Name: a human-machine-interface integrating low-cost sensors with a neuromuscular electrical stimulation system for post-stroke balance rehabilitation
Uploaded: 2016-04-12T13:00:00
Description: Watch this Scientific Journal Video about A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation at JoVE.com

Research conducted within the context of the Joint targeted Program in Information and Communication Science and Technology - ICST, supported by CNRS, Inria, and DST, under CEFIPRA&#39;s umbrella. The authors would like to acknowledge the support of students, specifically Rahima Sidiboulenouar, Rishabh Sehgal, and Gorish Aggarwal, towards development of the experimental setup.

Note: The HMI software pipeline was developed based on freely available open-source software and off-the-shelf low-cost video game sensors (details available at: https://team.inria.fr/nphys4nrehab/software/ and https://github.com/NeuroPhys4NeuroRehab/JoVE). The HMI software pipeline is provided for data collection during a modified functional reach task (mFRT)21 in a VR based gaming platform for visuomotor balance therapy (VBT)8.
Figure 2a shows the diagn...

<ol>
	<li>Sacco, R. L., Kasner, S. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+updated+definition+of+stroke+for+the+21st+century:+a+statement+for+healthcare+professionals+from+the+American+Heart+Association/American+Stroke+Association.">An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.</a> Stroke; a journal of cerebral circulation. 44 (7), 2064-2089 (2013).</li><li>Das, A., Botticello, A. L., Wylie, G. R., Radhakrishnan, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neurologic+Disability:+A+Hidden+Epidemic+for+India.">Neurologic Disability: A Hidden Epidemic for India.</a> Neurology. 79 (21), 2146-2147 (2012).</li><li>Verheyden, G. S. A. F., Weerdesteyn, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interventions+for+preventing+falls+in+people+after+stroke.">Interventions for preventing falls in people after stroke.</a> The Cochrane database of systematic reviews. 5, 008728 (2013).</li><li>Campbell, G. B., Matthews, J. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+integrative+review+of+factors+associated+with+falls+during+post-stroke+rehabilitation.">An integrative review of factors associated with falls during post-stroke rehabilitation.</a> Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 42, 395-404 (2010).</li><li>Geurts, A. C. H., de Haart, M., van Nes, I. J. W., Duysens, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+standing+balance+recovery+from+stroke.">A review of standing balance recovery from stroke.</a> Gait &amp; posture. 22, 267-281 (2005).</li><li>Marigold, D. S., Eng, J. J., Dawson, A. S., Inglis, J. T., Harris, J. E., Gylfad&#243;ttir, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exercise+leads+to+faster+postural+reflexes,+improved+balance+and+mobility,+and+fewer+falls+in+older+persons+with+chronic+stroke.">Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke.</a> Journal of the American Geriatrics Society. 53, 416-423 (2005).</li><li>Mansfield, A., Mochizuki, G., Inness, E. L., McIlroy, W. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+correlates+of+between-limb+synchronization+of+standing+balance+control+and+falls+during+inpatient+stroke+rehabilitation.">Clinical correlates of between-limb synchronization of standing balance control and falls during inpatient stroke rehabilitation.</a> Neurorehabilitation and neural repair. 26, 627-635 (2012).</li><li>Dutta, A., Lahiri, U., Das, A., Nitsche, M. A., Guiraud, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Post-stroke+balance+rehabilitation+under+multi-level+electrotherapy:+a+conceptual+review.">Post-stroke balance rehabilitation under multi-level electrotherapy: a conceptual review.</a> Neuroprosthetics. 8, 403 (2014).</li><li>Agnes Roby-Brami, S. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reaching+and+Grasping+Strategies+in+Hemiparetic+Patients.">Reaching and Grasping Strategies in Hemiparetic Patients.</a> Human Kinetics Journals. , (2010).</li><li>Sabut, S. K., Sikdar, C., Kumar, R., Mahadevappa, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+electrical+stimulation+of+dorsiflexor+muscle:+effects+on+dorsiflexor+strength,+plantarflexor+spasticity,+and+motor+recovery+in+stroke+patients.">Functional electrical stimulation of dorsiflexor muscle: effects on dorsiflexor strength, plantarflexor spasticity, and motor recovery in stroke patients.</a> NeuroRehabilitation. 29, 393-400 (2011).</li><li>Magalh&#227;es, F. H., Kohn, A. