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Paredes-Acuna N, Utpadel-Fischler D, Ding K, Thakor NV, Cheng G. Upper limb intention tremor assessment: opportunities and challenges in wearable technology. J Neuroeng Rehabil 2024; 21:8. [PMID: 38218890 PMCID: PMC10787996 DOI: 10.1186/s12984-023-01302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Tremors are involuntary rhythmic movements commonly present in neurological diseases such as Parkinson's disease, essential tremor, and multiple sclerosis. Intention tremor is a subtype associated with lesions in the cerebellum and its connected pathways, and it is a common symptom in diseases associated with cerebellar pathology. While clinicians traditionally use tests to identify tremor type and severity, recent advancements in wearable technology have provided quantifiable ways to measure movement and tremor using motion capture systems, app-based tasks and tools, and physiology-based measurements. However, quantifying intention tremor remains challenging due to its changing nature. METHODOLOGY & RESULTS This review examines the current state of upper limb tremor assessment technology and discusses potential directions to further develop new and existing algorithms and sensors to better quantify tremor, specifically intention tremor. A comprehensive search using PubMed and Scopus was performed using keywords related to technologies for tremor assessment. Afterward, screened results were filtered for relevance and eligibility and further classified into technology type. A total of 243 publications were selected for this review and classified according to their type: body function level: movement-based, activity level: task and tool-based, and physiology-based. Furthermore, each publication's methods, purpose, and technology are summarized in the appendix table. CONCLUSIONS Our survey suggests a need for more targeted tasks to evaluate intention tremors, including digitized tasks related to intentional movements, neurological and physiological measurements targeting the cerebellum and its pathways, and signal processing techniques that differentiate voluntary from involuntary movement in motion capture systems.
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Affiliation(s)
- Natalia Paredes-Acuna
- Institute for Cognitive Systems, Technical University of Munich, Arcisstraße 21, 80333, Munich, Germany.
| | - Daniel Utpadel-Fischler
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Keqin Ding
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gordon Cheng
- Institute for Cognitive Systems, Technical University of Munich, Arcisstraße 21, 80333, Munich, Germany
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Meng L, Jin M, Zhu X, Ming D. Peripherical Electrical Stimulation for Parkinsonian Tremor: A Systematic Review. Front Aging Neurosci 2022; 14:795454. [PMID: 35197841 PMCID: PMC8859162 DOI: 10.3389/fnagi.2022.795454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinsonian tremor is one of the most common motor disorders in patients with Parkinson's disease (PD). Compared to oral medications and brain surgery, electrical stimulation approaches have emerged as effective and non-invasive methods for tremor reduction. The pathophysiology, detection and interventions of tremors have been introduced, however, a systematic review of peripherical electrical stimulation approaches, methodologies, experimental design and clinical outcomes for PD tremor suppression is still missing. Therefore, in this paper, we summarized recent studies on electrical stimulation for tremor suppression in PD patients and discussed stimulation protocols and effectiveness of different types of electrical stimulation approaches in detail. Twenty out of 528 papers published from 2010 to 2021 July were reviewed. The results show that electrical stimulation is an efficient intervention for tremor suppression. The methods fall into three main categories according to the mechanisms: namely functional electrical stimulation (FES), sensory electrical stimulation (SES) and transcutaneous electrical nerve stimulation (TENS). The outcomes of tremor suppression were varied due to various stimulation approaches, electrode locations and stimulation parameters. The FES method performed the best in tremor attenuation where the efficiency depends mainly by the control strategy and accuracy of tremor detection. However, the mechanism underlying tremor suppression with SES and TENS, is not well-known. Current electrical stimulation approaches may only work for a number of patients. The potential mechanism of tremor suppression still needs to be further explored.
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Affiliation(s)
- Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Mengyue Jin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Xiaodong Zhu
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- *Correspondence: Dong Ming
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Karamesinis A, Sillitoe RV, Kouzani AZ. Wearable Peripheral Electrical Stimulation Devices for the Reduction of Essential Tremor: A Review. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:80066-80076. [PMID: 34178561 PMCID: PMC8224473 DOI: 10.1109/access.2021.3084819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Essential tremor is the most common pathological tremor, with a prevalence of 6.3% in people over 65 years of age. This disorder interferes with a patient's ability to carry out activities of daily living independently, and treatment with medical and surgical interventions is often insufficient or contraindicated. Mechanical orthoses have not been widely adopted by patients due to discomfort and lack of discretion. Over the past 30 years, peripheral electrical stimulation has been investigated as a possible treatment for patients who have not found other treatment options to be satisfactory, with wearable devices revolutionizing this emerging approach in recent years. In this paper, an overview of essential tremor and its current medical and surgical treatment options are presented. Following this, tremor detection, measurement and characterization methods are explored with a focus on the measurement options that can be incorporated into wearable devices. Then, novel interventions for essential tremor are described, with a detailed review of open and closed-loop peripheral electrical stimulation methods. Finally, discussion of the need for wearable closed-loop peripheral electrical stimulation devices for essential tremor, approaches in their implementation, and gaps in the literature for further research are presented.
