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Archive for July, 2018
In the modern world an extended life expectancy coupled with a sedentary lifestyle raises concerns over long term health in the population. This is highlighted by the increasing incidence of disability stemming from multiple sources, for example medical conditions such as cancer or stroke . While avoiding the lifestyle factors that have a high association with these diseases would be the preferred solutions of health services the world over, as populations get progressively older and more sedentary, this becomes increasingly more difficult , . The treatment of these conditions is often complex; in stroke for example, the initial incident is a constriction of blood flow in the brain which in turn damages the nervous system’s ability to communicate with the rest of the body. This damage will occur in one hemisphere of the body but can impact both the upper and lower limbs, as well as impairing functional processes such as speech and cognitive thinking.
[ARTICLE] Botulinum Toxin Type A Treatment Combined with Intensive Rehabilitation for Gait Poststroke: A Preliminary Study – Full Text
Materials and Methods
A comparative case series design was used. Subjects were 19 patients with chronic stroke and spastic hemiplegia. In 9 patients (group I), BoNT-A was injected into spastic muscles of the affected lower limbs, followed by a 4-week inpatient intensive rehabilitation program. In the other 10 patients (group II), a 4-week inpatient intensive rehabilitation program alone was first provided (control period) followed by the same treatment protocol in group I. The Modified Ashworth Scale (MAS) scores, range of motion (ROM), gait speed in the 10-Meter Walking Test, 6-Minute Walking Distance Test (6MD) scores, Timed Up and Go Test (TUG) scores, and Berg Balance Scale scores were evaluated every 4 weeks following baseline assessments.
All results except for the MAS score of knee flexor and the ROM of knee flexion improved in group I and the gait speed, 6MD, and TUG scores improved in group II. Intergroup comparisons at week 4 showed significantly greater improvements in the MAS score of ankle plantar flexor, ROM of ankle dorsiflexion, and 6MD in group I than in group II (P = .016, .011, and .009, respectively).
BoNT-A treatment for lower-limb spasticity, combined with intensive rehabilitation, was effective in improving spasticity and the 6MD compared with intensive rehabilitation alone in patients with chronic stroke.
Lower-limb spasticity is a major problem in the management of patients after stroke1, 2 because it causes gait disturbance.3 Such patients often have difficulty performing ankle dorsiflexion effectively during the swing phase of the gait cycle because of muscle spasticity and the inability to activate the ankle dorsiflexors.4 Calf muscle spasticity typically causes foot deformity, which results in the loss of heel strike, reduced toe clearance, and an inadequate base of support.5 These impairments decrease gait ability: cadence, stride length, speed, capacity, and stability.6, 7, 8, 9, 10 Thus, lower-limb spasticity causes gait disturbance, which limits activities of daily living and, eventually, quality of life. Effective treatment of lower-limb spasticity is important in improving gait ability and enhancing the independence of patients after a stroke.
One of the primary treatments for lower-limb spasticity is botulinum toxin type A (BoNT-A). Although BoNT-A has been shown to reduce lower-limb spasticity in patients after stroke,11, 12, 13its effects on improving gait ability have not been consistent among different previous studies. Pittock et al,14 Kaji et al,15 and Burbaud et al1 reported that BoNT-A injection reduced lower-limb spasticity but did not significantly improve gait pattern or speed. By contrast, Hesse et al11 and Mancini et al16 reported that BoNT-A treatment was effective in improving gait speed as well as lower-limb spasticity. Similarly, a systematic review and meta-analysis recently showed that BoNT-A treatment for lower-limb spasticity was associated with a small but statistically significant increase in gait speed.17 Consequently, the effect of BoNT-A alone for improving gait ability has been considered minimal.