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+of+electrical+noise+in+reducing+postural+sway:+a+comparison+between+imperceptible+stimulation+applied+to+the+anterior+and+to+the+posterior+leg+muscles.">Effectiveness of electrical noise in reducing postural sway: a comparison between imperceptible stimulation applied to the anterior and to the posterior leg muscles.</a> European Journal of Applied Physiology. 114, 1129-1141 (2014).</li><li>Hwang, S., Tae, K., Sohn, R., Kim, J., Son, J., Kim, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+balance+recovery+mechanisms+against+unexpected+forward+perturbation.">The balance recovery mechanisms against unexpected forward perturbation.</a> Annals of biomedical engineering. 37, 1629-1637 (2009).</li><li>Gatev, P., Thomas, S., Kepple, T., Hallett, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feedforward+ankle+strategy+of+balance+during+quiet+stance+in+adults.">Feedforward ankle strategy of balance during quiet stance in adults.</a> The Journal of physiology. 514, 915-928 (1999).</li><li>Cofre Lizama, E. L., Pijnappels, M., Reeves, N. P., Verschueren, S. M. P., van Die&#235;n, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+explicit+visual+feedback+of+postural+sway+efface+the+effects+of+sensory+manipulations+on+mediolateral+balance+performance.">Can explicit visual feedback of postural sway efface the effects of sensory manipulations on mediolateral balance performance.</a> Journal of Neurophysiology. , (2015).</li><li>Knash, M. E., Kido, A., Gorassini, M., Chan, K. M., Stein, R. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrical+stimulation+of+the+human+common+peroneal+nerve+elicits+lasting+facilitation+of+cortical+motor-evoked+potentials.">Electrical stimulation of the human common peroneal nerve elicits lasting facilitation of cortical motor-evoked potentials.</a> Experimental brain research. 153, 366-377 (2003).</li><li>Dinse, H. R., Tegenthoff, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evoking+plasticity+through+sensory+stimulation:+Implications+for+learning+and+rehabilitation.">Evoking plasticity through sensory stimulation: Implications for learning and rehabilitation.</a> The Journal of neuroscience: the official journal of the Society for Neuroscience. 6, 11-20 (2015).</li><li>Khaslavskaia, S., Sinkjaer, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motor+cortex+excitability+following+repetitive+electrical+stimulation+of+the+common+peroneal+nerve+depends+on+the+voluntary+drive.">Motor cortex excitability following repetitive electrical stimulation of the common peroneal nerve depends on the voluntary drive.</a> Experimental brain research. 162, 497-502 (2005).</li><li>Perez, M. A., Field-Fote, E. C., Floeter, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patterned+sensory+stimulation+induces+plasticity+in+reciprocal+ia+inhibition+in+humans.">Patterned sensory stimulation induces plasticity in reciprocal ia inhibition in humans.</a> The Journal of neuroscience: the official journal of the Society for Neuroscience. 23, 2014-2018 (2003).</li><li>Makeig, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mind+Monitoring+via+Mobile+Brain-Body+Imaging.">Mind Monitoring via Mobile Brain-Body Imaging.</a> Foundations of Augmented Cognition. Neuroergonomics and Operational. , 749-758 (2009).</li><li>Ojeda, A., Bigdely-Shamlo, N., Makeig, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=MoBILAB:+an+open+source+toolbox+for+analysis+and+visualization+of+mobile+brain/body+imaging+data.">MoBILAB: an open source toolbox for analysis and visualization of mobile brain/body imaging data.</a> Frontiers in Human Neuroscience. 8, 121 (2014).</li><li>Dutta, A., Chugh, S., Banerjee, A., Dutta, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care-testing+of+standing+posture+with+Wii+balance+board+and+microsoft+kinect+during+transcranial+direct+current+stimulation:+A+feasibility+study.">Point-of-care-testing of standing posture with Wii balance board and microsoft kinect during transcranial direct current stimulation: A feasibility study.</a> NeuroRehabilitation. 34, 789-798 (2014).</li><li>Nataraj, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Feedback Control Of Standing Balance Using Functional Neuromuscular Stimulation Following Spinal Cord Injury. , (2011).</li><li>Dutta, A., Paulus, W., Nitsche, A., M, <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Translational+Methods+for+Non-Invasive+Electrical+Stimulation+to+Facilitate+Gait+Rehabilitation+Following+Stroke+-+The+Future+Directions.">Translational Methods for Non-Invasive Electrical Stimulation to Facilitate Gait Rehabilitation Following Stroke - The Future Directions.