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Affiliation(s)
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Abbas Z Kouzani
- School of Engineering, Deakin University, Geelong, VIC 3216, Australia
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Zhou Y, Jenkins ME, Naish MD, Trejos AL. Characterization of Parkinsonian Hand Tremor and Validation of a High-Order Tremor Estimator. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1823-1834. [PMID: 30047891 DOI: 10.1109/tnsre.2018.2859793] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent progress in wearable technology has made wearable tremor suppression devices (WTSDs) for Parkinson's patients a potentially viable alternative solution for tremor management. So far, in contrast to wrist and elbow tremor, finger tremors have not been studied in depth despite the huge impact that they have on a patient's daily life. In addition, more evidence has been found showing that the performance of current tremor estimators may be limited by their model order due to the multiple harmonics present in tremor. The aim of this paper is to characterize finger and wrist tremor in both the time and frequency domains, and to propose a high-order tremor estimation algorithm. Tremor magnitudes are reported in the forms of linear acceleration, angular velocity, and angular displacement. The activation of forearm flexor and extensor muscles is also investigated. The frequency analysis shows that Parkinsonian tremors produce oscillations of the hand with pronounced harmonics. At last, a high-order weighted-frequency Fourier linear combiner (WFLC)-based Kalman filter is proposed. The percentage estimation accuracy achieved from the proposed estimator is 96.3 ± 1.7%, showing average improvements of 28.5% and 48.9% over its lower-order counterpart and the WFLC. The proposed estimator shows promise for use in a WTSD.
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López-Blanco R, Velasco MA, Méndez-Guerrero A, Romero JP, Del Castillo MD, Serrano JI, Benito-León J, Bermejo-Pareja F, Rocon E. Essential tremor quantification based on the combined use of a smartphone and a smartwatch: The NetMD study. J Neurosci Methods 2018; 303:95-102. [PMID: 29481820 DOI: 10.1016/j.jneumeth.2018.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of wearable technology is an emerging field of research in movement disorders. This paper introduces a clinical study to evaluate the feasibility, clinical correlation and reliability of using a system based in smartwatches to quantify tremor in essential tremor (ET) patients and check its acceptance as clinical monitoring tool. NEW METHOD The system is based on a commercial smartwatch and an Android smartphone. An investigational Android application controls the process of recording raw data from the smartwatch three-dimensional gyroscopes. Thirty-four ET patients were consecutively enrolled in the experiments and assessed along one year. Arm tremor was videofilmed and scored using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Tremor intensity was quantified with the root mean square of angular velocity measured in the patients' wrists. RESULTS Eighty-two assessments with smartwatches were performed. Spearman's correlation coefficients (ρ) between clinical tremor (FTM-TRS) scores and smartwatch measures for tremor intensity were 0.590 at rest; ρ = 0.738 in steady posture; ρ = 0.189 in finger-to-nose maneuvers; and ρ = 0.652 in pouring water task. Smartwatch reliability was checked by intraclass realiability coefficients: 0.85, 0.95, 0.91, 0.95 respectively. Most of patients showed good acceptance of the system. COMPARISON WITH EXISTING METHOD(S) This commodity hardware contributes to quantify tremor objectively in a consulting-room by customized Android smart devices as clinical monitoring tool. CONCLUSIONS The NetMD system for tremor analysis is feasible, well-correlated with clinical scores, reliable and well-accepted by patients to tremor follow-up. Therefore, it could be an option to objectively quantify tremor in ET patients during their regular follow-up.