To improve gait ability, adjunctive rehabilitation has recently been recommended to optimize the effects of BoNT-A treatment for lower-limb spasticity in poststroke patients.18, 19, 20, 21, 22, 23Gastaldi et al21 reported that BoNT-A treatment for lower-limb spasticity combined with additional stretching and physical therapy improved gait speed and single- and double-limb support during the stance phase of the gait cycle. Similarly, Roche et al22 reported that BoNT-A treatment for lower-limb spasticity combined with self-rehabilitation improved gait speed, capacity, and time to ascend and descend a flight of stairs. By contrast, Demetrios et al23 suggested no significant improvement in gait speed for 2 groups receiving BoNT-A treatment for lower-limb spasticity combined with high- or low-intensity rehabilitation. However, they concluded that both groups received BoNT-A treatment combined with regular rehabilitation, so there may have been insufficient variation of intensity during the rehabilitation phase. Therefore, the capacity of BoNT-A treatment combined with more intensive rehabilitation to improve gait ability remains unclear in poststroke patients.
The aim of this study was to examine the effects of BoNT-A treatment for lower-limb spasticity combined with intensive rehabilitation on improving gait ability in patients with chronic stroke and spastic hemiplegia compared with intensive rehabilitation alone. This study hypothesized that BoNT-A treatment combined with intensive rehabilitation would improve lower-limb spasticity and gait ability more effectively than intensive rehabilitation alone.[…]
One of the most basic things our bodies do is make new cells. It’s what allows tissues to grow and heal, and allows our bodies to continually rejuvenate themselves.
When it comes to cellular replenishment, one of the places researchers are most interested in is the brain. The formation of new brain cells is of critical interest to researchers studying everything from brain injuries to aging to mental illnesses like depression.
New Neurons Or No?
But researchers might be experiencing a bit of whiplash right now. Two papers, published just under a month apart, stand at odds with each other. One, led by researchers from the University of California, San Francisco, and published in Nature in early March, suggests that the hippocampus, a brain region important in the formation of memories, learning and emotional regulation, stops making new neurons after childhood, something that contradicts most previous research. The second, from Columbia University researchers out today in Cell Stem Cell, and using a very similar method, says that’s not true at all — the hippocampus does in fact make new cells throughout our lifespan.
It’s enough to tangle your neurons. But, it’s really a reminder that science is driven by debate and disagreement. It takes time and effort to arrive at a true consensus, and researchers can’t answer questions as definitively as we might wish.
In this case, the confusion seems to come down to methodology. Finding evidence of newly-formed neurons isn’t as simple as putting samples of brain tissue under a microscope. In fact, there are few direct ways of searching for neurogenesis. Instead, most researchers use indirect approaches, like searching for marker proteins involved in the maturation of new cells or other molecules somehow involved with cell development.
Though the way both teams of researchers looked for marker proteins differed slightly, both essentially involved highlighting cells expressing various marker proteins. They looked to see whether any cells “lit up”, and if so, checked to make sure they were actual new neurons.
What Do You See?
If both teams used the similar methods, how did they come to such different conclusions? Maura Boldrini, the author of the most recent paper who found the hippocampus continues to make new neurons throughout our lives, thinks it came down to the samples each team used.
“It’s not that they did something different from what we are doing substantially, I think it’s more a matter of what kind of tissue they had available,” she says. Boldrini studies how neurogenesis in the brain is related to things like depression and suicide. Over the years, she and others at Columbia University have built a large collection of brain tissue samples. Most importantly, she says, they had samples from people with healthy brains.
“As we started going on, we started having people with no psychiatric or neurological disease, no treatment, no history of drug abuse; spanning a big lifespan,” Boldrini says. “So we thought we had the right collection of brains to be able to look at the effects of aging, per se, without having these confounding factors … not too many brain collections in the world actually have information about this.”
The California researchers, says Sorrell, didn’t know the exact diagnosis of each brain sample, and had no toxicology reports for them. Drug use or psychological conditions like depression could affect the brain’s ability to make new neurons, potentially throwing the results off. In addition, some marker proteins begin to disappear soon after death, so if the samples aren’t preserved quickly, evidence of neurogenesis could be wiped away.
Another factor, Boldrini says, is the method of preservation. Some fixatives can obscure researchers’ ability to see certain types of cells. She encountered this problem during the course of her previous work, and that helped her choose the right fixatives to use. The California researchers used different fixatives than Boldrini did, and she thinks it’s another reason they might have come to different conclusions.