</a> Neuroscience and Biomedical Engineering. 1, 22-33 (2013).</li><li>Banerjee, A., Khattar, B., Dutta, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Low-Cost+Biofeedback+System+for+Electromyogram-Triggered+Functional+Electrical+Stimulation+Therapy:+An+Indo-German+Feasibility+Study.">A Low-Cost Biofeedback System for Electromyogram-Triggered Functional Electrical Stimulation Therapy: An Indo-German Feasibility Study.</a> ISRN Stroke. 2014, e827453 (2014).</li><li>Kerkhoff, G., Reinhart, S., Ziegler, W., Artinger, F., Marquardt, C., Keller, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Smooth+pursuit+eye+movement+training+promotes+recovery+from+auditory+and+visual+neglect:+a+randomized+controlled+study.">Smooth pursuit eye movement training promotes recovery from auditory and visual neglect: a randomized controlled study.</a> Neurorehabilitation and Neural Repair. 27, 789-798 (2013).</li><li>Carl, J. R., Gellman, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+smooth+pursuit:+stimulus-dependent+responses.">Human smooth pursuit: stimulus-dependent responses.</a> Journal of Neurophysiology. 57, 1446-1463 (1987).</li><li>Clark, R. A., Bryant, A. L., Pua, Y., McCrory, P., Bennell, K., Hunt, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validity+and+reliability+of+the+Nintendo+Wii+Balance+Board+for+assessment+of+standing+balance.">Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance.</a> Gait &amp; posture. 31, 307-310 (2010).</li><li>Clark, R. A., Pua, Y. -. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validity+of+the+Microsoft+Kinect+for+assessment+of+postural+control.">Validity of the Microsoft Kinect for assessment of postural control.</a> Gait &amp; posture. 36, 372-377 (2012).</li><li>Khattar, B., Banerjee, A., Reddi, R., Dutta, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+Functional+Electrical+Stimulation-Assisted+Neurorehabilitation+following+Stroke+in+India:+A+Case+Series.">Feasibility of Functional Electrical Stimulation-Assisted Neurorehabilitation following Stroke in India: A Case Series.</a> Case Reports in Neurological Medicine. 2012, e830873 (2012).</li><li>Sailer, U., Flanagan, J. R., Johansson, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Eye-hand+coordination+during+learning+of+a+novel+visuomotor+task.">Eye-hand coordination during learning of a novel visuomotor task.</a> The Journal of neuroscience: the official journal of the Society for Neuroscience. 25, 8833-8842 (2005).</li><li>Herr, H., Popovic, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Angular+momentum+in+human+walking.">Angular momentum in human walking.</a> The Journal of Experimental Biology. 211, 467-481 (2008).</li><li>Taub, E., Morris, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Constraint-induced+movement+therapy+to+enhance+recovery+after+stroke.">Constraint-induced movement therapy to enhance recovery after stroke.</a> Current atherosclerosis reports. 3, 279-286 (2001).</li><li>Kasten, E., Wuest, S., Sabel, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+vision+in+transition+zones+in+patients+with+cerebral+blindness.">Residual vision in transition zones in patients with cerebral blindness.</a> Journal of Clinical and Experimental Neuropsychology. 20, 581-598 (1998).</li><li>Marshall, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identifying+Cognitive+State+from+Eye+Metrics.">Identifying Cognitive State from Eye Metrics.</a> Aviation, Space, and Environmental Medicine. 78, 165-175 (2007).</li><li>Weerdesteyn, V., de Niet, M., van Duijnhoven, H. J. R., Geurts, A. C. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Falls+in+individuals+with+stroke.">Falls in individuals with stroke.</a> Journal of Rehabilitation Research and Development. 45, 1195-1213 (2008).</li><li>Stinear, C. M., Barber, P. A., Petoe, M., Anwar, S., Byblow, W. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+PREP+algorithm+predicts+potential+for+upper+limb+recovery+after+stroke.">The PREP algorithm predicts potential for upper limb recovery after stroke.</a> Brain: A Journal of Neurology. 135 ((Pt 8)), 2527-2535 (2012).</li><li>Dutta, A., Lahiri, D., Kumar, U., Das, A., Padma, M. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Post-stroke+engagement-sensitive+balance+rehabilitation+under+an+adaptive+multi-level+electrotherapy:+clinical+hypothesis+and+computational+framework.">Post-stroke engagement-sensitive balance rehabilitation under an adaptive multi-level electrotherapy: clinical hypothesis and computational framework.</a> Neuroscience and Biomedical Engineering. 2 (2), 68-80 (2015).</li></ol>

