Biosignal-Based Human-Machine Interfaces for Assistance and Rehabilitation: A Survey

Information Transmission through Biotic-Abiotic Interfaces to Restore or Enhance Human Function

Advancements in reliable information transfer across biotic-abiotic interfaces have enabled the restoration of lost human function. For example, communication between neuronal cells and electrical devices restores the ability to walk to a tetraplegic patient and vision to patients blinded by retinal disease. These impactful medical achievements are aided by tailored biotic-abiotic interfaces that maximize information transfer fidelity by considering the physical properties of the underlying biological and synthetic components. This Review develops a modular framework to define and describe the engineering of biotic and abiotic components as well as the design of interfaces to facilitate biotic-abiotic information transfer using light or electricity. Delineating the properties of the biotic, interface, and abiotic components that enable communication can serve as a guide for future research in this highly interdisciplinary field. Application of synthetic biology to engineer light-sensitive proteins has facilitated the control of neural signaling and the restoration of rudimentary vision after retinal blindness. Electrophysiological methodologies that use brain-computer interfaces and stimulating implants to bypass spinal column injuries have led to the rehabilitation of limb movement and walking ability. Cellular interfacing methodologies and on-chip learning capability have been made possible by organic transistors that mimic the information processing capacity of neurons. The collaboration of molecular biologists, material scientists, and electrical engineers in the emerging field of biotic-abiotic interfacing will lead to the development of prosthetics capable of responding to thought and experiencing touch sensation via direct integration into the human nervous system. Further interdisciplinary research will improve electrical and optical interfacing technologies for the restoration of vision, offering greater visual acuity and potentially color vision in the near future.

EEG and EMG-based human-machine interface for navigation of mobility-related assistive wheelchair (MRA-W)

The control of human-machine interfaces (HMIs), such as motorized wheelchairs, has been widely investigated using biopotentials produced by electrochemical processes in the human body. However, many studies in this field sometimes overlook crucial factors like special users' needs, who often have inadequate muscle mass and strength, and paresis needed to operate a wheelchair. This study proposes a novel solution: an economical, universally compatible, and user-centric manual-to-powered wheelchair conversion kit. The powered wheelchair is operated using a hybrid control system integrating electroencephalogram (EEG) and electromyography (EMG), utilizing an LSTM network. It uses a low-cost electroencephalogram (EEG) headset and a wearable electromyography (EMG) electrode armband to solve these constraints. The proposed system comprised three crucial objectives: the development of an EEG-based user attentive detection system, an EMG-based navigation system, and a transform conventional wheelchair into a powered wheelchair. Human test subjects were utilized to evaluate the proposed system, and the study complied with accepted ethical guidelines. We selected four EEG features (p < 0.023) for the attentive detection system and six EMG features (p < 0.037) to detect navigation intentions. User attentive detection was achieved at 83.33 (±0.34) %, while the navigation intention system produced 86.67 (±0.52) % accuracy. The overall system was successful in reaching an accuracy rate of 85.0 (±0.19) % and a weighted average precision of 0.89. After the dataset was trained using an LSTM network, the overall accuracy produced was 97.3 (±0.5) %, higher than the accuracy produced by the Quadratic SVM classifier. By giving older and disabled people a more convenient way to use powered wheelchairs, this research helps to build ergonomic and cost-effective biopotential-based HMIs, enhancing their quality of life.

A scoping review of gaze and eye tracking-based control methods for assistive robotic arms

Background: Assistive Robotic Arms are designed to assist physically disabled people with daily activities. Existing joysticks and head controls are not applicable for severely disabled people such as people with Locked-in Syndrome. Therefore, eye tracking control is part of ongoing research. The related literature spans many disciplines, creating a heterogeneous field that makes it difficult to gain an overview. Objectives: This work focuses on ARAs that are controlled by gaze and eye movements. By answering the research questions, this paper provides details on the design of the systems, a comparison of input modalities, methods for measuring the performance of these controls, and an outlook on research areas that gained interest in recent years. Methods: This review was conducted as outlined in the PRISMA 2020 Statement. After identifying a wide range of approaches in use the authors decided to use the PRISMA-ScR extension for a scoping review to present the results. The identification process was carried out by screening three databases. After the screening process, a snowball search was conducted. Results: 39 articles and 6 reviews were included in this article. Characteristics related to the system and study design were extracted and presented divided into three groups based on the use of eye tracking. Conclusion: This paper aims to provide an overview for researchers new to the field by offering insight into eye tracking based robot controllers. We have identified open questions that need to be answered in order to provide people with severe motor function loss with systems that are highly useable and accessible.