Though Boldrini’s work agrees with the bulk of prior research into the subject, she and her team are still relying on an indirect method of imaging neurons, and it makes it difficult at the moment to close the book on the subject.
And not every researcher is convinced. Arturo Alvarez-Buylla is a neuroscientist at UC, San Francisco and a co-author of the paper that found no evidence of adult neurogenesis in the hippocampus. While he says more work needs to be done, he thinks Boldrini’s work may be misinterpreting some evidence, specifically the cells they label as new neurons.
“I believe what they are calling dividing cells and what they are calling new neurons, they may be [those things], but the evidence is not there,” Alvarez-Buylla says.
He points to a marker protein both his team and Boldrini’s use to search for developing cells, called Ki-67. Boldrini’s team likely misread figures showing the protein, Alvarez-Buylla thinks, leading them to falsely conclude that new neurons existed.
As for his own research, he says the fact they identified new neurons in samples of young tissue proves that his team’s methodology was solid, and that his results weren’t simply the result of poor sampling or fixing. They watched those cells dwindle and disappear as they looked at samples from progressively older people, which is evidence that neurogenesis does stop.
In fact, their method did turn up similar structures in adults as Boldrini did, Alvarez-Buylla says, but their interpretation differs.
“So, we did see the same cells that they do see in our post-mortem material, it’s just that we do not agree that they are young neurons,” he says.
Where Do We Stand?
Jonas Frisen, a stem cell researcher at Sweden’s Karolinska Institutet who was not involved with either study, agrees that the reason both teams got such different answers most likely lies in how they went about collecting and analyzing samples. Furthermore, drawing conclusions from negative data, as Alvarez-Buylla’s team did, is difficult.
“The commonly used quote, ‘Absence of evidence is not evidence of absence,’ summarizes that,” Frisen says in an email. “An analogy to the current situation is that you send 10 people into the woods to search for blueberries. Nine come back with blueberries and one not—are there blueberries in that forest?”
The method that both teams relied on has its drawbacks as well. There is a poor signal-to-noise ratio when searching for marker proteins in the brain, Frisen says, and much of the evidence that it works is based on animal studies — which may not fully translate to humans.
In the end, he agrees with Boldrini that humans probably continue to make neurons throughout the course of their lives. It would be good news for those of us worried about cracking our heads one too many times, though it obviously doesn’t change how our brains actually behave. The real benefit would be to researchers studying how the formation of new neurons relates to depression and other mental disorders, as well as how we make new memories and regulate emotions.
These past few weeks have been a case study in the machinations of science, and it serves as a solid reminder that there aren’t many hard-and-fast truths in science. And, new neurons or not, it’s another piece of the puzzle of how our brains work. In the end, that’s good for all of us.
Neurogenesis is the mechanism whereby neurons are developed within the nervous system. It involves the formation of highly specialized neurons within the brain, both in fetal and adult growth.
Tight regulation of this process is required to ensure that each neuron differentiates into a specific sub-category. For example, within the hippocampus there are over 27 distinct classes of neuron, each with a different and equally vital role.
When neurons develop within embryos, the neural stem cells differentiate in a highly controlled manner. This process starts when the ectoderm forms a neural plate, which is subsequently arranged to form a neural groove, and then fused to form a neural tube and crest.
This forms the basis of the nervous system, including the brain and the spinal cord. Neural stem cells are located within the ventricular zone, where they divide to form the ventricular system of the brain.
Neurogenesis in adults
Once the nervous system is fully formed, neurogenesis only occurs due to stimuli. Upon stimulation, stem cells within the subventricular and subgranular zones begin to proliferate to form neuroblasts, eventually maturing into neurons.
These stem cells are usually maintained in a quiescent state within their niche, and are only activated upon the interaction with intrinsic or niche-derived stimuli. Once activated, they proliferate to form transit-amplifying cell, which develop into immature neurons. Further development results in the formation of new mature neurons, which can integrate into the pre-established neuronal system.
Within the subgranular zone, called dentate gyrus, the developing cells are differentiated to form excitatory granule cells. Alternately, within the subventricular zones, neural progenitor cells migrate via the rostral migratory stream (RMS) to the olfactory bulb, where they differentiate further into many types of highly specialised neuron. Therefore, even though neural stem cells are only located in two areas, they can still differentiate to form many varieties of neuron.
