitation, are increasingly being used to train the upper limbs after stroke, and their use at home allows us to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of the MERLIN robotic system based on serious games for upper limb rehabilitation in people with stroke in the home environment.Item Usability study of a device for compensation of foot drop based on FES and surface multi-field electrodes in a clinical environment(2017-07) Imatz-Ojanguren, Eukene; Sánchez-Márquez, Gema; Asiain-Aristu, Jose Ramón; Cueto-Mendo, Joxean; Jaunarena-Goicoechea, Edurne; Zabaleta, Haritz; Keller, Thierry; Tecnalia Research & InnovationFunctional Electrical Stimulation (FES) has shown successful assistive and rehabilitation effects in people affected by foot drop dysfunction caused by neurological disorders [1]. Still, FES-based foot drop devices are not present in regular therapy programs of many countries due to barriers caused by technological, usability or reliability issues [2]. FES devices based on surface multi-field electrodes bring new broader stimulation possibilities and features like compensation of eversion/inversion and thus, potentially increase the configuration options. In this study, the satisfaction and usability aspects of a multi-field based FES device were analyzed in a clinical environment. Method The FES device used in this study was the Fesia Walk device for compensation of foot drop, which is based on a multi-field surface electrode and an inertial sensor for gait phase detection. 10 acquired brain injury subjects in chronic stage and 4 therapists participated in the study. The therapists received a two-hour training session prior to the therapy sessions. Every subject was assigned to one therapist and received 3 sessions of habituation and 6 sessions of over ground walking with the Fesia Walk during three weeks. Both therapists and users were evaluated with the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST). Additionally, the therapists were evaluated with the System Usability Scale (SUS). An individual interview was carried out with each of the participants. Results The device received good scores in both the QUEST and SUS scales, with mean scores of 4.14 out of 5 and 85.6 out of 100 respectively. Furthermore, most users and all therapists showed interest to continue using the device after the study. Discussion and conclusions This usability study indicated that it is possible to include surface multi-field based FES devices for the compensation of foot drop in practical therapeutic programs and that they can be used as regular tools by therapists in clinical environments.Item The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study: A feasibility study(2017-05-10) Cuesta-Gómez, Alicia; Molina-Rueda, Francisco; Carratala-Tejada, Maria; Imatz-Ojanguren, Eukene; Torricelli, Diego; Miangolarra-Page, Juan Carlos; Tecnalia Research & Innovation; Medical TechnologiesIntroduction: Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses. Objective: To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems. Design: A cross-sectional study was carried out. Setting: The VICON Motion System® was used to conduct motion analysis. Participants: Twenty-one patients with chronic stroke. Intervention: The Compex® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition. Main outcome measures: We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass. Results: Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions. Conclusion: The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.