High Classification Accuracy of a Motor Imagery Based Brain-Computer Interface for Stroke Rehabilitation Training

Motor priming to enhance the effect of physical therapy in people with spinal cord injury

CONTEXT

Brain-Computer Interface (BCI) is an emerging neurorehabilitation therapy for people with spinal cord injury (SCI).

OBJECTIVE

The study aimed to test whether priming the sensorimotor system using BCI-controlled functional electrical stimulation (FES) before physical practice is more beneficial than physical practice alone.

METHODS

Ten people with subacute SCI participated in a randomized control trial where the experimental (N = 5) group underwent BCI-FES priming (∼15 min) before physical practice (30 min), while the control (N = 5) group performed physical practice (40 min) of the dominant hand. The primary outcome measures were BCI accuracy, adherence, and perceived workload. The secondary outcome measures were manual muscle test, grip strength, the range of motion, and Electroencephalography (EEG) measured brain activity.

RESULTS

The average BCI accuracy was 85%. The experimental group found BCI-FES priming mentally demanding but not frustrating. Two participants in the experimental group did not complete all sessions due to early discharge. There were no significant differences in physical outcomes between the groups. The ratio between eyes closed to eyes opened EEG activity increased more in the experimental group (theta Pθ = 0.008, low beta Plβ = 0.009, and high beta Phβ = 1.48e-04) indicating better neurological outcomes. There were no measurable immediate effects of BCI-FES priming.

CONCLUSION

Priming the brain before physical therapy is feasible but may require more than 15 min. This warrants further investigation with an increased sample size.

Enhancing Deep-Learning Classification for Remote Motor Imagery Rehabilitation Using Multi-Subject Transfer Learning in IoT Environment

One of the most promising applications for electroencephalogram (EEG)-based brain-computer interfaces (BCIs) is motor rehabilitation through motor imagery (MI) tasks. However, current MI training requires physical attendance, while remote MI training can be applied anywhere, facilitating flexible rehabilitation. Providing remote MI training raises challenges to ensuring an accurate recognition of MI tasks by healthcare providers, in addition to managing computation and communication costs. The MI tasks are recognized through EEG signal processing and classification, which can drain sensor energy due to the complexity of the data and the presence of redundant information, often influenced by subject-dependent factors. To address these challenges, we propose in this paper a multi-subject transfer-learning approach for an efficient MI training framework in remote rehabilitation within an IoT environment. For efficient implementation, we propose an IoT architecture that includes cloud/edge computing as a solution to enhance the system's efficiency and reduce the use of network resources. Furthermore, deep-learning classification with and without channel selection is applied in the cloud, while multi-subject transfer-learning classification is utilized at the edge node. Various transfer-learning strategies, including different epochs, freezing layers, and data divisions, were employed to improve accuracy and efficiency. To validate this framework, we used the BCI IV 2a dataset, focusing on subjects 7, 8, and 9 as targets. The results demonstrated that our approach significantly enhanced the average accuracy in both multi-subject and single-subject transfer-learning classification. In three-subject transfer-learning classification, the FCNNA model achieved up to 79.77% accuracy without channel selection and 76.90% with channel selection. For two-subject and single-subject transfer learning, the application of transfer learning improved the average accuracy by up to 6.55% and 12.19%, respectively, compared to classification without transfer learning. This framework offers a promising solution for remote MI rehabilitation, providing both accurate task recognition and efficient resource usage.

A bimodal deep learning network based on CNN for fine motor imagery

Motor imagery (MI) is an important brain-computer interface (BCI) paradigm. The traditional MI paradigm (imagining different limbs) limits the intuitive control of the outer devices, while fine MI paradigm (imagining different joint movements from the same limb) can control the mechanical arm without cognitive disconnection. However, the decoding performance of fine MI limits its application. Electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) are widely used in BCI systems because of their portability and easy operation. In this study, a fine MI paradigm including four classes (hand, wrist, shoulder and rest) was designed, and the data of EEG-fNIRS bimodal brain activity was collected from 12 subjects. Event-related desynchronization (ERD) from EEG signals shows a contralateral dominant phenomenon, and there is difference between the ERD of the four classes. For fNIRS signal in the time dimension, the time periods with significant difference can be observed in the activation patterns of four MI tasks. Spatially, the signal peak based brain topographic map also shows difference of these four MI tasks. The EEG signal and fNIRS signal of these four classes are distinguishable. In this study, a bimodal fusion network is proposed to improve the fine MI tasks decoding performance. The features of these two modalities are extracted separately by two feature extractors based on convolutional neural networks (CNN). The recognition performance was significantly improved by the bimodal method proposed in this study, compared with the performance of the single-modal network. The proposed method outperformed all comparison methods, and achieved a four-class accuracy of 58.96%. This paper demonstrates the feasibility of EEG and fNIRS bimodal BCI systems for fine MI, and shows the effectiveness of the proposed bimodal fusion method. This research is supposed to support fine MI-based BCI systems with theories and techniques.

