Yongtian He

Powered exoskeletons for bipedal locomotion after spinal cord injury

OBJECTIVE Powered exoskeletons promise to increase the quality of life of people with lower-body paralysis or weakened legs by assisting or restoring legged mobility while providing health benefits across multiple physiological systems. Here, a systematic review of the literature on powered exoskeletons addressed critical questions: What is the current evidence of clinical efficacy for lower-limb powered exoskeletons? What are the benefits and risks for individuals with spinal cord injury (SCI)? What are the levels of injury considered in such studies? What are their outcome measures? What are the opportunities for the next generation exoskeletons? APPROACH A systematic search of online databases was performed to identify clinical trials and safety or efficacy studies with lower-limb powered exoskeletons for individuals with SCI. Twenty-two studies with eight powered exoskeletons thus selected, were analyzed based on the protocol design, subject demographics, study duration, and primary/secondary outcome measures for assessing exoskeletons performance in SCI subjects. MAIN RESULTS Findings show that the level of injury varies across studies, with T10 injuries being represented in 45.4% of the studies. A categorical breakdown of outcome measures revealed 63% of these measures were gait and ambulation related, followed by energy expenditure (16%), physiological improvements (13%), and usability and comfort (8%). Moreover, outcome measures varied across studies, and none had measures spanning every category, making comparisons difficult. SIGNIFICANCE This review of the literature shows that a majority of current studies focus on thoracic level injury as well as there is an emphasis on ambulatory-related primary outcome measures. Future research should: 1) develop criteria for optimal selection and training of patients most likely to benefit from this technology, 2) design multimodal gait intention detection systems that engage and empower the user, 3) develop real-time monitoring and diagnostic capabilities, and 4) adopt comprehensive metrics for assessing safety, benefits, and usability.

A closed-loop brain computer interface to a virtual reality avatar: Gait adaptation to visual kinematic perturbations

The control of human bipedal locomotion is of great interest to the field of lower-body brain computer interfaces (BCIs) for rehabilitation of gait. While the feasibility of a closed-loop BCI system for the control of a lower body exoskeleton has been recently shown, multi-day closed-loop neural decoding of human gait in a virtual reality (BCI-VR) environment has yet to be demonstrated. In this study, we propose a real-time closed-loop BCI that decodes lower limb joint angles from scalp electroencephalography (EEC) during treadmill walking to control the walking movements of a virtual avatar. Moreover, virtual kinematic perturbations resulting in asymmetric walking gait patterns of the avatar were also introduced to investigate gait adaptation using the closed-loop BCI-VR system over a period of eight days. Our results demonstrate the feasibility of using a closed-loop BCI to learn to control a walking avatar under normal and altered visuomotor perturbations, which involved cortical adaptations. These findings have implications for the development of BCI-VR systems for gait rehabilitation after stroke and for understanding cortical plasticity induced by a closed-loop BCI system.

An integrated neuro-robotic interface for stroke rehabilitation using the NASA X1 powered lower limb exoskeleton.

Stroke remains a leading cause of disability, limiting independent ambulation in survivors, and consequently affecting quality of life (QOL). Recent technological advances in neural interfacing with robotic rehabilitation devices are promising in the context of gait rehabilitation. Here, the X1, NASAs powered robotic lower limb exoskeleton, is introduced as a potential diagnostic, assistive, and therapeutic tool for stroke rehabilitation. Additionally, the feasibility of decoding lower limb joint kinematics and kinetics during walking with the X1 from scalp electroencephalographic (EEG) signals - the first step towards the development of a brain-machine interface (BMI) system to the X1 exoskeleton - is demonstrated.

Real-time EEG-based brain-computer interface to a virtual avatar enhances cortical involvement in human treadmill walking

Recent advances in non-invasive brain-computer interface (BCI) technologies have shown the feasibility of neural decoding for both users’ gait intent and continuous kinematics. However, the dynamics of cortical involvement in human upright walking with a closed-loop BCI has not been investigated. This study aims to investigate the changes of cortical involvement in human treadmill walking with and without BCI control of a walking avatar. Source localization revealed significant differences in cortical network activity between walking with and without closed-loop BCI control. Our results showed sustained α/µ suppression in the Posterior Parietal Cortex and Inferior Parietal Lobe, indicating increases of cortical involvement during walking with BCI control. We also observed significant increased activity of the Anterior Cingulate Cortex (ACC) in the low frequency band suggesting the presence of a cortical network involved in error monitoring and motor learning. Additionally, the presence of low γ modulations in the ACC and Superior Temporal Gyrus may associate with increases of voluntary control of human gait. This work is a further step toward the development of a novel training paradigm for improving the efficacy of rehabilitation in a top-down approach.

Risk management and regulations for lower limb medical exoskeletons: a review.