A simple-to-use, clinically valid low-cost tool for movement and balance therapy will be a paradigm shift for neurorehabilitation in a low-resource setting. It is likely to have a very high societal impact since neurological disorders like stroke will dramatically increase in future due to aging world population2. There is, therefore, a pressing need to leverage cyber physical systems where the ability to customize, monitor, and support neuro-rehabilitation at remote sites has recently become possible with the...

An episode of neurological dysfunction caused by focal cerebral, spinal, or retinal infarction is called stroke1. Stroke is a global health problem and fourth leading cause of disability worldwide1. In countries like India and China, the two most populous nations of the world, neurologic disability due to stroke is being labeled as hidden epidemic2. One of the most common medical complications after a stroke are falls with a reported incidence of up to 73% in the first year post-stroke3. The post-stroke fall is multifactorial and includes both spinal and supraspinal factors like balance and visuospatial neglect4. A review by Geurts and colleagues5 identified 1) multi-directionally impaired maximal weight shifting during bipedal standing, 2) slow speed, 3) directional imprecision, and 4) small amplitudes of single and cyclic sub-maximal frontal plane weight shifts as the balance factors for fall risk. The consequent impact on activities of daily living can be significant since prior works have shown that balance is associated with ambulatory ability and independence in gross motor function5,6. Moreover, Geurts and colleagues5 suggested that supraspinal multisensory integration (and muscle coordination7) in addition to muscle strength is critical for balance recovery which is lacking in current protocols. Towards multisensory integration, our hypothesis8 on volitionally driven non-invasive electrotherapy (NMES/SES) is that this adaptive behavior can be shaped and facilitated by modulating active perception of sensory inputs during NMES/SES-assisted movement of the affected limb such that the brain can incorporate this feedback into subsequent movement output by recruiting alternate motor pathways9, if needed.
To achieve volitionally driven NMES/SES-assisted balance training in a resource-poor setting, a low-cost human-machine-interface (HMI) was developed by leveraging available open-source software and recent advances in off-the-shelf video game sensor technology for visual-auditory biofeedback. NMES involves coordinated electrical stimulation of nerves and muscles that has been shown to improve muscle strength and reduce spasticity10. Also, SES involves stimulation of sensory nerves with electrical current to evoke sensations where preliminary published work11 showed that subsensory stimulation applied over the tibialis anterior muscles alone is effective in attenuating postural sway. Here, the HMI will make possible sensory-motor integration during interactive post-stroke balance therapy where volitionally-driven NMES/SES for the ankle muscles will act as a muscle amplifier (with NMES) as well as enhance afferent feedback (with SES) to assist healthy ankle strategies12,13,14 to maintain upright stance during postural sways. This is based on the hypothesis presented in Dutta et al.8 that an increased corticospinal excitability of relevant ankle muscles effected through non-invasive electrotherapy may lend to an improved supraspinal modulation of ankle stiffness. Indeed, prior work has shown that NMES/SES elicits lasting changes in corticospinal excitability, possibly as a result of co-activating motor and sensory fibers15,16. Moreover, Khaslavskaia and Sinkjaer17 showed in humans that concurrent motor cortical drive present at the time of NMES/SES enhanced motor cortical excitability. Therefore, volitionally-driven NMES/SES may induce short-term neuroplasticity in spinal reflexes (e.g., reciprocal Ia inhibition17) where corticospinal neurons that project via descending pathways to a given motoneuron pool can inhibit the antagonistic motoneuron pool via Ia-inhibitory interneurons in humans18, as shown in Figure 1, towards an operant conditioning paradigm (see Dutta et al.8).
<img alt="Figure 1" src="/files/ftp_upload/52394/52394fig1.jpg" /> 
Figure 1: The concept (details at Dutta et al.21) underlying interactive human machine interface (HMI) to drive the center of pressure (CoP) cursor to the cued target to improve ankle muscle coordination under volitionally driven neuromuscular electrical stimulation (NMES)-assisted visuomotor balance therapy. EEG: electroencephalography, MN: &#945;-motoneuron, IN: Ia-inhibitory interneuron, EMG: electromyogram, DRG: dorsal root ganglion. Reproduced from8 and37&#8203;.&#160;<a href="https://www.jove.com/files/ftp_upload/52394/52394fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
The antero-posterior (A-P) displacements in center of mass (CoM) are performed by ankle plantarflexors (such as medial gastrocnemius and soleus muscles) and dorsiflexors (such as the anterior tibial muscle) while medio-lateral (M-L) displacements are performed by ankle invertors (such as the anterior tibial muscle) and evertors (such as peroneus longus and brevis muscles). Consequently, stroke-related ankle impairments including weakness of the ankle dorsiflexor muscles and increased spasticity of the ankle plantarflexor muscles lead to impaired postural control. Here, agility training programs6 can be leveraged in a virtual reality (VR) based gaming platform that challenge dynamic balance where tasks are progressively increased in difficulty which may be more effective than static stretching/weight-shifting exercise program in preventing falls6. For example, subjects can perform volitionally driven NMES/SES assisted A-P and M-L displacements during a dynamic visuomotor balance task where the difficulty can be progressively increased to ameliorate post-stroke ankle-specific control problems in weight shifting during bipedal standing. Towards volitionally driven NMES/SES assisted balance therapy in a resource-poor setting, we present a low-cost HMI for Mobile Brain/Body Imaging (MoBI)19, towards visual-auditory biofeedback which can also be used for data collection from low-cost sensors for offline data exploration in MoBILAB (see Ojeda et al.20).