Neurogenesis is tightly controlled, to ensure correct levels of activation. Both intrinsic and niche-derived factors are involved in this process, including Sox2, NeuroD1, Pax6, and many other factors. There are also epigenetic factors which are utilized in the control of neurogenesis, as well as cytokines, morphogens, neurotransmitters and growth factors. These include brain-derived neurotrophic factor (BDNF), epidermal growth factor (EGF), Wingless (Wnt) and Sonic hedgehog (Shh).
It is very important that this process is controlled to maintain a healthy population of quiescent stem cells. Each stem cell can only proliferate a certain number of times due to the “Hayflick limit”, and therefore uncontrolled proliferation can lead to loss of stem cell populations and premature aging.
Why is neurogenesis required in adults?
The ability of the nervous system to form new neurons is due to plasticity, which is important in both memory and learning. A balance between both stability and adaptability within the brain is the key to enable us to both remember things we have previously learnt and to learn new things.
Neurodegeneration is a natural process which occurs in adult brains, particularly at older age, in which neurons are broken down. Therefore, neurogenesis is used to counteract this problem, by generating new neurons to replace older ones.
This balance can be enhanced by many different factors, including increased neurogenesis due to more physical activity, engaging environments, and education. However, neurogenesis can also be impeded due to stress, inflammation, age and alcoholism.
Alterations have also been attributed to several diseases, such as depression and epilepsy, highlighting the importance of a highly controlled balance between neurogenesis and neurodegeneration.
Reviewed by Chloe Barnett, BSc
[Abstract + References] Using Orientation Sensors to Control a FES System for Upper-Limb Motor Rehabilitation
Contralaterally controlled functional electrical stimulation (CCFES) is a recent therapy aimed at improving the recovery of impaired limbs after stroke. For hemiplegic patients, CCFES uses a control signal from the non-impaired side of the body to regulate the intensity of electrical stimulation delivered to the affected muscles of the homologous limb on the opposite side of the body. CCFES permits an artificial muscular contraction synchronized with the patient’s intentionality to carry out functional tasks, which is a way to enhance neuroplasticity and to promote motor learning. This work presents an upper extremity motor rehabilitation system based on CCFES, using orientation sensors for control. Thus, the stimulation intensity (current amplitude) delivered to the paretic extremity is proportional to the degree of joint amplitude of the unaffected extremity. The implemented controller uses a control strategy that allows the delivered electrical stimulation intensity, to be comparable to the magnitude of movement. It was carried out a set of experiments to validate the overall system, for executing five bilateral mirror movements that include human wrist and elbow joints. Obtained results showed that movements voluntary signals acquired from right upper-limb were replicated successfully on left upper-limb using the FES system.
Stroke is among the top three causes of death in the United States, but nothing comes close to stroke as the leading cause of long-term disability. After patients survive a stroke, their risk of having another stroke increases, along with their likelihood of suffering a serious disability as a result. However, medical and technological advances have made it easier to help patients cope and recover. Occupational therapy is an effective way to restore mobility and reduce future risks for stroke survivors.
Therapy for stroke survivors often involves “re-training” or reprogramming the brain after neurological damage. As we learn more about the relationship between the brain, muscles, and connective tissue, one stimulating innovation is emerging as a top tool for recovery. Today, many patients are relying on a stroke rehabilitation gloves & dynamic splints to reverse damage, restore mobility, and reduce pain after a stroke.
But how, exactly, does wearing these orthoses treat symptoms of stroke survivors? Truth is, there are many benefits for patients who incorporate a glove or a dynamic splint into their recovery process.
Problems Stroke Can Cause
Especially with strokes, survivors can suffer from impaired function, weakness and spasticity. Spasticity causes involuntary muscle contractions in the arms and can even cause even short-term or long-term paralysis as the tendons and tissues around the muscles get tighter.
Strokes can really affect upper arm movements too. Survivors only use their affected upper limb approximately 3 hours per day.