Gait disability is a major health care problem worldwide. Powered exoskeletons have recently emerged as devices that can enable users with gait disabilities to ambulate in an upright posture, and potentially bring other clinical benefits. In 2014, the US Food and Drug Administration approved marketing of the ReWalk™ Personal Exoskeleton as a class II medical device with special controls. Since then, Indego™ and Ekso™ have also received regulatory approval. With similar trends worldwide, this industry is likely to grow rapidly. On the other hand, the regulatory science of powered exoskeletons is still developing. The type and extent of probable risks of these devices are yet to be understood, and industry standards are yet to be developed. To address this gap, Manufacturer and User Facility Device Experience, Clinicaltrials.gov, and PubMed databases were searched for reports of adverse events and inclusion and exclusion criteria involving the use of lower limb powered exoskeletons. Current inclusion and exclusion criteria, which can determine probable risks, were found to be diverse. Reported adverse events and identified risks of current devices are also wide-ranging. In light of these findings, current regulations, standards, and regulatory procedures for medical device applications in the USA, Europe, and Japan were also compared. There is a need to raise awareness of probable risks associated with the use of powered exoskeletons and to develop adequate countermeasures, standards, and regulations for these human-machine systems. With appropriate risk mitigation strategies, adequate standards, comprehensive reporting of adverse events, and regulatory oversight, powered exoskeletons may one day allow individuals with gait disabilities to safely and independently ambulate.

Unscented Kalman filter for neural decoding of human treadmill walking from non-invasive electroencephalography

The feasibility of decoding lower limb kinematics in human treadmill walking from noninvasive electroencephalography (EEG) has been demonstrated with linear Wiener filter. However, nonlinear relationship between neural activities and limb movements may challenge the linear decoders in real-time brain computer interface (BCI) applications. In this study, we propose a nonlinear neural decoder using an Unscented Kalman Filter (UKF) to infer lower limb joint angles from noninvasive scalp EEG signals during human treadmill walking. Our results demonstrate that lower limb joint angles during treadmill walking can be decoded from the fluctuations in the amplitude of slow cortical potentials in the delta band (0.1-3Hz). Overall, the average decoding accuracy were 0.43 ± 0.18 for Pearsons r value and 1.82 ± 3.07 for signal to noise ratio (SNR), and robust to ocular, muscle, or movement artifacts. Moreover, the signal preprocessing scheme and the design of UKF allow the implementation of the proposed EEG-based BCI for real-time applications. This has implications for the development of closed-loop EEG-based BCI systems for gait rehabilitation after stroke.

Brain–machine interfaces for controlling lower-limb powered robotic systems

OBJECTIVE Lower-limb, powered robotics systems such as exoskeletons and orthoses have emerged as novel robotic interventions to assist or rehabilitate people with walking disabilities. These devices are generally controlled by certain physical maneuvers, for example pressing buttons or shifting body weight. Although effective, these control schemes are not what humans naturally use. The usability and clinical relevance of these robotics systems could be further enhanced by brain-machine interfaces (BMIs). A number of preliminary studies have been published on this topic, but a systematic understanding of the experimental design, tasks, and performance of BMI-exoskeleton systems for restoration of gait is lacking. APPROACH To address this gap, we applied standard systematic review methodology for a literature search in PubMed and EMBASE databases and identified 11 studies involving BMI-robotics systems. The devices, user population, input and output of the BMIs and robot systems respectively, neural features, decoders, denoising techniques, and system performance were reviewed and compared. MAIN RESULTS Results showed BMIs classifying walk versus stand tasks are the most common. The results also indicate that electroencephalography (EEG) is the only recording method for humans. Performance was not clearly presented in most of the studies. Several challenges were summarized, including EEG denoising, safety, responsiveness and others. SIGNIFICANCE We conclude that lower-body powered exoskeletons with automated gait intention detection based on BMIs open new possibilities in the assistance and rehabilitation fields, although the current performance, clinical benefits and several key challenging issues indicate that additional research and development is required to deploy these systems in the clinic and at home. Moreover, rigorous EEG denoising techniques, suitable performance metrics, consistent trial reporting, and more clinical trials are needed to advance the field.

Data Descriptor: A mobile brainbody imaging dataset recorded during treadmill walking with a brain-computer interface

We present a mobile brain-body imaging (MoBI) dataset acquired during treadmill walking in a brain-computer interface (BCI) task. The data were collected from eight healthy subjects, each having three identical trials. Each trial consisted of three conditions: standing, treadmill walking, and treadmill walking with a closed-loop BCI. During the BCI condition, subjects used their brain activity to control a virtual avatar on a screen to walk in real-time. Robust procedures were designed to record lower limb joint angles (bilateral hip, knee, and ankle) using goniometers synchronized with 60-channel scalp electroencephalography (EEG). Additionally, electrooculogram (EOG), EEG electrodes impedance, and digitized EEG channel locations were acquired to aid artifact removal and EEG dipole-source localization. This dataset is unique in that it is the first published MoBI dataset recorded during walking. It is useful in addressing several important open research questions, such as how EEG is coupled with gait cycle during closed-loop BCI, how BCI influences neural activity during walking, and how a BCI decoder may be optimized.

Classification of finger vibrotactile input using scalp EEG

While there are many output brain-computer interface (output BCIs) studies, few have examined the input pathway, namely decoding the sensory input. To examine the possibility of building a BCI with sensory input using scalp electroencephalography (EEG), this study builds a classifier based on Local Fisher Discriminant Analysis (LFDA) and Gaussian Mixture Model (GMM) to classify neural activity generated by vibrotactile sensory stimuli delivered to the fingers. Small vibrators were placed on the fingertips of the participant. They vibrated one by one in a random sequence while the participant sat still with eyes closed. EEG data were recorded and later used to classify which finger was vibrated. There were two tasks: one focusing on differentiating between ipsilateral fingers, the other one focusing on differentiating contralateral fingers. Decoding accuracies were high in both tasks: 97.6% and 99.3% respectively. Event-related EEG features in both amplitude and power domain are discussed.