Human-robot interaction in motor imagery: A system based on the STFCN for unilateral upper limb rehabilitation assistance

BACKGROUND

Rehabilitation training based on the brain-computer interface of motor imagery (MI-BCI) can help restore the connection between the brain and movement. However, the performance of most popular MI-BCI system is coarse-level, which means that they are good at guiding the rehabilitation exercises of different parts of the body, but not for the individual component.

NEW METHODS

In this paper, we designed a fine-level MI-BCI system for unilateral upper limb rehabilitation assistance. Besides, due to the low discrimination of different sample classes in a single part, a classification algorithm called spatial-temporal filtering convolutional network (STFCN) was proposed that used spatial filtering and deep learning.

COMPARISON WITH EXISTING METHODS

Our STFCN outperforms popular methods in recent years using BCI IV 2a and 2b data sets.

RESULTS

To verify the effectiveness of our system, we recruited 6 volunteers and collected their data for a four-classification online experiments, resulting in an average accuracy of 62.7 %.

CONCLUSION

This fine-level MI-BCI system has good appli-cation prospects, and inspires more exploration of rehabilitation in a single part of the human body.

EEG-based sensorimotor neurofeedback for motor neurorehabilitation in children and adults: A scoping review

OBJECTIVE

Therapeutic interventions for children and young people with dystonia and dystonic/dyskinetic cerebral palsy are limited. EEG-based neurofeedback is emerging as a neurorehabilitation tool. This scoping review maps research investigating EEG-based sensorimotor neurofeedback in adults and children with neurological motor impairments, including augmentative strategies.

METHODS

MEDLINE, CINAHL and Web of Science databases were searched up to 2023 for relevant studies. Study selection and data extraction were conducted independently by at least two reviewers.

RESULTS

Of 4380 identified studies, 133 were included, only three enrolling children. The most common diagnosis was adult-onset stroke (77%). Paradigms mostly involved upper limb motor imagery or motor attempt. Common neurofeedback modes included visual, haptic and/or electrical stimulation. EEG parameters varied widely and were often incompletely described. Two studies applied augmentative strategies. Outcome measures varied widely and included classification accuracy of the Brain-Computer Interface, degree of enhancement of mu rhythm modulation or other neurophysiological parameters, and clinical/motor outcome scores. Few studies investigated whether functional outcomes related specifically to the EEG-based neurofeedback.

CONCLUSIONS

There is limited evidence exploring EEG-based sensorimotor neurofeedback in individuals with movement disorders, especially in children. Further clarity of neurophysiological parameters is required to develop optimal paradigms for evaluating sensorimotor neurofeedback.

SIGNIFICANCE

The expanding field of sensorimotor neurofeedback offers exciting potential as a non-invasive therapy. However, this needs to be balanced by robust study design and detailed methodological reporting to ensure reproducibility and validation that clinical improvements relate to induced neurophysiological changes.

Brain-computer interface on wrist training with or without neurofeedback in subacute stroke: a study protocol for a double-blinded, randomized control pilot trial

Background

After a stroke, damage to the part of the brain that controls movement results in the loss of motor function. Brain-computer interface (BCI)-based stroke rehabilitation involves patients imagining movement without physically moving while the system measures the perceptual-motor rhythm in the motor cortex. Visual feedback through virtual reality and functional electrical stimulation is provided simultaneously. The superiority of real BCI over sham BCI in the subacute phase of stroke remains unclear. Therefore, we aim to compare the effects of real and sham BCI on motor function and brain activity among patients with subacute stroke with weak wrist extensor strength.

Methods

This is a double-blinded randomized controlled trial. Patients with stroke will be categorized into real BCI and sham BCI groups. The BCI task involves wrist extension for 60 min/day, 5 times/week for 4 weeks. Twenty sessions will be conducted. The evaluation will be conducted four times, as follows: before the intervention, 2 weeks after the start of the intervention, immediately after the intervention, and 4 weeks after the intervention. The assessments include a clinical evaluation, electroencephalography, and electromyography using motor-evoked potentials.

Discussion

Patients will be categorized into two groups, as follows: those who will be receiving neurofeedback and those who will not receive this feedback during the BCI rehabilitation training. We will examine the importance of motor imaging feedback, and the effect of patients' continuous participation in the training rather than their being passive.Clinical Trial Registration: KCT0008589.