Individuals who have not suffered a neurological injury use their dominant hand for an average of 9 hours per day. Patientsless than 14 days following stroke use their affected upper limb only 38 minutes out of a 9-hour day.
Shortening of muscles and connective tissue can start occurring within hours/days. Maintaining a shortened position for a prolonged period of time leads to fibrous adhesion formation, loss of sarcomeres and a loss of tissue extensibility.
There Is Hope After A Stroke
Fortunately, we can respond to spasticity, and lessened arm movements and muscle tone by harnessing the brain’s own plasticity. Cortical Plasticity, also known as neuroplasticity, is the brain’s remarkable ability to reorganize itself by forming new neural connections based on individual experiences, lifestyle and environment. It essentially is the brain’s ability to “re-program” itself through mass practice, task-oriented arm training.
To get these neuroplastic changes, patents participate in skill-dependent rather than simply use-dependent activities. Skill-dependent activities are specific and progressively challenging tasks whereas use-dependent activities are repetition tasks in the absence of a meaningful challenge or an activity that requires problem solving strategies.
With these skill-dependent activities cortical maps are continuously remodeled throughout life and after injury by experiences and learning in response to activity and behavior from the stroke survivor. Stimulated through this task training, the brain has the ability to reorganize and form new connections between the intact neurons. The healthy surrounding tissue takes over some of the functions of the damaged area of the brain.
This Is Where Stroke Rehabilitation Gloves and Dynamic Splints Come Into Place
Task-specific training with rehabilitation gloves and dynamic splits improve upper extremity function in individuals suffering from neurological injuries. Treatment options are limited for neurological clients who cannot effectively incorporate their hand for functional grasp and release activities. This is where dynamic splints can really help rehabilitation.
Dynamic Splints Help Train the Brain
If the hand and arm muscles are no longer functional, it’s especially important to re-learn basic functions first, such asgrasping and releasing objects. A stroke rehabilitation device like the SaeboFlex can make this process easier for some patients and possible for those who otherwise would have no function left.
For a vast majority of stroke survivors, especially ones with incomplete spinal cord injury, patients do not exhibit sufficient active wrist and/or finger extension to allow the hand to be functional. Stroke recovery gloves like SaeboFlex has the biomechanical advantage in allowing prehension grasp and release activities for individuals with moderate to severe hemiparesis.
The SaeboFlex and other rehabilitative dynamic splints actually step in to compensate for some of the patient’s biomechanical disadvantages.
The majority of patients with neurological or spinal cord damage cannot extend their fingers or move their wrists, but this orthosis imitates the hand’s natural functions and makes it possible to grasp and release objects. The goal is to make the hand functional again, but it also minimizes joint damage and pain.
Dynamic Splints Help Fight Contracture
When stroke survivors lose function in their upper limbs after a stroke, sometimes hard static splints are used to keep the arm and wrist in a “neutral” position and avoid muscle contracture. Unfortunately, some studies have shown that static splinting is ineffective against muscle contracture, and others have actually linked the practice to joint damage and contracture. Contracture is a loss of motion over time due to abnormal shortening of the soft tissue structures spanning one or more joints. These include skin, ligaments, tendon, muscles and joint capsules.
The ideal splint is dynamic, moveable and helps stretch out muscles, tendons and ligaments like the SaeboStretch.
The splint’s energy-storing technology allows individuals suffering from spasticity to stretch comfortably and safely resulting in increased motivation and compliance. It allows the fingers to move through flexion caused by associated reactions and increased tone.
A dynamic splint may prevent contracture after a stroke, as well as:
- Reduce joint pain
- Protect the joints
- Prevent edema (buildup of excessive fluid in the muscle tissue)
- Allows the fingers to move through flexion caused by postural changes associated reactions and increased tone.
- Gradually repositions the fingers into extension
As patients recover from a stroke, every effort to restore strength and function is invaluable. Using a stroke rehabilitation dynamic splint is a proven way to reduce pain and complications while survivors focus on their recovery. It may also open up new possibilities by restoring the use of their arms.