Piezoelectric nanogenerators for self-powered wearable and implantable bioelectronic devices

One of the recent innovations in the field of personalized healthcare is the piezoelectric nanogenerators (PENGs) for various clinical applications, including self-powered sensors, drug delivery, tissue regeneration etc. Such innovations are perceived to potentially address some of the unmet clinical needs, e.g., limited life-span of implantable biomedical devices (e.g., pacemaker) and replacement related complications. To this end, the generation of green energy from biomechanical sources for wearable and implantable bioelectronic devices gained considerable attention in the scientific community. In this perspective, this article provides a comprehensive state-of-the-art review on the recent developments in the processing, applications and associated concerns of piezoelectric materials (synthetic/biological) for personalized healthcare applications. In particular, this review briefly discusses the concepts of piezoelectric energy harvesting, piezoelectric materials (ceramics, polymers, nature-inspired), and the various applications of piezoelectric nanogenerators, such as, self-powered sensors, self-powered pacemakers, deep brain stimulators etc. Important distinction has been made in terms of the potential clinical applications of PENGs, either as wearable or implantable bioelectronic devices. While discussing the potential applications as implantable devices, the biocompatibility of the several hybrid devices using large animal models is summarized. This review closes with the futuristic vision of integrating data science approaches in developmental pipeline of PENGs as well as clinical translation of the next generation PENGs. STATEMENT OF SIGNIFICANCE: Piezoelectric nanogenerators (PENGs) hold great promise for transforming personalized healthcare through self-powered sensors, drug delivery systems, and tissue regeneration. The limited battery life of implantable devices like pacemakers presents a significant challenge, leading to complications from repititive surgeries. To address such a critical issue, researchers are focusing on generating green energy from biomechanical sources to power wearable and implantable bioelectronic devices. This comprehensive review critically examines the latest advancements in synthetic and nature-inspired piezoelectric materials for PENGs in personalized healthcare. Moreover, it discusses the potential of piezoelectric materials and data science approaches to enhance the efficiency and reliability of personalized healthcare devices for clinical applications.

A smart approach to EMG envelope extraction and powerful denoising for human-machine interfaces

Electromyography (EMG) is widely used in human-machine interfaces (HMIs) to measure muscle contraction by computing the EMG envelope. However, EMG is largely affected by powerline interference and motion artifacts. Boards that directly provide EMG envelope, without denoising the raw signal, are often unreliable and hinder HMIs performance. Sophisticated filtering provides high performance but is not viable when power and computational resources must be optimized. This study investigates the application of feed-forward comb (FFC) filters to remove both powerline interferences and motion artifacts from raw EMG. FFC filter and EMG envelope extractor can be implemented without computing any multiplication. This approach is particularly suitable for very low-cost, low-power platforms. The performance of the FFC filter was first demonstrated offline by corrupting clean EMG signals with powerline noise and motion artifacts. The correlation coefficients of the filtered signals envelopes and the true envelopes were greater than 0.98 and 0.94 for EMG corrupted by powerline noise and motion artifacts, respectively. Further tests on real, highly noisy EMG signals confirmed these achievements. Finally, the real-time operation of the proposed approach was successfully tested by implementation on a simple Arduino Uno board.

An optoelectronic muscle contraction sensor for prosthetic hand application

Surface electromyography (sEMG) is considered an established means for controlling prosthetic devices. sEMG suffers from serious issues such as electrical noise, motion artifact, complex acquisition circuitry, and high measuring costs because of which other techniques have gained attention. This work presents a new optoelectronic muscle (OM) sensor setup as an alternative to the EMG sensor for precise measurement of muscle activity. The sensor integrates a near-infrared light-emitting diode and phototransistor pair along with the suitable driver circuitry. The sensor measures skin surface displacement (that occurs during muscle contraction) by detecting backscattered infrared light from skeletal muscle tissue. With an appropriate signal processing scheme, the sensor was able to produce a 0-5 V output proportional to the muscular contraction. The developed sensor depicted decent static and dynamic features. In detecting muscle contractions from the forearm muscles of subjects, the sensor showed good similarity with the EMG sensor. In addition, the sensor displayed higher signal-to-noise ratio values and better signal stability than the EMG sensor. Furthermore, the OM sensor setup was utilized to control the rotation of the servomotor using an appropriate control scheme. Hence, the developed sensing system can measure muscle contraction information for controlling assistive devices.

Changes in Forcecardiography Heartbeat Morphology Induced by Cardio-Respiratory Interactions

The cardiac function is influenced by respiration. In particular, various parameters such as cardiac time intervals and the stroke volume are modulated by respiratory activity. It has long been recognized that cardio-respiratory interactions modify the morphology of cardio-mechanical signals, e.g., phonocardiogram, seismocardiogram (SCG), and ballistocardiogram. Forcecardiography (FCG) records the weak forces induced on the chest wall by the mechanical activity of the heart and lungs and relies on specific force sensors that are capable of monitoring respiration, infrasonic cardiac vibrations, and heart sounds, all simultaneously from a single site on the chest. This study addressed the changes in FCG heartbeat morphology caused by respiration. Two respiratory-modulated parameters were considered, namely the left ventricular ejection time (LVET) and a morphological similarity index (MSi) between heartbeats. The time trends of these parameters were extracted from FCG signals and further analyzed to evaluate their consistency within the respiratory cycle in order to assess their relationship with the breathing activity. The respiratory acts were localized in the time trends of the LVET and MSi and compared with a reference respiratory signal by computing the sensitivity and positive predictive value (PPV). In addition, the agreement between the inter-breath intervals estimated from the LVET and MSi and those estimated from the reference respiratory signal was assessed via linear regression and Bland-Altman analyses. The results of this study clearly showed a tight relationship between the respiratory activity and the considered respiratory-modulated parameters. Both the LVET and MSi exhibited cyclic time trends that remarkably matched the reference respiratory signal. In addition, they achieved a very high sensitivity and PPV (LVET: 94.7% and 95.7%, respectively; MSi: 99.3% and 95.3%, respectively). The linear regression analysis reported almost unit slopes for both the LVET (R² = 0.86) and MSi (R² = 0.97); the Bland-Altman analysis reported a non-significant bias for both the LVET and MSi as well as limits of agreement of ±1.68 s and ±0.771 s, respectively. In summary, the results obtained were substantially in line with previous findings on SCG signals, adding to the evidence that FCG and SCG signals share a similar information content.