EEG Motor Imagery Classification: Tangent Space with Gate-Generated Weight Classifier

Individuals grappling with severe central nervous system injuries often face significant challenges related to sensorimotor function and communication abilities. In response, brain-computer interface (BCI) technology has emerged as a promising solution by offering innovative interaction methods and intelligent rehabilitation training. By leveraging electroencephalographic (EEG) signals, BCIs unlock intriguing possibilities in patient care and neurological rehabilitation. Recent research has utilized covariance matrices as signal descriptors. In this study, we introduce two methodologies for covariance matrix analysis: multiple tangent space projections (M-TSPs) and Cholesky decomposition. Both approaches incorporate a classifier that integrates linear and nonlinear features, resulting in a significant enhancement in classification accuracy, as evidenced by meticulous experimental evaluations. The M-TSP method demonstrates superior performance with an average accuracy improvement of 6.79% over Cholesky decomposition. Additionally, a gender-based analysis reveals a preference for men in the obtained results, with an average improvement of 9.16% over women. These findings underscore the potential of our methodologies to improve BCI performance and highlight gender-specific performance differences to be examined further in our future studies.

Development and evaluation of a BCI-neurofeedback system with real-time EEG detection and electrical stimulation assistance during motor attempt for neurorehabilitation of children with cerebral palsy

In the realm of motor rehabilitation, Brain-Computer Interface Neurofeedback Training (BCI-NFT) emerges as a promising strategy. This aims to utilize an individual's brain activity to stimulate or assist movement, thereby strengthening sensorimotor pathways and promoting motor recovery. Employing various methodologies, BCI-NFT has been shown to be effective for enhancing motor function primarily of the upper limb in stroke, with very few studies reported in cerebral palsy (CP). Our main objective was to develop an electroencephalography (EEG)-based BCI-NFT system, employing an associative learning paradigm, to improve selective control of ankle dorsiflexion in CP and potentially other neurological populations. First, in a cohort of eight healthy volunteers, we successfully implemented a BCI-NFT system based on detection of slow movement-related cortical potentials (MRCP) from EEG generated by attempted dorsiflexion to simultaneously activate Neuromuscular Electrical Stimulation which assisted movement and served to enhance sensory feedback to the sensorimotor cortex. Participants also viewed a computer display that provided real-time visual feedback of ankle range of motion with an individualized target region displayed to encourage maximal effort. After evaluating several potential strategies, we employed a Long short-term memory (LSTM) neural network, a deep learning algorithm, to detect the motor intent prior to movement onset. We then evaluated the system in a 10-session ankle dorsiflexion training protocol on a child with CP. By employing transfer learning across sessions, we could significantly reduce the number of calibration trials from 50 to 20 without compromising detection accuracy, which was 80.8% on average. The participant was able to complete the required calibration trials and the 100 training trials per session for all 10 sessions and post-training demonstrated increased ankle dorsiflexion velocity, walking speed and step length. Based on exceptional system performance, feasibility and preliminary effectiveness in a child with CP, we are now pursuing a clinical trial in a larger cohort of children with CP.

The evolution of neuromodulation for chronic stroke: From neuroplasticity mechanisms to brain-computer interfaces

Stroke is one of the most common and debilitating neurological conditions worldwide. Those who survive experience motor, sensory, speech, vision, and/or cognitive deficits that severely limit remaining quality of life. While rehabilitation programs can help improve patients' symptoms, recovery is often limited, and patients frequently continue to experience impairments in functional status. In this review, invasive neuromodulation techniques to augment the effects of conventional rehabilitation methods are described, including vagus nerve stimulation (VNS), deep brain stimulation (DBS) and brain-computer interfaces (BCIs). In addition, the evidence base for each of these techniques, pivotal trials, and future directions are explored. Finally, emerging technologies such as functional near-infrared spectroscopy (fNIRS) and the shift to artificial intelligence-enabled implants and wearables are examined. While the field of implantable devices for chronic stroke recovery is still in a nascent stage, the data reviewed are suggestive of immense potential for reducing the impact and impairment from this globally prevalent disorder.

Upper extremity training followed by lower extremity training with a brain-computer interface rehabilitation system

Introduction

Brain-computer interfaces (BCIs) based on functional electrical stimulation have been used for upper extremity motor rehabilitation after stroke. However, little is known about their efficacy for multiple BCI treatments. In this study, 19 stroke patients participated in 25 upper extremity followed by 25 lower extremity BCI training sessions.

Methods

Patients' functional state was assessed using two sets of clinical scales for the two BCI treatments. The Upper Extremity Fugl-Meyer Assessment (FMA-UE) and the 10-Meter Walk Test (10MWT) were the primary outcome measures for the upper and lower extremity BCI treatments, respectively.

Results

Patients' motor function as assessed by the FMA-UE improved by an average of 4.2 points (p < 0.001) following upper extremity BCI treatment. In addition, improvements in activities of daily living and clinically relevant improvements in hand and finger spasticity were observed. Patients showed further improvements after the lower extremity BCI treatment, with walking speed as measured by the 10MWT increasing by 0.15 m/s (p = 0.001), reflecting a substantial meaningful change. Furthermore, a clinically relevant improvement in ankle spasticity and balance and mobility were observed.

Discussion

The results of the current study provide evidence that both upper and lower extremity BCI treatments, as well as their combination, are effective in facilitating functional improvements after stroke. In addition, and most importantly improvements did not stop after the first 25 upper extremity BCI sessions.