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Affiliation(s)
- Roberto López-Blanco
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares Madrid, Spain.
| | | | | | - Juan Pablo Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain; Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | | | | | - Julián Benito-León
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Center of Biomedical Network Research on Neurodegenerative Dseases (CIBERNED), Spain; Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain
| | - Félix Bermejo-Pareja
- Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain; Clinical Research Unit, University Hospital, "12 de Octubre", Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica (CAR), CSIC-UPM, Madrid, Spain
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Chan PY, Ripin ZM, Halim SA, Tharakan J, Muzaimi M, Ng KS, Kamarudin MI, Eow GB, Hor JY, Tan K, Cheah CF, Soong N, Then L, Yahya AS. An In-Laboratory Validity and Reliability Tested System for Quantifying Hand-Arm Tremor in Motions. IEEE Trans Neural Syst Rehabil Eng 2018; 26:460-467. [PMID: 29432113 DOI: 10.1109/tnsre.2017.2782361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Despite the advancement of the tremor assessment systems, the current technology still lacks a method that can objectively characterize tremors in relative segmental movements. This paper presents a measurement system, which quantifies multi-degrees-of-freedom coupled relative motions of hand-arm tremor, in terms of joint angular displacement. In-laboratory validity and reliability tests of the system algorithm to provide joint angular displacement was carried out by using the two-degrees-of-freedom tremor simulator with incremental rotary encoder systems installed. The statistical analyses show that the developed system has high validity results and comparable reliability performances using the rotary encoder system as the reference. In the clinical trials, the system was tested on 38 Parkinson's disease patients. The system readings were correlated with the observational tremor ratings of six trained medical doctors. The moderate to very high clinical correlations of the system readings in measuring rest, postural and task-specific tremors add merits to the degree of readiness of the developed tremor measurement system in a routine clinical setting and/or intervention trial for tremor amelioration.
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Haubenberger D, Abbruzzese G, Bain PG, Bajaj N, Benito-León J, Bhatia KP, Deuschl G, Forjaz MJ, Hallett M, Louis ED, Lyons KE, Mestre TA, Raethjen J, Stamelou M, Tan EK, Testa CM, Elble RJ. Transducer-based evaluation of tremor. Mov Disord 2016; 31:1327-36. [PMID: 27273470 DOI: 10.1002/mds.26671] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 11/11/2022] Open
Abstract
The International Parkinson and Movement Disorder Society established a task force on tremor that reviewed the use of transducer-based measures in the quantification and characterization of tremor. Studies of accelerometry, electromyography, activity monitoring, gyroscopy, digitizing tablet-based measures, vocal acoustic analysis, and several other transducer-based methods were identified by searching PubMed.gov. The availability, use, acceptability, reliability, validity, and responsiveness were reviewed for each measure using the following criteria: (1) used in the assessment of tremor; (2) used in published studies by people other than the developers; and (3) adequate clinimetric testing. Accelerometry, gyroscopy, electromyography, and digitizing tablet-based measures fulfilled all three criteria. Compared to rating scales, transducers are far more sensitive to changes in tremor amplitude and frequency, but they do not appear to be more capable of detecting a change that exceeds random variability in tremor amplitude (minimum detectable change). The use of transducer-based measures requires careful attention to their limitations and validity in a particular clinical or research setting. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Dietrich Haubenberger
- Clinical Trials Unit, Office of the Clinical Director, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
| | | | - Peter G Bain
- Department of Neurology, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Nin Bajaj
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Kailash P Bhatia
- Sobell Department for Movement Neuroscience, UCL, Institute of Neurology, Queen Square, London, United Kingdom
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Maria João Forjaz
- National School of Public Health and Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Carlos III Institute of Health, Madrid, Spain
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Elan D Louis
- Departments of Neurology and Chronic Disease Epidemiology, Yale School of Medicine and Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Kelly E Lyons
- University of Kansas Medical Center, Kansas City, Kansas
| | - Tiago A Mestre
- Parkinson's disease and Movement Disorders Center, Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Jan Raethjen
- Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Maria Stamelou
- Neurology Department, University of Athens, Greece and Neurology Department, Philipps University, Marburg, Germany
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute (SGH campus), Duke NUS Medical School, Singapore General Hospital, Singapore
| | - Claudia M Testa
- Department of Neurology and Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rodger J Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Elble RJ, McNames J. Using Portable Transducers to Measure Tremor Severity. Tremor Other Hyperkinet Mov (N Y) 2016; 6:375. [PMID: 27257514 PMCID: PMC4872171 DOI: 10.7916/d8dr2vcc] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/23/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Portable motion transducers, suitable for measuring tremor, are now available at a reasonable cost. The use of these transducers requires knowledge of their limitations and data analysis. The purpose of this review is to provide a practical overview and example software for using portable motion transducers in the quantification of tremor. METHODS Medline was searched via PubMed.gov in December 2015 using the Boolean expression "tremor AND (accelerometer OR accelerometry OR gyroscope OR inertial measurement unit OR digitizing tablet OR transducer)." Abstracts of 419 papers dating back to 1964 were reviewed for relevant portable transducers and methods of tremor analysis, and 105 papers written in English were reviewed in detail. RESULTS Accelerometers, gyroscopes, and digitizing tablets are used most commonly, but few are sold for the purpose of measuring tremor. Consequently, most software for tremor analysis is developed by the user. Wearable transducers are capable of recording tremor continuously, in the absence of a clinician. Tremor amplitude, frequency, and occurrence (percentage of time with tremor) can be computed. Tremor amplitude and occurrence correlate strongly with clinical ratings of tremor severity. DISCUSSION Transducers provide measurements of tremor amplitude that are objective, precise, and valid, but the precision and accuracy of transducers are mitigated by natural variability in tremor amplitude. This variability is so great that the minimum detectable change in amplitude, exceeding random variability, is comparable for scales and transducers. Research is needed to determine the feasibility of detecting smaller change using averaged data from continuous long-term recordings with wearable transducers.