Stroke Recovery Glove For Improved Hand Functionality
It’s important to keep the muscles active after a stroke, in order to prevent stiffness and shortening of the tissue. Activity also helps to keep pathways between the brain and muscles open. Stroke recovery gloves that promote sensorimotor stimulation are useful to stroke survivors for many different reasons, from preventing complications to making life-changing therapy methods possible.
Therapy is a big part of the recovery process after a stroke, and occupational therapy often incorporates basic elements such as towels or small objects as patients learn to grasp, release, hold, and perform other basic tasks. Stroke rehabilitation gloves like the SaeboGlove can help with these activities. The SaeboGlove is a functional stroke recovery hand glove that has a tension system integrated into it which helps individuals extend their fingers and thumb after grasping. This helpful stimulation helps the neuroplastic changes the brain needs to help reprogram itself.
Positive results have been witnessed and experienced with professionals and clients when integrate them into upper arm rehabilitation exercises.
Results of stroke rehabilitation gloves in therapy have included:
- Significant increases on the Fugi-Meyer Assessment and Box and Block Test, which are designed to test the elbow’s control and strength during reach-to-grasp tasks
- Reduced jerkiness of the wrist, shoulder, and elbow joints during reach-to-grasp therapy tasks
- Improved flexion and abduction
- Support for hand and finger extension after loss of mobility
- Increased motor recovery
- Increased grip strength
- Active improvement to the overall functionality of patient hands, with some enjoying nearly full functionality
- Strong potential for future improvement of arm/wrist mobility.
Improved Stroke Recovery With Gloves And Dynamic Splints
Skill-dependent physical activities have long helped stroke survivors reprogram their brains, strengthen their muscles, and improve their quality of life after neurological damage. Stroke rehabilitation gloves and dynamic splints can give the patients the needed stimulation and help they are needing to progress. They are great to help protect the joints while improving strength and mobility. Because patients can incorporate these gloves and dynamic splints into occupational therapy as well as everyday tasks, they make it easier to achieve independence during their stroke recovery.
[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial
We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.
A single-blinded, 2-sequence, 2-period, crossover-designed study.
Rehabilitation clinics and participant’s home environment.
Individuals with disabilities poststroke.
During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.
Main Outcome Measures
Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.
Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.
The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.
via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial – Archives of Physical Medicine and Rehabilitation
[Abstract + References] The Identification and Control of a Finger Exoskeleton for Grasping Rehabilitation – Conference paper
This paper evaluates the efficacy of different classical control architectures in performing grasping motion. The exoskeleton system was obtained via system identification method in which the input and output data was measured by means of current sensor (ACS712) and encoder attached to a DC geared motor (SPG30e-270k). The data obtained is split with a ratio of 70:30 for estimation and validation, respectively. The transfer function of the system is evaluated by varying the number of poles and zeros that are able to fit well with validation data. The performance of the classical P, PI, PD and PID control techniques were then evaluated in its ability to track the desired trajectory. It was demonstrated from the study that the PID controller provides the least steady state error as well as a reasonably fast settling time.
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[Abstract + References] Classifying Imaginary Hand Movement through Electroencephalograph Signal for Neuro-rehabilitation
Brain-Computer-Interface (BCI) has been widely used in the field of neuro-rehabilitation such as automatic controls based on brain commands to upper and lower extremity prosthesis devices in patients with paralysis. In a post-stroke period, approximately 50% of stroke sufferers have unilateral motor deficits leading to a chronic decline in chronic upper extremity function. Stroke affects patients in their productive and elderly age which is potentially creating new problems in national health development. BCI can be used to aid post-stroke patient recovery, thus motion detection and classification is essential for optimizing BCI device control. Therefore, this study aims to distinguish several hand functions such as grasping, pinching, and hand lifting from releasing movement in accordance with the usual movements performed during post-stroke rehabilitation based on brain signals obtained from electroencephalogram (EEG). In this study, the information that obtained from the processing of EEG signals were be used as inputs for artificial neural networks then classified to distinguish two types of imaginary hand movements (grasping v. releasing, pinching v. releasing, hand lifting v. releasing). The results of these classifications using Extreme Learning Machine (ELM) based on spectral analysis and CSP (Common Spatial Pattern) calculation show that ELM and CSP was a good feature in distinguishing two types of motion with software/system accuracy average above 95%. This could be useful for optimizing BCI devices in neuro-rehabilitation, such as combining with Functional Electrical Stimulator (FES) device as a self-therapy for post-stroke patient.