A Few-Shot Transfer Learning Approach for Motion Intention Decoding from Electroencephalographic Signals

In this study, a few-shot transfer learning approach was introduced to decode movement intention from electroencephalographic (EEG) signals, allowing to recognize new tasks with minimal adaptation. To this end, a dataset of EEG signals recorded during the preparation of complex sub-movements was created from a publicly available data collection. The dataset was divided into two parts: the source domain dataset (including 5 classes) and the support (target domain) dataset, (including 2 classes) with no overlap between the two datasets in terms of classes. The proposed methodology consists in projecting EEG signals into the space-frequency-time domain, in processing such projections (rearranged in channels × frequency frames) by means of a custom EEG-based deep neural network (denoted as EEGframeNET5), and then adapting the system to recognize new tasks through a few-shot transfer learning approach. The proposed method achieved an average accuracy of 72.45 ± 4.19% in the 5-way classification of samples from the source domain dataset, outperforming comparable studies in the literature. In the second phase of the study, a few-shot transfer learning approach was proposed to adapt the neural system and make it able to recognize new tasks in the support dataset. The results demonstrated the system's ability to adapt and recognize new tasks with an average accuracy of 80 ± 0.12% in discriminating hand opening/closing preparation and outperforming reported results in the literature. This study suggests the effectiveness of EEG in capturing information related to the motor preparation of complex movements, potentially paving the way for BCI systems based on motion planning decoding. The proposed methodology could be straightforwardly extended to advanced EEG signal processing in other scenarios, such as motor imagery or neural disorder classification.

Transferring a deep learning model from healthy subjects to stroke patients in a motor imagery brain-computer interface

Objective.Motor imagery (MI) brain-computer interfaces (BCIs) based on electroencephalogram (EEG) have been developed primarily for stroke rehabilitation, however, due to limited stroke data, current deep learning methods for cross-subject classification rely on healthy data. This study aims to assess the feasibility of applying MI-BCI models pre-trained using data from healthy individuals to detect MI in stroke patients.Approach.We introduce a new transfer learning approach where features from two-class MI data of healthy individuals are used to detect MI in stroke patients. We compare the results of the proposed method with those obtained from analyses within stroke data. Experiments were conducted using Deep ConvNet and state-of-the-art subject-specific machine learning MI classifiers, evaluated on OpenBMI two-class MI-EEG data from healthy subjects and two-class MI versus rest data from stroke patients.Main results.Results of our study indicate that through domain adaptation of a model pre-trained using healthy subjects' data, an average MI detection accuracy of 71.15% (±12.46%) can be achieved across 71 stroke patients. We demonstrate that the accuracy of the pre-trained model increased by 18.15% after transfer learning (p<0.001). Additionally, the proposed transfer learning method outperforms the subject-specific results achieved by Deep ConvNet and FBCSP, with significant enhancements of 7.64% (p<0.001) and 5.55% (p<0.001) in performance, respectively. Notably, the healthy-to-stroke transfer learning approach achieved similar performance to stroke-to-stroke transfer learning, with no significant difference (p>0.05). Explainable AI analyses using transfer models determined channel relevance patterns that indicate contributions from the bilateral motor, frontal, and parietal regions of the cortex towards MI detection in stroke patients.Significance.Transfer learning from healthy to stroke can enhance the clinical use of BCI algorithms by overcoming the challenge of insufficient clinical data for optimal training.

Brain-computer interface treatment for gait rehabilitation in stroke patients

The use of Brain-Computer Interfaces (BCI) as rehabilitation tools for chronically ill neurological patients has become more widespread. BCIs combined with other techniques allow the user to restore neurological function by inducing neuroplasticity through real-time detection of motor-imagery (MI) as patients perform therapy tasks. Twenty-five stroke patients with gait disability were recruited for this study. Participants performed 25 sessions with the MI-BCI and assessment visits to track functional changes during the therapy. The results of this study demonstrated a clinically significant increase in walking speed of 0.19 m/s, 95%CI [0.13-0.25], p < 0.001. Patients also reduced spasticity and improved their range of motion and muscle contraction. The BCI treatment was effective in promoting long-lasting functional improvements in the gait speed of chronic stroke survivors. Patients have more movements in the lower limb; therefore, they can walk better and safer. This functional improvement can be explained by improved neuroplasticity in the central nervous system.

Scoping Review on Brain-Computer Interface-Controlled Electrical Stimulation Interventions for Upper Limb Rehabilitation in Adults: A Look at Participants, Interventions, and Technology

Purpose

While current rehabilitation practice for improving arm and hand function relies on physical/occupational therapy, a growing body of research evaluates the effects of technology-enhanced rehabilitation. We review interventions that combine a brain-computer interface (BCI) with electrical stimulation (ES) for upper limb movement rehabilitation to summarize the evidence on (1) populations of study participants, (2) BCI-ES interventions, and (3) the BCI-ES systems.