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>NMES stimulator</td>
			<td>Vivaltis, France</td>
			<td>PhenixUSBNeo</td>
			<td>NMES stimulator cum EMG sensor (Figure 2b)</td>
		</tr>
		<tr>
			<td>Balance Board</td>
			<td>Nintendo, USA</td>
			<td>Wii Balance Board</td>
			<td>Balance Board (Figure 2b)</td>
		</tr>
		<tr>
			<td>Motion Capture</td>
			<td>Microsoft, USA</td>
			<td>XBOX-360 Kinect</td>
			<td>Motion Capture (Figure 2b)</td>
		</tr>
		<tr>
			<td>Eye Tracker&#160;</td>
			<td>Eye Tribe</td>
			<td>The Eye Tribe</td>
			<td>SmartEye Tracker (Figure 2a)</td>
		</tr>
		<tr>
			<td>EEG Data Acquisition System</td>
			<td>Emotiv, Australia</td>
			<td>Emotiv Neuroheadset</td>
			<td>Wireless EEG headset (Figure 2b)</td>
		</tr>
		<tr>
			<td>EEG passive electrode</td>
			<td>Olimex</td>
			<td>EEG-PE</td>
			<td>EEG passive electrode for EOG and references (6 in number)(Figure 2b)</td>
		</tr>
		<tr>
			<td>EEG active electrode</td>
			<td>Olimex</td>
			<td>EEG-AE</td>
			<td>EEG active electrode (10 in number)(Figure 2b)</td>
		</tr>
		<tr>
			<td>Computer with PC monitor</td>
			<td>Dell</td>
			<td></td>
			<td>Data processing and visual feedback (Figure 2)</td>
		</tr>
		<tr>
			<td>Softwares, EMG electrodes, NMES electrodes, and cables</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

a human-machine-interface integrating low-cost sensors with a neuromuscular electrical stimulation system for post-stroke balance rehabilitation

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers.

Figure 4 shows the eye gaze features that were extracted offline for the quantification of an able-bodied performance during a smooth pursuit task. The following features were extracted as shown in Table 1:
Feature 1 = percentage deviation between target stimulus position and the centroid of participant&#39;s fixation points when the stimulus is changing position in the horizontal direction....

Watch this Scientific Journal Video about A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation at JoVE.com

A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation

A novel low-cost human-machine interface for interactive post-stroke balance rehabilitation system is presented in this article. The system integrates off-the-shelf low-cost sensors towards volitionally driven electrotherapy paradigm. The proof-of-concept software interface is demonstrated on healthy volunteers.

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing ...

Research

JoVE Journal

Neuroscience

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