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The EU FET Symbitron project gathered researchers from 5 European countries to build wearable exoskeletons to help people who have suffered a spinal cord injury to walk again. The next step is to prepare the robot to compete at the Cybathlon games in 2020 in Zurich.
One of human beings’ most interesting features is the interaction between the mind and the body, and hence the control that the brain exerts on the body and the continuous feedback received from it. Spinal cord injuries (SCI) interrupt the crucial bi-directional communication pathway between the brain and the rest of the body, and make it difficult or impossible for patients to walk.
At the moment, although scientific advances are being made, there is no way of regenerating and totally restoring a damaged spinal cord and the nerve pathways connected to it. Nonetheless, researchers in the field of assistive robotics are currently working to develop wearable devices that can compensate for lost motor functions. Over the past four years, scientists in the Symbitron project, supported by the EU FET programme, developed lower limb exoskeletons that people with SCI can use to walk again. The multidisciplinary team included mechanical, electronic and biomedical engineers, neurologists, psychologists and physical therapists.
Project researchers from 5 European countries (the Netherlands (University of Twente and Delft University of Technology), Italy (Fondazione Santa Lucia IRCCS), UK (Imperial College), Switzerland (EPFL) and Iceland (Össur), developed a versatile wearable robot adaptable for use by SCI patients with very different impairments. Their great ambition was to let patients walk autonomously, regain their mobility and independence, and overcome the psychological barriers created by their disability.
One of the main challenges to be faced was to overcome the traditional engineering design approach, which often focuses almost exclusively on technological issues and only partially takes into account the perspective and clinical needs of users. The Symbitron project put the patients at the center of the exoskeleton design paradigm, trying to tailor the technology around their body, their mind and the residual communication between them that is still possible. From the very beginning of the project, 13 patients with SCI, each one with unique clinical features related to specific spinal cord damage, were involved as part of the experimental team and considered as “test pilots” of the machine to be developed. Their precious feedback on performance and their experience of using the technology was successfully embedded in a user-centred optimisation loop, in which great attention was given to robotic adaptation and customization aspects, as these are key to ensuring that the human-machine interaction works as well as possible.
Form the hardware point of view, the exoskeletons were designed in an innovative modular format, making different robotic configurations possible: for example, to support the ankle or knee joints of patients who still have some ability to walk independently, or the entire legs of those with more severe SCI who cannot walk unaided. The control software was designed to be flexible to match. A biologically inspired control algorithm was developed to mirror muscular and reflex-like movements in the legs of the exoskeletons and to let the users control the machine and walk in a smooth, intuitive and natural way. Not only engineers and clinical experimenters, but also the “test pilot” patients, were actively involved in honing the software’s functions and its use to control the machines: their feedback was crucial.
The test pilots were involved throughout the project in several experiments to obtain neurophysiological information useful for the mechatronic design process, personal experiences needed to customize the behavior of the exoskeletons, and biomechanical data on human-robot performance to improve the hardware and software. A major project milestone was a “measurements marathon” organized at the University of Twente. Nine test pilots moved from the Italian clinical partner, Fondazione Santa Lucia IRCCS, to the Netherlands to take part to 5 full days of testing, including 11 different experiments (around 120 different tests), which involved 14 Symbitron researchers and 3 experimental setups.
The Symbitron project was successfully concluded in Rome with clinical approval of the modular exoskeleton it developed, demonstrating the possibility of improving the walking performance of the test pilots after a period of training performed in a clinical setting. The tests were proof of the feasibility of Symbitron’s unique approach. Moreover, a multi-factor psychological assessment showed that the users were not only highly motivated through the training but also very satisfied about the capacity of the exoskeleton to adapt to their personal walking and balance strategies. The Symbitron exoskeleton will be further developed in the years to come in order to compete in the Cybathlon games in 2020 in Zurich.