Method

After searching seven databases, two reviewers identified 23 eligible studies. We consolidated information on the study participants, interventions, and approaches used to develop integrated BCI-ES systems. The included studies investigated the use of BCI-ES interventions with stroke and spinal cord injury (SCI) populations. All studies used electroencephalography to collect brain signals for the BCI, and functional electrical stimulation was the most common type of ES. The BCI-ES interventions were typically conducted without a therapist, with sessions varying in both frequency and duration.

Results

Of the 23 eligible studies, only 3 studies involved the SCI population, compared to 20 involving individuals with stroke.

Conclusions

Future BCI-ES interventional studies could address this gap. Additionally, standardization of device and rehabilitation modalities, and study-appropriate involvement with therapists, can be considered to advance this intervention towards clinical implementation.

A comprehensive review on motion trajectory reconstruction for EEG-based brain-computer interface

The advance in neuroscience and computer technology over the past decades have made brain-computer interface (BCI) a most promising area of neurorehabilitation and neurophysiology research. Limb motion decoding has gradually become a hot topic in the field of BCI. Decoding neural activity related to limb movement trajectory is considered to be of great help to the development of assistive and rehabilitation strategies for motor-impaired users. Although a variety of decoding methods have been proposed for limb trajectory reconstruction, there does not yet exist a review that covers the performance evaluation of these decoding methods. To alleviate this vacancy, in this paper, we evaluate EEG-based limb trajectory decoding methods regarding their advantages and disadvantages from a variety of perspectives. Specifically, we first introduce the differences in motor execution and motor imagery in limb trajectory reconstruction with different spaces (2D and 3D). Then, we discuss the limb motion trajectory reconstruction methods including experiment paradigm, EEG pre-processing, feature extraction and selection, decoding methods, and result evaluation. Finally, we expound on the open problem and future outlooks.

BCI-activated electrical stimulation in children with perinatal stroke and hemiparesis: A pilot study

Background

Perinatal stroke (PS) causes most hemiparetic cerebral palsy (CP) and results in lifelong disability. Children with severe hemiparesis have limited rehabilitation options. Brain computer interface- activated functional electrical stimulation (BCI-FES) of target muscles may enhance upper extremity function in hemiparetic adults. We conducted a pilot clinical trial to assess the safety and feasibility of BCI-FES in children with hemiparetic CP.

Methods

Thirteen participants (mean age = 12.2 years, 31% female) were recruited from a population-based cohort. Inclusion criteria were: (1) MRI-confirmed PS, (2) disabling hemiparetic CP, (3) age 6–18 years, (4) informed consent/assent. Those with neurological comorbidities or unstable epilepsy were excluded. Participants attended two BCI sessions: training and rehabilitation. They wore an EEG-BCI headset and two forearm extensor stimulation electrodes. Participants’ imagination of wrist extension was classified on EEG, after which muscle stimulation and visual feedback were provided when the correct visualization was detected.

Results

No serious adverse events or dropouts occurred. The most common complaints were mild headache, headset discomfort and muscle fatigue. Children ranked the experience as comparable to a long car ride and none reported as unpleasant. Sessions lasted a mean of 87 min with 33 min of stimulation delivered. Mean classification accuracies were (M = 78.78%, SD = 9.97) for training and (M = 73.48, SD = 12.41) for rehabilitation. Mean Cohen’s Kappa across rehabilitation trials was M = 0.43, SD = 0.29, range = 0.019–1.00, suggesting BCI competency.

Conclusion

Brain computer interface-FES was well -tolerated and feasible in children with hemiparesis. This paves the way for clinical trials to optimize approaches and test efficacy.

A study of action difference on motor imagery based on delayed matching posture task

Objective. Motor imagery (MI)-based brain-computer interfaces (BCIs) provide an additional control pathway for people by decoding the intention of action imagination. The way people imagine greatly affects MI-BCI performance. Action itself is one of the factors that influence the way people imagine. Whether the different actions cause a difference in the MI performance is unknown. What is more important is how to manifest this action difference in the process of imagery, which has the potential to guide people to use their individualized actions to imagine more effectively.Approach.To explore action differences, this study proposes a novel paradigm named as action observation based delayed matching posture task. Ten subjects are required to observe, memorize, match, and imagine three types of actions (cutting, grasping and writing) given by visual images or videos, to accomplish the phases of encoding, retrieval and reinforcement of MI. Event-related potential (ERP), MI features, and classification accuracy of the left or the right hand are used to evaluate the effect of the action difference on the MI difference.Main results.Action differences cause different feature distributions, resulting in that the accuracy with high event-related (de)synchronization (ERD/ERS) is 27.75% higher than the ones with low ERD/ERS (p< 0.05), which indicates that the action difference has impact on the MI difference and the BCI performance. In addition, significant differences in the ERP amplitudes exists among the three actions: the amplitude of P300-N200 potential reaches 9.28μV of grasping, 5.64μV and 5.25μV higher than the cutting and the writing, respectively (p< 0.05).Significance.The ERP amplitudes derived from the supplementary motor area shows positive correlation to the MI classification accuracy, implying that the ERP might be an index of the MI performance when the people is faced with action selection. This study demonstrates that the MI difference is related to the action difference, and can be manifested by the ERP, which is important for improving MI training by selecting suitable action; the relationship between the ERP and the MI provides a novel index to find the suitable action to set up an individualized BCI and improve the performance further.