Multimodal Finger Pulse Wave Sensing: Comparison of Forcecardiography and Photoplethysmography Sensors

Pulse waves (PWs) are mechanical waves that propagate from the ventricles through the whole vascular system as brisk enlargements of the blood vessels' lumens, caused by sudden increases in local blood pressure. Photoplethysmography (PPG) is one of the most widespread techniques employed for PW sensing due to its ability to measure blood oxygen saturation. Other sensors and techniques have been proposed to record PWs, and include applanation tonometers, piezoelectric sensors, force sensors of different kinds, and accelerometers. The performances of these sensors have been analyzed individually, and their results have been found not to be in good agreement (e.g., in terms of PW morphology and the physiological parameters extracted). Such a comparison has led to a deeper comprehension of their strengths and weaknesses, and ultimately, to the consideration that a multimodal approach accomplished via sensor fusion would lead to a more robust, reliable, and potentially more informative methodology for PW monitoring. However, apart from various multichannel and multi-site systems proposed in the literature, no true multimodal sensors for PW recording have been proposed yet that acquire PW signals simultaneously from the same measurement site. In this study, a true multimodal PW sensor is presented, which was obtained by integrating a piezoelectric forcecardiography (FCG) sensor and a PPG sensor, thus enabling simultaneous mechanical-optical measurements of PWs from the same site on the body. The novel sensor performance was assessed by measuring the finger PWs of five healthy subjects at rest. The preliminary results of this study showed, for the first time, that a delay exists between the PWs recorded simultaneously by the PPG and FCG sensors. Despite such a delay, the pulse waveforms acquired by the PPG and FCG sensors, along with their first and second derivatives, had very high normalized cross-correlation indices in excess of 0.98. Six well-established morphological parameters of the PWs were compared via linear regression, correlation, and Bland-Altman analyses, which showed that some of these parameters were not in good agreement for all subjects. The preliminary results of this proof-of-concept study must be confirmed in a much larger cohort of subjects. Further investigation is also necessary to shed light on the physical origin of the observed delay between optical and mechanical PW signals. This research paves the way for the development of true multimodal, wearable, integrated sensors and for potential sensor fusion approaches to improve the performance of PW monitoring at various body sites.

Design of a 3D-Printed Hand Exoskeleton Based on Force-Myography Control for Assistance and Rehabilitation

Voluntary hand movements are usually impaired after a cerebral stroke, affecting millions of people per year worldwide. Recently, the use of hand exoskeletons for assistance and motor rehabilitation has become increasingly widespread. This study presents a novel hand exoskeleton, designed to be low cost, wearable, easily adaptable and suitable for home use. Most of the components of the exoskeleton are 3D printed, allowing for easy replication, customization and maintenance at a low cost. A strongly underactuated mechanical system allows one to synergically move the four fingers by means of a single actuator through a rigid transmission, while the thumb is kept in an adduction or abduction position. The exoskeleton’s ability to extend a typical hypertonic paretic hand of stroke patients was firstly tested using the SimScape Multibody simulation environment; this helped in the choice of a proper electric actuator. Force-myography was used instead of the standard electromyography to voluntarily control the exoskeleton with more simplicity. The user can activate the flexion/extension of the exoskeleton by a weak contraction of two antagonist muscles. A symmetrical master–slave motion strategy (i.e., the paretic hand motion is activated by the healthy hand) is also available for patients with severe muscle atrophy. An inexpensive microcontroller board was used to implement the electronic control of the exoskeleton and provide feedback to the user. The entire exoskeleton including batteries can be worn on the patient’s arm. The ability to provide a fluid and safe grip, like that of a healthy hand, was verified through kinematic analyses obtained by processing high-framerate videos. The trajectories described by the phalanges of the natural and the exoskeleton finger were compared by means of cross-correlation coefficients; a similarity of about 80% was found. The time required for both closing and opening of the hand exoskeleton was about 0.9 s. A rigid cylindric handlebar containing a load cell measured an average power grasp force of 94.61 N, enough to assist the user in performing most of the activities of daily living. The exoskeleton can be used as an aid and to promote motor function recovery during patient’s neurorehabilitation therapy.