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Affiliation(s)
- Rodger J. Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - James McNames
- Department of Electrical and Computer Engineering, Maseeh College of Engineering and Computer Science, Portland State University, Portland, OR, USA
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Vilas-Boas MDC, Cunha JPS. Movement Quantification in Neurological Diseases: Methods and Applications. IEEE Rev Biomed Eng 2016; 9:15-31. [PMID: 27008673 DOI: 10.1109/rbme.2016.2543683] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kobravi HR, Ali SH, Vatandoust M, Marvi R. Prediction of the Wrist Joint Position During a Postural Tremor Using Neural Oscillators and an Adaptive Controller. JOURNAL OF MEDICAL SIGNALS AND SENSORS 2016; 6:117-27. [PMID: 27186540 PMCID: PMC4855885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The prediction of the joint angle position, especially during tremor bursts, can be useful for detecting, tracking, and forecasting tremors. Thus, this research proposes a new model for predicting the wrist joint position during rhythmic bursts and inter-burst intervals. Since a tremor is an approximately rhythmic and roughly sinusoidal movement, neural oscillators have been selected to underlie the proposed model. Two neural oscillators were adopted. Electromyogram (EMG) signals were recorded from the extensor carpi radialis and flexor carpi radialis muscles concurrent with the joint angle signals of a stroke subject in an arm constant-posture. The output frequency of each oscillator was equal to the frequency corresponding to the maximum value of power spectrum related to the rhythmic wrist joint angle signals which had been recorded during a postural tremor. The phase shift between the outputs of the two oscillators was equal to the phase shift between the muscle activation of the wrist flexor and extensor muscles. The difference between the two oscillators' output signals was considered the main pattern. Along with a proportional compensator, an adaptive neural controller has adjusted the amplitude of the main pattern in such a way so as to minimize the wrist joint prediction error during a stroke patient's tremor burst and a healthy subject's generated artificial tremor. In regard to the range of wrist joint movement during the observed rhythmic motions, a calculated prediction error is deemed acceptable.
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Affiliation(s)
- Hamid Reza Kobravi
- Department of Biomedical Engineering, Faculty of Electrical Engineering, Islamic Azad University of Mashhad, Mashhad, Iran,Address for correspondence: Dr. Hamid Reza Kobravi, Department of Biomedical Engineering, Faculty of Electrical Engineering, Islamic Azad University of Mashhad, Mashhad, Iran. E-mail:
| | | | - Masood Vatandoust
- Department of Biomedical Engineering, Faculty of Electrical Engineering, Islamic Azad University of Mashhad, Mashhad, Iran
| | - Rasoul Marvi
- Department of Biomedical Engineering, Faculty of Electrical Engineering, Islamic Azad University of Mashhad, Mashhad, Iran
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Hayashibe M, Guiraud D, Pons JL, Farina D. Editorial: Biosignal processing and computational methods to enhance sensory motor neuroprosthetics. Front Neurosci 2015; 9:434. [PMID: 26594147 PMCID: PMC4633489 DOI: 10.3389/fnins.2015.00434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/26/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mitsuhiro Hayashibe
- French Institute for Research in Computer Science and Automation, University of Montpellier Montpellier, France
| | - David Guiraud
- French Institute for Research in Computer Science and Automation, University of Montpellier Montpellier, France
| | - Jose L Pons
- Spanish National Research Council Madrid, Spain
| | - Dario Farina
- Department of Neurorehabilitation Engineering, University Medical Center Göttingen, Georg-August University Göttingen, Germany
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