A Review of Online Classification Performance in Motor Imagery-Based Brain–Computer Interfaces for Stroke Neurorehabilitation

Motor imagery (MI)-based brain–computer interfaces (BCI) have shown increased potential for the rehabilitation of stroke patients; nonetheless, their implementation in clinical practice has been restricted due to their low accuracy performance. To date, although a lot of research has been carried out in benchmarking and highlighting the most valuable classification algorithms in BCI configurations, most of them use offline data and are not from real BCI performance during the closed-loop (or online) sessions. Since rehabilitation training relies on the availability of an accurate feedback system, we surveyed articles of current and past EEG-based BCI frameworks who report the online classification of the movement of two upper limbs in both healthy volunteers and stroke patients. We found that the recently developed deep-learning methods do not outperform the traditional machine-learning algorithms. In addition, patients and healthy subjects exhibit similar classification accuracy in current BCI configurations. Lastly, in terms of neurofeedback modality, functional electrical stimulation (FES) yielded the best performance compared to non-FES systems.

Decoding EEG rhythms offline and online during motor imagery for standing and sitting based on a brain-computer interface

Motor imagery (MI)-based brain-computer interface (BCI) systems have shown promising advances for lower limb motor rehabilitation. The purpose of this study was to develop an MI-based BCI for the actions of standing and sitting. Thirty-two healthy subjects participated in the study using 17 active EEG electrodes. We used a combination of the filter bank common spatial pattern (FBCSP) method and the regularized linear discriminant analysis (RLDA) technique for decoding EEG rhythms offline and online during motor imagery for standing and sitting. The offline analysis indicated the classification of motor imagery and idle state provided a mean accuracy of 88.51 ± 1.43% and 85.29 ± 1.83% for the sit-to-stand and stand-to-sit transitions, respectively. The mean accuracies of the sit-to-stand and stand-to-sit online experiments were 94.69 ± 1.29% and 96.56 ± 0.83%, respectively. From these results, we believe that the MI-based BCI may be useful to future brain-controlled standing systems.

Machine Learning for Motor Imagery Wrist Dorsiflexion Prediction in Brain-Computer Interface Assisted Stroke Rehabilitation

Stroke is a life-changing event that can affect the survivors' physical, cognitive and emotional state. Stroke care focuses on helping the survivors to regain their strength; recover as much functionality as possible and return to independent living through rehabilitation therapies. Automated training protocols have been reported to improve the efficiency of the rehabilitation process. These protocols also decrease the dependency of the process on a professional trainer. Brain-Computer Interface (BCI) based systems are examples of such systems where they make use of the motor imagery (MI) based electroencephalogram (EEG) signals to drive the rehabilitation protocols. In this paper, we have proposed the use of well-known machine learning (ML) algorithms, such as, the decision tree (DT), Naive Bayesian (NB), linear discriminant analysis (LDA), support vector machine (SVM), ensemble learning classifier (ELC), and artificial neural network (ANN) for MI wrist dorsiflexion prediction in a BCI assisted stroke rehabilitation study conducted on eleven stroke survivors with either the left or right paresis. The doubling sub-band selection filter bank common spatial pattern (DSBS-FBCSP) has been proposed as feature extractor and it is observed that the ANN based classifier produces the best results.

Optimizing Motor Imagery Parameters for Robotic Arm Control by Brain-Computer Interface

Brain-Computer Interface (BCI) technology has been shown to provide new communication possibilities, conveying brain information externally. BCI-based robot control has started to play an important role, especially in medically assistive robots but not only there. For example, a BCI-controlled robotic arm can provide patients diagnosed with neurodegenerative diseases such as Locked-in syndrome (LIS), Amyotrophic lateral sclerosis (ALS), and others with the ability to manipulate different objects. This study presents the optimization of the configuration parameters of a three-class Motor Imagery (MI) -based BCI for controlling a six Degrees of Freedom (DOF) robotic arm in a plane. Electroencephalography (EEG) signals are recorded from 64 positions on the scalp according to the International 10-10 System. In terms of the resulting classification of error rates, we investigated twelve time windows for the spatial filter and classifier calculation and three time windows for the variance smoothing time. The lowest error rates were achieved when using a 3 s time window for creating the spatial filters and classifier, for a variance time window of 1.5 s.

Neuromechanical Biomarkers for Robotic Neurorehabilitation

One of the current challenges for translational rehabilitation research is to develop the strategies to deliver accurate evaluation, prediction, patient selection, and decision-making in the clinical practice. In this regard, the robot-assisted interventions have gained popularity as they can provide the objective and quantifiable assessment of the motor performance by taking the kinematics parameters into the account. Neurophysiological parameters have also been proposed for this purpose due to the novel advances in the non-invasive signal processing techniques. In addition, other parameters linked to the motor learning and brain plasticity occurring during the rehabilitation have been explored, looking for a more holistic rehabilitation approach. However, the majority of the research done in this area is still exploratory. These parameters have shown the capability to become the “biomarkers” that are defined as the quantifiable indicators of the physiological/pathological processes and the responses to the therapeutical interventions. In this view, they could be finally used for enhancing the robot-assisted treatments. While the research on the biomarkers has been growing in the last years, there is a current need for a better comprehension and quantification of the neuromechanical processes involved in the rehabilitation. In particular, there is a lack of operationalization of the potential neuromechanical biomarkers into the clinical algorithms. In this scenario, a new framework called the “Rehabilomics” has been proposed to account for the rehabilitation research that exploits the biomarkers in its design. This study provides an overview of the state-of-the-art of the biomarkers related to the robotic neurorehabilitation, focusing on the translational studies, and underlying the need to create the comprehensive approaches that have the potential to take the research on the biomarkers into the clinical practice. We then summarize some promising biomarkers that are being under investigation in the current literature and provide some examples of their current and/or potential applications in the neurorehabilitation. Finally, we outline the main challenges and future directions in the field, briefly discussing their potential evolution and prospective.

Binary Semantic Classification Using Cortical Activation with Pavlovian-Conditioned Vestibular Responses in Healthy and Locked-In Individuals

To develop a more reliable brain–computer interface (BCI) for patients in the completely locked-in state (CLIS), here we propose a Pavlovian conditioning paradigm using galvanic vestibular stimulation (GVS), which can induce a strong sensation of equilibrium distortion in individuals. We hypothesized that associating two different sensations caused by two-directional GVS with the thoughts of “yes” and “no” by individuals would enable us to emphasize the differences in brain activity associated with the thoughts of yes and no and hence help us better distinguish the two from electroencephalography (EEG). We tested this hypothesis with 11 healthy and 1 CLIS participant. Our results showed that, first, conditioning of GVS with the thoughts of yes and no is possible. And second, the classification of whether an individual is thinking “yes” or “no” is significantly improved after the conditioning, even in the absence of subsequent GVS stimulations. We observed average classification accuracy of 73.0% over 11 healthy individuals and 85.3% with the CLIS patient. These results suggest the establishment of GVS-based Pavlovian conditioning and its usability as a noninvasive BCI.

Decoding Finger Tapping With the Affected Hand in Chronic Stroke Patients During Motor Imagery and Execution

In stroke rehabilitation, motor imagery based on a brain-computer interface is an extremely useful method to control an external device and utilize neurofeedback. Many studies have reported on the classification performance of motor imagery to decode individual fingers in stroke patients compared with healthy controls. However, classification performance for a given limb is still low because the differences between patients owing to brain reorganization after stroke are not considered. We used electroencephalography signals from eleven healthy controls and eleven stroke patients in this study. The subjects performed a finger tapping task during motor execution, and motor imagery was performed with the dominant and affected hands in the healthy controls and stroke patients, respectively. All fingers except for the thumb were classified using the proposed framework based on a voting module. The averaged four-class accuracies during motor execution and motor imagery were 53.16 ± 8.42% and 46.94 ± 5.99% for the healthy controls and 53.17 ± 14.09% and 66.00 ± 14.96% for the stroke patients, respectively. Importantly, the classification accuracies in the stroke patients were statistically higher than those in healthy controls during motor imagery. However, there was no significant difference between the accuracies of motor execution and motor imagery. These findings show the potential for high classification performance for a given limb during motor imagery in stroke patients. These results can also provide insights into controlling an external device on the basis of a brain-computer interface.

Brain-Computer Interface Coupled to a Robotic Hand Orthosis for Stroke Patients' Neurorehabilitation: A Crossover Feasibility Study

Brain-Computer Interfaces (BCI) coupled to robotic assistive devices have shown promise for the rehabilitation of stroke patients. However, little has been reported that compares the clinical and physiological effects of a BCI intervention for upper limb stroke rehabilitation with those of conventional therapy. This study assesses the feasibility of an intervention with a BCI based on electroencephalography (EEG) coupled to a robotic hand orthosis for upper limb stroke rehabilitation and compares its outcomes to conventional therapy. Seven subacute and three chronic stroke patients (M = 59.9 ± 12.8) with severe upper limb impairment were recruited in a crossover feasibility study to receive 1 month of BCI therapy and 1 month of conventional therapy in random order. The outcome measures were comprised of: Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), motor evoked potentials elicited by transcranial magnetic stimulation (TMS), hand dynamometry, and EEG. Additionally, BCI performance and user experience were measured. All measurements were acquired before and after each intervention. FMA-UE and ARAT after BCI (23.1 ± 16; 8.4 ± 10) and after conventional therapy (21.9 ± 15; 8.7 ± 11) were significantly higher (p < 0.017) compared to baseline (17.5 ± 15; 4.3 ± 6) but were similar between therapies (p > 0.017). Via TMS, corticospinal tract integrity could be assessed in the affected hemisphere of three patients at baseline, in five after BCI, and four after conventional therapy. While no significant difference (p > 0.05) was found in patients’ affected hand strength, it was higher after the BCI therapy. EEG cortical activations were significantly higher over motor and non-motor regions after both therapies (p < 0.017). System performance increased across BCI sessions, from 54 (50, 70%) to 72% (56, 83%). Patients reported moderate mental workloads and excellent usability with the BCI. Outcome measurements implied that a BCI intervention using a robotic hand orthosis as feedback has the potential to elicit neuroplasticity-related mechanisms, similar to those observed during conventional therapy, even in a group of severely impaired stroke patients. Therefore, the proposed BCI system could be a suitable therapy option and will be further assessed in clinical trials.

Reconstruction of hand, elbow and shoulder actual and imagined trajectories in 3D space using EEG current source dipoles

OBJECTIVE

Growing evidence suggests that EEG electrode (sensor) potential time series (PTS) of slow cortical potentials (SCPs) hold motor neural correlates that can be used for motion trajectory prediction (MTP), commonly by multiple linear regression (mLR). It is not yet known whether arm-joint trajectories can be reliably decoded from current sources, computed from sensor data, from which brain areas they can be decoded and using which neural features.

APPROACH

In this study, the PTS of 44 sensors were fed into sLORETA source localization software to compute current source activity in 30 regions of interest (ROIs) found in a recent meta-analysis to be engaged in action execution, motor imagery and motor preparation. The current sources PTS and band-power time series (BTS) in several frequency bands and time lags were used to predict actual and imagined trajectories in 3D space of the three velocity components of the hand, elbow and shoulder of nine subjects using an mLR model.

MAIN RESULTS

For all arm joints and movement types, current source SCPs PTS contributed most to trajectory reconstruction with time lags 150ms, 116ms and 84ms providing the highest contribution, and current source BTS in any of the tested frequency bands was not informative. Person's correlation coefficient (r) averaged across movement types, arm joints and velocity components using source data was slightly lower than using sensor data (r=0.25 and r=0.28, respectively). For each ROI, the three current source dipoles had different contribution to the reconstruction of each of the three velocity components.

SIGNIFICANCE

Overall, our results demonstrate the feasibility of predicting of actual and imagined 3D trajectories of all arm joints from current sources, computed from scalp EEG. These findings may be used by developers of a future BCI as a validated set of contributing ROIs.

EEG Biomarkers Related With the Functional State of Stroke Patients

Introduction

Recent studies explored promising new quantitative methods to analyze electroencephalography (EEG) signals. This paper analyzes the correlation of two EEG parameters, Brain Symmetry Index (BSI) and Laterality Coefficient (LC), with established functional scales for the stroke assessment.

Methods

Thirty-two healthy subjects and thirty-six stroke patients with upper extremity hemiparesis were recruited for this study. The stroke patients where subdivided in three groups according to the stroke location: Cortical, Subcortical, and Cortical + Subcortical. The participants performed assessment visits to record the EEG in the resting state and perform functional tests using rehabilitation scales. Then, stroke patients performed 25 sessions using a motor-imagery based Brain Computer Interface system (BCI). BSI was calculated with the EEG data in resting state and LC was calculated with the Event-Related Synchronization maps.

Results

The results of this study demonstrated significant differences in the BSI between the healthy group and Subcortical group (P = 0.001), and also between the healthy and Cortical+Subcortical group (P = 0.019). No significant differences were found between the healthy group and the Cortical group (P = 0.505). Furthermore, the BSI analysis in the healthy group based on gender showed statistical differences (P = 0.027). In the stroke group, the correlation between the BSI and the functional state of the upper extremity assessed by Fugl-Meyer Assessment (FMA) was also significant, ρ = −0.430 and P = 0.046. The correlation between the BSI and the FMA-Lower extremity was not significant (ρ = −0.063, P = 0.852). Similarly, the LC calculated in the alpha band has significative correlation with FMA of upper extremity (ρ = −0.623 and P < 0.001) and FMA of lower extremity (ρ = −0.509 and P = 0.026). Other important significant correlations between LC and functional scales were observed. In addition, the patients showed an improvement in the FMA-upper extremity after the BCI therapy (ΔFMA = 1 median [IQR: 0–8], P = 0.002).

Conclusion

The quantitative EEG tools used here may help support our understanding of stroke and how the brain changes during rehabilitation therapy. These tools can help identify changes in EEG biomarkers and parameters during therapy that might lead to improved therapy methods and functional prognoses.